lecture 7 Flashcards
Kroenke & Price (1993)Lifetime prevalence of 26 common symptoms
What was the explanation for symptoms?
50.5% due to medically condition or injury
16% minor or transient symptoms
2% due to medication/substance use
31% no medical diagnosis or explanation
“medically unexplained symptoms” and syndromes
Symptoms for which no medical diagnosis or explanation can be found are often called
When symptoms occur together regularly in clusters to form a recognisable illness, this may be defined as a “syndrome”
So we also have “medically unexplained syndromes”
MUS often tend to persist for a long time - dutch study
Dutch primary care study (n=254) of patients with unexplained fatigue, abdominal or musculoskeletal complaints.
43% still had unexplained symptoms 1 year later (Koch et al, 2009)
People with lots of persistent MUS tend to consult the doctor a lot - “frequent attenders”
The “problem” of MUSMUS
violate the biomedical model which combines disease and illness
disease > symptoms > diagnosis > intervention > cure
But MUS are symptoms or illness without disease…
Somatization + “Somatization disorder
Somatization: “The process by which psychological distress is expressed as physical symptoms.”
“Somatization disorder” a diagnostic label for people with multiple medically unexplained symptoms.
Somatization is an unsatisfactory construct
Patients hate it as they feel that it delegitimizes their symptoms
There is scant evidence that having lots of bodily symptoms is related to denying emotional problems – in fact the opposite is true
Distress is common
+ study
MUS are often accompanied by psychological symptoms or distress
Study of co-occurrence of MUS and psychiatric symptoms in large community sample
More MUS, greater likelihood of anxiety and depression symptoms. (Simon & Vonkorff, 1991)
What is a symptom?
Bodily sensations (e.g. Dizziness, pain)
Bodily signs (e.g. Raised temperature)
which are attributed to illness
Perceptual and cognitive factors
Perception of bodily sensations:
Noticing sensations
Attending to sensations
Interpretation of sensations:
Context important
Beliefs and personal models of illness, illness prototypes
May use heuristics – e.g. stress, age
Interpretations affected by emotional factors
How does emotion interact with cognition? (1 sentence)
In the community, emotion is positively correlated with physical symptoms e.g. fatigue (Pawlikowska et al, 1994)
How does mood affect our symptoms? - 4 points
1) Worry about being ill makes you more vigilante
2) Some people worry about becoming ill. Hypochrondriasis
3) Worry also has it’s own symptoms - symptoms of anxiety
4) Symptoms of depression. Again, many physical symptoms can be interpreted as signs of illness
How are MUS managed in clinical practice?
Reassurance’ (effective for approx 24 hours; Lucock et al, 1997)
Referral to secondary care departments: 30-70% no physical pathology
Physical investigation
e.g. blood tests, scans/x-rays, endoscopy, laparoscopy
Symptomatic treatment
e.g. analgesia, antibiotics, antidepressants
How do doctors explain MUS to patients?
Patients with persistent MUS. Interviewed about the different explanations they had received from GPs and other health professionals
ejecting
Colluding
Empowering
Rejecting & colluding
Denies reality of symptom, Implies imaginary disorder
Implications are:
Unresolved explanatory conflict
GP is distrusted with future symptoms
Colluding:
GP sanctions patient’s own explanation
Implications are:
Questioning GP’s openness and competence
Empowering Explanations
Tangible mechanism
Exculpation
Opportunity for self-management
Implications are:
Legitimises patient’s suffering and removes blame from patient
Allies GP and patient
Allows for discussion of psychological features
Empowering
