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  • 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Pszichiátriai és Pszichoterápiás Klinika, Budapest
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Összefoglaló. Bevezetés: A pszichoszomatikus medicina területéhez tartozó betegek ellátása rossz hatásfokú. Ez egyaránt jelentős terhet jelent a betegek és az egészségügy számára. Célkitűzés: A pszichoszomatikus tünetek és betegségek megjelenésének és ellátási ajánlásainak vizsgálata az irányadó hivatalos szakmai anyagban. Módszer: Az adatgyűjtés időpontjában elérhető 531 Szakmai irányelvből annak a 134 dokumentumnak a részletesebb elemzése, amelynek témájában pszichoszomatikus tünetek/betegségek gyakoribbak. Ebből 39 egyértelműen pszichoszomatikus vonatkozású anyag tartalmi vizsgálata, továbbá a Szakmai Kollégiumok listáján szereplő három pszichiátriai szakterület összes (26) szakmai irányelvének hasonló szempontú értékelése. Eredmények: A megvizsgált irányelvek töredéke tartalmaz csupán a pszichoszomatikus tünetképzésre, illetve kezelésre, megelőzésre vonatkozó megállapítást. A releváns témájú irányelvekben szereplő diagnosztikai utalások aránya: direkt 10,25, indirekt forma 23,7, a terápiás ajánlások között direkt 25,64, indirekt forma 15,38%. A megelőzésre vonatkozóan alig (5,12%-ban) szerepel említés, a pszichés betegségek egyidejű fennállásának esélyére is mindössze 10,25%-ban történik megállapítás. A szorongásos zavarok befolyásáról kevesebb, mint minden harmadik irányelv számol be (30,76%). A pszichiátriai irányelvek között pszichoszomatikus betegségekre vonatkozóan nincs célzott szakmai irányelv. Következtetés: A pszichoszomatikus medicina a hatékony betegellátás követelményeit meghatározó szakmai irányelvekben elégtelen arányban jelenik meg. Okait szemléleti zavarokban, a pszichiátriai szakmai konszenzus és a szakmaközi együttműködés hiányosságaiban kell keresni. Mind a vonatkozó kutatásokban, mind az irányelvek fejlesztése során erőfeszítéseket kell tenni a fentiek miatt kallódó nagy betegpopuláció hatékonyabb ellátása érdekében. A szerző javaslatot tesz a szükséges konkrét lépésekre. Orv Hetil. 2021; 162(7): 252–261.

Summary. Introduction: The care of patients with psychosomatic disorders has bad efficacy. It beards hard both for the patients and the health care providers. Objective: Review of presentrecommendations for psychosomatic symptoms and illnesses in the recent Hungarian medical protocols. Method: A detailed evaluation of 134 medical protocols from altogether 531 protocols with closer connection with psychosomatic disorders were carried out, their diagnostic and therapeutic recommendations were analyzed. Further review of 39 (of the 134)directly related to psychosomatics was done. Investigation of psychiatric protocols for the same aspects was carried out, as well. Results: Only a small part of the protocols contain recommendations for psychosomatic disorders. Ratios of their presence: diagnostic – direct 10.25, indirect 23.7, therapeutic – direct 25.64, indirect 15.38%. Efforts for prevention are only in 5.12% of the materials and 10.25% of the protocols mention a possible dual nature of the given clinical manifestation. Anxiety disorders occur only in 30.76%. Psychiatric protocol directly aiming psychosomatic problems is lacking. Conclusion: Presence of psychosomatic medicine in clinical guidelines defining the conditions of successful care of patients is practically minimal. Possible explanations: confusion in approaches, lack of consensus among the psychiatric institutions, and deficiency of interdisciplinary cooperation. Both in relevant clinical research and in development of medical protocols common additive efforts are necessary for achieving a more successful care of high numbers of patients presently neglected because of the mentioned causes. Author advises some concrete steps for the solution. Orv Hetil. 2021; 162(7): 252–261.

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