Evaluation and Management of Medically Unexplained Physical Symptoms

Richardson, Ralph D.; Engel, Charles C.

doi:10.1097/01.nrl.0000106921.76055.24

Cited by 99 publications

(71 citation statements)

References 66 publications

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“…If there are positive changes in health, then a qualitative study can clarify the potential reasons for these changes. It is also challenging to identify any one treatment that may have had an impact on the improvement in health symptoms (Rundall et al 2002;Richardson and Engel 2004). It may be a combination of treatments in addition to education and lifestyle changes that is impacting the health of an individual.…”

Section: Discussionmentioning

confidence: 99%

Measuring health outcomes of a multidisciplinary care approach in individuals with chronic environmental conditions using an abbreviated symptoms questionnaire

Fox

Sampalli

Fox³

2008

JMDH

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Abstract:The Nova Scotia Environmental Health Centre is a treatment facility for individuals with chronic environmental conditions such as multiple chemical sensitivity, chronic fatigue syndrome, fi bromyalgia, chronic respiratory conditions and in some cases chronic pain. The premise of care is to provide a patient-centred multidisciplinary care approach leading to selfmanagement strategies. In order to measure the outcome of the treatment in these complex problems, with overlapping diagnoses, symptoms in many body systems and suspected environmental triggers, a detailed symptoms questionnaire was developed specifi cally for this patient population and validated. Results from a pilot study in which an abbreviated symptoms questionnaire based on the top reported symptoms captured in previous research was used to measure the effi cacy of a multidisciplinary care approach in individuals with multiple chemical sensitivity are presented in this paper. The purpose of this study was to examine the extent, type and patterns of changes over time in the top reported symptoms with treatment measured using the abbreviated symptoms questionnaire. A total of 183 active and 109 discharged patients participated in the study where the health status was measured at different time periods of follow up since the commencement of treatment at the Centre. The fi ndings from this study were successful in generating an initial picture of the nature and type of changes in these symptoms. For instance, symptoms such as diffi culty concentrating, sinus conditions and tiredness showed early improvement, within the fi rst 6 months of being in treatment, while others, such as fatigue, hoarseness or loss of voice, took longer while others showed inconsistent changes warranting further enquiry. A controlled longitudinal study is planned to confi rm the fi ndings of the pilot study.

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Section: Discussionmentioning

confidence: 99%

Measuring health outcomes of a multidisciplinary care approach in individuals with chronic environmental conditions using an abbreviated symptoms questionnaire

Fox

Sampalli

Fox³

2008

JMDH

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“…Olguların %4'ten fazlası çok sayıda, süreğen, açıklanamayan belirti mevcut olup, yıl içinde bu belirtilerin tekrarladığından yakınmışlardır. [24,25] Kroenke ve arkadaşları birinci basamak ve dahiliye bölümüne gerçekleştiri-len 1000 başvuruyu 3 yıl süre ile takip etmişler ve 14 yaygın belirtiye ulaşmış-lardır. Bu yaygın belirtilerden en az birine sahip olgular %38 iken, sadece %16'sında organik bir etken saptanmış, semptomatik hastalar ortalama 11 ay süre ile izlenmişler ve %47'sinin belirtilerinin devam ettiği gözlenmiştir.…”

Section: Epidemiyolojiunclassified

“…Mantıklı ve etik yaklaşım, etyolojik heterojeniteyi, orta düzeyde tıbbi belirsizliği klinisyen göz önünde bulundurmak ve gerçeği ortaya çıkarıcı, geçerli, hastanın görüşünü de iyi bir iletişimle değerlendirerek, olası tıbben açıklanamayan sendromların tedavi planını yürürlüğe koymalı-dır. [24] Geçmiş Tıbbi Öykünün Alınması Son 5 yıllık muayene sayısı, hekim sayısı, cerrahi müdahaleler ve endikasyonları, kronik ağrı ve psikososyal problemler not edilmelidir. Hastanın tanımla-maları dinlenmelidir; kronik tıbben açıklanamayan sendromlu hastaların önceki hekimi ile ilişkisi, hekimin hastayı abartılı şekilde hor görmesi, gereğinden fazla iyimser yaklaşım gibi konular yeni hekimle olan ilişkisini etkileyecektir.…”

