scholarly journals A CBT-based approach to medically unexplained symptoms

2009 ◽  
Vol 15 (2) ◽  
pp. 146-151 ◽  
Author(s):  
Catriona Kent ◽  
Graham McMillan
Keyword(s):  
Medically Unexplained Symptoms ◽  
Behavioural Therapy ◽  
Liaison Psychiatry ◽  
General Psychiatry ◽  
Cognitive Behavioural ◽  
Medically Unexplained ◽  
Unexplained Symptoms ◽  
The Common ◽  
Common Problems ◽  
Set Up

SummaryThis article discusses a cognitive–behavioural therapy (CBT) approach to the treatment of medically unexplained symptoms that is based on the ‘five areas’ model of CBT. We describe a typical course of therapy and some of the common problems encountered during treatment. Emphasis is placed on the practical management of these conditions, and the focus is on symptoms as opposed to cause. We believe that this approach is widely applicable and could be used in a large range of settings to tackle these debilitating conditions. In writing this article we intended to provide an overview of patients with medically unexplained symptoms. The article would be of interest to staff within liaison psychiatry departments looking to set up a medically unexplained symptoms service and general psychiatry teams who may have contact with patients presenting with somatic symptoms. Psychiatric teams without access to a liaison department may also find this article interesting.

scholarly journals Cognitive-behavioural therapyv.structured care for medically unexplained symptoms: randomised controlled trial

2008 ◽  
Vol 193 (1) ◽  
pp. 51-59 ◽  
Author(s):  
A. Sumathipala ◽  
S. Siribaddana ◽  
M. R. N. Abeysingha ◽  
P. De Silva ◽  
M. Dewey ◽  
...  
Keyword(s):  
Primary Care ◽  
Cognitive Behavioural Therapy ◽  
Primary Care Physicians ◽  
Medically Unexplained Symptoms ◽  
Behavioural Therapy ◽  
Randomised Control Trial ◽  
Structured Care ◽  
Cognitive Behavioural ◽  
Medically Unexplained ◽  
Unexplained Symptoms

BackgroundA pilot trial in Sri Lanka among patients with medically unexplained symptoms revealed that cognitive-behavioural therapy (CBT) administered by a psychiatrist was efficaciousAimsTo evaluate CBT provided by primary care physicians in a comparison with structured careMethodA randomised control trial (n=75 in each arm) offered six 30 min sessions of structured care or therapy. The outcomes of the two interventions were compared at 3 months, 6 months, 9 months and 12 monthsResultsIn each arm, 64 patients (85%) completed the three mandatory sessions. No difference was observed between groups in mean scores on the General Health Questionnaire or the Bradford Somatic Inventory, or in number of complaints or patient-initiated consultations at 3 months. For both groups, all outcome measures improved at 3 months, and remained constant in the follow-up assessmentsConclusionsCognitive–behavioural therapy given by primary care physicians after a short course of training is no more efficacious than structured care. Natural remission is an unlikely explanation for improvements in people with chronic medically unexplained symptoms, but lack of a ‘treatment as usual’ arm limits further conclusions. Further research on enhanced structured care, medical assessment and structured care incorporating simple elements of CBT principles is worthy of consideration

scholarly journals The ‘medically unexplained symptoms’ syndrome concept and the cognitive-behavioural treatment model

2021 ◽  
pp. 135910532110380
Author(s):  
Michael J Scott ◽  
Joan S Crawford ◽  
Keith J Geraghty ◽  
David F Marks
Keyword(s):  
Medically Unexplained Symptoms ◽  
Chronic Fatigue ◽  
Behavioural Therapy ◽  
Routine Practice ◽  
Treatment Model ◽  
Behavioural Treatment ◽  
Cognitive Behavioural ◽  
Practitioner Training ◽  
Medically Unexplained ◽  
Unexplained Symptoms

The American Psychiatric Association’s, 2013 DSM-5 abandoned the use of the term ‘medically unexplained symptoms’ for non-neurological disorders. In the UK, treatments for various medical illnesses with unexplained aetiology, such as chronic fatigue syndrome, irritable bowel syndrome and fibromyalgia, continue to fall under an MUS umbrella with cognitive behavioural therapy promoted as a primary therapeutic approach. In this editorial, we comment on whether the MUS concept is a viable diagnostic term, the credibility of the cognitive-behavioural MUS treatment model, the necessity of practitioner training and the validity of evidence of effectiveness in routine practice.

