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Medically unexplained symptoms

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https://www.readbyqxmd.com/read/28003283/clinical-practitioners-views-on-the-management-of-patients-with-medically-unexplained-physical-symptoms-mups-a-qualitative-study
#1
A Keith W Brownell, Chloe Atkins, Andrea Whiteley, Robert F Woollard, Jude Kornelsen
OBJECTIVES: By identifying strategies that practicing physicians use in managing patients with medically unexplained physical symptoms (MUPS), we present an interim practical management guide (IPMG) that clinical practitioners may find useful in their clinical practices and that may help guide future research. DESIGN: A qualitative research study based on interview data from practicing physicians with experience in dealing with MUPS and known to the physician members of the research team...
December 21, 2016: BMJ Open
https://www.readbyqxmd.com/read/27996317/cardiac-arrest-with-clozapine-and-olanzapine-revealing-long-qt-syndrome
#2
Edward Woloszyn, Nishant Whig, Eileen Trigoboff, Jeffery J Grace
The authors describe a rare case of "concealed" congenital Long QT Syndrome (LQTS) Type 3 in a patient with treatment resistant schizophrenia and no known personal or family history of cardiac disease. The patient in this Case Report had a hidden genetic condition revealed only following the essential administration of antipsychotics. As a result, this patient experienced an aborted cardiac arrest and a total of five episodes of ventricular tachycardia (VT) requiring cardioversion. Successful control of the VT occurred with an Automatic Internal Defibrillator (AID), judicious use of antipsychotic medications, and anti-arrhythmic medications...
December 20, 2016: Clinical Schizophrenia & related Psychoses
https://www.readbyqxmd.com/read/27995604/exercise-therapy-for-chronic-fatigue-syndrome
#3
REVIEW
Lillebeth Larun, Kjetil G Brurberg, Jan Odgaard-Jensen, Jonathan R Price
BACKGROUND: Chronic fatigue syndrome (CFS) is characterised by persistent, medically unexplained fatigue, as well as symptoms such as musculoskeletal pain, sleep disturbance, headaches and impaired concentration and short-term memory. CFS presents as a common, debilitating and serious health problem. Treatment may include physical interventions, such as exercise therapy, which was last reviewed in 2004. OBJECTIVES: The objective of this review was to determine the effects of exercise therapy (ET) for patients with CFS as compared with any other intervention or control...
December 20, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27984257/preliminary-predictors-of-initial-attendance-symptom-burden-and-motor-subtype-in-a-us-functional-neurological-disorders-clinic-population
#4
David L Perez, Sigrid S Young, Julie N King, Anthony J Guarino, Barbara A Dworetzky, Alice Flaherty, Zeina Chemali, David Caplan, Bradford C Dickerson
BACKGROUND AND OBJECTIVE: Although many patients present with functional neurological symptoms (FNS), few US clinics offer specialized FNS care, and data on clinic attendees remain limited. We determined predictors of initial attendance, symptom burden, and FNS subtype in the first patients referred to our Functional Neurological Disorders Clinic for suspected FNS. METHODS: We reviewed the charts of 62 consecutive patients (46 women, 16 men). Regression analyses investigated predictors of keeping the first scheduled clinic appointment...
December 2016: Cognitive and Behavioral Neurology: Official Journal of the Society for Behavioral and Cognitive Neurology
https://www.readbyqxmd.com/read/27977289/somatic-symptoms-deserve-our-attention
#5
Kurt Kroenke
This commentary focuses on two articles in this issue which provide important insights regarding the diagnosis and management of medically unexplained symptoms (MUS). Up to half of all outpatient visits are prompted by a physical/somatic complaint of which at least a third are MUS. Analyzing data from the National Ambulatory Care Medical Survey, Gates, Petterson, Wingrove, Miller, and Klink (2016) confirmed the common finding that depression and anxiety in patients presenting with somatic symptoms are underrecognized...