Section: Tıbben Açıklanmayan Sendromlarda Tanısal Yaklaşımunclassified

“…Çekirdek ailedeki kronik hastalık ya da fizik düşkünlük varlığı hastanın bunu öğrenmiş olabileceğine işaret edebilir. [24] Laboratuvar ve Tanısal Yaklaşımlar Laboratuvar testleri, tıbben açıklanamayan sendromların tanınmasında zayıf ama önemlidir. Yanlış pozitif sonuçlar, istenecek test sayısını arttırır.…”

Section: Tıbben Açıklanmayan Sendromlarda Tanısal Yaklaşımunclassified

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Psychiatric Aspects of Medically Unexplained Symptoms

Kandemir¹,

Ak²

2013

Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychia

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ÖZETBedensel belirtileri için tıbbi açıklama bulunamayan hastalar genel tıp uygulamasında oldukça yaygındırlar. Bu hastalar, tüm sağlık hizmeti basmaklarını sıkça kullanırlar. Bu durum kendilerine sağlık hizmeti sunan hekimlerinde hayal kırıklığı yarattığı gibi hastalar da aldıkları tıbbi bakımdan pek memnun olmazlar. Tüm dünyada ve farklı kültürel gruplar arasında bedensel belirtiler toplumsal sorunların ve duygusal sıkıntının en yaygın bireysel ifadeleridir. Tıbben açıklanamayan belirtilere hasta grubunda depresyon ve anksiyete başta olmak üzere diğer psikiyatrik durumlar eşlik etmektedir. Bu gözden geçirme yazısında tıbben açıklanamayan belirtilere ve psikiyatrik belirtiler arasındaki ilişki incelenmesi amaçlanmıştır. Anahtar Sözcükler: Tıbben açıklanamayan belirti, anksiyete,depresyon. ABSTRACTThe patients with medically unexplained symptoms for their physical symptoms are generally prevalent in the primary care consultation. Such patient, frequently consume primary and secondary healthcare services and it is a situation that disappointed medical stuff and also patients are uncomfortable for medical services. Physical symptoms commonly are regarded as products of emotional and social problems between different cultural groups and over the world. Generally, depression and anxiety and other psychiatric conditions accompany to patient group with medically unexplained symptoms. The aim of this review article is to investigate the relationship between medically unexplained symptoms and psychiatric symptoms.

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“…They have been defined [3] as ‘physical symptoms that prompt the sufferer to seek healthcare but remain unexplained after an appropriate medical evaluation’. The MUS are also common, affecting as many as one third of people seeking medical care [4].…”

Section: Introductionmentioning

confidence: 99%

Developmental Influences on Medically Unexplained Symptoms

Buffington

2009

Psychother Psychosom

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Background: Medically unexplained (or ‘functional’) symptoms (MUS) are physical symptoms that prompt the sufferer to seek healthcare but remain unexplained after an appropriate medical evaluation. Examples of MUS also occur in veterinary medicine. For example, domestic cats suffer a syndrome comparable to interstitial cystitis, a chronic pelvic pain syndrome of humans. Method: Review of current evidence suggests the hypothesis that developmental factors may play a role in some cases of MUS. Maternal perception of a threatening environment may be transmitted to the fetus when hormones cross the placenta and affect fetal physiology, effectively ‘programming’ the fetal stress response system and associated behaviors toward enhanced vigilance. After birth, intense stress responses in the individual may result in similar vulnerability, which may be unmasked by subsequent stressors. Results: Epigenetic modulation of gene expression (EMGEX) appears to play a central role in creation of this ‘survival phenotype’. The recent development of techniques to identify the presence of EMGEX provides new tools to investigate these questions, and drugs and other interventions that may reverse EMGEX are also under active investigation. Conclusion: Viewing MUS from the perspective of underlying developmental influences involving EMGEX that affect function of a variety of organs based on familial (genetic and environmental) predispositions rather than from the traditional viewpoint of isolated organ-originating diseases has at least two important implications: it provides a parsimonious explanation for findings heretofore difficult to reconcile, and it opens whole new areas of investigation into causes and treatments for this class of disorders.

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Evaluation and Management of Medically Unexplained Physical Symptoms

Cited by 99 publications

References 66 publications

Measuring health outcomes of a multidisciplinary care approach in individuals with chronic environmental conditions using an abbreviated symptoms questionnaire

Measuring health outcomes of a multidisciplinary care approach in individuals with chronic environmental conditions using an abbreviated symptoms questionnaire

Psychiatric Aspects of Medically Unexplained Symptoms

Developmental Influences on Medically Unexplained Symptoms

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