Intensive short-term dynamic psychotherapy to reduce rates of emergency department return visits for patients with medically unexplained symptoms: preliminary evidence from a pre-post intervention study.
OBJECTIVE
Somatization of emotions accounts for excess emergency department (ED) visits in the form of medically unexplained symptoms (MUS). Intensive short-term dynamic psychotherapy (ISTDP) has been used to diagnose and manage somatization. We examined the effectiveness of this procedure for ED patients with MUS.


METHODS
We implemented a service that included staff education, timely access to consultation and gathering of outcome data.


RESULTS
Patients were assessed and treated shortly after referral. There was a mean reduction of 3.2 (69.0%) ED visits per patient (standard deviation [SD] 6.4) the year afterward (95% confidence interval [CI] 1.3-5.0, p< 0.001). In comparison revisit rates during the same time interval for 3 available ED populations (i.e., those matched by visit rates, those with matching complaints and all patients referred to the service but never seen) showed either smaller reductions or higher ED use (ranging from a 15% reduction to a 43% increase). Treatments averaged 3.8 sessions per patient (SD 5.3). Self reported symptoms improved significantly with the Brief Symptom Inventory global rating, which changed from a mean of 1.21 (SD 0.58) before assessment to 0.86 (SD 0.63) ( p< 0.01) at the end of contact with the service. The service appeared acceptable to both emergency physicians and patients.


CONCLUSIONS
This emotion-focused assessment and treatment method appeared to be feasible and may be effective in reducing both symptoms and repeat ED use.
Abbass
Allan
A
Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada. allan.abbass@dal.ca
Campbell
Samuel
S
Magee
Kirk
K
Tarzwell
Robert
R
D000328:Adult; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009674:Nova Scotia / Q000453:epidemiology; D017060:Patient Satisfaction; D011614:Psychotherapy, Brief; D013001:Somatoform Disorders / Q000453:epidemiology / Q000628:therapy*; D016896:Treatment Outcome; D014743:Videotape Recording