Neurological and Medical Factors

2017 ◽  
Author(s):  
Victoria S. S. Wong ◽  
Martin Salinsky
Keyword(s):  
Medically Unexplained Symptoms ◽  
Chronic Fatigue ◽  
Physical Symptoms ◽  
Health Care Use ◽  
Psychogenic Nonepileptic Seizures ◽  
Medical Factors ◽  
Fatigue Syndrome ◽  
Medically Unexplained ◽  
Nonepileptic Seizures ◽  
Unexplained Symptoms

This chapter addresses the neurological and medical factors associated with psychogenic nonepileptic seizures (PNES). PNES can occur concurrently with epilepsy in 5 to 20% of patients. Traumatic brain injury (TBI) is a major cause of epilepsy, but it is also commonly cited by patients with PNES as the primary cause of their seizures. PNES are also overrepresented in patients with intellectual and learning disabilities. Patients with PNES usually have additional subjective neurological and medical complaints. Pain complaints are overrepresented in patients with PNES and are a major contributor to health care use. Cognitive complaints are also common, with a patient’s mood playing a larger role than objective cognitive dysfunction. Medically unexplained symptoms such as fibromyalgia and chronic fatigue syndrome are overrepresented in patients with PNES. Their occurrence increases the likelihood of diagnosing PNES over epilepsy. These observations reveal a complex pattern of susceptibility to the development of PNES. PNES are thus best viewed as only one symptom of a heterogeneous disorder characterized by multiple physical symptoms used to express psychological distress.

THE RISE AND FALL OF THE WESSELY SCHOOL

2021 ◽  
Author(s):  
David Francis Marks
Keyword(s):  
Medically Unexplained Symptoms ◽  
Chronic Fatigue ◽  
Fatigue Syndrome ◽  
Empirically Supported ◽  
Causal Assumptions ◽  
Scientific Approach ◽  
Scientific Principles ◽  
Share Data ◽  
Medically Unexplained ◽  
Unexplained Symptoms

The Wessely School’s (WS) approach to medically unexplained symptoms, myalgic encephalomyelitis and chronic fatigue syndrome (MUS/MECFS) is critically reviewed using scientific criteria. Based on the ‘Biopsychosocial Model’, the WS proposes that patients’ dysfunctional beliefs, deconditioning and attentional biases cause illness, disrupt therapies, and lead to preventable deaths. The evidence reviewed here suggests that none of the WS hypotheses is empirically supported. The lack of robust supportive evidence, fallacious causal assumptions, inappropriate and harmful therapies, broken scientific principles, repeated methodological flaws and unwillingness to share data all give the appearance of cargo cult science. The WS approach needs to be replaced by an evidence-based, biologically-grounded, scientific approach to MUS/MECFS.

Ethical Psychotherapeutic Management of Patients with Medically Unexplained Symptoms: The Risk of Misdiagnosis and Harm

2020 ◽  
Author(s):  
Diane O'Leary ◽  
Keith Geraghty
Keyword(s):  
Mental Health ◽  
Health Management ◽  
Medically Unexplained Symptoms ◽  
Chronic Fatigue ◽  
Medical Settings ◽  
Diagnostic Uncertainty ◽  
Fatigue Syndrome ◽  
Psychological Diagnosis ◽  
Medically Unexplained ◽  
Unexplained Symptoms

Management of medically unexplained symptoms (MUS) is undergoing a period of change. We see this in the recent breakdown of consensus on mental health management of quintessential medically unexplained conditions (like myalgic encephalomyelitis/chronic fatigue syndrome), and in recent work in bioethics suggesting that the issue of biological versus mental health management of MUS is fundamentally an ethical matter. For these reasons, it is important to think carefully about ethical aspects of MUS management in psychotherapeutic settings. In the first part of this chapter, the authors show how ambiguity in the term “MUS” leads to routine conflation of diagnostic uncertainty with psychological diagnosis for unexplained symptoms in medical settings. The second part of the chapter explores evidence suggesting that substantial harm results from a failure to draw that distinction in medical settings, and clarifies the psychotherapist’s obligations to avoid those harms. The authors then explore the risk for psychological harms when psychotherapists conflate diagnostic uncertainty with psychological diagnosis. Finally, they consider challenges to informed consent in psychotherapy for MUS. The chapter concludes with principles for ethical psychotherapeutic management of MUS.

Learning to provide patient-centered care with patients with medically unexplained symptoms: a grounded theory study in Australian general practice.

