MUS Flashcards
1) What are medically unexplained symptoms?
2) What can MUS lead to?
3) Who is more commonly affected by MUS?
4) What proportion of GP patients are affected by MUS?
5) What proportion of patients that see a neurologist are affected by MUS?
1) Physical complaints without evidence of an underlying organic cause.
2) frustration, excessive investigations and chronic disability.
3) These disorders more commonly affect women.
4) Around 1/4.
5) 1/3.
1) What 3 factors predispose to the development of MUS?
2) What types of attitudes to disease play a role in MUS?
3) What may MUS be precipitated by?
4) What might MUS be maintained by?
5) Name the 3 main underlying theories for MUS.
1) Genetics, a shorter duration of formal education and childhood experiences.
2) Cultural and family attitudes towards disease play a role in MUS development.
3) Stressful life events.
4) Unhelpful cognitive styles.
5) Somatisation, psychiatric illness and cognitive models (such as an individual’s interpretation of normal physiology).
1) What is somatisation?
2) Describe the psychiatric illness theory of MUS.
3) What can create anxiety and perpetuate MUS.
4) What 2 behaviours might maintain anxiety long term?
5) What is chronic fatigue syndrome also known as?
1) The unconscious expression of psychological distress through physical symptoms (for example, rather than anger a patient may experience abdominal pain).
2) Depression and anxiety symptoms can be psychological and physical, and both disorders can commonly present with physical symptoms in primary care.
3) An individuals interpretation of normal physiology.
4) Repeated checking and seeking reassurance.
5) Myalgic encephalomyelitis (ME).
1) What might chronic fatigue syndrome develop after?
2) What is important in the management of chronic fatigue syndrome?
3) What therapy is used to improve fatigue and physical functioning?
4) Who is somatisation disorder more common in?
5) Describe somatisation disorder.
1) Viral infection such as glandular fever, but can arise spontaneously.
2) Pacing of activity is important: patients need realistic goals and should not do more activity than planned as this can exacerbate problems.
3) CBT.
4) 10 times more common in women.
5) Multiple MUS affecting any system in the body.
Describe chronic fatigue syndrome.
1) Extreme fatigue is the main complaint.
2) Patients are typically exhausted by mild exertion.
3) Produces an alternating pattern of activity and debilitating fatigue or complete exercise avoidance.
4) Symptoms such as aches and pains are common.
1) What informs a patient’s symptoms in somatisation disorder?
2) What is there strong evidence for in the management of CFS?
1) A patient’s understanding of illness informs their symptoms which may thus show unusual characteristics.
2) Graded exercise (scheduled and gradually increasing activity, rather than rest).
Name and describe the differential diagnoses for MUS.
1) Organic cause: rule out any possible physical cause, even is symptoms are multiple and changing as a multi system physical illness may be responsible.
2) Psychiatric illness: depression/ anxiety/ hypochondriasis/ schizophrenia/ persistent delusional disorder/ affective psychosis.
3) Deliberate production of symptoms (rare): Factitious disorder/ Munchausen’s/ Malingering.
1) What might help to diagnose MUS disorders where physical symptoms are present?
2) What is hypochondriasis?
3) How might depression and anxiety result in MUS?
4) Why should schizophrenia, persistent delusional disorder and affective psychosis be considered as differentials for MUS?
5) What is factitious disorder?
1) The HADS.
2) An extreme form of health anxiety where patients believe that they have a specific illness rather than presenting with inexplicable symptoms.
3) Depression and anxiety can cause or exacerbate physical symptoms (for example, depression lowers the pain threshold).
4) Because hypochondriacal and somatic hallucinations may occur in these illnesses.
5) The deliberate production of symptoms to receive medical treatment.
1) What are extreme cases of factitious disorder called?
2) Describe what presentations of factitious disorder might include.
3) What is malingering?
1) Munchausen’s syndrome.
2) Pyrexia of unknown origin, haematuria and skin lesions.
3) Feigning symptoms to contain external reward (escape military service/ gain money or drugs).
State the 9 steps of management for medically unexplained symptoms.
1) Therapeutic assessment
2) Explain and reassure
3) Avoid over-investigation, unnecessary specialist referrals or physical medications.
4) Emotional support.
5) Encourage normal functioning.
6) Antidepressants
7) Treat co-morbid illness
8) CBT
9) Graded exercise
1) For MUS, what is crucial to resolution and progress for the patient?
2) What model should be used to explain to and reassure the patient with MUS?
3) What might be a consequence of over-investigation or unnecessary specialist referrals?
4) What co-morbid illnesses of MUS do you need to make sure to treat in particular?
5) Within CBT, what 3 activities help to modify unhelpful cognitions in patients with MUS?
1) engagement.
2) The reattribution model.
3) Reinforcement of physical illness beliefs and an increase in anxiety.
4) Anxiety and depression.
5) Discussion, diaries and behavioural experiments.
State the 3 factors which need to be covered according to the Reattribution model.
1) Ensure the patient feels understood.
2) Broaden the agenda from a physical cause to a physical and psychological explanation.
3) Make the link between symptoms and psychological factors.
1) What does CBT help to reduce in patients with MUS?
2) Which 2 disorders is graded exercise particularly useful in?
1) Decreases avoidance and reassurance seeking.
2) CFS and fibromyalgia.
1) What has a better prognosis in patient with MUS?
2) What proportion of patients with MUS in primary care remain symptomatic after a year?
3) What happens in conversion disorders?
4) Briefly describe the presentation of a conversion disorder.
5) What informs a patient’s symptoms in conversion disorder?
1) Shorter duration of symptoms and milder symptoms.
2) Over 1/4.
3) Internal conflict is unconsciously ‘converted’ into neurological symptoms.
4) Presentations are acute, specific and often dramatic, usually following sudden stress or conflict.
5) the patient’s own concept of illness informs symptoms (for example, sudden anaesthesia might follow a distribution that does not reflect dermatomes or other sensory loss patterns).
Name 8 examples of conversion disorders.
1) Paralysis
2) Blindness
3) Aphonia (inability to produce speech)
4) Seizures
5) Psychogenic amnesia (loss of all semantic memories including own identity).
6) Multiple personality disorder (rare and controversial)
7) Fugue (patients lose their memory entirely and wander away from home)
8) Stupor.
