Medically Unexplained Symptoms Research Articles

Intensive short-term dynamic psychotherapy for irritable bowel syndrome: a randomized controlled trial examining improvements in emotion regulation, defense mechanisms, quality of life, and IBS symptoms.

Studies have provided evidence for the effectiveness of intensive short-term dynamic psychotherapy (ISTDP) in treating medically unexplained symptoms (MUS). This study aimed to examine the effectiveness of ISTDP on individuals living with irritable bowel syndrome (IBS) in terms of, emotion regulation (ER) abilities, defense mechanisms, quality of life (QOL), and IBS symptoms. A total of 30 patients diagnosed with IBS were recruited and randomly assigned to either the intervention (n = 15) or control (n = 15) group. Pre- and post-treatment assessments were conducted, along with a follow-up assessment after ten weeks. Repeated measures analyses of variance were employed to analyze the data. The findings revealed that ISTDP led to significant improvements in ER, defense mechanisms, and QOL, as well as a reduction in the severity and frequency of IBS symptoms. These results provide further support for the efficacy of ISTDP as a treatment modality for individuals with IBS.

Medically Unexplained Symptoms Are Linked to Chronic Inflammatory Diseases: Is There a Role for Frontal Cerebral Blood Oxygen Content?

Patients often go to the physician with medically unexplained symptoms (MUS). MUS can be autonomic nervous system-related "unspecific" symptoms, such as palpitations, heart rhythm alterations, temperature dysregulation (hand, feet), anxiety, or depressive manifestations, fatigue, somnolence, nausea, hyperalgesia with varying pains and aches, dizziness, etc. Methods: In this real-world study, we investigated MUS in a cohort of unselected outpatients from general practitioners in Italy. It was our aim to increase the understanding of MUS by using principal component analyses to identify any subcategories of MUS and to check a role of chronic inflammatory diseases. Additionally, we studied cerebral blood oxygen (rCBO2) and associations with MUS and chronic inflammatory disease. Participants included 1,597 subjects (50.6 ± 0.4 years, 65%/35% women/men). According to ICD-10 codes, 137 subjects had chronic inflammatory diseases. MUS were checked by a questionnaire with a numeric rating scale and cerebral blood flow with optical techniques. The analyses of men and women were stratified. Psychological symptom severity was higher in the inflamed compared to the non-inflamed group (fatigue, insomnia in women and men; recent mood changes, daytime sleepiness, anxiety, apathy, cold hands only in women; abnormal appetite and heart rhythm problems only in men). Principal component analysis with MUS provided new subcategories: brain symptoms, gut symptoms, and unspecific symptoms. Brain and gut symptoms were higher in inflamed women and men. Chronic inflammatory diseases and pain were tightly interrelated in men and women (p < 0.0001). In women, not in men, average frontal rCBO2 content was higher in inflamed compared to non-inflamed subjects. In men, not in women, individuals with pain demonstrated a lower average frontal rCBO2 content compared to pain-free men. MUS did not relate to rCBO2 parameters. This study shows close relationships between MUS and chronic inflammatory diseases but not between MUS and rCBO2 parameters.

30 Socially Responsible Neuropsychology (SRN) in Action: The Role of Neuropsychology in Migraine Care Among Bilingual Latina/o Patients