2015 ◽  
Vol 4 (3) ◽  
pp. 173-179
Author(s):  
Louise Stone ◽  
Jill Gordon
Keyword(s):  
General Practice ◽  
Grounded Theory ◽  
Medically Unexplained Symptoms ◽  
Patient Centered Care ◽  
Physical Symptoms ◽  
Patient Centered ◽  
Grounded Theory Study ◽  
Centered Care ◽  
Medically Unexplained ◽  
Unexplained Symptoms

Background Culture shapes the way illness is experienced and disease is understood. Patients with medically unexplained symptoms describe feeling their suffering is not valued because they lack a “legitimate” diagnosis. Doctors also describe feeling frustrated with these patients. This is particularly problematic for young general practitioners (GPs) who lack experience in managing patients with medically unexplained symptoms in primary care settings.Objectives To explore how general practice supervisors help registrars to provide patient-centered care for patients with medically unexplained. Methods A constructivist grounded theory study was undertaken with 24 general practice registrars and supervisors from Australian GP training practices in urban, rural and remote environments. Participants were asked to describe patients with mixed emotional and physical symptoms without an obvious medical diagnosis. Results Registrars came from hospital posts into general practice equipped with skills to diagnose and manage organic disease but lacked a framework for assessing and managing patients with medically unexplained symptoms. They described feelings of helplessness, frustration and sometimes hostility. Because these feelings were inconsistent with their expressed value systems, they were uncomfortable and confronting. The registrars valued interactions that helped them explore this area. Conclusions In hospital practice, biomedical language and explanations predominate, but in general practice patients bring different explanatory illness models to the consultation, using their own language, beliefs and cultural frameworks. Medically unexplained symptoms occupy a contested space in both the social and medical worlds of the doctor and patient. Negative feelings and a lack of diagnostic language and frameworks may prevent registrars from providing patient-centered care.

Anthrax Exposure, Belief in Exposure, and Postanthrax Symptoms Among Survivors of a Bioterrorist Attack on Capitol Hill

2018 ◽  
Vol 13 (03) ◽  
pp. 555-560
Author(s):  
Stephanie Chiao ◽  
Howard Kipen ◽  
William K. Hallman ◽  
David E. Pollio ◽  
Carol S. North
Keyword(s):  
Medically Unexplained Symptoms ◽  
Physical Symptoms ◽  
Care Utilization ◽  
Physical Injury ◽  
Multivariate Models ◽  
Diagnostic Interviews ◽  
Capitol Hill ◽  
High Incidence ◽  
Medically Unexplained ◽  
Unexplained Symptoms

ABSTRACTBackgroundFollowing chemical, biological, radiological, and nuclear disasters, medically unexplained symptoms have been observed among unexposed persons.ObjectivesThis study examined belief in exposure in relation to postdisaster symptoms in a volunteer sample of 137 congressional workers after the 2001 anthrax attacks on Capitol Hill.MethodsPostdisaster symptoms, belief in exposure, and actual exposure status were obtained through structured diagnostic interviews and self-reported presence in offices officially designated as exposed through environmental sampling. Multivariate models were tested for associations of number of postdisaster symptoms with exposure and belief in exposure, controlling for sex and use of antibiotics.ResultsThe sample was divided into 3 main subgroups: exposed, 41%; unexposed but believed they were exposed, 17%; and unexposed and did not believe that they were exposed, 42%. Nearly two-thirds (64%) of the volunteers reported experiencing symptoms after the anthrax attacks. Belief in anthrax exposure was significantly associated with the number of ear/nose/throat, musculoskeletal, and all physical symptoms. No significant associations were found between anthrax exposure and the number of postdisaster symptoms.ConclusionsGiven the high incidence of these symptoms, these data suggest that even in the absence of physical injury or illness, there may be surges in health care utilization. (Disaster Med Public Health Preparedness.2019;13:555-560)

Liaison Psychiatry and Organic Illness

2014 ◽  
Author(s):  
Andrew Horton ◽  
Mark Broadhurst
Keyword(s):  
Medically Unexplained Symptoms ◽  
Physical Symptoms ◽  
Mental Illnesses ◽  
Working Relationships ◽  
Liaison Psychiatry ◽  
Medically Unexplained ◽  
Unexplained Symptoms ◽  
The Uk

Liaison psychiatry is a subspecialty of psychiatry which involves the diag­nosis, treatment, and management of psychiatric illness in patients who have physical illnesses or present with physical symptoms. There is considerable overlap between psychiatric and medical condi­tions which requires close working relationships with medical colleagues. Liaison psychiatry is a fascinating area where the range of psychiatric presentations is wide, every case is different, and there is opportunity to keep up to date with medicine as it evolves. Within the UK there are different models practiced in different areas, ranging from assessment and signposting services to services with provi­sion for long-term outpatient follow-up. There is increasing interest in the provision of liaison services in primary care because of the challenges faced by GPs in treating patients with medically unexplained symptoms. Another driver is the hugely increased morbidity and mortality rates seen in patients with co-morbid physical and mental illnesses who receive the majority of their treatment in secondary care.

