Hospitalized Patients with Medically Unexplained Physical Symptoms: Clinical Context and Economic Costs of Healthcare Management.

Poloni Poloni,Caselli Caselli,Isella Isella,Ielmini Ielmini,Bellini Bellini,Di Sarno Di Sarno,Mattia Mattia,Callegari Callegari,De Leo De Leo

doi:10.3390/bs9070080

Poloni Poloni, Caselli Caselli + Show 7 more

Open Access

https://doi.org/10.3390/bs9070080

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Abstract

Medically Unexplained Physical Symptoms (MUPS) are physical symptoms without a medical explanation. This study collected data from hospitalized patients presenting MUPS, aiming to draw a clinical and socio-demographic profile of patients with MUPS, to explore psychopathological correlations of Somatic Symptoms Disorder (SSD) diagnosis, and to estimate economic costs related to hospital management for MUPS. The cross-sectional study consisted in the evaluation of data referring to hospitalized patients admitted between 2008 and 2018 in a teaching hospital in Northern Italy. A total of 273 patients presenting MUPS have been hospitalized. The sample showed a prevalence of female, married and employed patients. The most frequent wards involved are Neurology, Internal Medicine and Short Unit Stay. The most common symptoms found are headache, pain, syncope and vertigo. There is no evidence that a history of medical disease is associated with a diagnosis of SSD. A personality disorder diagnosis in patients with MUPS was associated with increased probability of having a diagnosis of SSD. A marginally significant positive association emerged with anxiety disorders, but not with depressive disorder. The overall estimated cost of hospitalization for patients with MUPS is 475′409.73 €. The study provides the investigation of a large number of patients with MUPS and a financial estimate of related hospitalization costs.

Highlights

Unexplained physical symptoms (MUPS) are physical symptoms without a medical explanation
Data from patients fulfilled the following inclusion criteria: age > 18; be an inpatient in the teaching hospital; present symptoms with apparently no medical cause, or whose cause remains unclear (Medically Unexplained Physical Symptoms); have a diagnosis of Somatoform Disorder or Somatic Symptoms Disorder and related disorders by non-specialists; present all test clear
Clinical and diagnostic features of somatoform disorder have been debated by authors over the years, without reaching a consensus on which one could be the best and more useful diagnostic classifications

Summary

Introduction

Unexplained physical symptoms (MUPS) are physical symptoms without a medical explanation. In DSM-5, the somatic symptom and related disorders chapter has a limited clinical utility and presents some ambiguity [8,9,10] This diagnostic classification reduces the importance of medically unexplained symptoms and emphasizes the psychological criteria and the functional impairment experimented by the patient. The present study provided for the collection of data from hospitalized patients presenting medically unexplained physical symptoms (MUPS) referring to different hospital wards, aiming at the following outcomes: (1) to draw a clinical and socio-demographic profile of hospitalized patients with MUPS; (2) to explore psychopathological correlations of SSD diagnosis; (3) to estimate economic costs related to healthcare utilization of MUPS

Materials and Methods

Socio-Demographics and Clinics

Psychopathological Correlates of SSD Diagnosis

Healthcare Management Costs

Discussion