Lecture 7 - Medically Unexplained Symptoms Flashcards
What did Pawlikowska et al. (1994) find about mood and fatigue?
There is a strong positive correlation between mood and fatigue
People who scored more highly on a measure of distress also rated themselves with higher levels of fatigue
What percentage of people received no medical diagnosis in a sample of 13.5k people with lifetime prevalence of common symptoms?
31% - no explanation for symptoms
What is the meaning of medically unexplained syndromes?
When symptoms occur together regularly in clusters to form illness defined as a syndrome. E.G - IBS, chronic fatigue
What are examples of medically unexplained symptoms?
Heavy periods, abdominal pain, seizures, dizziness, chronic fatigue, low back pain
How many people receive no diagnosis once referred to secondary care?
1/3 to 1/2 of PPTs
What did Koch et al. (2009) find? - Dutch primary care study about MUS
254 patients with unexplained fatigue, abdominal or musculoskeletal complaints. Attended doctors multiple times and 43% still had unexplained symptoms one year later
What is the problem of MUS?
- Problems for patients and medical professions
- Violates the biomedical model for disease and illness:
Disease -> symptoms -> diagnosis -> intervention -> cure
What is Somatisation? - Lipowsky 1988
The manifestation of psychological difficulty or distress through somatic symptoms, tendency to experience and communicate somatic distress and symptoms unaccounted for by pathological findings and attribute them to physical illness and seek medical help.
PSYCHOLOGICAL DISTRESS IS EXPRESSED AS PHYSICAL SYMPTOMS
Why do patients dislike the construct of somatisation?
- Delegitimises their symptoms
- Symptoms are often debilitating - feel like they are not being taken seriously
- Makes patients feel stupid / as if they are imagining / feel dismissed
What are perceptual and cognitive factors to symptoms?
- Noticing bodily sensations and attending to them
- Sensations
- Context
- Heuristics - stress in exam period = headache
- Age - attribute sensations to a sign of ageing
How does mood affect symptoms?
- Fear of being ill, people are more alert to bodily sensations (vigilant)
- Hypochondria - transient symptom my become worse / phobia of illness
- Physical sensations of anxiety - sweating, shaking, fainting
- Depression - affects appetite and sleep
How does emotion correlate with physical symptoms?
When sad, may stay in bed = more tired, don’t exercise or socialise = more tired
What can doctors do with MUS patients?
- Reassure
- Refer to secondary care department (30-70% no diagnosis)
- Physical interventions such as blood tests
How do doctors explain MUS to patients?
- Rejecting = some deny reality of symptoms, claim it’s imaginary. Implication = unresolved conflict, GP appears untrustworthy
- Colluding = GP sanctions patients own explanation and agrees with patient. This can make a patient question the GPs competence
- Empowering = Tangible mechanism, opportunity for self management - give physical or muscular explanation, TENSION CAUSING NECK PAIN - find a solution together - regaining control of body
What is iatrogenesis?
Harm caused by healthcare - unnecessary treatment
How can psychological factors maintain MUS?
Bodily sensation -> interpreted as symptom -> worry -> preoccupied and hyper-vigilant -> increased bodily sensations
How can CBT help MUS?
- Identifies the patients interpretation of their sensation
- Develop an alternative belief - the pain is not a disease
- Remain active but not over vigilant - reduce worry
- Reduces preoccupation & less debilitating
What did Kroenke & Swindle (2000) find about CBT for MUS?
12 month improvement compared with normal treatment in physical, functional and emotional symptoms
When patient is engaged, CBT is effective
What are the issues with engaging patients to CBT?
- Likely to be fed up and frustrated with the lack of answers
- Believe they are ill - hard belief to change
- Feel like they aren’t being taken seriously
What is Reattribution Therapy
- Hierarchical model of stages:
- Feeling understood (explore the illness and listen)
- Broadening the agenda - exploration of emotional factors and how the physical symptoms may be linked to this
- Making the link - STRESS, TENSION
- Collaborating on a treatment
- Important to feel heard
What’s the evidence of Reattribution Therapy working?
- Improvement in patient satisfaction and decreased somatisation
- Less likely to believe cause of symptom was purely physical - change of beliefs
- However, no benefit in reduction in healthcare use - still just as likely to take meds and see GP
How many MUS occurs in dental sector?
50% males, 33% females
How many MUS occurs in chest sector?
26% males, 53% females
How many MUS occurs in cardiology?
42% males, 63% females
