Week 7 Lecture 7 - Medically Unexplained symptoms Flashcards
Kroenke & Price (1993) conducted a large community sample of the lifetime prevalence of 26 common symptoms
They asked what the explanation for symptoms was
What did they find?
- 50.5% due to medically condition or injury
- 16.4% minor or transient symptoms
- 2.1% due to medication/substance use
31% no medical diagnosis or explanation!!
What are medically unexplained symptoms?
Symptoms for which no medical diagnosis or explanation can be found
What are medically unexplained syndromes?
When symptoms occur together regularly in clusters to form a recognisable illness, this may be defined as a “syndrome”
A study looked at consecutive referrals to 7 clinics in 2 London hospitals
What was the percentage of cases for which no medical diagnosis or explanation could be found?
- Dental –> M=50, F=33
- Chest –> M=26, F=53
- Neurology –> M=55, F=66
- Gynaecology –> F=66
around a 1/3 to 2/3 of cases referred to secondary care did not receive a diagnosis
What are the different groups of symptoms that are present in MUS?
- gynaecological symptoms e.g. heavy/painful periods
- neurological symptoms e.g. seizures, dizziness
- regional pain presentations e.g. atypical chest pain, headaches
- musculoskeletal symptoms e.g. low back pain
- widespread pain/fatigue e.g. chronic fatigue, fibromyalgia
- gastrointestinal symptoms e.g. abdominal pain
True or false?
MUS often tend to persist for a long time
True
A Dutch primary care study (n=254) was conducted with patients with unexplained fatigue, abdominal or musculoskeletal complaints
What was found?
43% still had unexplained symptoms 1 year later
People with lots of persistent MUS tend to consult the doctor a lot
What are these people called?
“frequent attenders”
What is the problem of MUS?
- MUS violate the biomedical model which conflates disease and illness
(disease > symptoms > diagnosis > intervention > cure) - But MUS are symptoms or illness without disease…
- If (according to the biomedical model) illness is a sign of disease and a person is ill without a disease, what can be going on?
What is the medical/psychiatric response to MUS violating the biomedical model?
- Somatization
What is somatization?
- psychological difficulty through somatic symptoms
- unaccounted for by pathological findings
- to attribute them to physical illness
- seek medical help
What is the difference between somatization and somatization disorder?
- Somatization: “The process by which psychological distress is expressed as physical symptoms.”
- “Somatization disorder” a diagnostic label for people with multiple medically unexplained symptoms.
Is somatization as a construct satisfactory?
- no
- Patients hate it as they feel that it delegitimizes their symptoms
- What does it mean for “psychological distress” to “come out” as bodily symptoms?
- There is scant evidence that having lots of bodily symptoms is related to denying emotional problems – in fact the opposite is true
What are MUS often accompanied by
psychological symptoms or distress
What did a study of co-occurrence of MUS and psychiatric symptoms in large community sample find?
More MUS, greater likelihood of anxiety and depression symptoms
Why is “medically unexplained” an unsatisfactory term?
- Diagnosis by exclusion.
- Continued concern ‘have we missed something?’
- indicates failure of medical system
- Patients can feel dismissed
Are the symptoms real in MUS?
yes
What is an alternative approach to try and explain MUS?
Alternative approaches try to explain the experience of symptoms in terms of interacting biological, psychological and (to a lesser extent) social factors, and help people to manage them.
What is a symptom?
- Bodily sensations (e.g. Dizziness, pain)
- Bodily signs (e.g. Raised temperature)
which are attributed to illness
How do we perceive bodily sensations?
- by noticing sensations
- and then attending to sensations
How do we interpret bodily sensations (cognitive factors)?
- Context important
- Beliefs and personal models of illness, illness prototypes
- May use heuristics – e.g. stress, age
- Interpretations affected by emotional factors
What did a community study find about how emotion interacts with cognition?
In the community, emotion is positively correlated with physical symptoms e.g. fatigue
In what ways does emotion interact with cognition?
- Fear of being ill – more vigilant to bodily sensations
Physical sensations of anxiety:
- Sweating, shaking, dry throat, dizzy, nausea, stomach cramps, butterflies
Physical sensations of depression:
- Weight/appetite change, sleeplessness, early waking
- Tiredness, aches and pains
Is the interaction between emotion and cognition directional?
is bidirectional