December 2016: Families, Systems & Health: the Journal of Collaborative Family Healthcare
https://www.readbyqxmd.com/read/27977288/our-continuing-exploration-of-medically-unexplained-symptoms
#6
Larry B Mauksch, Colleen T Fogarty
In this issue, the reader will find three articles examining different but converging perspectives on medically unexplained symptoms (MUS). In the first article, Gates, Petterson, Wingrove, Miller, and Klink (2016) examined 110,000 office visits to primary care providers between 2002 and 2010. In the second article, Clarke (2016), an internist and gastroenterologist, presents a model for diagnosing and treating MUS. The person most referenced in the first two articles and author of the landmark study-Kroenke (2016) writes the third article, an invited commentary...
December 2016: Families, Systems & Health: the Journal of Collaborative Family Healthcare
https://www.readbyqxmd.com/read/27973580/a-small-molecule-inhibitor-of-sarcomere-contractility-acutely-relieves-left-ventricular-outflow-tract-obstruction-in-feline-hypertrophic-cardiomyopathy
#7
Joshua A Stern, Svetlana Markova, Yu Ueda, Jae B Kim, Peter J Pascoe, Marc J Evanchik, Eric M Green, Samantha P Harris
Hypertrophic cardiomyopathy (HCM) is an inherited disease of the heart muscle characterized by otherwise unexplained thickening of the left ventricle. Left ventricular outflow tract (LVOT) obstruction is present in approximately two-thirds of patients and substantially increases the risk of disease complications. Invasive treatment with septal myectomy or alcohol septal ablation can improve symptoms and functional status, but currently available drugs for reducing obstruction have pleiotropic effects and variable therapeutic responses...
2016: PloS One
https://www.readbyqxmd.com/read/27957879/lead-intoxication-due-to-ayurvedic-medications-as-a-cause-of-abdominal-pain-in-adults
#8
Varun Mehta, Vandana Midha, Ramit Mahajan, Vikram Narang, Praneet Wander, Ridhi Sood, Ajit Sood
BACKGROUND: Though a majority of cases of lead intoxication come from occupational exposures, traditional and folk remedies have also been reported to contain toxic amounts of lead. We present a large series of patients with lead poisoning due to intake of Ayurvedic medicines, all of whom presented with unexplained abdominal pain. METHODOLOGY: This was a retrospective, observational case series from a tertiary care center in India. The charts of patients who underwent blood lead level (BLL) testing as a part of workup for unexplained abdominal pain between 2005 and 2013 were reviewed...
December 13, 2016: Clinical Toxicology
https://www.readbyqxmd.com/read/27929264/unexplained-lymphadenopathy-evaluation-and-differential-diagnosis
#9
Heidi L Gaddey, Angela M Riegel
Lymphadenopathy is benign and self-limited in most patients. Etiologies include malignancy, infection, and autoimmune disorders, as well as medications and iatrogenic causes. The history and physical examination alone usually identify the cause of lymphadenopathy. When the cause is unknown, lymphadenopathy should be classified as localized or generalized. Patients with localized lymphadenopathy should be evaluated for etiologies typically associated with the region involved according to lymphatic drainage patterns...
December 1, 2016: American Family Physician
https://www.readbyqxmd.com/read/27905341/heidenhain-variant-of-creutzfeldt-jakob-disease-in-a-patient-who-had-bovine-bioprosthetic-valve-implantation
#10
Jehard Hashoul, Waleed Saliba, Irina Bloch, Haneen Jabaly-Habib
Creutzfeldt-Jakob disease (CJD) is a rare neurodegenerative disorder characterized by rapidly progressing dementia, general neurologic deterioration, and death. When the leading symptoms are visual disturbances, it is termed as the Heidenhain variant of CJD (HvCJD). CJD was reported following prion-contaminated pericardium transplants but never after bovine bioprosthetic cardiac valve. In this case report, we describe HvCJD in a patient who had a bovine bioprosthetic cardiac valve implant. An 82-year-old-woman was referred to neuro-ophthalmology clinic for unexplained visual loss that started 1 month previously...
