Medically Unexplained Symptoms Presenting at Secondary Care—A Comparison of White Europeans and People of South Asian Ethnicity

2009 ◽  
Vol 39 (1) ◽  
pp. 33-44 ◽  
Author(s):  
Sonia Mangwana ◽  
Sarah Burlinson ◽  
Francis Creed
Keyword(s):  
South Asian ◽  
Secondary Care ◽  
Medically Unexplained Symptoms ◽  
Asian Ethnicity ◽  
South Asian Ethnicity ◽  
Medically Unexplained ◽  
Unexplained Symptoms

Frequent attenders in secondary care: a 3-year follow-up study of patients with medically unexplained symptoms

2003 ◽  
Vol 33 (3) ◽  
pp. 519-524 ◽  
Author(s):  
S. REID ◽  
T. CRAYFORD ◽  
A. PATEL ◽  
S. WESSELY ◽  
M. HOTOPF
Keyword(s):  
Functional Impairment ◽  
Secondary Care ◽  
Service Use ◽  
Psychiatric Morbidity ◽  
Medically Unexplained Symptoms ◽  
Follow Up Study ◽  
Frequent Attenders ◽  
Medically Unexplained ◽  
Unexplained Symptoms

Background. There are few longitudinal studies of patients with medically unexplained symptoms. The aim of this study was to investigate outcome in frequent attenders in secondary care who present repeatedly with medically unexplained symptoms.Method. Forty-eight patients presenting with medically unexplained symptoms, from a sample of 61, participated in a 3-year follow-up study. Psychiatric morbidity, functional impairment and use of services were evaluated.Results. At follow-up there was a high prevalence of psychiatric morbidity with 69% having at least one psychiatric diagnosis. The sample continued to be high users of a range of health services and substantial functional impairment was reported.Conclusion. In this group of frequent attenders with medically unexplained symptoms outcome as measured by psychiatric morbidity, service use and functional impairment remained poor after 3 years.

scholarly journals Psychosomatic therapy for patients frequently attending primary care with medically unexplained symptoms, the CORPUS trial: study protocol for a randomised controlled trial

Trials ◽  
2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Margreet S. H. Wortman ◽  
Johannes C. van der Wouden ◽  
Janneke P. C. Grutters ◽  
Bart Visser ◽  
Willem J. J. Assendelft ◽  
...  
Keyword(s):  
Primary Care ◽  
Economic Evaluation ◽  
Usual Care ◽  
Secondary Care ◽  
Outcome Measure ◽  
Medically Unexplained Symptoms ◽  
Secondary Outcome ◽  
Patient Specific ◽  
Medically Unexplained ◽  
Unexplained Symptoms

Abstract Background Medically unexplained symptoms (MUS) are highly prevalent and pose a burden both on patients and on health care. In a pilot study psychosomatic therapy delivered by specialised therapists for patients with MUS showed promising results with regard to patient’s acceptability, feasibility and effects on symptoms. The aim of this study is to establish whether psychosomatic therapy by specialised psychosomatic exercise therapists is cost- effective in decreasing symptoms and improving functioning in patients who frequently consult their general practitioner (GP) with MUS. Methods A randomised effectiveness trial with an economic evaluation in primary care with 158 patients aged 18 years and older who are frequently consulting their GP with MUS. Patients will be assigned to psychosomatic therapy in addition to usual care or usual care only. Psychosomatic therapy is a multi-component and tailored intervention, aiming to empower patients by applying psycho-education, relaxation techniques, mindfulness, cognitive approaches and/or graded activity. Patients assigned to the psychosomatic therapy receive 6 to 12 sessions of psychosomatic therapy, of 30–45 min each, delivered by a specialised exercise or physical therapist. Primary outcome measure is patient-specific functioning and disability, measured with the Patient-Specific Functional Scale (PSFS). Secondary outcome measures are symptom severity, consultation frequency and referrals to secondary care, patient satisfaction, quality of life and costs. Assessments will be carried out at baseline, and after 4 and 12 months. An economic evaluation alongside the trial will be conducted from a societal perspective, with quality-adjusted life years (QALYs) as outcome measure. Furthermore, a mixed-methods process evaluation will be conducted. Discussion We expect that psychosomatic therapy in primary care for patients who frequently attend the GP for MUS will improve symptoms and daily functioning and disability, while reducing consultation frequency and referrals to secondary care. We expect that the psychosomatic therapy provides value for money for patients with MUS. Trial registration Netherlands Trial Register, ID: NL7157 (NTR7356). Registered 13 July 2018.

scholarly journals Encouraging clinicians to work effectively with people with medically unexplained symptoms - is a change in underlying attitudes required?

