Update on consultation-liaison psychiatry (psychosomatic medicine).

PURPOSE OF REVIEW

Current issues in consultation-liaison psychiatry, which is now labeled psychosomatic medicine as a formal subspecialty by the American Board of Psychiatry and Neurology, are discussed.

RECENT FINDINGS

There is continued interest in how to best manage depression and anxiety in a primary-care setting. Collaborative care that utilizes a psychiatrist within the treatment center, as well as case management by a nurse, have been reviewed and meta-analyses suggest it is an efficient and effective approach. The diagnostic issues within psychosomatic medicine are also an area of concern as the Diagnostic and Statistical Manual of Mental Disorders, 5 edition, is in the planning stages. How to improve both the reliability and validity of somatoform disorders will be a major challenge. Organ transplantation is a clinical challenge for patients, donors and healthcare providers. Issues in assessment and management continue to evolve. Ethical questions also arise due to the shortage of available organs.

SUMMARY

Psychosomatic medicine continues to manage patients in medical settings that cut across a continuum from primary-care to complex medical and surgical centers. The clinical problems containing a medical-psychiatric interface offer a clinical challenge but also an area for new knowledge and better interventions.