MEDICALLY UNEXPLAINED SYMPTOMS Flashcards
what are medically unexplained symptoms?
Physical symptoms not explained by organic disease which causes distress and impairs function
There is positive evidence or a strong assumption that the symptoms are linked to psychological factors
what is somatisation?
physical expression of emotional distress
what is hypochondriasis?
a condition in which a person is excessively and unduly worried about having a serious illness
why can medically unexplained symptoms be difficult to treat?
because they have wide variation in severity and presentation
what is illness behaviour?
any actions or reactions of an individual who feels unwell for the purpose of defining their state of health and obtaining physical or emotional relief from perceived or actual illness.
what is illness denial?
Behaviours to avoid the ‘stigma’/inability to accept physical/mental disease
what are the 4 features of the sick role?
(1) exempts them from certain responsibilities
(2) gives them the right to expect help and seek care
(3) obligation to seek and co-operate with treatment
(4) the expectation of a desire to recover
what is the aetiology of MUS?
familial transmission, attachment, cognitive processing, heightened central pain mechanisms
what are heightened central pain mechanisms?
give a case study
psychosocial factors can affect pain perception
that patients who have been abused and have IBS report more pain than patients with IBS who have not been abused
how can childhood impact MUS?
if in childhood you only received attention after being ill then you may develop MUS to unconsciously get that attention
what are some maintaining factors of MUS?
iatrogenic harm by providing the option for further tests and endorsing the fact that there could be something physically wrong
mental illness
on going stresses
what is selective attention?
the process of focusing on a particular object in the environment for a certain period of time.
what is the prevalence of MUS?
1/5 of general population will experience it
1/3 hospital outpatients are due to MUS
how do you clinically diagnose a MUS?
If the symptom doesn’t fit with known disease models or the patient is unable to give a clear and precise description of the symptoms
If the symptom/disability seem excessive in comparison to pathology
If symptoms seem to have a relationship to stressful life events
If patient attends frequently (with different symptoms)
If the patient is overly anxious about the meaning of the symptoms and has strongly held beliefs about a disease process causing the symptoms
Patient complains of pain in various sites or multiple physical symptoms
how do doctors manage MUS?
Explanation is the key
Symptom management – medication, exercise, acupuncture, physiotherapy
Promote self-efficacy
Initiate treatment for depression/anxiety if present
Psychotherapies - attention is directed away from the symptoms to the problems that have provoked the MUS
Aim is not for symptom cure but to help patient cope, which in turn minimises impact
