Medically Unexplained Symptoms

Question 1

What are Persistent Physical Symptoms

Name a few common ones

Answer 1

No underlying pathology but cause functional disability/distress

• pain
• fatigue
• dizzy
• headache
• GI motility changes
• sensory issues

Question 2

What are the 4 main features of IBS

What demographic is it common in

Answer 2

Abdo pain
Bloating
Constipation
Diarrhea

Young females

Question 3

What are the main features of CFS

Answer 3

Persistent/relapsing debilitating fatigue + somatic symptoms

-mental+physical fatigue

Question 4

What is the main feature of fibromyalgia

Answer 4

Widespread pain not explained by other factors

Question 5

Why does the number of investigations lead to harm

Answer 5

More uneccassery investigations
Overmedicalisation of symptoms
Polypharmacy => increasing SE risk

Question 6

How can we improve outcomes

• patients
• doctors

Answer 6

Patient

• emotional support
• reassurance and explanations

doctors
-increased awareness, training

Question 7

What are the predisposing factors that may increase the chance of PPS

Answer 7

Genetic
Personality
Childhood EXP
PHx mood issues
Long term conditions

ALL CAUSE DISTRESS

Question 8

What are the precipitant factors that may trigger PPS

What is a possible precipitant factor for

• CFS
• IBS
• post concussion syndrome

Answer 8

Repeated/major life events
Physical trauma
Illness

• Glandular fever => CFS
• Campylobacter => IBS
• mild brain trauma => PCS

Question 9

What perpetuating factors may lead to the prolongation of PPS

• social environment
• physiology
• cognition
• emotion
• behaviour

Answer 9

Social environment

• medical uncertainty
• isolation, stigma
• unhelpful social contexts

Physiology

• autonomic issues
• central sensitisation
• HPA issues
• circadian issues

Cognition

• symptom attention
• catastrophic appraisal
• intolerance of uncertainty

Emotion

• anxiety, worry, depression, low mood
• stress

Behaviour

• avoidance of symptoms/activity
• all of nothing

Question 10

How would you manage PPS

What is the effect of this?

Answer 10

CBT

• collaboration
• tackle all or nothing mindset/avoidance behaviours/unhelpful thoughts
• stress, sleep management

Decrease physical symptoms and distress

Question 11

How would you interact with patients with PPS

Answer 11

Biopsychosocial explanation of symptoms
-convey belief in reality of symptoms

Focus on symptom management and improve function

Partnership in a shared plan