October 2016: Indian Journal of Ophthalmology
https://www.readbyqxmd.com/read/27905001/guidelines-for-diagnosis-and-management-of-the-cobalamin-related-remethylation-disorders-cblc-cbld-cble-cblf-cblg-cblj-and-mthfr-deficiency
#11
Martina Huemer, Daria Diodato, Bernd Schwahn, Manuel Schiff, Anabela Bandeira, Jean-Francois Benoist, Alberto Burlina, Roberto Cerone, Maria L Couce, Angeles Garcia-Cazorla, Giancarlo la Marca, Elisabetta Pasquini, Laura Vilarinho, James D Weisfeld-Adams, Viktor Kožich, Henk Blom, Matthias R Baumgartner, Carlo Dionisi-Vici
BACKGROUND: Remethylation defects are rare inherited disorders in which impaired remethylation of homocysteine to methionine leads to accumulation of homocysteine and perturbation of numerous methylation reactions. OBJECTIVE: To summarise clinical and biochemical characteristics of these severe disorders and to provide guidelines on diagnosis and management. DATA SOURCES: Review, evaluation and discussion of the medical literature (Medline, Cochrane databases) by a panel of experts on these rare diseases following the GRADE approach...
January 2017: Journal of Inherited Metabolic Disease
https://www.readbyqxmd.com/read/27898081/understanding-unspecific-complaints-through-genetics
#12
Eli Sprecher
Unspecific and unexplained medical complaints can be frustrating to both patients and clinicians. A cause for these complex symptoms and signs may now have been identified.
November 29, 2016: Nature Genetics
https://www.readbyqxmd.com/read/27894609/what-is-the-problem-with-medically-unexplained-symptoms-for-gps-a-meta-synthesis-of-qualitative-studies
#13
REVIEW
May-Lill Johansen, Mette Bech Risor
OBJECTIVE: To gain a deeper understanding of challenges faced by GPs when managing patients with MUS. METHODS: We used meta-ethnography to synthesize qualitative studies on GPs' perception and management of MUS. RESULTS: The problem with MUS for GPs is the epistemological incongruence between dominant disease models and the reality of meeting patients suffering from persistent illness. GPs have used flexible approaches to manage the situation, yet patients and doctors have had parallel negative experiences of being stuck, untrustworthy and helpless...
November 21, 2016: Patient Education and Counseling
https://www.readbyqxmd.com/read/27894463/what-should-we-say-to-patients-with-unexplained-neurological-symptoms-how-explanation-affects-offence
#14
Juen Mei Ding, Richard A A Kanaan
OBJECTIVES: Unexplained neurological symptoms (UNS) are common presentations in neurology but there is no consensus as to what they should be called. This is important, as patient acceptance is a predictor of outcome and there is evidence that patients are unhappy with the terms used. Patient understanding of these terms may be limited, however, and, once explained, the terms may seem more or less offensive. We sought to elicit patients' views of 7 frequently used terms for UNS, and whether these changed once definitions were provided...
December 2016: Journal of Psychosomatic Research
https://www.readbyqxmd.com/read/27894448/the-intersection-of-medical-child-abuse-and-medical-complexity
#15
REVIEW
Hillary W Petska, John B Gordon, Debra Jablonski, Lynn K Sheets
Children with medical complexity and victims of medical child abuse may have similar clinical presentations. Atypical or unexplained signs and symptoms due to rare diseases may lead providers to suspect medical child abuse when not present. Conversely, medical child abuse may be the cause of or coexist with medical complexity. Careful consideration of whether or not medical child abuse is present is essential when assessing a child with medical complexity since either diagnosis has significant consequences for children and families...