Objective:Migraine is one of the leading causes of disability worldwide and a recognized contributor to health disparities with public health implications. Although migraine is a highly prevalent neurological condition, research on the cognitive manifestations of migraines is inconsistent. Studies have confirmed neurocognitive compromise during the presence of a migraine attack, with it’s onset and frequency being associated with greater cognitive decline. Research on the cognitive implications of migraines in underserved communities is scarce. The American Migraine Prevalence and Prevention Study (2015) found that the prevalence of chronic migraines was the highest amongst Hispanic females compared to White females. Latina/os are 50% less likely to receive a migraine diagnosis and adequate headache medication when compared to non-Hispanic White patients. Latina women were more likely to report somatic symptoms than White and African American participants (F=8.96; p>0.001) (Liefland et al., 2014). Somatoform disorders are often diagnosed amongst Latina/os to account for medical unexplained symptoms, and if misdiagnosed can be stigmatizing and detrimental to treatment. We illustrate the critical role that neuropsychologists play by utilizing Socially Responsible Neuropsychology (SRN), a theoretical framework that promotes equitable and precise neuropsychological care to reduce misdiagnosis, elucidate cognitive implications, and address the complex medical needs of Latina/o/ patients. Given the limited literature on migraines and neurocognitive functioning, our objective is to present two case studies to illustrate the neuropsychological implications among bilingual Latina/o with chronic migraines.Participants and Methods:Two highly educated Latina/o women, ages 39 and 41 years old, with chronic migraines, cognitive decline, diagnoses and a history of somatization symptoms. The onset of symptoms was gradual, worsening in intensity and frequency, along with notable motor symptoms (e.g., paralysis, weakness, numbness, bilateral tremors), photophobia, and phonophobia. Their cognitive complaints were conceptualized as part of a somatoform presentation by their providers.Results:The SRN model guided clinical decision-making to establish reliable normative anchors to identify relative impairment compared to premorbid estimates. Testing was completed in English after establishing language dominance via English and Spanish measures of verbal fluency. Cognitive profiles identified declines in attention, processing speed, language, perceptual reasoning, visual memory, executive functioning, motor functioning, and notable decline in their functioning over several years. The neuropsychological profile discounted the presence of a somatoform disorder. One case was diagnosed with an Unspecified Mild Neurocognitive Disorder, while the other case met criteria for a Major Neurocognitive Disorder due to Multiple Etiologies (i.e., vascular contribution, migraines, history of other contributions- choking episode).Conclusions:Given the decline in each profile, it was hypothesized that the patients’ utilization of compensatory strategies and higher education may have masked the onset of symptoms. These complex cases highlight the need for comprehensive neuropsychological evaluations that are culturally and linguistically responsive to boost the sensitivity of accurate diagnosis. The ability to objectively capture neurocognitive decline offers a unique opportunity to enhance treatment, which would have otherwise remained undetected and untreated. The SRN model enhanced diagnostic considerations, treatment planning, and allowed for advocacy strategies to improve the quality of life, and access to culturally/linguistically appropriate resources.

‘She thought the same way I that I thought:’ a qualitative study of patient-provider concordance among Gulf War Veterans with Gulf War Illness

Objective: Medically unexplained symptoms (MUS), such as chronic fatigue syndrome, irritable bowel syndrome, and Gulf War Illness (GWI), are difficult to treat. Concordance—shared understanding between patient and provider about illness causes, course, and treatment—is an essential component of high-quality care for people with MUS. This qualitative paper focuses on the experiences of United States military Veterans living with GWI who have endured unique healthcare challenges. Methods & Measures: Qualitative interviews were conducted with 31 Veterans with GWI to explore factors that contribute to and detract from concordance with their Veteran Affairs (VA) healthcare providers. In addition to being seen by VA primary care, over half of participants also sought care at a War Related Illness and Injury Study Center, which specializes in post-deployment health. Deductive and inductive codes were used to organize the data, and themes were identified through iterative review of coded data. Results: Major themes associated with patient-provider concordance included validation of illness experiences, perceived provider expertise in GWI/MUS, and trust in providers. Invalidation, low provider expertise, and distrust detracted from concordance. Conclusion: These findings suggest providers can foster concordance with MUS patients by legitimizing patients’ experiences, communicating knowledge about MUS, and establishing trust.

What initiates chemical intolerance? Findings from a large population-based survey of U.S. adults

