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Medically unexplained symptoms

Anke Maatz, Megan Wainwright, Andrew J Russell, Jane Macnaughton, Yan Yiannakou
BACKGROUND: The term 'difficult' is pervasively used in relation to medically unexplained symptoms (MUS) and patients with MUS. This article scrutinises the use of the term by analysing interview data from a study of secondary care specialists' experiences with and attitudes towards patients suffering from MUS. DESIGN: Qualitative design employing semi-structured open-ended interviews systematically analysed in three stages: first, data were analysed according to the principles of content analysis...
November 2016: Journal of Psychosomatic Research
Mette Trollund Rask, Eva Ørnbøl, Marianne Rosendal, Per Fink
OBJECTIVE: The upcoming International Classification of Diseases, 11th Revision for primary care use suggests inclusion of a new diagnostic construct, bodily (di)stress syndrome (BDS), for individuals with medically unexplained symptoms. We aimed to explore the long-term outcome of BDS in health care costs, work disability, and self-rated health. METHODS: Consecutive patients consulting their family physician for a new health problem were screened for physical and mental symptoms by questionnaires (n = 1785)...
October 20, 2016: Psychosomatic Medicine
K H N Weerdesteijn, F G Schaafsma, A J van der Beek, J R Anema
Purpose The purpose of this study was to obtain consensus among physicians of several medical specialties on the level of limitations to work-related functioning of people with persistent "medically unexplained" physical symptoms (PPS). Methods A modified Delphi study was conducted with 15 physicians of five different medical specialties. The study involved two email rounds and one meeting. In each round, the physicians prioritized the level of limitations in 78 work-related functioning items for four different PPS cases...
October 19, 2016: Journal of Occupational Rehabilitation
Emily McNicholas, Ahmed H Abdelhafiz
Unexplained fever and confusion is a common reason for emergency medical admission. When this occurs in the context of new urinary incontinence, a urinary tract infection may be considered to be the most likely cause. However it is also important to consider spinal pathology when this combination of symptoms arises. We present a case of a retropharygeal collection presenting in a patient with this combination of symptoms.
2016: Acute Medicine
T A M Teunissen, S H Lo Fong Wong, A L M Lagro-Janssen
Sexual abuse is very common. In the Netherlands 42% of women and 13% of men aged over 25 years have experienced unacceptable sexual behaviour. Most victims do not seek professional help nor do they report the abuse to the police, and most of the victims who do seek medical help do not mention the abuse. Doctors often do not recognize the signs of sexual abuse. Most victims of rape have symptoms that may develop into posttraumatic stress disorder (PTSD) if they persist for more than 4 weeks, such as sleep problems or panic attacks...
2016: Nederlands Tijdschrift Voor Geneeskunde
William L Hasler
Chronic unexplained nausea and vomiting (CUNV) refers to a symptom complex defined by nausea and/or vomiting with normal diagnostic testing, including anatomic assessments (including upper endoscopy) and measures of upper gut function (e.g., gastric emptying testing). Nausea and vomiting in this condition are postulated to result from aberrant peripheral or central neurohumoral activity. A substantial subset of patients satisfies this diagnosis as more than half of individuals referred for scintigraphic testing exhibit normal gastric emptying rates...
October 10, 2016: Current Treatment Options in Gastroenterology
Shireen Patel, Sam Malins, Boliang Guo, Marilyn James, Joe Kai, Catherine Kaylor-Hughes, Emma Rowley, Jayne Simpson, David Smart, Michelle Stubley, Helen Tyrer, Richard Morriss
BACKGROUND: Health anxiety and medically unexplained symptoms cost the National Health Service (NHS) an estimated £3 billion per year in unnecessary costs with little evidence of patient benefit. Effective treatment is rarely taken up due to issues such as stigma or previous negative experiences with mental health services. An approach to overcome this might be to offer remotely delivered psychological therapy, which can be just as effective as face-to-face therapy and may be more accessible and suitable...
January 2016: BJPsych Open
David D Clarke
Medically unexplained symptoms and chronic functional syndromes are common but few healthcare professionals have had formal training about their connection to psychosocial issues. A systematic approach to diagnosis and treatment based on experience with over 7000 of these patients is described. Outcomes improve with assessment for and treatment of current life stresses, the prolonged impact of adversity in childhood and somatic presentations of depression, post-traumatic stress, and anxiety disorders.
