scholarly journals War Syndromes: The Impact of Culture on Medically Unexplained Symptoms

2005 ◽  
Vol 49 (1) ◽  
pp. 55-78 ◽  
Author(s):  
Edgar Jones ◽  
Simon Wessely
Keyword(s):  
Medically Unexplained Symptoms ◽  
Cerebral Haemorrhage ◽  
Agent Orange ◽  
Toxic Exposure ◽  
Physical And Mental Health ◽  
Gulf War Syndrome ◽  
Causal Explanations ◽  
Medically Unexplained ◽  
Unexplained Symptoms ◽  
The Impact

The general principle that the experience of combat damages servicemen's long-term physical and mental health is recognized. However, controversy has raged over the nature of particular post-combat disorders such as shell shock, disordered action of the heart (DAH), effort syndrome, effects of Agent Orange and, not least, Gulf War syndrome. We, among many others, have argued that they should be classified as functional syndromes characterized by medically unexplained symptoms, which include: fatigue, weakness, sleep difficulties, headache, muscle ache and joint pain, problems with memory, attention and concentration, nausea and other gastro-intestinal symptoms, anxiety, depression, irritability, palpitations, shortness of breath, dizziness, sore throat and dry mouth. Despite popular claims to the contrary, no simple biomedical aetiology has been discovered to account for these disorders, hence the term “medically unexplained”. Furthermore, they are not easily interpreted using accepted psychiatric classifications. Without demonstrable organic cause, war syndromes have attracted diverse causal explanations, ranging from pressure on the arteries of the chest, constitutional inferiority, toxic exposure, bacterial infection to microscopic cerebral haemorrhage.

scholarly journals Historical approaches to post-combat disorders

2006 ◽  
Vol 361 (1468) ◽  
pp. 533-542 ◽  
Author(s):  
Edgar Jones
Keyword(s):  
Medical Science ◽  
Medically Unexplained Symptoms ◽  
Agent Orange ◽  
Oil Well ◽  
Post Traumatic Stress ◽  
Gulf War Syndrome ◽  
Shell Shock ◽  
Medically Unexplained ◽  
Unexplained Symptoms ◽  
Combat Disorders

Almost every major war in the last century involving western nations has seen combatants diagnosed with a form of post-combat disorder. Some took a psychological form (exhaustion, combat fatigue, combat stress reaction and post-traumatic stress disorder), while others were characterized by medically unexplained symptoms (soldier's heart, effort syndrome, shell shock, non-ulcer dyspepsia, effects of Agent Orange and Gulf War Syndrome). Although many of these disorders have common symptoms, the explanations attached to them showed considerable diversity often reflected in the labels themselves. These causal hypotheses ranged from the effects of climate, compressive forces released by shell explosions, side effects of vaccinations, changes in diet, toxic effects of organophosphates, oil-well fires or depleted-uranium munitions. Military history suggests that these disorders, which coexisted in the civilian population, reflected popular health fears and emerged in the gaps left by the advance of medical science. While the current Iraq conflict has yet to produce a syndrome typified by medically unexplained symptoms, it is unlikely that we have seen the last of post-combat disorders as past experience suggests that they have the capacity to catch both military planners and doctors by surprise.

Therapeutic processes and personalised care in body oriented psychological therapy for patients with Medically Unexplained Symptoms (MUS)

2017 ◽  
Vol 5 (4) ◽  
pp. 449
Author(s):  
Nina Papadopoulos ◽  
Claire Burrell ◽  
Layla Smith ◽  
Frank Röhricht
Keyword(s):  
Care Setting ◽  
Emotional Responses ◽  
Medically Unexplained Symptoms ◽  
Psychological Therapy ◽  
Centered Care ◽  
Medically Unexplained ◽  
Unexplained Symptoms ◽  
The One ◽  
The Impact ◽  
The Relationship

Background: Body oriented psychological therapy (BOPT) for patients with MUS is a new and innovative intervention offering patients an alternative way to engage with and manage their MUS symptoms as well as their emotional responses. Methods: This paper is a qualitative report on a pilot study which took place in a primary care setting. Patients were offered 10 weekly sessions of BOPT in small groups.Results: The qualitative findings suggest that (i) patients responded well to this treatment approach, (ii) they experienced their bodily realities in a more positive way and not just as a source of negativity or pain, (iii) they learnt to manage their symptoms more effectively and (iv) they began to understand the relationship between their bodily symptoms and their emotional state as well as the impact of the one on the other including very poignant themes such as loss and dislocation.Conclusion: BOPT is a useful therapeutic approach in the person-centered care of MUS.