BackgroundWorldwide observations point to a two-stage theory of disease called Toxicant-Induced Loss of Tolerance (TILT): Stage I, Initiation by an acute high-level or repeated lower-level chemical exposures, followed by Stage II, Triggering of multisystem symptoms by previously tolerated, structurally diverse chemical inhalants, foods/food additives and drugs. Until recently, there was no known biological mechanism that could explain these observations. In 2021, we published a plausible and researchable two-stage biomechanism for TILT involving mast cells: Stage I, Initiation via mast cell sensitization; Stage II, Triggering of mast cell degranulation by previously tolerated exposures, resulting in the release of thousands of mediators, including histamine and a host of inflammatory molecules. The objective of this study was to identify common TILT initiators.MethodsA randomized, population-based sample of 10,981 U.S. adults responded to a survey which included items concerning medical diagnoses, personal exposures, antibiotic use, and several possible initiators of Chemical Intolerance (CI). CI was assessed using the internationally validated Quick Environmental Exposure and Sensitivity Inventory (QEESI). Participants identified as chemically intolerant were asked to recall when their intolerances began and what they felt had initiated their condition.ResultsTwenty percent met QEESI criteria for TILT, approximately half of whom identified one or more initiating exposures. Initiators in order of frequency were mold (15.6%), pesticides (11.5%), remodeling/new construction (10.7%), medical/surgical procedures (11.3%), fires/combustion products (6.4%), and implants (1.6%). Protracted antibiotic use for infections involving the prostate, skin, tonsils, gastrointestinal tract, and sinuses were strongly associated with TILT/CI (OR > 2).DiscussionParticipants identified two broad classes of TILT initiators: 1) fossil fuel-derived toxicants (i.e., from coal, oil, natural gas), their combustion products, and/or synthetic organic chemical derivatives, e.g., pesticides, implants, drugs/antibiotics, volatile organic compounds (VOCs); and 2) biogenic toxicants, e.g., particles and VOCs from mold or algal blooms. One in four primary care patients suffers from Medically Unexplained Symptoms (MUS). Doctors in primary care, neurology, psychiatry, psychology, occupational medicine, and allergy/immunology would be well-advised to include TILT in their differential diagnosis of patients with so-called MUS. Because 20% of U.S. adults meet QEESI criteria for CI, the role of contemporary exposures in initiating and exacerbating these conditions via mast cells needs our immediate attention. There is a concomitant need for policies and practices that reduce initiating exposures as well as ubiquitous and often unavoidable triggers such as fragranced personal care, cleaning, and laundry products in multi-occupant housing, workplaces, medical settings, schools, places of worship, and all public buildings—literally anywhere air is shared. Fossil fuels are assaulting humans and other animal species both from within via mast cell sensitization, and from without via climate change.

Self-reported quantity and quality of sleep in children and adolescents with a chronic condition compared to healthy controls

To assess self-reported quantity and quality of sleep in Dutch children with a chronic condition compared to healthy controls and to the recommended hours of sleep for youth. Sleep quantity and quality were analyzed in children with a chronic condition (cystic fibrosis, chronic kidney disease, congenital heart disease, (auto-)immune disease, and medically unexplained symptoms (MUS); n = 291; 15 ± 3.1 years, 63% female. A subset of 171 children with a chronic condition were matched to healthy controls using Propensity Score matching, based on age and sex, ratio 1:4. Self-reported sleep quantity and quality were assessed with established questionnaires. Children with MUS were analyzed separately to distinguish between chronic conditions with and without an identified pathophysiological cause. Generally, children with a chronic condition met the recommended amount of sleep, however 22% reported poor sleep quality. No significant differences in sleep quantity and quality were found between the diagnosis groups. Children with a chronic condition and with MUS slept significantly more than healthy controls at ages 13, 15, and 16. Both at primary and secondary school, poor sleep quality was least frequent reported in children with a chronic condition and most often reported in children with MUS.  Conclusion: Overall, children with chronic conditions, including MUS, met the recommended hours of sleep for youth, and slept more than healthy controls. However, it is important to obtain a better understanding of why a substantial subset of children with chronic conditions, mostly children with MUS, still perceived their sleep quality as poor.What is Known:• According to the Consensus statement of the American Academy of Sleep medicine, typically developing children (6 to 12 years) should sleep 9 to 12 h per night, and adolescents (13 to 18 years) should sleep 8 to 10 h per night.• Literature on the optimal quantity and quality of sleep in children with a chronic condition is very limited.What is New:Our findings are important and provide novel insights:• In general, children with a chronic condition sleep according to the recommended hours of sleep.• A substantial subset of children with chronic conditions, perceived their sleep quality as poor. Although this was reported mostly by children with medically unexplained symptoms (MUS), the found poor sleep quality was independent of specific diagnosis.

Process Evaluation of a Motivational Interviewing Intervention in a Social Security Setting: A Qualitative Study among Work-Disabled Patients.

