The management of idiopathic chronic pain: a holistic approach.

The evaluation and treatment of the patient with idiopathic chronic pain traditionally has involved a sequence of studies first by the internist, then the neurologist, and finally the psychiatrist. This has resulted in an overutilization of costly health care services and may paradoxically have helped to promote symptom chronicity. In keeping with recent developments in the field of psychosomatic medicine, a coordinated biopsychosocial approach is advocated with the identification and amelioration of the multiple determinants of symptom formation in each of these interrelated sub-systems. A case if presented in which the application of this holistic approach appeared to help curtail the overuse of health care services and at the same time helped to diminish psychosocial reinforcers in the form of secondary gain.

The expanding roles of general-hospital psychiatry.

The number and the roles of psychiatric units in general hospitals have been growing rapidly in recent years, and general-hospital psychiatry presents broad opportunities for service delivery, education, and research. Most or all the basic components of a community mental health center can be found within a general hospital, and as psychiatrists move back into the mainstream of medicine, the general hospital takes on added value. Training advantages include the exposure of medical students and primary care residents and physicians to mental illness and its impact on families as well as the interaction between psychiatric and nonpsychiatric trainees at various levels. The author discusses differences that hinder the optimal use of general-hospital psychiatric units, such as funding, regulatory controls, and regional variations in length of stay.