September 1, 2016: Zdravstveno Varstvo
Ang Dawson, Geoffrey C Cloud, Anthony C Pereira, Barry J Moynihan
Stroke services have been centralised in several countries in recent years. Diagnosing acute stroke is challenging and a high proportion of patients admitted to stroke units are diagnosed as a non-stroke condition (stroke mimics). This study aims to describe the stroke mimic patient group, including their impact on stroke services. We analysed routine clinical data from 2,305 consecutive admissions to a stroke unit at St George's Hospital, London. Mimic groupings were derived from 335 individual codes into 17 groupings...
October 2016: Clinical Medicine: Journal of the Royal College of Physicians of London
John M Wo, Thomas V Nowak, Shamaila Waseem, Matthew P Ward
Gastroparesis is a heterogeneous clinical syndrome. Some patients have debilitating vomiting, weight loss, and dehydration, while others have effortless regurgitation of undigested foods or postprandial distress suggestive of functional dyspepsia. Gastric electrical stimulation (GES) has been proposed as an effective treatment option for patients with gastroparesis refractory to medical therapy. Evidence suggests that the clinically available device, a low-energy high-frequency GES, activates the vagal afferent pathways to influence the central control mechanisms for nausea and vomiting...
September 27, 2016: Current Treatment Options in Gastroenterology
Leonie T van Hulsteijn, J Sven D Mieog, Maarten H T Zwartbol, Jos W S Merkus, Cees van Nieuwkoop
BACKGROUND: Several infectious processes of intra-abdominal origin may atypically present as skin or soft tissue infections or abscess in the thigh. CASE REPORT: We describe the case of a 73-year-old woman who presented to the emergency department with the clinical picture of a skin infection of the right leg. The patient's condition deteriorated during medical treatment with intravenous antibiotics. Subsequent radiologic imaging revealed that the complaints were caused by a bulging retroperitoneal appendicular abscess along the iliopsoas muscle, although the patient experienced no abdominal symptoms...
September 19, 2016: Journal of Emergency Medicine
Emin Mehmet Ceylan, Bariş Önen Ünsalver, Alper Evrensel
Meningiomas are mostly benign tumors of the meninges that may stay clinically silent or present first with psychiatric symptoms only. We present a case of medial cranial fossa meningioma that was first diagnosed as mixed anxiety disorder with dissociative symptoms and vertigo. In light of the intact neurological and vestibular system examination, our patient's vertigo and depersonalization were firstly addressed as psychosomatic symptoms of the psychiatric syndrome. Despite decreased anxiety and improved mood, dissociative symptoms and vertigo were resistant to treatment which prompted further research yielding a left hemisphere localized meningioma...
2016: Case Reports in Psychiatry
Kimberley Lee, Malcolm H Johnson, Julie Harris, Frederick Sundram
OBJECTIVES: As patients with medically unexplained physical symptoms may present frequently to hospital settings and receive potentially unnecessary investigations and treatments, we aimed to assess the frequency and type of medically unexplained physical symptoms presentations to clinical services and estimate the associated direct healthcare costs. METHODS: This study was undertaken at the largest district health board in New Zealand. All patients with a diagnosed presentation of medically unexplained physical symptoms in 2013 were identified using the district health board's clinical coding system...
2016: SAGE Open Medicine
Jun Kyu Mun, Jinyoung Youn, Jin Whan Cho, Eung-Seok Oh, Ji Sun Kim, Suyeon Park, Wooyoung Jang, Jin Se Park, Seong-Beom Koh, Jae Hyeok Lee, Hee Kyung Park, Han-Joon Kim, Beom S Jeon, Hae-Won Shin, Sun-Ah Choi, Sang Jin Kim, Seong-Min Choi, Ji-Yun Park, Ji Young Kim, Sun Ju Chung, Chong Sik Lee, Tae-Beom Ahn, Won Chan Kim, Hyun Sook Kim, Sang Myung Cheon, Jae Woo Kim, Hee-Tae Kim, Jee-Young Lee, Ji Sun Kim, Eun-Joo Kim, Jong-Min Kim, Kwang Soo Lee, Joong-Seok Kim, Min-Jeong Kim, Jong Sam Baik, Ki-Jong Park, Hee Jin Kim, Mee Young Park, Ji Hoon Kang, Sook Kun Song, Yong Duk Kim, Ji Young Yun, Ho-Won Lee, In-Uk Song, Young H Sohn, Phil Hyu Lee, Jeong-Ho Park, Hyung Geun Oh, Kun Woo Park, Do-Young Kwon
Despite the clinical impact of non-motor symptoms (NMS) in Parkinson's disease (PD), the characteristic NMS in relation to the motor subtypes of PD is not well elucidated. In this study, we enrolled drug-naïve PD patients and compared NMS between PD subtypes. We enrolled 136 drug-naïve, early PD patients and 50 normal controls. All the enrolled PD patients were divided into tremor dominant (TD) and non-tremor dominant (NTD) subtypes. The Non-Motor Symptom Scale and scales for each NMS were completed. We compared NMS and the relationship of NMS with quality of life between normal controls and PD patients, and between the PD subtypes...