Purpose Return to work (RTW) may be facilitated by motivational interviewing (MI), a counseling style designed to increase motivation towards behavior change. MI's relevance in a RTW context remains however unclear. Exploring how, for whom and in what circumstances MI works is therefore necessary. Methods Eighteen people (29-60years; sick leave > 12weeks) with low back pain (LBP) or medically unexplained symptoms (MUS) participated in a semi-structured interview after one MI consultation. We conducted a realist-informed process evaluation to explore MI's mechanisms of impact, its outcomes and how external factors may influence these. Data were coded using thematic analysis. ResultsMain mechanisms were supporting autonomy, communicating with empathy and respect, facilitating feelings of competence and focusing on RTW solutions instead of hindrances. Competence support was more salient among LBP patients, whereas MUS patients benefited more from empathy and understanding. External factors were mentioned to have impacted MI's effectiveness and/or the further RTW process, being personal (e.g. acceptance of the condition), work-related (e.g. supervisor support) and societal (e.g. possibility of gradual RTW). Conclusions These results stress the importance of self-determination theory's support for autonomy, relatedness and competence, together with a solution-focused approach when stimulating patients' engagement regarding RTW. These mechanisms' instalment during RTW counseling and their long-term impact depends on both personal and system-like external factors. Belgium's social security system's premise, based on control, might actually hinder RTW instead of facilitating it. Further longitudinal research could explore MI's long-term effects as well as its complex interaction with external factors.

M.U.P.S (Medically Unexplained Physical Symptoms): Is the Accurate Diagnosis Necessary for the Rehab-Team?

Background: Physiatrists often treat patients with medically unexplained symptoms (MUPS), which suggest various psychiatric, psychosomatic or physical diagnoses. Some patients are finally diagnosed with somatoform, dissociative or factitious disorders, while some experience psychological factors affecting physical conditions. It happens that patients are admitted to rehabilitative medical facilities without a clear diagnosis. Apparently, there are overlapping symptoms between chronic fatigue syndrome, PTSD (post-traumatic stress disorder), "Gulf War syndrome", fibromyalgia, CRPS, and others.Aims: To assess recognition of medically unexplained physical symptoms (MUPS) by physicians, mostly specialists in physical and rehabilitative medicine are engaged.Methods: All information was collected from scientific database site, and derived from the authors' nearly 50 years of clinical experience.Results: Cognitive-affective disturbance, chronic muscle and joint pain, panic disorder, chronic fatigue syndrome, malingering, and others can be described in the medical literature as unexplained physical symptoms.Conclusions: Treatment should comprise a multidisciplinary-integrative approach, by practitioners from medicine, psychology, allied health professionals and social work. MUPS is not a "non-disease" entity, but rather, an unexplained clinical phenomenon. Patients are entitled to benefit from the rehabilitative medicine model of treatment even if their clinical diagnosis is not accurate or clear.

Understanding Patient-Provider Interaction, Treatment Acceptance, and Outcomes in Medically Unexplained Symptoms.

Medically unexplained symptoms (MUS) is an umbrella term used for chronic and often disabling health symptoms and conditions that remain unexplained after standard medical examinations, testing, and/or appropriate workup. Patients with MUS tend to receive little to no treatment but remain distressed, stigmatized, and disabled by symptoms and iatrogenic factors. A qualitative phenomenological study was conducted to explore daily challenges and psychosocial and iatrogenic factors affecting the management of MUS. The analysis of the interviews revealed that MUS could cause significant distress to patients, impairing their functioning and leading to permanent disability. Conventional healthcare cannot meet the medical needs of these patients and might be a potential source of harm to them. It should be noted that confirmation of conditions associated with clinically significant psychiatric premorbidity was not provided. Inconsistent diagnostic criteria, lack of proper training and research, diagnostic overshadowing, and implicit bias in healthcare professionals can lead to negative patient outcomes and the overuse of alternative or non-evidence-based services. Guidance, practice-based improvement ideas, and suggestions specific to improving patient-provider relationships can be applied to generate positive health effects.

Communication interventions for medically unexplained symptom conditions in general practice: A systematic review and meta-analysis of randomised controlled trials.

