Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical Private University, Nuremberg General Hospital, Nuremberg, Germany.
Department of Internal Medicine 3, Respiratory Medicine, Paracelsus Medical Private University, Nuremberg General Hospital, Nuremberg, Germany.
Front Public Health. 2022 Apr 12;10:844874. doi: 10.3389/fpubh.2022.844874. eCollection 2022.
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 " uremberg ntegrated sychosomatic cute Unit" (NIPA) has been developed to integrate treatment of both, psychosocial and physical impairments, in an acute somatic care setting.
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).
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: = 10.9, = 6.1, discharge: = 7.6, = 5.3, = 0.58, = ), anxiety (admission: = 10.6, = 4.9, discharge: = 7.3, = 4.1, = 0.65, < ) and stress (admission: = 6.0, = 3.6, discharge: = 4.1, = 2.5, = 0.70, < ). Somatic symptom burden was reduced by NIPA treatment (admission: = 10.9, = 5.8, discharge: = 9.6, = 5.5, = 0.30), albeit not statistically significant ( = ) ZUF-8 revealed that 89% reported large or full satisfaction and 11% partial dissatisfaction with treatment.
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.
在急症医院中，需要专门的生物心理社会护理理念来克服身体和心理社会治疗之间的二元对立。对于患有复杂和慢性共病的身体和心理健康问题的患者，单独的标准化精神病/身心或躯体护理单位都不能满足他们的需求。“纽伦堡综合身心急症病房”（NIPA）的设立是为了在急性躯体护理环境中整合身心和身体损伤的治疗。
NIPA 已在呼吸医学、肿瘤学和胃肠病学的住院内科病房中设立。每个病房有一到两名患者定期接受 NIPA 治疗，在完成躯体护理后仍留在同一住院床位上。在自然主义研究设计中，我们通过使用患者健康问卷（PHQ）和广泛性焦虑症量表-7（GAD-7）在入院和出院时评估症状负荷来评估治疗效果。此外，我们在治疗期间使用诊断数据评估发病率的严重程度。出院时，我们通过患者满意度问卷（ZUF-8）评估治疗满意度。
对 41 名 NIPA 患者的数据进行了分析（18-87 岁，76%为女性）。78%的患者至少患有中度抑郁，49%的患者患有焦虑症。其他诊断包括躯体形式疼痛障碍、躯体形式自主神经功能障碍、饮食障碍和创伤后应激障碍。高血压、慢性肺部疾病和肌肉骨骼疾病以及慢性肿瘤和心脏疾病是最常见的躯体合并症。治疗导致抑郁情绪显著减轻（入院：=10.9，=6.1，出院：=7.6，=5.3，=0.58，=），焦虑（入院：=10.6，=4.9，出院：=7.3，=4.1，=0.65，）和压力（入院：=6.0，=3.6，出院：=4.1，=2.5，=0.70，）。NIPA 治疗减轻了躯体症状负担（入院：=10.9，=5.8，出院：=9.6，=5.5，=0.30），尽管无统计学意义（=）。ZUF-8 显示，89%的患者报告对治疗非常满意或满意，11%的患者部分不满意。
NIPA 急症护理为需要心理社会治疗的复杂躯体合并症患者提供了治疗机会。进一步的长期评估将显示，通过预防住院和短期住院再入院，心理社会 NIPA 护理是否能够减轻身体疾病的进程和住院费用。
