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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

Published online by Cambridge University Press:  21 May 2015

Allan Abbass ,
Samuel Campbell ,
Kirk Magee  and
Robert Tarzwell
Allan Abbass*
Affiliation:
Department of Psychiatry, Dalhousie University, Halifax, NS
Samuel Campbell
Affiliation:
Department of Emergency Medicine, Dalhousie University, Halifax, NS
Kirk Magee
Affiliation:
Department of Emergency Medicine, Dalhousie University, Halifax, NS
Robert Tarzwell
Affiliation:
Department of Psychiatry, St. Paul's Hospital, and Faculty of Medicine, University of British Columbia, Vancouver, BC
*
5909 Veterans Memorial Lane, Rm. 8203, Abbie J. Lane Building, QEII Health Sciences Centre, Halifax NS B3H 2E2; allan.abbass@dal.ca

Abstract

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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.

Conclusion:

This emotion-focused assessment and treatment method appeared to be feasible and may be effective in reducing both symptoms and repeat ED use.

Keywords

somatizationmedically unexplained symptomsshort-term dynamic psychotherapy
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 11 , Issue 6 , November 2009 , pp. 529 - 534
Copyright
Copyright © Canadian Association of Emergency Physicians 2009

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