Lecture 7, MUS Flashcards
What are medically unexplained symptoms?
Symptoms for which no medical diagnosis or explanation can be found
What are medically unexplained syndromes?
When symptoms occur together regularly in clusters to form a recognisable illness
What are the groups of symptoms?
Gynaecological, Neurological, Regional Pain Presentations, Musculoskeletal, Widespread Pain/Fatigue, Gastrointestinal
How long does MUS tend to persist?
A long time - Dutch primary care study, patients with unexplained fatigue, abdominal or musculoskeletal complaints - 43% had MUS 1 year later.
What is the “problem” with MUS?
Violates the biomedical model - MUS are symptoms or illness without disease
What is Somatisation?
The process by which psychological distress is expressed as physical symptoms
What is “somatisation disorder”?
A diagnostic label for people with multiple medically explained symptoms
What does competition of cues mean?
Individuals can only process finite amount of information at any given time - internal sensory and external environmental cues compete for attention
Which ways do emotion interact with cognition?
> Fear of being ill - more vigilant to bodily sensations
Physical sensations of anxiety, e.g., sweating, shaking, dry throat, dizzy etc
Physical sensations of depression, e.g., weight/appetite change
How are MUS managed in clinical practice?
Doctors don’t know what to do, so they try:
- Reassurance (effective for 24 hours)
- Referral to secondary care departments. 30-70% no physical pathology
- Symptomatic treatment, e.g., analgesia, antibiotics, antidepressants
What are the consequences of the current medical approach to MUS?
- Excessive investigation and treatment
- Iatrogenesis - e.g., unnecessary treatment can lead to harm caused by healthcare
- Heightened awareness of symptoms
- Lack of explanation causes distress
- Breakdown of therapeutic relationship
How is CBT a psychological approach to managing MUS?
Identifies patients’ interpretations of sensations and beliefs about symptoms and it helps patients to develop alternative models. It promotes behavioural changes which improves symptoms.
Which ways do doctors explain the ‘unexplained’?
- Reject explanations, meaning they deny the reality of symptom and imply an imaginary disorder.
- Colluding explanations, meaning GP sanctions patient’s own explanation
- Empowering explanations, this is a tangible mechanism and is an opportunity for self-management
What are the issues with engaging patients with psychological therapy?
Disenchanted with medical care; Suspicious of MH services; Beliefs that symptoms are caused by disease; Feel symptoms are not believed; Sheer volume of individuals with MUS and limited capacity of CBT-trained therapists
What is reattribution therapy?
An adaptation of CBT to primary care