2017 ◽  
Vol 5 (3) ◽  
pp. 389
Author(s):  
Marta J Buszewicz
Keyword(s):  
Clinical Practice ◽  
Health Service ◽  
Secondary Care ◽  
Medically Unexplained Symptoms ◽  
Physical Symptoms ◽  
Normal Function ◽  
Negative Consequences ◽  
Postgraduate Level ◽  
Medically Unexplained ◽  
Unexplained Symptoms

Medically unexplained symptoms are defined as physical symptoms for which there is no clear diagnosis of organic pathology, including after relevant investigations. Several other terms are also used to describe such symptoms and will be briefly described, although none is ideal. The present paper summarizes the current research, illustrating how patients consulting clinicians in both primary and secondary care often present with symptoms which, while undoubtedly distressing for the patient, do not link with any clear organic pathology. This raises difficult issues for clinicians in terms of how much they should investigate and how to manage the patient’s problems in a way which will be helpful and mean they will feel their symptoms have been appropriately recognised and addressed. Failure to do this can lead to many negative consequences, including a breakdown in trust between patients and clinicians, over-investigation or inappropriate treatments, a loss of normal function for the patient and significant costs to the health service and economy. Despite this, the evidence is that doctors receive very little if any training about how to manage such symptoms at either the undergraduate or postgraduate level. This paper will focus on the attitudes of both junior and more senior doctors across a range of specialities to working with people with unexplained symptoms and how these may affect their management. The implications for clinical practice and recommendations for future training will be discussed and in particular the need to consider the psychosocial as well as the biomedical aspects of patients’ presentations from the outset.

scholarly journals Epistemological and methodological paradoxes: secondary care specialists and their challenges working with adolescents with medically unexplained symptoms

2018 ◽  
Vol 12 (1) ◽  
Author(s):  
Silje Vagli Østbye ◽  
Catharina Elisabeth Arfwedson Wang ◽  
Ida Pauline Høilo Granheim ◽  
Kjersti Elisabeth Kristensen ◽  
Mette Bech Risør
Keyword(s):  
Secondary Care ◽  
Medically Unexplained Symptoms ◽  
Medically Unexplained ◽  
Unexplained Symptoms

Depression and anxiety in patients repeatedly referred to secondary care with medically unexplained symptoms: a case-control study

2010 ◽  
Vol 41 (3) ◽  
pp. 555-563 ◽  
Author(s):  
C. Burton ◽  
K. McGorm ◽  
D. Weller ◽  
M. Sharpe
Keyword(s):  
Secondary Care ◽  
Case Control Study ◽  
Medically Unexplained Symptoms ◽  
Case Control ◽  
Depression And Anxiety ◽  
Control Groups ◽  
Panic Disorders ◽  
Medically Unexplained ◽  
Unexplained Symptoms ◽  
Control Study

BackgroundOne third of referrals from primary to secondary care are for medically unexplained symptoms (MUS). We aimed to determine the association of depression and anxiety disorders with high use of specialist services by patients with MUS. We did this by comparing their prevalence in patients who had been repeatedly referred with symptoms for which they had received repeated specialist diagnoses of MUS with that in two control groups. We also determined the adequacy of treatment received.MethodA case-control study in five general practices in Edinburgh, UK. Data collection was by case note review and questionnaire. Cases were 193 adults with three or more referrals over 5 years, at least two of which resulted in a diagnosis of MUS. Controls were: (a) patients referred only once over 5 years (n=152); (b) patients with three or more referrals for symptoms always diagnosed as medically explained (n=162).ResultsIn total, 93 (48%) of the cases met our criteria for current depression, anxiety or panic disorders. This compared with 38 (25%) and 52 (35.2%) of the control groups; odds ratios (95% confidence intervals) of 2.6 (1.6–4.1) and 1.6 (1.01–2.4), respectively. Almost half (44%) of the cases with current depression or anxiety had not received recent minimum effective therapy.ConclusionsDepression, anxiety and panic disorders are common in patients repeatedly referred to hospital with MUS. Improving the recognition and treatment of these disorders in these patients has the potential to provide better, more appropriate and more cost-effective medical care.

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