The state of the art in European liaison psychiatry and psychosomatics

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The 11th meeting of the European Association for Consultation-Liaison Psychiatry and Psychosomatics (EACLPP) was held in Zaragoza, Spain, from June 25 to June 28, 2008. This was the second time that Spain had played host to the EACLPP meeting which was held in collaboration with the meeting of the Spanish Psychosomatic Medicine Association (SEMP) and the European Conference on Psychosomatic Research (ECPR).

The conference was very well attended by delegates from Europe, the USA, and other countries. The meeting also coincided with the EXPO International Exhibition, and it was a great opportunity to visit Zaragoza and combine research with culture. Unfortunately, because of the success of EXPO 2008, there were some initial problems with hotel accommodation but these were resolved quickly. We are convinced that most people agreed it was worth the effort and the meeting was probably one of the best attended of all the European psychosomatic and liaison psychiatry meetings.

A central issue of the conference was holistic medicine, both from the clinical and the research perspectives. The “psychosomatic” humanistic views were obvious in the presentations, as was the empirical philosophy, which was used in an attempt to find “evidence-based” foundations for our practice. Interactivity was promoted through “meet the expert” discussions, round tables, debates, workshops and symposia, following the tradition of recent years in our meetings.

Recent advances were presented, and the range of topics covered gave an idea of the contemporary scope in the field. One of the most important topics covered was delirium. This included issues of clinical guidelines, new neuroleptics, the importance of cytokines in the pathogenesis or collaborative treatment issues. One of the highlights of the meeting was the intervention by Prof. Robinson, from Iowa, USA, who gave a presentation of new data related to the prevention of post-stroke depression and the reduction of mortality by means of antidepressant treatment. The current state of liaison psychiatry in Europe was discussed once again in Zaragoza, but the president of the American Academy of Psychosomatic Medicine, Dr. C. Alter, also informed the conference about new developments in the US. Dr. A. Leentjens, President of the EACLPP, presented the recently authorized guideline for liaison psychiatry of the Dutch Psychiatric Association. The future of psychosomatic medicine in Europe was also discussed, in a session chaired by Prof. H. Deter, from Berlin, who is leading new initiatives in association with some of the best known experts on this side of the Atlantic. Distinguished epidemiologists presented data about the EURODEP Project, an ambitious series of studies of depression in the elderly across European cities. They focused the attention here on the relationship between depression and somatic diseases. The first day ended with an emotional obituary session in honor of a distinguished Spanish liaison psychiatrist, Dr. Maxi Lozano.

Liaison psychiatry in children and adolescents was covered by papers relating to such contemporary issues as chronic fatigue in children or suicide. The research by Dr. Hindley was one of the most relevant investigations presented. Similarly, important parts of the conference were dedicated to liaison with primary care and to training aspects. Treatment of schizophrenia in primary care, and the prevention and treatment of the metabolic syndrome were also discussed. Communication skills with patients was the main issue in an important session. However, one of the main topics discussed at the conference was somatisation disorders, and several sessions were dedicated to this issue. New cognitive behavior therapies were presented; possible biological causes were discussed and certainly the issue of the influence of culture and social factors stirred considerable interest. A special symposium, led by the Danish group, concerned outcome measures used in clinical trials for functional somatic symptoms. This highlighted the different dimensions of somatisation including health beliefs, healthcare costs, functioning, psychological distress as well as the symptoms themselves. A related session of the EACLPP working group concerned the care of patients with medically unexplained symptoms and somatisation, which is preparing contributions for forthcoming EACLPP meetings.

A state-of-the-art lecture by Prof. U. Malt reviewed the use of psychotropic medications in medical patients. Other sessions were dedicated to topics such as organ transplantation; liaison psychiatry in special environments such as dermatological clinics; cardiovascular disorders; or obsessive-compulsive disorders. Psychotherapy in the medically ill was also considered. Organization of services and quality improvement in the field attracted considerable interest. The “complex patient” and models of care related to this were also some of the main issues in the conference. Dr. F. Huyse was a leading speaker here, but high-quality speakers from both the USA and Europe participated. Early detection, new models of intervention, fragmentation of care and the modern med-psych units were similarly discussed.

Prof. J. Ormel presented the WHO study in 15 countries, documenting that psychological disorders can be more disabling than physical disorders, despite the former being less recognized. Comorbidity of psychological and somatic disorders was addressed in different sessions. The Zaragoza group presented a longitudinal study on the issue of depression on incident diabetes. Alexithymia has long been a classical subject in the European meetings and was also addressed in Zaragoza. Similarly, eating disorders were also analyzed. The organization of care in consultation–liaison (CL) units attracted considerable attention, and psycho-oncological issues were also discussed extensively. Original methods presented on the approach of psychological disorders in medical patients included expressive and art therapies. Finally, one important session was dedicated to depression and cardiovascular disorder, and Prof. de Jonge's group presented attractive views in the field. The heterogeneity of depression following myocardial infarction was the main focus of interest.

As expected, it seems clear that the field is ready to progress and to continue discussions on these issues, first in the EACLPP XII meeting in Noordwijkerhout (The Netherlands, 2009), dedicated to evidence based medicine in CL psychiatry and psychosomatics, and then in the combined EACLPP/ECPR meeting in Innsbruck (Austria, 2010).