Neurology out-patients with symptoms unexplained by disease: illness beliefs and financial benefits predict 1-year outcome

Abstract

Background. Patients whose symptoms are ' unexplained by disease ' often have a poor symptomatic outcome after specialist consultation, but we know little about which patient factors predict this. We therefore aimed to determine predictors of poor subjective outcome for new neurology out-patients with symptoms unexplained by disease 1 year after the initial consultation.Method. The Scottish Neurological Symptom Study was a 1-year prospective cohort study of patients referred to secondary care National Health Service neurology clinics in Scotland (UK). Patients were included if the neurologist rated their symptoms as ' not at all ' or only ' somewhat explained ' by organic disease. Patient-rated change in health was rated on a five-point Clinical Global Improvement (CGI) scale (' much better ' to ' much worse ') 1 year later.Results. The 12-month outcome data were available on 716 of 1144 patients (63 %). Poor outcome on the CGI (' unchanged ', ' worse ' or ' much worse ') was reported by 482 (67 %) out of 716 patients. The only strong independent baseline predictors were patients' beliefs [expectation of non-recovery (odds ratio [OR] 2.04, 95 % confidence interval [CI] 1.40-2.96), non-attribution of symptoms to psychological factors (OR 2.22, 95 % CI 1.51-3.26)] and the receipt of illness-related financial benefits (OR 2.30,. Together, these factors predicted 13 % of the variance in outcome.Conclusions. Of the patients, two-thirds had a poor outcome at 1 year. Illness beliefs and financial benefits are more useful in predicting poor outcome than the number of symptoms, disability and distress.

Functional movement disorders

“…[89]. Receiving healthrelated benefits has a negative effect on outcome [90]. Longer duration of symptoms seems to correlate with negative outcome [91].…”

Understanding patient perceptions following a psycho-educational intervention for psychogenic non-epileptic seizures

“…For instance, studies in epilepsy have demonstrated that illness perceptions are related to clinically important behaviours (such as medical adherence) and explain a greater proportion of the variance of anxiety measures and people's ability to cope with their disorder than seizurerelated variables [23 24 25 26]. Illness beliefs have also been shown to predict outcome in patients with medically unexplained neurological symptoms [27]. Patients' illness perceptions are a key feature of the self-regulation model.…”

Multidisciplinary Inpatient Programme for Functional Neurological Symptoms: A Prospective Study Assessing Efficacy and Predictors of Good Outcome

“…These are: timeline acute/chronic-the belief about the chronicity of illness, consequence-the expected adverse effects and outcomes; timeline cyclical-the day to day variability of symptoms; personal control-the degree to which symptoms can be self-controlled; treatment control-the degree to which symptoms can be helped with treatment; illness coherence-understanding about symptoms; emotional representations-degree of distress caused by symptoms. Each question is answered on a 1-5 Likert scale, and subscores for each of domain are calculated [22].…”