Medically unexplained symptoms (MUS) account for 3-50% of all General Practitioner (GP) consultations and are difficult to diagnose due to their unknown aetiology, symptom overlap between conditions, and lack of effective treatment options. MUS patients' and primary care clinicians frequently face challenges during consultations, with GPs reporting difficulty identifying and classifying MUS, whilst patients report stigma and feeling illegitimised by clinicians. Communication interventions have been proposed as a method to facilitate the doctor-patient relationship and aid the management of MUS. This systematic review aims to evaluate the effectiveness of primary care based communication interventions at improving MUS patients' and/or clinician outcomes. Four electronic databases were searched from inception to November 2021. Two researchers independently undertook screening, data extraction and quality appraisal. Given the heterogeneous nature of the studies identified, narrative syntheses were conducted, along with meta-analyses where possible to pool data. 9 papers from 10 Randomised Controlled Trials were included. The included studies displayed considerable risk of bias and poor reporting. Some limited evidence suggests that communication interventions tailored to MUS and not following a pre-specified model (such as reattribution) could improve pain, mental and physical functioning whilst reattribution training may improve clinician confidence treating MUS. However, methodological limitations mean that these findings should be interpreted with caution. A range of interventions for improving communication with MUS patients in primary care have been evaluated. However, the heterogeneous nature of existing evidence and poor study quality mean we cannot conclude whether these interventions are effective. Before considering further randomised controlled trials researchers should focus on developing a new or modified communication intervention for MUS patients and their clinicians. The systematic review was prospectively registered with PROSPERO (registration record CRD42020206437).

The patient experience of medically unexplained symptoms: an existentialist analysis.

This article explores the patient experience of medically unexplained symptoms (MUS) from an existentialist standpoint. Drawing on the work of Jean-Paul Sartre and Simone de Beauvoir, I explore their concepts of existential situation, existential project, authenticity, and praxis. I then analyze the situation of MUS patients in the current cultural and institutional context, elucidating that a lack of explanation for their symptoms puts MUS patients in an existential bind. I illustrate the effects of the experience of MUS on patients' existential projects. Last, I develop an ethical response in the existentialist tradition from the perspective of patients, providers, and society at large. I argue that there is a collective responsibility to foster conditions more conducive to authentic patient well-being and to improve the experience of patients with medically unexplained symptoms.

Differences of medically unexplained symptoms among patients of different ages and sexes in the psychological clinic of a general hospital and the influencing factors of MUS: A cross-sectional study

ObjectiveTo analyse differences in sex, age, depression, insomnia, psychological stress, resilience, and perceived social support among patients with medically unexplained symptoms (MUS) in a psychological clinic of a general hospital, and to explore the influencing factors of MUS.MethodsThis is a cross-sectional study. Seven hundred forty-six first-time patients were assessed with the integrated psychosomatic comprehensive evaluation system (IPS) to evaluate their MUS, depression, insomnia, psychological stress, resilience, and perceived social support. The psychological characteristics were compared with regard to sex and age group (<25 years, low age group; 26–44 years, middle age group; >45 years, high age group). The relationships between age and MUS were explored, and how psychological stress affects MUS was analyzed using the mediator effect model.ResultsDifferent age groups had significant differences in sex, MUS, depression, psychological stress, resilience, and perceived social support. In further pairwise comparison, no significant difference existed in depression, psychological stress, resilience and perceived social support in the middle and low age groups, depression and psychological stress were higher than those in the high age group, resilience and perceived social support were lower than those of the high age group. MUS were higher in the middle age group than in the low age group. No significant difference existed between the two groups and the high age group. Age, severity of MUS, and perceived social support were significantly different between the sexes. Differences in MUS between men and women in different age groups were analyzed using two-factor analysis of variance. It revealed no interaction between sex and different age groups on MUS. The main effect analysis showed that the effects of different age groups on MUS were statistically significant. Based on pairwise comparative analysis, the MUS score in the low age group was lower than that in the middle age group. To clarify a nonlinear relationship between age and MUS, threshold effect analysis was conducted. The results indicated that the piecewise linear regression model could better depict the relationship between age and MUS. The inflection point was at the age of 60 years. Before the age of 60 years, MUS increased with age. No significant correlation existed between age and MUS after the age of 60 years. To understand the influencing factors of MUS, the intermediary effect model was analyzed using MUS as the dependent variable, psychological stress as the independent variable, resilience as mediator variable M1, perceived social support as mediator variable M2, and depression as mediator variable M3. Resilience, perceived social support, and depression had significant mediator effects on the effects of psychological stress on MUS with a total indirect effect of 69.81%.ConclusionThe middle age group had greater MUS than the low age group. Before the age of 60 years, MUS increased with increasing age. Women had more severe MUS than men. Resilience, perceived social support, and depression had significant mediating effects on the effects of perceived stress on MUS. These findings suggest that clinicians should make more comprehensive and detailed evaluations and timely intervention for middle-aged and female patients. Improving psychological resilience and social support can reduce the impact of psychological stress on MUS. Therefore, psychotherapy and multidisciplinary comprehensive treatment are very important for patients is very important for patients.

