Medically Unexplained Symptoms

Question 1

Definition of MUS

Answer 1

• Symptoms for which no medical cause can be found
• Because cause is:
  
  • Unknown
  • Uncertain
  • Disputed
• Does not imply the cause is psychological

Question 2

Systems involved in MUS

Answer 2

• GI 54%
• Neurology 50%
• Cardiology 34%
• Rheumatology 33%
• Orthopaedics 30%
• ENT 27%
• Gynaecology 17%

Question 3

Classification

Answer 3

• Somatoform disorders (unconscious)
  
  • Do not know they are producing these symptoms
  • Multiple physical symptoms present for at least 2 years
  • Patient refuses to accept reassurance or negative tests results
• Factitious disorders (conscious)
  
  • They know they are producing these symptoms but do now know why
  • Also known as Munchausen’s syndrome
• Malingering (conscious) - not patients!
  
  • They know they are producing these symptoms and they know why
• Hychondrial disorders
  
  • Presistent belief in the presence of an underlying disease
  • Patient refuses to accept reassurance or negative tests results
• Conversion disorder
  
  • Typically involves loss of motor or sensory function
  • Patient doesn’t consciously feign the symptoms (factitious) or seek material gain (malingering)
  • Patients may be indiferent to their apparent disorder
• Dissociative disorder
  
  • Dissociation is a process of ‘separating off’ certain memories from normal consciousness
  • In contrast to conversion disorder involves psychiartic symptoms (i.e. amnesia, stupor)
  • Dissociative identity disorder (DID) is the new term for multiple personality disorder and is most severe form

Question 4

Management of MUS

Answer 4

• Anti-depressants
• CBT