scholarly journals Medically unexplained symptoms in children: an experimental investigation of the impact of internet searching on parental responses

2020 ◽  
pp. 1-13
Author(s):  
Tyler Hughes ◽  
Francesca Meredith ◽  
Sabrina Monteregge ◽  
Sophie D. Bennett ◽  
Roz Shafran
Keyword(s):  
Medically Unexplained Symptoms ◽  
Young Person ◽  
Physical Symptoms ◽  
Internet Searching ◽  
Adult Participants ◽  
Medically Unexplained ◽  
Unexplained Symptoms ◽  
Free Search ◽  
The Impact ◽  
Parental Responses

Abstract Background: Medically unexplained symptoms (MUS) are symptoms for which no medical cause can be identified. For children and adolescents, symptoms can be maintained through parental responses. Aims: The present study investigated the impact that internet searching of symptoms has on parental responses to MUS. Method: One hundred and twenty-seven adult participants read a vignette in which they were asked to imagine they were a parent of a young person with MUS and completed visual analogue scales (VAS) reporting their beliefs, emotions and behavioural intentions about the MUS. Participants were then randomly assigned to one of three conditions: searching reputable websites for further information about the symptoms (n = 47), free search of any websites for further information about the symptoms (n = 38) or a control condition (n = 42) during which participants spent 10 minutes doing their usual behaviour on the internet, for example checking email and social media. Participants then completed the VAS for a second time. Results: Searching reputable websites led to a significantly greater decrease in behaviour VAS scores compared with the free search condition [F (1,123) = 11.374, p < .001], indicating that participants were less likely to seek a second opinion and to advise the child to avoid usual activities. Conclusions: This study demonstrated that internet searching reputable sites for information regarding physical symptoms can be positive and it may therefore be advisable for health professionals meeting children with MUS to provide the family with information links to reputable sources.

Searching for a Gulf War syndrome using cluster analysis

2002 ◽  
Vol 32 (8) ◽  
pp. 1371-1378 ◽  
Author(s):  
B. EVERITT ◽  
K. ISMAIL ◽  
A. S. DAVID ◽  
S. WESSELY
Keyword(s):  
Cluster Analysis ◽  
Psychiatric Symptoms ◽  
Medically Unexplained Symptoms ◽  
Musculoskeletal Symptoms ◽  
Gulf War Syndrome ◽  
Gap Statistic ◽  
Active Service ◽  
Medically Unexplained ◽  
Unexplained Symptoms ◽  
Cluster 2

Background. Gulf veterans report medically unexplained symptoms more frequently than non-Gulf veterans did. We examined whether Gulf and non-Gulf veterans could be distinguished by their patterns of symptom reporting.Method. A k-means cluster analysis was applied to 500 randomly sampled veterans from each of three United Kingdom military cohorts of veterans; those deployed to the Gulf conflict between 1990 and 1991; to the Bosnia peacekeeping mission between 1992 and 1997; and military personnel who were in active service but not deployed to the Gulf (Era). Sociodemographic, health variables and scores for ten symptom groups were calculated.Results. The gap statistic indicated the five-group solution as one that provided a particularly informative description of the structure in the data. Cluster 1 consisted of low scores for all symptom groups. Cluster 2 had veterans with highest symptom scores for musculoskeletal symptoms and high scores for psychiatric symptoms. Cluster 3 had high scores for psychiatric symptoms and marginally elevated scores for the remaining nine groups symptom groups. Cluster 4 had elevated scores for musculoskeletal symptoms only and cluster 5 was distinguishable from the other clusters in having high scores in all symptom groups, especially psychiatric and musculoskeletal.Conclusion. The findings do not support the existence of a unique syndrome affecting a subgroup of Gulf veterans but emphasize the excess of non-specific self-reported ill health in this group.

scholarly journals Management of medically unexplained symptoms: outcomes of a specialist liaison clinic

2014 ◽  
Vol 38 (3) ◽  
pp. 102-107 ◽  
Author(s):  
Frank Röhricht ◽  
Thomas Elanjithara
Keyword(s):  
Medically Unexplained Symptoms ◽  
Primary Diagnosis ◽  
Somatoform Disorder ◽  
Assessment Process ◽  
Service Utilisation ◽  
Cross Sectional ◽  
Care Models ◽  
Medically Unexplained ◽  
Unexplained Symptoms ◽  
The Impact

