Psycology: Unexplained Symptoms

Question 1

How many cases go down as medically unexplained

Answer 1

40-50%

Question 2

What is medically unexplained symptom

Answer 2

Physical symptoms not explained organically

Cause distress/disability

Can’t be associated to mental

Singular or combinations

Eg. Pain fatigue headache gut motility change

Question 3

Issues with MUS terms

Answer 3

Patients want answer from doctor

Want positive description of symptoms

Question 4

Idiopathic

Answer 4

No certain reason

Question 5

Top 3 unexplained illness symptoms

Answer 5

Irritable bowel syndrome
Fibromyalgia
Chronic fatigue syndrome

Question 6

how do you know you have IBS

Answer 6

Recurrent abdominal pain or discomfort 3 days a month in last 3 months

Question 7

Symptoms of IBS

Answer 7

Improvement with defecation

Change in freq of stool

Change appearance stool

Question 8

Chronic fatigue syndrome symptoms

Answer 8

Persistent or relapsing and debilitating for 6 months

4/8 of other specific somatic symptoms

Question 9

Fibromyalgia ?

Answer 9

Widespread pain

Pain for 3 months at least

No other disorder

Question 10

Investigation of patient can be bad as

Answer 10

Unnecessary cost
Over medication

Over prescribing

Question 11

What about missed medical explanations?

Answer 11

There is no increased risk of misdiagnosis in MUPS

Question 12

How to reduce costs and improve outcomes for MUPS?

Answer 12

Building shared understanding ➢Training
Positive Practice Guide guidance- LINK ➢ MUS Long Term Conditions toolkit
Scotland- LINK
➢Awareness ➢Formulation ➢Practical skill development ➢Training materials

Question 13

The Cognitive Behavioural Model of MUPS

3ps?

Answer 13

Predisposing factors
Precipitating Factor
Perpetuating factor

Question 14

Predisposing or risk factors

Answer 14

Genetic factors (CF➢ Personality traits ➢ Distress ➢
Lower fitness and bed rest
➢ Previous history of mood disorders, stressful life events and
➢ Childhood experience of llness in self or parent
➢ Learning in childhood that symptoms are dangerous
➢ Long term conditions

Question 15

Precipitants are?

Answer 15

Triggers

Question 16

Common precipitants

Answer 16

➢Repeated and/or major stressful life events
Physical trauma
Illness infection

Question 17

Order of perpetuating factors od pops

Answer 17

Social environment 
Physiology 
Cognition
Emotion
Behaviour

Question 18

Method to treat MUPS

Answer 18

CBT

cognitive behavioural based treatments

Question 19

Benefits of CBT

Answer 19

CBT is an effective treatment for health
anxiety and MUPS

Improves physical symptoms and
associated disability

Also effective for CFS, IBS, chronic pain
syndromes with larger effect sizes

Question 20

Does treatment for MUPS differ from treatment for mental health conditions?

Answer 20

anxiety and depression are qualitatively different from MUPS

So yes

Question 21

Depression and anxiety in MUPS

Answer 21

Depression or anxiety disorder is over three times more common in severe forms of MUPS than no MUPS

Question 22

Principles of CBT

Answer 22

Collaborative approach
• Assess and explore areas of difficulties • Set targets for dealing with difficulties
➢Tackling all-or-nothing
• Do

Question 23

How to engage people with mups

Answer 23

ICE
EMPATHY
ETC

Question 24

Providing a bio-psychosocial explanation

Answer 24

Explicitly convey belief in reality of physical symptoms

Normalise that all symptoms are influenced by bio-psychosocial factors.

Question 25

Positive treatment options

Answer 25

Explain to the patient that although you have not found a cause that is amenable to a
si

Question 26

Working with other HCP’s?

Answer 26

For MUS/PPS, good practice consensus recognises that not investigating may be best for the patient