[Psychosomatic-psychotherapeutic rehabilitation of social medicine problem patients--an exploratory study of findings, follow-up and treatment outcome].

The group of social-medical problem patients was defined as comprising those patients who are admitted during an on-going invalidity pension award procedure or who are drawing a fixed-term pension, patients who have declared their intention to apply for pension award and/or have been on sick leave for an uninterrupted 6 months at the time of admission. In light of this definition, some 25-30% of the patients referred to us would be considered social-medical problem patients. The main focus of the present study had been to identify the subgroup of patients who might be expected to profit from psychosomatic rehabilitation notwithstanding their social-medical problems. Improvement in physical symptoms was achieved in 34% of the patients, and in 43% relative to the psychological symptoms present. The group of patients showing the greatest measure of improvement can be described by the following prognostically favourable factors: incapacity for work at the time of admission but no application for pension award made or planned; lower average age, higher motivation on admission, and lower severity of the social-medical problems, no denial of psychosocial factors, and willingness to join group psychotherapy. Prognostically unfavourable factors were found to be a fixed-term pension already awarded, along with repeated participation in rehabilitation measures on purely somatic grounds, and a higher age. Pertinent literature is reviewed in light of these findings, underscoring the significance of the time factor in chronification of neurotic disorders of the capacity for work and gainful activity. Consequently, these patients should as speedily as possible undergo efficient psychosomatic diagnosis and be referred for inpatient psychosomatic rehabilitation.