title: Intensive multidisciplinary treatment of severe somatoform disorder: a prospective evaluation.
abstract: Chronic severe somatoform disorder (SFD) is resistant to treatment. In a prospective observational study, we evaluated an intensive multidisciplinary treatment focusing on body-related mentalization and acceptance. Patients included in the study were 183 (146 women, 37 men) of 311 eligible patients with chronic severe SFD, referred consecutively to a specialized tertiary care center between 2002 and 2009. Primary outcome measures were somatic symptoms (SCL-90) and health-related quality of life (EuroQol 5-Dimensional [EQ-5D]). These measures were assessed four times before treatment (on intake, twice during an observation period, at start of treatment) and four times after treatment (during follow-up for 2 years). Multilevel analysis was used to separate effects of time (maturation) and treatment. Results revealed significant improvements in SCL-90 somatic symptoms (d = 0.51), EQ-5D index (d = 0.27), and EQ visual analogue scale (d = 0.56). Significant reductions were also observed in SCL-90 anxiety, depression, and overall psychopathology as well as in medical consumption associated with psychiatric illness (Trimbos/iMTA Questionnaire for Costs Associated With Psychiatric Illness). Large interindividual differences were found in treatment outcome. The long-term improvement seen in many patients suggests that intensive multidisciplinary tertiary care treatment is a useful approach to chronic severe SFD.
authors.affiliation: *Altrecht Psychosomatic Medicine Eikenboom, Zeist; †University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation, Groningen; and ‡Department of Clinical and Health Psychology, Utrecht University, Utrecht, the Netherlands.
authors.forename: Jan H
authors.initials: JH
authors.lastname: Houtveen
authors.forename: Saskia
authors.initials: S
authors.lastname: van Broeckhuysen-Kloth
authors.forename: Lotte L
authors.initials: LL
authors.lastname: Lintmeijer
authors.forename: Martina E F
authors.initials: ME
authors.lastname: Bühring
authors.forename: Rinie
authors.initials: R
authors.lastname: Geenen
mesh_terms: D000328:Adult; D001007:Anxiety / Q000503:physiopathology / Q000628:therapy*; D002908:Chronic Disease; D003863:Depression / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007206:Individuality; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011613:Psychotherapy / Q000379:methods*; D011788:Quality of Life / Q000523:psychology*; D012720:Severity of Illness Index; D013001:Somatoform Disorders / Q000503:physiopathology / Q000628:therapy*; D013315:Stress, Psychological / Q000503:physiopathology / Q000628:therapy*; D063128:Tertiary Health Care; D016896:Treatment Outcome