TIBBİ OLARAK AÇIKLANAMAYAN SEMPTOMLAR(MUS); KISA BİR BAKIŞ

Medikal değerlendirmeyle, organik bir sebebe dayandırılamayan ve en az üç aydır devam eden bu şikayetler, DSM-V’de somatik şikayetlerin MUS ve tıbbi olarak açıklanan semptomlar (MES) olarak gerekli ikiliğe ayrılması önerilmiştir. MUS tanılı hastaların, artmış anksiyete, depresyon ve bozulmuş sosyal fonksiyonları ile belirgin morbiditelerinin olduğu, ayrıca yüksek seviyede sağlık harcamalarına sebep oldukları bilinmektedir. Birinci basamakta MUS prevelansı %3-11 olarak tespit edilmiştir. Semptomlar genelde sırt ağrısı, halsizlik, güçsüzlük hissi, ekstremite ağrıları, uyku bozukluğu ve dispeptik şikayetler şeklindedir ve prognozlarının 5 yıllık periyotta kötüleştiği bilinmektedir. Herhangi bir patolojiyi atlamamak adına bu hastalar, ciddi araştırmalara tabi tutulup gereksiz tetkik ve tedaviye maruz kalabilmektedir. Mezuniyet öncesi ve/veya sonrasında MUS ile ilgili eğitim almış olan doktorların, hastaya yaklaşımı, iletişimi ve hastayı anlamadaki becerisinin daha olumlu olduğu belirtilmiştir. Hastaların yönetimi ile ilgili ortak bir tutum geliştirilmediği gibi, ülkemizde de bu konuda yapılmış herhangi bir çalışmaya rastlanmamıştır. Bu nedenle bu alanda çalışma yapılmasına ve hekimlerin farkındalığının arttırılmasına ihtiyaç vardır.

Somatic comorbidity and physical frailty in elderly with medically unexplained symptoms

IntroductionReported prevalence rates of medically unexplained symptoms (MUS) in people aged ≥65 years range between 1.5 and 18%. People with MUS often describe a low quality of life and frequently suffer from co-morbid anxiety and depressive disorders. In our pilot study on older patients with MUS, the level of somatic comorbidity as well as frailty parameters were significantly higher among patients with MUS which was partially explained by a somatic origin compared to patients with MUS for which no explanation at all was found.ObjectivesThe objective of this study was to examine the level of frailty and somatic comorbidity in older patients with medically unexplained symptoms (MUS) and compare this to patients with medically explained symptoms (MES).MethodsFrailty was assessed according to Fried’s criteria (gait speed, handgrip strength, unintentional weight loss, exhaustion, and low physical activity), somatic comorbidity according to the self-report Charlson Comorbidity Index and the number of prescribed medications.ResultsAlthough MUS-patients had less physical comorbidity compared to MES-patients, they were prescribed the same number of medications. Moreover, MUS-patients were more often frail compared to MES-patients. Among MUS-patients, physical frailty was associated with the severity of unexplained symptoms, the level of hypochondriacal beliefs, and the level of somatisation.ConclusionsDespite a lower prevalence of overt somatic diseases, MUS-patients are more frail compared to older MES-patients. These results suggest that at least in some patients age-related phenomena might be erroneously classified as MUS, which may affect treatment strategy.DisclosureNo significant relationships.