Disagreement in Doctor's and Patient's Rating About Medically Unexplained Symptoms and Health Care Use

2011 ◽  
Vol 20 (1) ◽  
pp. 30-37 ◽  
Author(s):  
Sarah Schumacher ◽  
Winfried Rief ◽  
Elmar Brähler ◽  
Alexandra Martin ◽  
Heide Glaesmer ◽  
...  
Keyword(s):  
Health Care ◽  
Medically Unexplained Symptoms ◽  
Health Care Use ◽  
Medically Unexplained ◽  
Unexplained Symptoms

scholarly journals Encouraging clinicians to work effectively with people with medically unexplained symptoms - is a change in underlying attitudes required?

2017 ◽  
Vol 5 (3) ◽  
pp. 389
Author(s):  
Marta J Buszewicz
Keyword(s):  
Clinical Practice ◽  
Health Service ◽  
Secondary Care ◽  
Medically Unexplained Symptoms ◽  
Physical Symptoms ◽  
Normal Function ◽  
Negative Consequences ◽  
Postgraduate Level ◽  
Medically Unexplained ◽  
Unexplained Symptoms

Medically unexplained symptoms are defined as physical symptoms for which there is no clear diagnosis of organic pathology, including after relevant investigations. Several other terms are also used to describe such symptoms and will be briefly described, although none is ideal. The present paper summarizes the current research, illustrating how patients consulting clinicians in both primary and secondary care often present with symptoms which, while undoubtedly distressing for the patient, do not link with any clear organic pathology. This raises difficult issues for clinicians in terms of how much they should investigate and how to manage the patient’s problems in a way which will be helpful and mean they will feel their symptoms have been appropriately recognised and addressed. Failure to do this can lead to many negative consequences, including a breakdown in trust between patients and clinicians, over-investigation or inappropriate treatments, a loss of normal function for the patient and significant costs to the health service and economy. Despite this, the evidence is that doctors receive very little if any training about how to manage such symptoms at either the undergraduate or postgraduate level. This paper will focus on the attitudes of both junior and more senior doctors across a range of specialities to working with people with unexplained symptoms and how these may affect their management. The implications for clinical practice and recommendations for future training will be discussed and in particular the need to consider the psychosocial as well as the biomedical aspects of patients’ presentations from the outset.

Medically unexplained symptoms

2020 ◽  
pp. 6460-6462
Author(s):  
Michael Sharpe
Keyword(s):  
Cognitive Behaviour Therapy ◽  
Psychological Treatment ◽  
Medically Unexplained Symptoms ◽  
Physical Symptoms ◽  
Behaviour Therapy ◽  
Cognitive Behaviour ◽  
Medically Unexplained ◽  
Unexplained Symptoms ◽  
Iatrogenic Harm ◽  
Complex Cases

Physical symptoms are not always associated with disease. In secondary medical care as many as a third of patients present with symptoms unexplained by disease. Such ‘medically unexplained symptoms’ pose a challenge for clinical services that focus on identifying and treating disease. The principles of effective management are to: (a) avoid overinvestigation and giving speculative treatment for disease; (b) take a positive approach with the patient, accepting the reality of the symptoms while explaining clearly that they do not indicate disease; (c) identify and provide treatment for associated depression and anxiety disorders; (d) refer for psychiatric or psychological treatment when required. Complex cases with multiple persistent medically unexplained symptoms are at particular risk of iatrogenic harm and require active multidisciplinary management. Psychological treatments such as cognitive behaviour therapy may be effective.

Functional and dissociative disorders in neurology

2018 ◽  
Author(s):  
Jon Stone ◽  
Alan Carson
Keyword(s):  
Medically Unexplained Symptoms ◽  
Conversion Disorder ◽  
Physical Symptoms ◽  
Neurological Symptoms ◽  
Dissociative Disorders ◽  
Medically Unexplained ◽  
Unexplained Symptoms

In this chapter, the focus is on patients who present with physical symptoms, such as weakness, or seizures, which can be positively identified as inconsistent with pathological diseases. These are called functional and dissociative neurological symptoms, although there are many other terms that could be used, such as conversion disorder, psychogenic symptoms, somatization, hysterical symptoms, medically unexplained symptoms, non-organic symptoms, and pseudoseizures, to name a few.

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