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G. Richard Smith, Jr, MD; Kathryn Rost, PhD; T. Michael Kashner, PhD

Arch Gen Psychiatry. 1995;52(3):238-243.

Abstract
Background
Patients who somatize but who do not meet criteria for somatization disorder are common in the community. Virtually no research has been conducted to determine how to treat these patients.

Methods
We conducted a randomized controlled clinical trial of a psychiatric consultation intervention we had previously shown to improve the management of somatization disorder. The study population included 51 physicians treating 56 somatizing patients who had a history of seeking help for six to 12 lifetime unexplained physical symptoms. At the onset of the experiment, physicians randomized to the treatment condition received a consultation letter recommending a specific management approach; physicians randomized to the control/crossover condition received the consultation letter after 12 months. Data on health outcomes and charges were collected every 4 months for 2 years after randomization for 96% of subjects who entered the study.

Results
Patients of physicians who received the intervention reported significantly increased physical functioning, an improvement that remained stable during the year after the intervention. The intervention reduced annual medical care charges by $289 (95% confidence interval, $40 to $464) in 1990 constant dollars, which equates to a 32.9% reduction in the annual median cost of their medical care.

Conclusions
Somatizing patients with a lifetime history of six to 12 unexplained physical symptoms reported better physical functioning after their primary care physician was provided appropriate treatment recommendations via a psychiatric consultation. Such a consultation is cost-effective because it reduces subsequent charges for medical care, while improving health outcomes in a chronically impaired population.

Author Affiliations
From the Department of Psychiatry and Behavioral Sciences, University of Arkansas for Medical Sciences, National Institute of Mental Health Center for Rural Mental Healthcare Research, and Veterans Affairs Health Services Research and Development Field Program for Mental Health, Little Rock (Drs Smith and Rost); and Department of Psychiatry, University of Texas Southwestern Medical School, Dallas, and Research Service, Dallas Veterans Affairs Medical Center (Dr Kashner).

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