Studies Showing Psychiatry's Value to Medically Ill Patients Needed, Says Award Lecturer

The skills that psychiatrists bring to the care of medically ill patients can “make medicine better” by improving patient outcomes, said Michael Sharpe, M.D., emeritus professor of psychological medicine at Oxford University.

Sharpe delivered the 2023 Adolf Meyer Award Lecture on Sunday at APA’s Annual Meeting. The award honors an individual for lifetime achievement in psychiatric research.

Sharpe said this integration of psychiatry and medicine was championed by Meyer, who was an early proponent of “whole patient care” and developed the concept of “psychobiology.” This notion was picked up by later psychiatrists, most notably George Engel, M.D., who conceptualized the biopsychosocial model.

But the historical separation of psychiatry from the rest of medicine has made that integration challenging, and Sharpe said psychiatry needs to define specifically what it can bring to the care of medically ill patients and prove its value in robust clinical trials.

As examples, he presented clinical trials focused on three problem areas of medical care: management of chronic fatigue syndrome, depression care for people with cancer, and long hospital stays in elderly patients.

In patients with chronic fatigue syndrome (sometimes called myalgic encephalomyelitis), Sharpe described a “vicious circle” of fatigue, fear of fatigue, avoidance of activity, disability, and physiological changes leading to more fatigue. A study published in the British Medical Journal in 1996 compared four interventions designed to gradually reduce avoidance of activity: cognitive-behavioral therapy (CBT), graded exercise therapy, adaptive pacing therapy, and standard medical care.

Patients receiving CBT had the lowest scores on fatigue (standard medical care had the highest) and the highest scores on physical function. “Cognitive-behavioral therapy was both acceptable and more effective than medical care alone in improving patients’ day-to-day functioning in the medium term,” wrote Sharpe and colleagues. “It was also more effective in helping patients to feel better.”

Similarly, Sharpe presented results of a 2014 study published in The Lancet comparing integrated collaborative depression care for patients with cancer and usual care. That study found that 62% of patients receiving integrated depression care experienced a 50% decrease in depression scores compared with 17% receiving usual care.

Finally, he presented the outlines of the ongoing HOME Study, which looks at the effects of a model of proactive integrated consultation-liaison psychiatry on length of stay for elderly hospitalized patients. Results of that study are pending.

A common thread in all three trials is a more holistic approach to care of medically ill patients, something that has been lost in general medical care over time. “As medicine has become more technological, it has become less humane,” Sharpe said.

“The idea that we can bring psychiatry back into medicine with the things that psychiatry does well but that medicine has lost and make medical care better is often proclaimed but not often enough proven in robust clinical trials,” he said. The three clinical trials “show that it can be true and isn’t just a self-serving fantasy. That’s the good news—we can change medicine when we implement these findings in clinical care.” ■