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.

Depression and panic: Comorbidity

1998 ◽  
Vol 13 (S2) ◽  
pp. 65s-70s ◽  
Author(s):  
DS Baldwin
Keyword(s):  
Panic Disorder ◽  
Medically Unexplained Symptoms ◽  
Epidemiological Studies ◽  
Community Settings ◽  
Recurrent Brief Depression ◽  
Cross Sectional ◽  
Increased Risk ◽  
Medically Unexplained ◽  
Unexplained Symptoms ◽  
Use Of Medical Services

SummaryPanic disorder is a common condition. Epidemiological studies throughout the world consistently indicate that the lifetime prevalence of panic disorder (with or without agoraphobia) is between 1.5% and 3.5%. Panic disorder shows substantial comorbidity with other forms of mental illness. Major depressive disorder occurs in 50 to 65% of individuals with panic disorder and there is considerable cross-sectional and longitudinal comorbidity with recurrent brief depression and dysthymia. Phobic anxiety disorders, most notably social phobia and generalised anxiety disorder, commonly occur with panic disorder, especially in individuals with more severe agoraphobia. Approximately 35 to 50% of individuals with panic disorder in community settings also have agoraphobia. Panic disorder also shows significant comorbidity with physical illness. Compared with individuals without or with some other psychiatric diagnosis, patients with panic disorder have an increased risk of suffering from multiple medically unexplained symptoms and are associated with high use of medical services and increased mortality from both cardiovascular and cerebrovascular disease.

Factors influencing adherence to therapeutic recommendations made after diagnostic reassessment of medically unexplained symptoms in children and adolescents

2019 ◽  
Vol 25 (1) ◽  
pp. 62-77
Author(s):  
Sam LB Bonduelle ◽  
Johan Vanderfaeillie ◽  
Katrien Denijs ◽  
Annik Lampo ◽  
Lindita Imeraj
Keyword(s):  
Children And Adolescents ◽  
Influencing Factors ◽  
Somatoform Disorders ◽  
Medically Unexplained Symptoms ◽  
Primary Outcome Measure ◽  
Influential Factors ◽  
Cross Sectional ◽  
Medically Unexplained ◽  
Therapeutic Recommendations ◽  
Unexplained Symptoms

Background: Medically unexplained symptoms (MUS) are common among children and adolescents and may be highly impairing. Even after long diagnostic and/or therapeutic trajectories, many of these children and their parents feel dissatisfied with the advice and therapies they were given. Objectives: After a 2-week hospitalisation for somatic and psychiatric reassessment, children and their families were given recommendations for further treatment. This study evaluates which of these recommendations were carried out (primary outcome measure) and which factors influenced the (non-)adherence to therapeutic advice. Methods: Parents of 27 children aged 7–17 with impairing MUS took part in a structured telephone survey to assess adherence to and perceived effectiveness of therapeutic recommendations (cross-sectional study). Influencing factors were analysed retrospectively. Results: Psychotherapy was recommended to all 27 patients and their families; 19 of them (70.4%) carried out this advice. When physiotherapy was recommended, adherence proved lower (6/22 children; 27.3%). No influencing factors were found to have a statistically significant correlation with adherence. Effect sizes may be indicative of clinically relevant influential factors, but should be considered cautiously. Conclusion: Results suggest that more efforts need to be made to ensure adherence to therapeutic recommendations. Known risk factors for non-adherence to treatments for chronic somatic disorders may not apply for children with somatoform disorders.

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.

Gulf War Illness: Lessons from medically unexplained symptoms

2007 ◽  
Vol 27 (7) ◽  
pp. 842-854 ◽  
Author(s):  
Amy Iversen ◽  
Trudie Chalder ◽  
Simon Wessely
Keyword(s):  
Medically Unexplained Symptoms ◽  
Gulf War ◽  
Gulf War Illness ◽  
Medically Unexplained ◽  
Unexplained Symptoms

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.

scholarly journals Internal Medicine Physicians and Social media: Knowledge, Skills, and Attitudes

2020 ◽  
Vol 11 ◽  
pp. 215013272096902
Author(s):  
Mohammed Nadir Bhuiyan ◽  
Jose R. Medina-Inojosa ◽  
Ivana T. Croghan ◽  
Jasmine R. Marcelin ◽  
Karthik Ghosh ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Social Media ◽  
Medical Education ◽  
Healthcare Delivery ◽  
Medically Unexplained Symptoms ◽  
Audience Response ◽  
Cross Sectional ◽  
Medically Unexplained ◽  
Unexplained Symptoms ◽  
Continued Medical Education

Objective Increasing adoption of social media have revolutionized communications between individuals, groups, and organizations This research study was designed to assess the knowledge, skills, and attitudes of internal medicine physicians’ awareness and engagement with social media (sometimes referred to as #SoMe) within the digital landscape of healthcare delivery. Methods An audience-response survey focused on social media “ Social media in Healthcare: Physician Survey,” was administered during the “A Systematic Approach to Medically Unexplained Symptoms” continuing medical education conference. The Conference took place between August 22, 2019 and August 24, 2019. Data was collected on August 23, 2019. A range of 103 (59.5%) to 112 (64.7%) of the total 173 attendees participated in this cross-sectional audience-response survey, depending on the questions answered. Results Most responders were between the ages of 35 and 65 years (79.6%) and female (60.2%). A majority of responders were aware of social media terminology (88.7%), and many had used it personally (46.7%), but only 12% knew how to use social media to search medical topics, 18% used it to network professionally and most (68.9%) had a distrust of social media when it came to the protection of their privacy or their patients’ privacy. Overall, about 29.6% indicated an interest in future continued medical education focused on social media (and 27.4% were neutral). Conclusions Approximately half of the responders used social media but far less engaged its platforms for professional use likely due to privacy related concerns. Distance from academic institutions, where professional social media use is more common likely, played a role in aversion. Awareness of social media’s role in healthcare has increased among physicians in practice, however their participation and knowledge of opportunities remains limited.

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.

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