Anxiety in German psychosomatic units: Long term extensive experience of treatment

A study published in the current issue of Psychotherapy and Psychosomatics reports on a long term extensive experience of treatment of psychosomatic symptoms related to anxiety in German psychosomatic units.

This study reports on a long term extensive experience of treatment of psychosomatic symptoms related to anxiety in German psychosomatic units. The predominance of PTSD, panic and generalized anxiety disorders corresponds to the proportion of presentation in general practice; however, the number of patients presenting with agoraphobia without panic and of other anxiety disorders was comparatively high. Psychiatric comorbidity was high pertaining up to 80% of this group. The majority (60%) was also diagnosed with an additional somatic disorder.

Anxiety disorders are among the most frequent mental disorders in the general population, with a median 12-month prevalence of 13.5% (excluding OCD and PTSD). Comorbidity is the rule rather than the exception. In order to provide effective treatments for patients with psychosomatic disorders or somatic and psychiatric comorbidity, a total of 3,000 beds have been established in acute medical hospitals and another 15,000 beds in rehabilitation clinics in Germany providing integrated medical and psychotherapeutic services. Inpatient treatment is indicated when outpatient treatment proves unsuccessful or insufficient due to the severity, acuity and complexity of the disease or a necessity for multimodal and intensive treatment.

From January 2001 to December 2008, data of 37,052 patients from 14 psychosomatic clinics in Bavaria were collected in a standardized way. This included diagnoses after ICD-10 and characteristics such as length of the disease. A total of 5,022 (13.55%) received a primary diagnosis of anxiety. Regarding the primary diagnosis, PTSD (F43.1; 26.1%) were the largest subgroup, followed by panic disorder (F41.0; 23.6%), generalized anxiety (F41.1; 13.7%) and agoraphobia (F40.0X;13.3%), mostly without panic (F40.01; 11.7%). Social phobia was comparatively rare (F40.1; 6.1%), and specific phobia was reported least (F40.2; 1.6%) as a primary diagnosis. The group with other anxiety disorders was comparatively large (15.5%), and dominated by the category F41.2 (14.3%). The most frequent comorbid condition was depression with 47.4%, followed by personality disorders (20.1%), somatoform disorders (17.8%), substance abuse (15.1%) and eating disorders (12.3%). Comorbid anxiety disorders, i.e.having a second diagnosis of an anxiety disorder, were diagnosed in 9.8% of the patients. Only 19.7% of the anxiety patients received no second psychiatric diagnosis.

The purposes of this large-scale study were to determine the proportion of anxiety disorders and comorbid conditions in inpatient psychosomatic treatment. The predominance of PTSD, panic and generalized anxiety disorders corresponds to the proportion of presentation in general practice; however, the number of patients presenting with agoraphobia without panic (F40.01) and of other anxiety disorders (predominantly F41.2) was comparatively high. Recent surveys contrasting patient selfreport and clinical diagnoses make it seem likely that social phobia is under-diagnosed in inpatient samples. Specific phobias, as the most frequent conditions in the general population, are less likely to induce medical help-seeking or inpatient treatment as a primary diagnosis. Psychiatric comorbidity was high pertaining up to 80% of this group. The majority (60%) was also diagnosed with an additional somatic disorder.