Clinical Management of Gulf War Veterans with Medically Unexplained Physical Symptoms

Objective Conditions defined by persistent “medically unexplained” physical symptoms and syndromes (MUS) are common and disabling. Veterans from the Gulf War (deployed 1990–1991) have notably high prevalence and disability from MUS conditions. Individuals with MUS report that providers do not recognize their MUS conditions. Our goal was to determine if Veterans with MUS receive an ICD-10 diagnosis for a MUS condition or receive disability benefits available to them for these conditions. Methods A chart review was conducted with US Veterans who met case criteria for Gulf War Illness, a complex MUS condition (N = 204, M = 53 years-old, SD = 7). Three coders independently reviewed Veteran’s medical records for MUS condition diagnosis or service-connection along with comorbid mental and physical health conditions. Service-connection refers to US Veterans Affairs disability benefits eligibility for conditions or injuries experienced during or exacerbated by military service. Results Twenty-nine percent had a diagnosis of a MUS condition in their medical record, the most common were irritable colon/irritable bowel syndrome (16%) and fibromyalgia (11%). Slightly more Veterans were service-connected for a MUS condition (38%) as compared to diagnosed. There were high rates of diagnoses and service-connection for mental health (diagnoses 76% and service-connection 74%), musculoskeletal (diagnoses 86%, service-connection 79%), and illness-related conditions (diagnoses 98%, service-connection 49%). Conclusion Given that all participants were Gulf War Veterans who met criteria for a MUS condition, our results suggest that MUS conditions in Gulf War Veterans are under-recognized with regard to clinical diagnosis and service-connected disability. Veterans were more likely to be diagnosed and service-connected for musculoskeletal-related and mental health conditions than MUS conditions. Providers may need education and training to facilitate diagnosis of and service-connection for MUS conditions. We believe that greater acknowledgement and validation of MUS conditions would increase patient engagement with healthcare as well as provider and patient satisfaction with care.

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Patient activism and the struggle for diagnosis: Gulf War illnesses and other medically unexplained physical symptoms in the US

Social Science & Medicine ◽

10.1016/s0277-9536(03)00157-6 ◽

2004 ◽

Vol 58 (1) ◽

pp. 161-175 ◽

Cited By ~ 64

Author(s):

Stephen Zavestoski ◽

Phil Brown ◽

Sabrina McCormick ◽

Brian Mayer ◽

Maryhelen D’Ottavi ◽

...

Keyword(s):

Physical Symptoms ◽

Gulf War ◽

Medically Unexplained Physical Symptoms ◽

The Us ◽

Medically Unexplained ◽

Patient Activism ◽

Unexplained Physical Symptoms

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Recognition of patients with medically unexplained physical symptoms by family physicians: results of a focus group study

BMC Family Practice ◽

10.1186/s12875-016-0451-x ◽

2016 ◽

Vol 17 (1) ◽

Cited By ~ 6

Author(s):

Madelon den Boeft ◽

Danielle Huisman ◽

Johannes C. van der Wouden ◽

Mattijs E. Numans ◽

Henriette E. van der Horst ◽

...

Keyword(s):

Focus Group ◽

Family Physicians ◽

Physical Symptoms ◽

Focus Group Study ◽

Medically Unexplained Physical Symptoms ◽

Medically Unexplained ◽

Unexplained Physical Symptoms

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Medically unexplained physical symptoms.

BMJ ◽

10.1136/bmj.304.6818.52-b ◽

1992 ◽

Vol 304 (6818) ◽

pp. 52-53 ◽

Cited By ~ 2

Author(s):

R. Jones

Keyword(s):

Physical Symptoms ◽

Medically Unexplained Physical Symptoms ◽

Medically Unexplained ◽

Unexplained Physical Symptoms

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Medically unexplained physical symptoms - a multidisciplinary approach

European Psychiatry ◽

10.1016/s0924-9338(11)73277-1 ◽

2011 ◽

Vol 26 (S2) ◽

pp. 1573-1573

Author(s):

V. Pais ◽

D. Correia ◽

F. Ramalho e Silva

Keyword(s):

Multidisciplinary Approach ◽

Somatoform Disorders ◽

Physical Symptoms ◽

Medically Unexplained Physical Symptoms ◽

Daily Work ◽

Medline Search ◽

Effective Interventions ◽

Medically Unexplained ◽

Unexplained Physical Symptoms

BackgroundMedically unexplained physical symptoms (MUPS) can be defined as physical symptoms that have no currently known physical pathological cause. MUPS account for one in five new consultations in primary care and for one third of new patients when neurology consultations are considered.Patients with MUPS present significant distress and impaired function and their diagnosis is sometimes hard to establish. The classification of somatoform disorders has been found to be insufficiently useful for therapeutic and scientific purposes. Some authors suggest that new classifications should attend to clinical utility, defined as (1) the extent to which a diagnosis can help clinicians understand or conceptualize a disorder in their daily work; (2) the extent to which a diagnosis can help the clinician communicate useful information to others, including practitioners, family members, patients, and administrators; (3) the extent to which the presence of a disorder helps the clinician choose effective interventions, and (4) the extent to which a disorder can predict future clinical management needs.AimThis review aims to discuss the management of MUPS in mental health services, attending to the importance of a multidisciplinary approach.MethodsPubmed Medline search on MUPS and review of recent literature.DiscussionThe management of MUPS implies a multidisciplinary approach that can offer different solutions for different degrees of disorder severity and takes into account the perception of the patient about his own illness. New classifications of somatoform disorders that include comprehensible explanations about these symptoms could be helpful for patients and health professionals.

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The Fish Can Sing by Halldór Laxness: Holding fast against vanity and illusion

BJPsych Advances ◽

10.1192/apt.bp.116.016675 ◽

2017 ◽

Vol 23 (6) ◽

pp. 428-430

Author(s):

David S. Baldwin

Keyword(s):

Alcohol Use ◽

Alcohol Use Disorders ◽

Nobel Laureate ◽

Physical Symptoms ◽

The Novel ◽

Medically Unexplained Physical Symptoms ◽

Celebrity Suicide ◽

Medically Unexplained ◽

Adaptive Resilience ◽

Unexplained Physical Symptoms

SummaryIn his early novels, the Icelandic Nobel laureate Halldór Laxness portrayed troubled individuals beset by familial, societal and economic challenges within an unpredictable and often unforgiving landscape; his later work addressed humanistic concerns regarding a well-lived life and the harmony of individual and environment. His 1957 novel The Fish Can Sing lies at the cusp of these preoccupations. Laxness contrasts the economic privations experienced by hard-pressed Icelanders with the ostentatious displays of their Danish colonial overloads; he also portrays individuals afflicted by psychosis, alcohol use disorders and medically unexplained physical symptoms, and delineates the path towards a ‘celebrity’ suicide. The novel warns against self-deceptive vanity and community-endorsed illusions, and celebrates the persistent benefits of nurturing relationships, all within a lyric contemplation of individual adaptive resilience and quotidian domestic pleasures.

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