An exploratory study of primary-care therapists' perceived competence in providing cognitive behavioural therapy to people with medically unexplained symptoms

2013 ◽  
Vol 6 ◽  
Author(s):  
Hilary Lewis
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Problems ◽  
Medically Unexplained Symptoms ◽  
Perceived Competence ◽  
Behavioural Therapy ◽  
Cognitive Behavioural ◽  
Common Mental Health Problems ◽  
Medically Unexplained ◽  
Unexplained Symptoms

AbstractThe scope of the Improving Access to Psychological Therapies (IAPT) initiative has been extended to include the treatment of medically unexplained symptoms (MUS). However, MUS was not one of the original common mental health problems that the therapists were trained to treat. No studies have explored whether primary-care cognitive behavioural therapists feel competent to treat people with MUS. This paper aimed to explore and gain an understanding of primary-care therapists’ perceived competence in providing cognitive behavioural therapy (CBT) to people with MUS. Eight CBT therapists working in primary care participated in semi-structured interviews; the Framework approach was used to analyse the data. Five themes were generated by the data analysis, regarding the therapists’ perceived competence. The therapists described unfamiliarity with MUS. They also described some issues in engaging clients in therapy and that progress in therapy could sometimes be slow. Participants often used more general CBT skills and techniques, rather than models and interventions designed specifically for MUS. They had a number of different emotional reactions to this work. CBT therapists in primary care described unfamiliarity with MUS, in comparison to common mental health problems. They identified some difficulties in treatment, but most did not see this group as being more complex to treat. All were interested in receiving training about this client group.

scholarly journals New models of care: a liaison psychiatry service for medically unexplained symptoms and frequent attenders in primary care

2017 ◽  
Vol 41 (6) ◽  
pp. 340-344 ◽  
Author(s):  
Janine Bestall ◽  
Najma Siddiqi ◽  
Suzanne Heywood-Everett ◽  
Charlotte Freeman ◽  
Paul Carder ◽  
...  
Keyword(s):  
Primary Care ◽  
Evidence Synthesis ◽  
Medically Unexplained Symptoms ◽  
Cost Savings ◽  
Models Of Care ◽  
Liaison Psychiatry ◽  
Long Term Conditions ◽  
Early Results ◽  
Medically Unexplained ◽  
Unexplained Symptoms

Aims and methodThis paper describes the process of setting up and the early results from a new liaison psychiatry service in primary care for people identified as frequent general practice attenders with long-term conditions or medically unexplained symptoms. Using a rapid evidence synthesis, we identified existing service models, mechanisms to identify and refer patients, and outcomes for the service. Considering this evidence, with local contingencies we defined options and resources. We agreed a model to set up a service in three diverse general practices. An evaluation explored the feasibility of the service and of collecting data for clinical, service and economic outcomes.ResultsHigh levels of patient and staff satisfaction, and reductions in the utilisation of primary and secondary healthcare, with associated cost savings are reported.Clinical implicationsA multidisciplinary liaison psychiatry service integrated in primary care is feasible and may be evaluated using routinely collected data.

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.

Liaison psychiatry

2019 ◽  
pp. 839-880
Author(s):  
David Semple ◽  
Roger Smyth
Keyword(s):  
Medically Unexplained Symptoms ◽  
Physical Illness ◽  
Anxiety Symptoms ◽  
Differential Diagnoses ◽  
Psychotic Symptoms ◽  
Liaison Psychiatry ◽  
Medically Unexplained ◽  
Medical Population ◽  
Self Harm ◽  
Unexplained Symptoms

This chapter concerns liaison psychiatry and the assessment and management of psychiatric and psychological illnesses in the general medical population. It covers the 12 most common referral types, assessment of depressive and anxiety symptoms, psychotic symptoms and confusion, depression in physical illness, delirium, and management after self-harm. Focusing on capacity and consent, as well as differential diagnoses and potential management principles for medically unexplained symptoms, it covers the basis of working as a psychiatrist in a hospital.

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