Psycology: Unexplained Symptoms Flashcards
How many cases go down as medically unexplained
40-50%
What is medically unexplained symptom
Physical symptoms not explained organically
Cause distress/disability
Can’t be associated to mental
Singular or combinations
Eg. Pain fatigue headache gut motility change
Issues with MUS terms
Patients want answer from doctor
Want positive description of symptoms
Idiopathic
No certain reason
Top 3 unexplained illness symptoms
Irritable bowel syndrome
Fibromyalgia
Chronic fatigue syndrome
how do you know you have IBS
Recurrent abdominal pain or discomfort 3 days a month in last 3 months
Symptoms of IBS
Improvement with defecation
Change in freq of stool
Change appearance stool
Chronic fatigue syndrome symptoms
Persistent or relapsing and debilitating for 6 months
4/8 of other specific somatic symptoms
Fibromyalgia ?
Widespread pain
Pain for 3 months at least
No other disorder
Investigation of patient can be bad as
Unnecessary cost
Over medication
Over prescribing
What about missed medical explanations?
There is no increased risk of misdiagnosis in MUPS
How to reduce costs and improve outcomes for MUPS?
Building shared understanding ➢Training
Positive Practice Guide guidance- LINK ➢ MUS Long Term Conditions toolkit
Scotland- LINK
➢Awareness ➢Formulation ➢Practical skill development ➢Training materials
The Cognitive Behavioural Model of MUPS
3ps?
Predisposing factors
Precipitating Factor
Perpetuating factor
Predisposing or risk factors
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
Precipitants are?
Triggers
Common precipitants
➢Repeated and/or major stressful life events
Physical trauma
Illness infection
Order of perpetuating factors od pops
Social environment Physiology Cognition Emotion Behaviour
Method to treat MUPS
CBT
cognitive behavioural based treatments
Benefits of CBT
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
Does treatment for MUPS differ from treatment for mental health conditions?
anxiety and depression are qualitatively different from MUPS
So yes
Depression and anxiety in MUPS
Depression or anxiety disorder is over three times more common in severe forms of MUPS than no MUPS
Principles of CBT
Collaborative approach
• Assess and explore areas of difficulties • Set targets for dealing with difficulties
➢Tackling all-or-nothing
• Do
How to engage people with mups
ICE
EMPATHY
ETC
Providing a bio-psychosocial explanation
Explicitly convey belief in reality of physical symptoms
Normalise that all symptoms are influenced by bio-psychosocial factors.
Positive treatment options
Explain to the patient that although you have not found a cause that is amenable to a
si
Working with other HCP’s?
For MUS/PPS, good practice consensus recognises that not investigating may be best for the patient
