Specialized Biopsychosocial Care in Inpatient Somatic Medicine Units—A Pilot Study, 2022, Köbler et al

Introduction: Specialized biopsychosocial care concepts are necessary to overcome the dualism between physical and psychosocial treatment in acute care hospitals. For patients with complex and chronic comorbid physical and mental health problems, neither standardized psychiatric/psychosomatic nor somatic care units alone are appropriate to their needs. The “Nuremberg Integrated Psychosomatic Acute Unit” (NIPA) has been developed to integrate treatment of both, psychosocial and physical impairments, in an acute somatic care setting.

Method: NIPA has been established in inpatient internal medical wards for respiratory medicine, oncology and gastroenterology. One to two patients per ward are regularly enrolled in the NIPA treatment while remaining in the same inpatient bed after completion of the somatic care. In a naturalistic study design, we evaluated treatment effects by assessment of symptom load at admission and at discharge using the Patient Health Questionnaire (PHQ) and the Generalized Anxiety Disorder Scale-7 (GAD-7). Furthermore, we assessed the severity of morbidity using diagnosis data during treatment. At discharge, we measured satisfaction with treatment through the Patient Satisfaction Questionnaire (ZUF-8).

Results: Data from 41 NIPA patients were analyzed (18–87 years, 76% female). Seventy-eight percent suffered from at least moderate depression and 49% from anxiety disorders. Other diagnoses were somatoform pain disorder, somatoform autonomic dysfunction, eating disorder and posttraumatic stress disorder. Hypertension, chronic lung diseases and musculoskeletal disorders as well as chronic oncological and cardiac diseases were the most common somatic comorbidities. Treatment resulted in a significant reduction of depressive mood (admission: M = 10.9, SD = 6.1, discharge: M = 7.6, SD = 5.3, d = 0.58, p = 0.001), anxiety (admission: M = 10.6, SD = 4.9, discharge: M = 7.3, SD = 4.1, d = 0.65, p< 0.001) and stress (admission: M = 6.0, SD = 3.6, discharge: M = 4.1, SD = 2.5, d = 0.70, p< 0.001). Somatic symptom burden was reduced by NIPA treatment (admission: M = 10.9, SD = 5.8, discharge: M = 9.6, SD = 5.5, d = 0.30), albeit not statistically significant (p = 0.073) ZUF-8 revealed that 89% reported large or full satisfaction and 11% partial dissatisfaction with treatment.

Discussion: NIPA acute care is bridging the gap for patients in need of psychosocial treatment with complex somatic comorbidity. Further long-term evaluation will show whether psychosocial NIPA care is able to reduce the course of physical illness and hospital costs by preventing hospitalization and short-term inpatient re-admissions.

Open access, https://www.frontiersin.org/articles/10.3389/fpubh.2022.844874/full

 

My bolding.
"An individual treatment plan is drawn up in line with therapy goals, which are achieved by low-threshold, psychoeducational and practice-based interventions. The aim of this biopsychosocial approach is 1. to provide acute and low-threshold psychosocial support and 2. to serve as a “door-opener” for further specialized psychosocial mental health treatment in the outpatient or day-care sector. This is realized by extending the patients' disease model by focusing on psychosomatic and psychosocial understanding of disease processes, supporting stabilization and resource activation. The important psychoeducational content is based especially on clarifying psychosomatic relationships between anxiety, tension and stress with bodily signals such as dyspnea and pain, as well as showing the effectiveness of relaxation on the organism, combined with experiential exercises (e.g., relaxation and imagination techniques)."

 

From the results section of the paper - my bolding:

So, in order to save money, these researchers are declaring that cancer is a chronic illness, rather than attempting to cure it? One of the defining features of cancer is that for most people it is very painful. Suffering from severe pain, short or long term, caused by an illness that isn't going to get better, is very depressing indeed.

The section I've quoted implies that cancer is secondary to depression, not that depression is secondary to cancer.

Anyone with cancer and who is paying for health insurance is probably, eventually, going to get their insurance benefits cut off because they are depressed. The cancer is going to be treated as a secondary issue which was caused by the depression.

There are a surprising number of sadists in the world. I actually realised this many, many years ago, and nothing has happened since then to make me change my mind.

 

None of those concepts have a reliable assessment and are maximally vague. They also have wildly different values to different people. It's just as valid as asking whether people's chakras are better aligned after chakra-realignment therapy.

I don't specifically object to people pretending this BPS thing is new and must be treated as a brand-new-never-tried-before thing, it's absurd but whatever, people are weird. How does this not get edited out, however? This paradigm literally has been around for decades, there are clinics that have been exclusively built around the concept that have been running for decades. And every time, it's always newly-developed and brand-new.

And not even bothering to make sense: specialized biopsychosocial. Now that's revealing. The premise of the BPS ideology is to treat the individual as a whole, all its components. In reality, it's mindless obsession over the placebo trinity: depression, anxiety and stress, vague concepts whose definitions can wildly change based on context for which there is no formal testing possible. The "placebo" isn't in how it changes perception, but in how easily manipulable the questions are, leading to incorrect evaluation. It's also possible to change someone's appreciation of a movie by learning bad things about the main actor, changing their given score of the movie. It says absolutely nothing about the movie, or the person. It's imprecise and arbitrary.

So it has absolutely nothing to do with treating the individual as a whole, instead it makes everything about 3 vague concepts. That's what gets specialized: everything is depression, anxiety and stress. Zero difference between making everything about an axis of fear and love. That's about as far as it can get from a holistic model, it reduces people to 3 simple numbers that have no reliable meaning or interpretation.

And here they do 2 things:

Forget that they are supposed to pretend this is biopsychosocial, and instead use psychosocial, which is what this is. And of course it's about costs. It's always ever about costs. There is no other objective but kicking as many sick people out of healthcare. It's the "calling", you see, healers get that calling, you know, to kick sick people out of healthcare by lying about them.

Seriously, healthcare is currently the most broken profession and it's not even close. This is borderline at a Nero fiddling while the city burns. Doctors, who are supposed to help people, instead dedicate themselves to lying to sick people. Absurd.