Patterns of referral in patients with medically unexplained motor symptoms

Crimlisk, Helen; Bhatia, Kailash P.; Cope, Helen; David, Anthony; Marsden, D.; Ron, María A.

doi:10.1016/s0022-3999(00)00167-7

Cited by 37 publications

(24 citation statements)

References 7 publications

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“…Visual Analogue Scales ranging from 0 'not useful at all' to 10 'very useful', subdivided into three categories (0-4, 4-6, 6-10) a result, many specialists refrain from explaining the symptoms to these patients. Better recognition and more confidence in diagnosing somatoform disorders by neurologists may prevent inadequate care, delay in treatment and overconsumption of health care [8]. Thus, although our study shows that this group of patients benefits from a second opinion or tertiary referral, these referrals may be unnecessary if physicians take extra time to explain somatoform disorders.…”

Section: Discussionmentioning

confidence: 75%

“…The high number of somatoform disorders in our study and number of new diagnoses in this category may reflect the inconsistency of care for these patients in general and specialist practice. Probably, many neurologists are hesitant to inform patients that they have a somatoform disorder, which is time consuming and often difficult, since many patients with somatoform disorders are convinced to have an organic disease [6,8] Fig. 1 a Opinion of neurologist concerning medical relevance.…”

Section: Discussionmentioning

confidence: 99%

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Second opinions and tertiary referrals in neurology

et al. 2008

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Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Second opinions and tertiary referrals in neurology

et al. 2008

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“…Patients describe feeling rejected and unheard [13] and worry they are viewed as fraudulent [14] to the extent that they may disengage from health services [15], or seek alternative opinions [16]. Their rejection of the diagnosis is a key prognostic factor [17].…”

Section: Accepted M Manuscriptmentioning

confidence: 99%

What should we say to patients with unexplained neurological symptoms? How explanation affects offence

Ding

Kanaan

2016

Journal of Psychosomatic Research

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Please cite this article as: Ding Juen Mei, Kanaan Richard Antony Alexander, What should we say to patients with unexplained neurological symptoms? How explanation affects offence, Journal of Psychosomatic Research (2016Research ( ), doi:10.1016Research ( /j.jpsychores.2016 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Tables: 3 Figures: 3 References: 27 A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT ABSTRACTObjectives: Unexplained neurological symptoms (UNS) are common presentations in neurology but there is no consensus as to what they should be called. This is important, as patient acceptance is a predictor of outcome and there is evidence that patients are unhappy with the terms used. Patient understanding of these terms may be limited, however, and, once explained, the terms may seem more or less offensive. We sought to elicit patients" views of 7 frequently used terms for UNS, and whether these changed once definitions were provided.Methods: 185 participants were recruited from a medical outpatients" waiting area. They were given questionnaires outlining a hypothetical situation of leg weakness, with 7 possible labels.Participants were asked whether they endorsed 4 connotations for each label and the "number needed to offend" (NNO) calculated, before and after definitions were given.

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“…Die Rate von Fehldiagnosen lag bei über 25%. Sie wird in jün-geren Studien jedoch als bedeutend niedriger eingeschätzt [9,10] …”

Section: Differenzialdiagnoseunclassified

“…Auch wenn die Krankheit schnell erkannt wird, werden Patienten vom Allgemeinarzt (oder auf eigene Initiative wegen Zweifeln an der Diagnose) etliche Male bei weiteren Fachärzten vorgestellt. In einer retrospektiven Studie an 64 Patienten 6 Jahre nach Diagnose einer Konversionsstörung wurde beobachtet, dass nur in 60% eine psychiatrisch/psychotherapeutische Behandlung begonnen wurde [10].…”

Section: Therapieunclassified

Conversion disorders

Schönfeldt‐Lecuona¹,

Connemann²,

Höse³

et al. 2004

Nervenarzt

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The two international systems of diagnostic classification for psychiatric disorders, ICD-10 and DSM-IV, differentiate a variety of disorders or syndromes characterized by the common feature of the presence of physical symptoms without "organic correlate." Conversion disorders (DSM) or dissociative disorders (ICD) are historically related to the concept of hysteria. Like psychoanalytical theories, the DSM and ICD refer to a psychological conflict preceding the onset of physical symptoms, although in a purely descriptive manner. The etiology of these disorders is still not very well understood. This article summarizes present knowledge from clinical and epidemiological studies. Functional neuroimaging studies on conversion disorders, although still very rare, allow testing of hypotheses about neuronal mechanisms. Such studies question the traditional and often misinterpreted dichotomy between organic and psychogenic diseases.

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Patterns of referral in patients with medically unexplained motor symptoms

Cited by 37 publications

References 7 publications

Second opinions and tertiary referrals in neurology

Second opinions and tertiary referrals in neurology

What should we say to patients with unexplained neurological symptoms? How explanation affects offence

Conversion disorders

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