Behavioral Medicine Clinic Solves Conundrums

Mayo Clinic's Department of Psychiatry and Psychology developed its Behavioral Medicine Program to address the needs of people affected by physical symptoms that are not easily explained or understood. The program also benefits patients with medical conditions who also have depression, anxiety or other psychological problems that complicate medical treatment outcomes.

Jeffrey P. Staab, M.D., a Mayo Clinic psychiatrist, wishes to dispel the negative connotations associated with his area of expertise and to help patients understand that treatment is available. "Behavioral medicine focuses on the problems that lie at the interface of medicine, surgery, and behavior," says Dr. Staab. "The idea of a body-brain disconnect is a misperception. We want to treat the baffling cases, the medical and behavioral conundrums, in patients who don't have an explanation for their physical symptoms."

Teamwork Drives Success

Initiated in 2007 as the Psychiatry and Psychology Assessment Service and renamed in 2009, the Behavioral Medicine Clinic explores medical, behavioral, family, and lifestyle elements and their impact on the patient and his or her medical problem. Patients entering Mayo's Behavioral Medicine Program often have seen several doctors and are still looking for answers. "The real benefit Mayo Clinic offers is the opportunity to be examined by various specialists who then work together to evaluate their findings," says Dr. Staab.

Patient satisfaction ratings, team versus individual approach

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An example of a patient seen in this program is one with stubborn dizziness. Patients with dizziness generally see several specialists during the same visit at Mayo Clinic. Within the Behavioral Medicine Program, psychologists, psychiatrists, psychiatric nurses, and therapists apply their expertise to an array of clinical problems. Medical and surgical specialists are also available when needed. Using all available history and results, these specialists, working as a team, reach consensus regarding their findings, report to the patient's referring physician, and recommend interventions.

"The team approach ensures that many minds contribute to the determination of what's really happening. As a result, patient satisfaction is high," says James R. Rundell, M.D., a Mayo Clinic psychiatrist. "Treatment becomes more consistent from patient to patient as the team identifies approaches that work well and modifies or discontinues ineffective practices."

Dr. Rundell notes that the program provides patients with an understanding of why they have what they have, which allows them to reduce the impact of their illness. Treatment is considered a success if there are reductions in psychological morbidity, reduced health care expenses, and improved quality of life.

Example of What's Possible

A patient with a six-year history of persistent dizziness and imbalance following an inner ear infection was referred to the program. She had received diagnoses ranging from multiple sclerosis to Meniere's disease in the three years before coming to Mayo Clinic. Assuming herself disabled, she quit her job and was using a wheelchair.

A review of existing records plus detailed balance tests, neurologic and psychiatric examinations, and physiotherapy evaluations resulted in medical-psychiatric explanation: The vestibular neuritis was the initial trigger, but then the patient developed a high level of vigilance about her balance, and the resulting anxiety caused the dizziness to worsen.

Giving the patient full understanding of her situation by knitting together the medical and behavioral factors involved — and proving to her that she could trust her balance — resulted in successful treatment. The patient's dizziness was neither entirely medical nor fully psychiatric. Only the combination made sense.

Follow-up Options

Mayo Clinic specialists work with the patient's physician to determine the most appropriate approach to follow-up care. Normally, the patient returns to the referring physician for follow-up, and Mayo provides consultation as requested.

Some patients are best served if their physician provides daily management of their Mayo-recommended treatment plan and Mayo recommendations can be incorporated into routine health care. Some patients do not need follow-up treatment. A few require ongoing care at Mayo.