February 2017: Pediatric Clinics of North America
https://www.readbyqxmd.com/read/27888403/the-predictor-of-mortality-outcome-in-adult-patients-with-ebola-virus-disease-during-the-2014-2015-outbreak-in-guinea
#16
M S Cherif, N Koonrungsesomboon, M P Diallo, E Le Gall, D Kassé, F Cherif, A Koné, M Diakité, F Camara, N Magassouba
The purpose of this study was to examine the association of any demographic and clinical factors with mortality outcome among adult patients with Ebola virus disease (EVD) in Guinea. This retrospective observational study analyzed medical records of laboratory confirmed EVD adult patients during the 2014-2015 EVD outbreak in Guinea. The associations between any demographic or clinical variables and mortality outcome of EVD were assessed using univariate and multivariate logistic regression analyses. Of 2,310 EVD adult patients included for analysis, the overall case fatality rate was 68...
November 25, 2016: European Journal of Clinical Microbiology & Infectious Diseases
https://www.readbyqxmd.com/read/27886517/organic-vs-functional-neurological-disorders-the-role-of-childhood-psychological-trauma
#17
Thanos Karatzias, Ruth Howard, Kevin Power, Florentina Socherel, Craig Heath, Alison Livingstone
Although the relationship between psychological trauma and medically unexplained symptoms (MUS) is well established, this relationship is less well understood in people with medically unexplained neurological symptoms. In the present study, we set out to compare people with functional neurological disorders, and organic neurological disorders, in terms of childhood and adulthood traumatic events, traumatic stress, emotional dysregulation and symptoms of depression and anxiety. We have hypothesised that those with functional neurological disorders would be more likely to report childhood and adulthood traumatic life events, traumatic symptomatology, emotional dysregulation and symptoms of anxiety and depression, compared to those with organic neurological disorders...
January 2017: Child Abuse & Neglect
https://www.readbyqxmd.com/read/27825568/osteoarticular-manifestations-of-celiac-disease-and-non-celiac-gluten-hypersensitivity
#18
Stéphanie Dos Santos, Frédéric Lioté
Celiac disease is a chronic inflammatory autoimmune enteropathy based disorder that is triggered by the ingestion of gluten in genetically susceptible individuals. The global prevalence of 1% to 2% represents only the tip of the iceberg. The diagnosis is confirmed by positive specific antibody, anti-transglutaminase or anti-endomysium, specific lesions of the small intestine and a response to strict gluten-free diet. The diagnosis is difficult and often delayed because the clinical variability is very large, ranging from digestive clinical presentation "classic" to "atypical" symptoms, often extra-intestinal, that are sometimes attributed to a concomitant disease or a complication...
November 4, 2016: Joint, Bone, Spine: Revue du Rhumatisme
https://www.readbyqxmd.com/read/27821895/health-care-utilization-of-mexican-patients-with-medically-unexplained-physical-symptoms
#19
Azucena Maribel Rodriguez González, José Manuel Ramírez Aranda, Homero de Los Santos Reséndiz, María Yolanda Lara Duarte, Santiago Oscar Pazaran Zanella, Jafet Felipe Méndez López, Issa Gil Alfaro, Félix Gilberto Islas Ruz, Gloria Navarrete Floriano, Edith Guillen Salomón, Obdulia Texon Fernández, Silvia Cruz Duarte, Juan Carlos Romo Salazar, Claudia Elsa Pérez Ruiz, Sara de Jesús López Salas, Lizbeth Benítez Amaya, Javier Nahum Zapata Gallardo
OBJECTIVE: To determine the prevalence of medically unexplained physical symptoms and the characteristics and use of health services in a group of patients with medically unexplained physical symptoms and a group of patients with other illnesses. METHODS: This was a cross-sectional, retrospective and multicenter study. We included 1,043 patients over 18 years of age from 30 primary care units of a government health institution, in 11 states of Mexico, attended by 39 family physicians...
September 30, 2016: Colombia Médica: CM
https://www.readbyqxmd.com/read/27772554/what-s-difficult-a-multi-stage-qualitative-analysis-of-secondary-care-specialists-experiences-with-medically-unexplained-symptoms
#20
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
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