Improving treatment in Consultation-Liaison Psychiatry requires better targeting of psychological treatments at the patients who benefit from them most. This paper will demonstrate that patients with severe irritable bowel syndrome (IBS), who also have somatisation, benefit greatly from antidepressants or psychotherapy.

257 patients with severe IBS were randomized to receive over 3 months brief interpersonal psychotherapy, 20 mg daily of the SSRI antidepressant, paroxetine, or treatment as usual. They were assessed at baseline for somatisation and psychiatric disorder. One year after treatment total costs and health-related quality of life, using SF36 physical component summary (PCS) score were assessed and scores adjusted for baseline values.

The patients with the highest baseline somatisation score had the most severe IBS, most psychiatric disorders, were most impaired and the highest total costs. At 1 year after the end of treatment these patients had significantly higher (improved) quality of life scores in the active treatment groups compared to usual care: mean (standard error) PCS scores at 15 months were 36.6 (2.2), 35.5 (1.9) & 26.4 (2.7) for psychotherapy, antidepressant and treatment as usual groups respectively (adjusted p= 0.014). Corresponding data for total costs over the follow-up year, adjusted for baseline costs were £1092 (487), £1394 (443) and £2949 (593) (adjusted p=0.050).

Patients with severe IBS who have high somatisation scores have marked impairment and incur very high costs but they improve greatly with treatment and show marked reduction of costs. Methods of recruiting the patients most likely to benefit from psychological treatments in C-L psychiatry will be discussed.