3.9.12 Medically unexplained symptoms
Medically Unexplained Symptoms
In primary care, medically unexplained symptoms (MUS) are often reported. Between 25-50% of all cases when MUS are brought up in primary care, there is no evidence to suggest an underlying physical illness. MUS are a diverse range of symptoms that might include practically all of the symptoms that people report to their general practitioner. MUS also refers to functional somatic syndromes, such as irritable bowel syndrome (IBS), fibromyalgia, and chronic fatigue syndrome (CFS), as well as symptoms resulting from a particular somatic disease that is more severe, persistent, or severely restricted functioning than anticipated, based on (objective) disease parameters.
MUS is characterised by functional restrictions and an increase in the number and duration of symptoms, ranging from mild to severe. The majority of the time, MUS are transient and self-limiting, but on occasion, MUS persist, necessitating in-depth examinations, referrals, and exorbitant medical expenses. Therefore, it is crucial to identify MUS as soon as possible. Despite the fact that about 2.5% of patients in routine practice fit the requirements for chronic or severe MUS (such multiple symptoms that persist for longer than 3 months resulting in severe functional limitations) (Kirmayer et al., 2004).
| Medically unexplained conditions: | Summary: |
| Dissociative (Conversion) Disorder | A common theme is a partial or complete loss of the typical integration between memories of the past, awareness of identity and immediate sensations, and control of bodily movements. Somatic manifestations of psychiatric illness are more common in the elderly, children, lower social classes and Eastern countries. |
| Dissociative Amnesia | A core feature is a patchy loss of memory, usually of recent traumatic events. Perplexity, distress, and varying degrees of attention-seeking behaviour may be evident. Thought to occur more commonly in women and more often is younger rather than older adults. |
| Dissociative Fugue | It includes all of the characteristics of dissociative amnesia plus an apparently deliberate journey away from home or job, during which self-care is maintained. In some cases, a new identity is assumed. Often a history of disturbing relationships with parents in childhood and are found to be habitual liars. |
| La Belle Indifference | A French term that translates to “beautiful ignorance.” La belle indifference is a paradoxical absence or indifference of psychological distress despite having a serious medical illness or symptoms related to a health condition. |
| Münchausen Syndrome | Previously referred to as ‘hospital addiction’ syndrome. Generally, these patients have severe personality difficulties. Patients present to the hospital with symptoms suggestive of serious physical illness. There needs to be evidence of conscious stimulation of symptoms and deception of medical staff. Primary and secondary gains. |
(Rosendal, 2017)
| Somatoform disorders: | Summary: |
| Somatization Disorder | A disorder characterized by multiple, recurrent, and frequent changing physical symptoms, usually present for at least two years. For diagnosis, the patient needs to have refused to accept reassurance and there needs to be some social/occupational impairment. |
| Hypochondriacal Disorder | Preoccupation with the possibility of having one or more serious and progressive physical disorders, and even disfigurement. Non-delusional dysmorphophobia |
| Somatoform Pain Disorder | Inconsistent with the anatomical distribution of the nervous system. May have symbolic significance eg. chest pain where mother died of myocardial infarction. |
(D’Souza, 2019)
References:
(1) D’Souza, R.S. and Hooten, W.M. (2019). Somatic Syndrome Disorders. [online] Nih.gov. Available at: https://www.ncbi.nlm.nih.gov/books/NBK532253/.
(2) Kirmayer, L. J., Groleau, D., Looper, K. J., & Dao, M. D. (2004). Explaining medically unexplained symptoms. The Canadian journal of psychiatry, 49(10), 663-672.
(3) Rosendal, M., Olde Hartman, T.C., Aamland, A., van der Horst, H., Lucassen, P., Budtz-Lilly, A. and Burton, C. (2017). ‘Medically unexplained’ symptoms and symptom disorders in primary care: prognosis-based recognition and classification. BMC Family Practice, 18(1). doi:10.1186/s12875-017-0592-6.