scholarly journals Management of medically unexplained symptoms (MUS): a stepwise integrated model between primary and secondary caremanagement of medically unexplained symptoms (MUS): a stepwise integrated model between primary and secondary care

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S4-S4
Author(s):  
Zaineb S Y Al-Dahash ◽  
William Loveday ◽  
Naomi Law ◽  
Mutahira Qureshi ◽  
Paul Gallagher ◽  
...  
Keyword(s):  
Physical Health ◽  
Medically Unexplained Symptoms ◽  
Integrated Model ◽  
Clinical Psychologist ◽  
Psychological Interventions ◽  
Clinical Role ◽  
Integration Of Care ◽  
Use Of Resources ◽  
Medically Unexplained ◽  
Unexplained Symptoms

AimsDescription of a model to improve care for patients with Medically Unexplained Symptoms (MUS) by small targeted investment and maximisation of existing resources.BackgroundTreatment of MUS presents several challenges including a lack of clarity on the best models of care and limited service provision. Patients typically present with a physical complaint to physical health outlets: here limited confidence in professionals around how to address these often leads to poor patient/doctor experience, inappropriate use of resources and repeated attendance. Evidence shows that integration of care, psychological interventions and upskilling physicians in interventions such as positive communication, can significantly improve outcomes. Psychiatric Liaison Teams (PLT) are positioned at the interface of mental and physical health services and can play a crucial role for these patients, when provided with the right skill-mix.Method1FTE Clinical Psychologist specialising in MUS was integrated into the PLT. Pathways to triage between primary, secondary psychology and the new service were agreed, alongside channels of communication and supervision. The job plan included integrated sessions in Gastroenterology, Rheumatology and PLT. The activities included: assessments, formulations and discharges; brief psychological interventions; group sessions for patients; one-day long courses to GP trainees and physicians, and input in specialities MDTs. Clinical outcomes, numbers of patients seen and signposted, teaching sessions and simulation training delivered were collected.ResultOver 20 months the service was able to process 237 referrals, 35 were managed over the phone. Referral sources: Gastroenterology 32%, Rheumatology 37%, Psychiatric liaison 28%.116 patients attended 315 face to face appointments and 21 phone contacts were made. Core-10 data show reduction from moderately severe to mild psychological distress in a sample of patients. 58% of patients were referred on for continuing care. The service ran 8 patient groups including sessions on pain management and joint sessions with Rheumatology. It ran 9 one-day long courses for GP and physician trainees, training a total of 120 doctors: feedback showed increased confidence in managing and recognising MUS. Attendances to Emergency Departments covered by Barking Havering and Redbridge and Bart's Health Trusts combined (5 sites) reduced by 22%, saving an estimated £19,200, while ambulance usage in the cohort dropped by 29%, saving an estimated £9072.ConclusionThe integration of a specialist psychologist with a mix of educational, advisory and clinical role to a PLT can provide an effective and efficient stepped-up model to increase the provision of care for patients with MUS

scholarly journals CBT to reduce healthcare use for medically unexplained symptoms: systematic review and meta-analysis

2019 ◽  
Vol 69 (681) ◽  
pp. e262-e269 ◽  
Author(s):  
Brittni Jones ◽  
Amanda C de C Williams
Keyword(s):  
Systematic Review ◽  
Healthcare Costs ◽  
Meta Analysis ◽  
Medically Unexplained Symptoms ◽  
Psychological Interventions ◽  
Healthcare Use ◽  
Cognitive Behavioural ◽  
Medically Unexplained ◽  
Unexplained Symptoms ◽  
Medical Investigations

BackgroundStudies have reported that medically unexplained symptoms (MUS) tend to be associated with increased healthcare use, which is demanding of resources and potentially harmful to patients. This association is often used to justify the funding and study of psychological interventions for MUS, yet no systematic review has specifically examined the efficacy of psychological interventions in reducing healthcare use.AimTo conduct a systematic review and meta-analysis to evaluate the effectiveness of cognitive behavioural therapies (CBT) for MUS in reducing healthcare use.Design and settingSystematic review and meta-analysis.MethodThe search from a previous systematic review was updated and expanded. Twenty-two randomised controlled trials reported healthcare use, of which 18 provided data for meta-analysis. Outcomes were healthcare contacts, healthcare costs, medication, and medical investigations.ResultsSmall reductions in healthcare contacts and medication use were found for CBT compared with active controls, treatment as usual, and waiting list controls, but not for medical investigations or healthcare costs.ConclusionCognitive behavioural interventions show weak benefits in reducing healthcare use in people with MUS. The imprecise use of MUS as a diagnostic label may impact on the effectiveness of interventions, and it is likely that the diversity and complexity of these difficulties may necessitate a more targeted approach.