Multiple Chemical Sensitivity: The Underrecognized Diagnosis but True Disease

IntroductionMultiple chemical sensitivity (MCS) is a chronic condition characterized by adverse health effects due to exposure to common chemicals which may lead to disability. The pervasive nature of stigma associated with MCS and similar conditions, including that which exists among providers, creates unbearable barriers to healthcare access.ObjectivesThe main objectives of this study are: (1) to describe the symptoms associated with MCS, (2) determine whether environmental exposure has an impact on psychological well-being of patients with MCS.MethodsThe qualitative phenomenological study consisting of 42 individuals presenting with medically-unexplained symptoms was conducted using semi-structured interviews.ResultsThe symptoms experienced by participants with MCS are diverse, with common symptoms being migraine, paresthesias, seizure-like attacks, allergic reactions, respiratory symptoms (e.g., SOB, swollen throat), GI distress, muscle pain, chronic fatigue and persistent insomnia. These symptoms always develop in response to low level exposures to various toxicants, recur reproducibly and improve when toxic agents are removed. Finally, the adults with MCS are more likely to experience significant affective and PTSD-like reactions. The participants stated the stigmas and misconceptions against those with toxicant sensitivities affected their mental wellness.ConclusionsMultiple clinically significant behavioral and psychological symptoms are associated with MCS. Our data suggested that diagnostic overshadowing is pervasive in the healthcare system. This study also highlights the importance of psychological interventions and doctor–patient relationship in the management of MCS in various settings. Public education to increase knowledge around environmental illness is paramount.DisclosureNo significant relationships.

Prevalence and correlates of alexithymia in older persons with medically (un)explained physical symptoms.

ObjectivesMuch is unknown about the combination of Medically Unexplained Symptoms (MUS) and alexithymia in later life, but it may culminate in a high disease burden for older patients. In the present study we assess the prevalence of alexithymia in older patients with either MUS or Medically Explained Symptoms (MES) and we explore physical, psychological and social correlates of alexithymia.Methods and DesignA case control study was performed. We recruited older persons (>60 years) with MUS (N = 118) or MES (N = 154) from the general public, general practitioner clinics and hospitals. Alexithymia was measured by the 20‐item Toronto Alexithymia Scale, correlates were measured by various questionnaires.ResultsPrevalence and severity of alexithymia were higher among older persons with MUS compared to MES. Alexithymia prevalence in the MUS subgroup was 23.7%. We found no association between alexithymia and increasing age. Alexithymia was associated with depressive symptoms, especially in the MUS population.ConclusionsAlexithymia prevalence was lower than generally found in younger patients with somatoform disorder, but comparable to studies with similar diagnostic methods for MUS. Considering the high prevalence and presumed etiological impact of alexithymia in older patients with MUS, as well as its association with depression, this stresses the need to develop better understanding of the associations between alexithymia, MUS and depression in later life.

Characteristics of outpatients with functional somatic syndromes at a university hospital's general medicine clinic.

BackgroundThe term medically unexplained symptoms (MUS) is unhelpful for both patients and physicians, and more acceptable illness categories are needed as substitutes for MUS. While some potential substitutes are characterized by excessive psychological burden related to somatic symptoms, “functional somatic syndromes” (FSS) is a category that focuses on physical dysfunction and emphasizes similarities among individual syndromes. Examples of FSS include irritable bowel syndrome, functional dyspepsia, and fibromyalgia syndrome. This study aimed to distinguish FSS from MUS and compare the somatic and psychobehavioral characteristics of FSS with those of other diseases.MethodsThis study included 1975 first‐visit outpatients at a Japanese university hospital's general medicine clinic. According to their first‐listed diagnosis, they were classified as having FSS, acute infection, organic disease (OD), psychiatric disorder, and unknown condition (UC). The somatic symptom burden and health‐related quality of life (HRQoL) were assessed using the Somatic Symptom Scale‐8 and EuroQol‐5 Dimension, respectively; the involvement of psychobehavioral factors affecting somatic symptoms was also evaluated.ResultsOverall, 33% of patients were included in the FSS category, and 93% of the supposed MUS (FSS and UC) were diagnosed with FSS. Compared with OD, FSS showed more severe somatic symptom burden, similar reduced HRQoL, and higher involvement of psychobehavioral factors.ConclusionIt can be useful to improve FSS diagnostic skills for the reduction of MUS misdiagnosis. Psychobehavioral factors might be less associated with MUS (in the narrow sense of the term) than FSS.

