Presentation on theme: "Medically Unexplained Physical Symptoms for GP trainees Dr Sarah Burlinson Consultant in Liaison Psychiatry Royal Oldham Hospital Pennine Care NHS Trust."— Presentation transcript:
Medically Unexplained Physical Symptoms for GP trainees Dr Sarah Burlinson Consultant in Liaison Psychiatry Royal Oldham Hospital Pennine Care NHS Trust
Aims Appreciate how common these are Increase assessment skills Recognise associated psychiatric diagnoses Strategies to manage in primary care Simple scenarios Complex patients
List 8 common physical symptoms which are often medically unexplained?
What % of these are found to have a medical cause when followed up for 1 year? 76%-100% 51%-75% 25%-50% 0-24%
These common symptoms….. At 1 year: only 10-15% due to organic cause (Katon 1998) Prompt < 50% of primary care consultations 10% of patients with ‘MUS’ diagnosed with organic disease at 18 months FU (Morriss 2007)
How common are MUS in NP in Primary Care? 76%-100% 51%-75% 25%-50% 0-24% Are they more or less common in Secondary Care OP clinics?
How common are MUS? Primary Care 20% of new GP consultations 1/3 of these persist Secondary Care 25-50% of new medical out-patients Chronic MUPS/ somatisation disorder % community prevalence
Impact of MUS Patients Psychological Physical Social Staff Frustration/ demoralisation ‘Heart sink’ patient Resources Investigations/ admissions/clinics/medication
Somatisation Disorder >2 years multiple and variable medically unexplained physical symptoms Preoccupation & distress Repeated consultations Refusal to accept medical reassurance > 6 from a list Undifferentiated SD & Somatoform Pain Disorder
Hypochondriacal disorder Persistent belief of the presence of a serious disease Preoccupation/ distress/ disability Refusal to accept medical reassurance
Dissociative Disorder (Hysteria) Sudden loss of function Temporal link with stressful event/ situation No medical explanation
Delusional Disorder Single or set of related delusions Hallucinations/ thought disorder rare Relatively well functioning Themes include Hypochondriacal Erotomanic Persecutory
Factitious Disorder Intentional feigning of symptoms Aim is to receive medical care Often marked personality disorder & interpersonal difficulties (Malingering- different motive e.g: Financial Avoid court/ conscription)
Management Case note review Clinical assessment and Ix Will simple explanation work? Is this depression/ anxiety? Is there another psychiatric disorder?
Management Reattribution Acknowledging reality of symptoms Feeling understood Making the link Antidepressant May reduce symptoms even if not depressed Psychotherapy Cognitive behaviour therapy Psychodynamic interpersonal therapy