scholarly journals Assessing the Effectiveness of Brief and Low Intensity Psychological Interventions for Medically Unexplained Symptoms and Health Anxiety: A Systematic Review of the Literature

2020 ◽  
Author(s):  
Orla McDevitt-Petrovic ◽  
Karen Kirby
Keyword(s):  
Systematic Review ◽  
Health Anxiety ◽  
Medically Unexplained Symptoms ◽  
Future Research ◽  
Psychological Interventions ◽  
Review Of The Literature ◽  
Illness Anxiety Disorder ◽  
Medically Unexplained ◽  
Unexplained Symptoms ◽  
Illness Anxiety

This chapter presents a systematic review of the literature to assess the effectiveness of brief psychological interventions for medically unexplained symptoms (MUS)/somatic symptom disorder, non-cardiac chest pain, and illness anxiety disorder or health anxiety (HA). Google Scholar, PubMed, and Web of Science were searched as data sources. Reference lists were subsequently examined for other relevant articles. Studies were assessed according to specified inclusion criteria and extracted according to PRISMA guidelines. A total of 23 studies were included in the final synthesis. Significant effects for intervention groups relative to control groups were reported in 19 studies, whilst 4 studies did not determine any significant benefits of interventions compared with controls. All of the brief interventions (CBT, psychosocial, psychophysiological, psychosomatic, relaxation and group therapy), with the exception of metaphor therapy, showed significant effects relative to controls in at least one study. The evidence suggests that brief psychological interventions, more specifically time limited CBT based interventions may be effective in treating HA and MUS with psychological distress. Findings are comparable with other reviews. Future research may facilitate the piloting of an intervention, and there remains a need to provide more robust evidence of cost effectiveness.

scholarly journals Does It Matter Who Provides Psychological Interventions for Medically Unexplained Symptoms? A Meta-Analysis

2015 ◽  
Vol 84 (4) ◽  
pp. 217-226 ◽  
Author(s):  
Heike Gerger ◽  
Michaela Hlavica ◽  
Jens Gaab ◽  
Thomas Munder ◽  
Jürgen Barth
Keyword(s):  
Meta Analysis ◽  
Medically Unexplained Symptoms ◽  
Psychological Interventions ◽  
Medically Unexplained ◽  
Unexplained Symptoms

scholarly journals A systematic review of randomised controlled trials using psychological interventions for children and adolescents with medically unexplained symptoms: A focus on mental health outcomes

2019 ◽  
Vol 25 (1) ◽  
pp. 273-290 ◽  
Author(s):  
Christine O’Connell ◽  
Roz Shafran ◽  
Sophie Bennett
Keyword(s):  
Mental Health ◽  
Health Outcomes ◽  
Children And Adolescents ◽  
Medically Unexplained Symptoms ◽  
Mental Health Outcomes ◽  
Psychological Interventions ◽  
Medically Unexplained ◽  
Mental Health Difficulties ◽  
Unexplained Symptoms ◽  
Randomised Controlled

Background: Medically unexplained symptoms affect between 4% and 20% of children and adolescents; 30–60% of these children also experience mental health difficulties. Trials and reviews have focussed on physical gains in this population, often overlooking mental health outcomes. Objectives: To use a systematic review methodology guided by the PRISMA checklist to (1) investigate the effectiveness of psychological interventions for mental health difficulties in children and adolescents with medically unexplained symptoms and (2) identify aspects of interventions associated with their success. Methods: Randomised controlled studies investigating the impact of psychological interventions on mental health in children and adolescents with medically unexplained symptoms were included. Systematic searches of PsycINFO, MEDLINE and CINAHL were undertaken from inception to January 2018. Studies were appraised using the quality appraisal checklist. A qualitative synthesis of studies was completed. Results: In all, 18 studies were identified. Interventions targeting parental responses to illness and family communication appeared to have the best outcomes. Conclusions: Psychological interventions may be effective in improving mental health outcomes within this population; however, evidence for the efficacy of these interventions is limited due to a high risk of bias within the majority of reviewed studies. Future research using rigorous methodology and non–cognitive behavioural therapy interventions is recommended.

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