Medically Unexplained Physical Symptoms (MUPS) Flashcards
MUPS definition
- MUPS are complaints of physical symptoms or signs for which there is no objective
pathophysiological evidence. - Not a formal diagnosis but a term used to describe a clinical predicament
- Symptoms may be transient/ persistent, acute/ chronic, single/ multiple
3 categories of MUPS
- Disguisers - recognise that they have a psychological complaint but present to the doctor
- Deniers
- Don’t knows
Common presentations of MUPS
Common presenting symptoms: mostly pain symptoms
- Muscle and joint pain
- Low back pain
- Tension headache
- Atypical facial pain
- Chronic fatigue
- Non-cardiac chest pain
- Palpitations
- Non-ulcer dyspepsia
- Abdominal pain
- Dizziness
- Insomnia
Common underlying causes of MUPS
Common “diagnosis” of MUPS
- Tension headache
- Irritable Bowel Syndrome
- Globus syndrome/ Globus Hystericus
- Chronic fatigue syndrome
- Fibromyalgia
- Chronic pelvic pain
- Non-cardiac chest pain
- Multiple chemical sensitivity
- Functional Dyspepsia
- Benign Paroxysmal Postural Vertigo (BPPV)
- Sleep disorder
Biological and psychological causes of MUPS
Social and iatrogenic causes of MUPS
Complications of MUPS
Features indicating MUPS
Assessment of MUPS
Advice for patient with MUPS
Reassurance and explanation by empowerment:
- The doctor provides a physical mechanism of causation often with use of appropriate physical metaphors connecting the physical and psychological factors
- The doctor removes any sense of blame from the patient
- The doctor strengthens the relationship with the patient, enabling them to resolve the problem together
“Do”s
- Help identify the stress or unhappiness they experience
- Explain the reason they have the symptoms
- Develop a symptom management plan
- Patient’s needs are identified, acknowledged and
dealt with in the appropriate context
“Don’t”s
- Rejection/ Tell that nothing is wrong, despite patient having symptoms
- Blame the patient
- Collude/ go along with patient’s explanation
Advice and Counselling in MUPS
- Address any misconceptions
- Help gain a better understanding about the association between psychological distress and
somatic symptoms by explaining that the mind and body can be linked - Provide condition-specific education and advice
- 4Ps (Bio-psycho-social)
- Epidemiology
- Pathogenesis
- Prognosis
Examples to explain mind-body linkage
Prescription practice for MUPS
Referral advice for MUPS
Investigations advice for MUPS
Observation/ FU advice for MUPS
Prevention of MUPS
