Abstract
Aims and method Service utilisation and clinical outcomes of a newly developed specialist primary-secondary care liaison clinic for patients with medically unexplained symptoms (MUS) were evaluated in a cross-sectional and feasibility pilot study. The impact of body-oriented psychological therapy (BOPT) was explored in a small cohort of patients with an identified somatoform disorder.Results Of 147 consecutive referrals, 113 patients engaged with the assessment process. Of patients with MUS, 42% (n = 45) had a primary diagnosis of somatoform disorder, 36% (n = 38) depressive disorder, and depressive symptoms (even subsyndromal) mediated the effect of somatic symptoms. A marked variation of presenting complaints and service utilisation across ethnic groups was noted. A significant reduction in somatic symptom levels and service utilisation was achieved for patients undergoing BOPT.Clinical implications A high proportion of patients with MUS have undiagnosed and therefore untreated mental disorders. New and locally derived collaborative care models of active engagement in primary care settings are required. Patients with somatoform disorder may benefit from BOPT; this requires further evaluation in adequately powered clinical trials.
Highlights
Patients with somatoform disorder may benefit from body-oriented psychological therapy (BOPT); this requires further evaluation in adequately powered clinical trials
Similar ethnic differences in expression of musculoskeletal pain have previously been reported in UK samples[22] and this may be regarded as an unspecific but meaningful indicator for the prevalence of the somatoform syndrome in this group
More than a third of patients assessed for medically unexplained symptoms (MUS) had a significant depressive disorder with somatic symptoms in the context of this primary diagnosis
Summary
A total of 147 patients were referred to the clinic. Most referrals came from GPs (n = 65, 44.2%) and fellow mental health professionals (n = 59, 40.1%). Attendance for assessment did not vary significantly among different ethnic groups Those patients who did not attend the MUS clinic had significantly lower attendance rates at their GP practice (but no higher A&E attendance rates or specialist referral rates) in the previous year: mean = 7.8, s.d. There was no significant difference between patients attending/not attending in respect of age, gender, employment status, source of referral, presenting complaint, PHQ-15 scores, or with regard to a history of physical or mental disorder. Out of the group of 41 patients identified with a primary diagnosis of somatoform disorder and referred for BOPT, only 12 (29.3%) participated in the assessment and treatment process (3 males (7.3%) and 9 females (22%)).
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