2016: PloS One
Carolina X Sandler, Blake A Hamilton, Sarah L Horsfield, Barbara K Bennett, Ute Vollmer-Conna, Chris Tzarimas, Andrew R Lloyd
BACKGROUND: Medically-unexplained chronic fatigue states are prevalent, and challenging to manage. Cognitive behavioural therapy (CBT) and graded exercise therapy (GET) are effective in clinical trials. Evaluation of delivery in a standard health care setting is rare. An integrated treatment program with individualised allocation of resources to patients' needs, was developed and implemented though an academic outpatient clinic. It was hypothesised that the program would result in similar responses to those observed in the clinical trials...
September 13, 2016: Internal Medicine Journal
Denise J C Hanssen, Peter L B J Lucassen, Peter H Hilderink, Paul Naarding, Richard C Oude Voshaar
OBJECTIVE: Research on health-related quality of life (HRQoL) in older persons with medically unexplained symptoms (MUS) is scarce, and, in contrast with younger patients, interactions with chronic somatic diseases are more complex. DESIGN: In the current study we compared HRQoL between older persons with MUS and older persons with medically explained symptoms (MES). Our study sample consisted of 118 older MUS-patients and 154 older MES-patients. SETTING/MEASUREMENTS: The diagnosis of MUS was ascertained by the general practitioner and confirmed by a geriatrician within a multidisciplinary diagnostic assessment...
November 2016: American Journal of Geriatric Psychiatry
S D M van Dijk, D Hanssen, P Naarding, P Lucassen, H Comijs, R Oude Voshaar
BACKGROUND: Personality dysfunction has been postulated as the most clinically salient problem of persons suffering from medically unexplained symptoms (MUS) but empirical studies are scarce. This study aims to compare the personality profile of older patients suffering from MUS with two comparison groups and a control group. METHODS: Ninety-six older patients with MUS were compared with 153 frequent attenders in primary care suffering from medically explained symptoms (MES), 255 patients with a past-month depressive disorder (DSM-IV-TR), and a control group of 125 older persons...
October 2016: European Psychiatry: the Journal of the Association of European Psychiatrists
Vikas Menon, Balasubramanian Shanmuganathan, Anand Babu Arun, Jaiganesh Selvapandian Thamizh, Nivedhitha Selvakumar, Siddharth Sarkar
BACKGROUND: Knowledge about subjective perceptions and explanatory models has the potential to inform clinical evaluation and lead to development of patient-friendly treatment models in medically unexplained physical symptoms (MUPS). AIM: To collect qualitative data about explanatory models in MUPS. METHODS: A cross-sectional observational study was done among patients with MUPS presenting over a 2-year period to a specialty psychosomatic clinic...
September 8, 2016: International Journal of Social Psychiatry
Xia Hong, Jing Wei, Xiao-Hui Zhao, Ping Zeng, Li-Li Shi, Jin-Ya Cao, Xiao-Hong Liu
Objective To analyze liaison psychiatric service in a geriatric ward in a big general hospital and explore the way to improve accessibility of geriatric psychiatric service in general hospitals. Methods Elderly inpatients aged 65 years old or more admitted to a geriatrics ward in Peking Union Medical College Hospital in 7 years duration (January 2008 to December 2014) were enrolled in the study. Liaison psychiatrists attended ground round combined with psychiatric consultation from January 2008 to December 2009 (T1 period)...
August 2016: Zhongguo Yi Xue Ke Xue Yuan Xue Bao. Acta Academiae Medicinae Sinicae
Marie Angélique De Scheerder, Sylvie Rottey, An Mariman, Marleen Praet, Dirk Vogelaers
We describe a 43-year-old patient with subacute appearance of neurological and atypical complaints of anergia, anorexia and weight loss six months earlier. In spite of several admissions in different hospitals, no underlying somatic cause could be found and he was admitted to a psychiatric hospital with a tentative diagnosis of major depressive disorder. Subsequently, he was referred to the unit of medically unexplained physical symptoms within the department of general internal medicine for assessment by the psychiatrist, involved in this programme...
September 2, 2016: Acta Clinica Belgica
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