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Medically unexplained symptoms in patients attending medical clinics 

Medically unexplained symptoms in patients attending medical clinics

Chapter:
Medically unexplained symptoms in patients attending medical clinics
Author(s):

Michael Sharpe

DOI:
10.1093/med/9780199204854.003.260503
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date: 24 April 2017

Patients commonly present to doctors with symptoms, and doctors seek disease to explain these symptoms. However, in about one-third of medical outpatients the symptoms remain inadequately explained by disease, even after exhaustive assessment. The size of the problem of medically unexplained symptoms, their cost to services, and public health importance are all becoming increasingly clear.

Medically unexplained symptoms may be described as due to somatization, or as somatoform or functional symptoms—common examples being pain, fatigue, and weakness. They may also be described in terms of a functional somatic syndrome diagnosis such as irritable bowel syndrome, fibromyalgia, or chronic fatigue syndrome.

Clinical approach—patients with medically unexplained symptoms may have substantial disability, distress, and a poor prognosis. Most doctors still regard such symptoms as purely mental in origin, but it has become increasingly obvious that such an approach is both scientifically inadequate and practically unhelpful. Patients regard a purely mental explanation as dismissive and stigmatizing, and physicians find it frustrating as it does not help them manage the patient. The evidence favours a more complex understanding of aetiology in which genetic vulnerability, early experience, and life stress interact to produce symptoms that are associated with reversible changes in the nervous system and associated function. Developments in neuroscience combined with increasing consumerism amongst patients require that we take a more positive approach to this neglected area of medical research and practice.

Management—to be effective, this requires more than simply the exclusion of disease: (1) the patient needs their symptoms to be taken seriously; (2) it is important to seek other symptoms of depression and anxiety that are commonly associated; (3) a positive diagnosis needs to be made (often as a functional somatic syndrome with or without associated depression or anxiety) and appropriate explanation for the symptoms (in terms or reversible changes in bodily function) given to the patient; (4) a practical management plan is required, including education about the symptoms and a gradual return to normal activity. The so-called antidepressants drugs may be effective even if the patient is not depressed; (5) some patients may require referral for specialist treatment, there being most evidence of efficacy for cognitive behavioural therapy (CBT).

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