Beyond the medical encounter: can the free association narrative interview method extend psychosocial understandings of non-epileptic attack disorder?

This exploratory interdisciplinary study was devised to explore how using the free association narrative interview (FANI) method might extend understanding of non-epileptic attack disorder (NEAD) within a psychosocial framework. NEAD is the medical definition of what can be described as embodied events that resemble epilepsy, but which are not associated with the abnormal electrical discharges in the brain found in epilepsy. They are the most frequent ‘functional’ disorder or medically unexplained symptom (MUS) seen by neurologists. While NEAD is associated with trauma, distress and negative life events, a significant minority of patients report no trauma history. The FANI method, we argue, produced narratives which shed light on events that patients have not acknowledged as traumatic, but which might be considered as such, and we explore what aspects of the method may facilitate this process. Previous work has highlighted that a diagnosis of NEAD is often experienced as deeply troubling and contentious to both give and to receive. We thus reflect on the need for patients to feel a sense of legitimacy and how the challenges of living with a NEAD diagnosis are negotiated. Drawing on the work of Benjamin (2004) on ‘thirdness’, we suggest that the FANI method can allow the research interview to become a space that facilitates novel ways of engaging around NEAD. We conclude that the method may be a powerful tool for studying NEAD, and that further studies should be undertaken using this approach since it may have broader utility in understanding the landscape of functional neurological disorders.

The Careful Assessment Tool for Managing Patients with Medically Unexplained Symptoms - the Experience of Slovenian Family Medicine Trainees: a Qualitative Study.

IntroductionPrimary care physicians use various tools and methods to identify medically unexplained symptoms (MUS). The main purpose of our study is to determine the views of Slovenian family medicine trainees (FMT) about using the “Careful Assessment” tool for managing patients with MUS.MethodsA qualitative study using open survey questions focused on the experience of family medicine trainees in managing patients with MUS. The sample consisted of surveys from 184 family medicine trainees. These trainees analysed a total of 702 patients with MUS. Manual coding was used for quantitative content analysis.ResultsIn the coding process, 49 codes were developed that included broader research fields about using the “Careful Assessment” tool for managing patients with MUS. The codes were grouped into four theoretically grounded, logical categories in accordance with the elaborated theoretical concept: multi-purpose utility; improved patient management; in-depth knowledge and new skills; and patient response.ConclusionThe study demonstrated that, in the view of Slovenian FMT, the “Careful Assessment” tool has multi-purpose utility. The study showed that FMT felt that this tool helps them in systematic patient management. Their opinion is that it helps them establish a trusting relationship with patients, which is a precondition for providing further treatment.

Beliefs and viewpoints of family medicine physicians on approaches to identify and treat medically unexplained symptoms

Purpose: The purpose of our study was to identify the beliefs and viewpoints of family medicine physicians (FMPs) on the approaches to identify and treat medically unexplained symptoms (MUS).&#x0D; Methods: We used qualitative and quantitative research methods, and prepare a purposive sample for the implementation of five focus groups (three in Maribor and two in Ljubljana) between July and September 2011. The findings were used as questions in the quantitative part of the study applying random sampling (n = 90). FMPs were invited throughout Slovenia to participate in our study (January – March 2012). Analysis of qualitative material was performed using ATLAS.ti 7 software, and quantitative data were statistically processed using SPSS 21.0.&#x0D; Results: In the process of coding, we created 64 codes, which were categorized into 8 categories. In the quantitative part, we received responses from 63 (70%) of the invited FMPs, 84.1% (n = 53) and 77.8% (n = 49) of whom stressed the importance of MUS prevention and treatment, and the importance of good communication, respectively. Of the 63 FMPs, 93.7% (n = 59) were of the opinion that patients with MUS leave feeling exhausted. As potential reasons for MUS, FMPs described problems in patients’ interactions with their surroundings (100%, n = 63), past and current stressful events (96.8%, n=61), and occult psychiatric diseases (68.3%, n = 43). The quality of MUS patient care would improve with more education in the field of basic psychotherapeutic techniques, difficult patient approaches (95.2%, n = 60), and communication skills (95.2%, n = 60).&#x0D; Conclusion: We found that Slovenian FMPs place a strong emphasis on prevention and treatment of patients with MUS, and these patients generally leave them feeling tired and frustrated.