Abstract
Empirical studies on the clinical characteristics of older persons with medically unexplained symptoms are limited to uncontrolled pilot studies. Therefore, we aim to examine the psychiatric characteristics of older patients with medically unexplained symptoms (MUS) compared to older patients with medically explained symptoms (MES), also across healthcare settings. A case-control study including 118 older patients with MUS and 154 older patients with MES. To include patients with various developmental and severity stages, patients with MUS were recruited in the community (n= 12), primary care (n= 77), and specialized healthcare (n= 29). Psychopathology was assessed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria (Mini-International Neuropsychiatric Interview) and by dimensional measures (e.g., psychological distress, hypochondriasis, and depressive symptoms). A total of 69/118 (58.5%) patients with MUS met the criteria for a somatoform disorder according to DSM-IV-TR criteria, with the highest proportion among patients recruited in specialized healthcare settings (p= 0.008). Patients with MUS had a higher level of psychological distress and hypochondriasis compared to patients with MES. Although psychiatric disorders (beyond somatoform disorders) were more frequently found among patients with MUS compared to patients with MES (42.4 vs. 24.8%, p= 0.008), this difference disappeared when adjusted for age, sex, and level of education (odds ratio = 1.7 [95% confidence interval: 1.0-3.0], p= 0.070). Although psychological distress is significantly higher among older patients with MUS compared to those with MES, psychiatric comorbidity rates hardly differ between both patient groups. Therefore, treatment of MUS in later life should primarily focus on reducing psychological distress, irrespective of the healthcare setting patients are treated in.
Highlights
Unexplained symptoms (MUS) are defined as “physical symptoms that have existed for more than several weeks and for which adequate medical examination has not revealed any condition that sufficiently explains the symptoms” [1]
The Older Persons with Medically Unexplained Symptoms (OPUS) study has been designed as a case–control study including a total of 272 older patients suffering from actual physical symptoms (118 cases suffering from medically unexplained symptoms (MUS), 154 controls suffering from medically explained symptoms (MES))
Older patients with MUS had, as expected, higher levels of depressive symptoms, anxiety symptoms, hypochondriasis, and psychoticism compared to older patients with MES, but this was not reflected by a significantly higher prevalence of psychiatric disorders according to DSM-IV-TR criteria
Summary
Unexplained symptoms (MUS) are defined as “physical symptoms that have existed for more than several weeks and for which adequate medical examination has not revealed any condition that sufficiently explains the symptoms” [1]. We aim to examine the psychiatric characteristics of older patients with medically unexplained symptoms (MUS) compared to older patients with medically explained symptoms (MES), across healthcare settings. Patients with MUS had a higher level of psychological distress and hypochondriasis compared to patients with MES. Psychiatric disorders (beyond somatoform disorders) were more frequently found among patients with MUS compared to patients with MES (42.4 vs 24.8%, p = 0.008), this difference disappeared when adjusted for age, sex, and level of education (odds ratio = 1.7 [95% confidence interval: 1.0–3.0], p = 0.070). Psychological distress is significantly higher among older patients with MUS compared to those with MES, psychiatric comorbidity rates hardly differ between both patient groups. Treatment of MUS in later life should primarily focus on reducing psychological distress, irrespective of the healthcare setting patients are treated in
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