Aims and methodService utilisation and clinical outcomes of a newly developed specialist primary–secondary care liaison clinic for patients with medically unexplained symptoms (MUS) were evaluated in a cross-sectional and feasibility pilot study. The impact of body-oriented psychological therapy (BOPT) was explored in a small cohort of patients with an identified somatoform disorder.ResultsOf 147 consecutive referrals, 113 patients engaged with the assessment process. Of patients with MUS, 42% (n= 45) had a primary diagnosis of somatoform disorder, 36% (n= 38) depressive disorder, and depressive symptoms (even subsyndromal) mediated the effect of somatic symptoms. A marked variation of presenting complaints and service utilisation across ethnic groups was noted. A significant reduction in somatic symptom levels and service utilisation was achieved for patients undergoing BOPT.Clinical implicationsA high proportion of patients with MUS have undiagnosed and therefore untreated mental disorders. New and locally derived collaborative care models of active engagement in primary care settings are required. Patients with somatoform disorder may benefit from BOPT; this requires further evaluation in adequately powered clinical trials.

scholarly journals Multi-symptom illnesses, unexplained illness and Gulf War Syndrome

2006 ◽  
Vol 361 (1468) ◽  
pp. 543-551 ◽  
Author(s):  
Khalida Ismail ◽  
Glyn Lewis
Keyword(s):  
Factor Analysis ◽  
Medically Unexplained Symptoms ◽  
Epidemiological Studies ◽  
Explanatory Models ◽  
Gulf War ◽  
Gulf War Syndrome ◽  
Cross Sectional ◽  
Sociological Factors ◽  
Medically Unexplained ◽  
Unexplained Symptoms

Explanatory models for the increased prevalence of ill health in Gulf veterans compared to those not deployed to the Gulf War 1990–1991 remain elusive. This article addresses whether multi-symptom reporting in Gulf veterans are types of medically unexplained symptoms and whether the alleged Gulf War Syndrome is best understood as a medically unexplained syndrome. A review of the epidemiological studies, overwhelmingly cross-sectional, describing ill health was conducted including those that used factor analysis to search for underlying or latent clinical constructs. The overwhelming evidence was that symptoms in Gulf veterans were either in keeping with currently defined psychiatric disorders such as depression and anxiety or were medically unexplained. The application of factor analysis methods had varied widely with a risk of over interpretation in some studies and limiting the validity of their findings. We concluded that ill health in Gulf veterans and the alleged Gulf War Syndrome is best understood within the medically unexplained symptoms and syndromes constructs. The cause of increased reporting in Gulf veterans are still not clear and requires further inquiry into the interaction between sociological factors and symptomatic distress.

scholarly journals Base Rates of Invalid Test Performance Across Clinical Non-forensic Contexts and Settings

2020 ◽  
Vol 35 (6) ◽  
pp. 717-725 ◽  
Author(s):  
Phillip K Martin ◽  
Ryan W Schroeder
Keyword(s):  
Test Performance ◽  
Medically Unexplained Symptoms ◽  
Base Rate ◽  
Forensic Evaluations ◽  
Base Rates ◽  
Medically Unexplained ◽  
Unexplained Symptoms ◽  
Context Specific ◽  
External Incentives ◽  
The Impact

Abstract Objective Base rates of invalidity in forensic neuropsychological contexts are well explored and believed to approximate 40%, whereas base rates of invalidity across clinical non-forensic contexts are relatively less known. Methods Adult-focused neuropsychologists (n = 178) were surveyed regarding base rates of invalidity across various clinical non-forensic contexts and practice settings. Median values were calculated and compared across contexts and settings. Results The median estimated base rate of invalidity across clinical non-forensic evaluations was 15%. When examining specific clinical contexts and settings, base rate estimates varied from 5% to 50%. Patients with medically unexplained symptoms (50%), external incentives (25%–40%), and oppositional attitudes toward testing (37.5%) were reported to have the highest base rates of invalidity. Patients with psychiatric illness, patients evaluated for attention deficit hyperactivity disorder, and patients with a history of mild traumatic brain injury were also reported to invalidate testing at relatively high base rates (approximately 20%). Conversely, patients presenting for dementia evaluation and patients with none of the previously mentioned histories and for whom invalid testing was unanticipated were estimated to produce invalid testing in only 5% of cases. Regarding practice setting, Veterans Affairs providers reported base rates of invalidity to be nearly twice that of any other clinical settings. Conclusions Non-forensic clinical patients presenting with medically unexplained symptoms, external incentives, or oppositional attitudes are reported to invalidate testing at base rates similar to that of forensic examinees. The impact of context-specific base rates on the clinical evaluation of invalidity is discussed.

Sign in / Sign up

Export Citation Format

Share Document