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 Medically Unexplained Symptoms and Somatoform Disorders: Diagnostic Challenges to Psychiatrists

2009 ◽  
Vol 72 (5) ◽  
pp. 251-256 ◽  
Author(s):  
Cheng-Ta Li ◽  
Yuan-Hwa Chou ◽  
Kai-Chun Yang ◽  
Cheng-Hung Yang ◽  
Ying-Chiao Lee ◽  
...  
Keyword(s):  
Somatoform Disorders ◽  
Medically Unexplained Symptoms ◽  
Medically Unexplained ◽  
Unexplained Symptoms

Being a botanist and a gardener: using diagnostic frameworks in general practice patients with medically unexplained symptoms

2013 ◽  
Vol 19 (2) ◽  
pp. 90 ◽  
Author(s):  
Louise Stone
Keyword(s):  
Somatoform Disorders ◽  
Medically Unexplained Symptoms ◽  
Multiple Perspectives ◽  
Medical Specialties ◽  
Mixed Methods Approach ◽  
Evidence Based Treatment ◽  
Medically Unexplained ◽  
Unexplained Symptoms ◽  
Reliable Classification ◽  
The Way

Patients with multiple medically unexplained symptoms commonly seek treatment in primary care. Many of these patients seem to have a psychological ‘core’ to their illness that affects the way they experience, conceptualise and communicate their distress. There is considerable debate around diagnosis for this group of patients. Existing diagnoses include somatoform disorders in psychiatry and functional disorders in the medical specialties. Some clinicians use the term ‘heartsink’ patients, which reflects the interpersonal frustration inherent in some therapeutic relationships. A good diagnosis should be clinically useful, helping clinicians and patients understand and manage illness. Diagnosis should also provide a reliable classification for research and evidence-based treatment. The allegory of the botanist and the gardener has been used to describe diagnosis. For the botanist, a good diagnosis produces a taxonomy that is rigorous and reliable. For the gardener, it informs the way a garden is described and understood in a specific context. Clinicians need both: a ‘botanical’ type of classification to bring rigour to research and therapy, and clinical ‘gardening’, which allows for multiple perspectives and diagnostic frameworks. Clinical reasoning is a form of research with therapeutic intent. Botany and gardening represent a mixed-methods approach that can enrich diagnosis. The challenge is to integrate multiple perspectives in clinically helpful ways that help us retain both richness and rigour.

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