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Röhricht F, Green C, Filippidou M, Lowe S, Power N, Rassool S, Rothman K, Shah M, Papadopoulos N. Integrated care model for patients with functional somatic symptom disorder - a co-produced stakeholder exploration with recommendations for best practice. BMC Health Serv Res 2024; 24:698. [PMID: 38831287 PMCID: PMC11145802 DOI: 10.1186/s12913-024-11130-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 05/21/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Functional somatic symptoms (FFS) and bodily distress disorders are highly prevalent across all medical settings. Services for these patients are dispersed across the health care system with minimal conceptual and operational integration, and patients do not currently access therapeutic offers in significant numbers due to a mismatch between their and professionals' understanding of the nature of the symptoms. New service models are urgently needed to address patients' needs and to align with advances in aetiological evidence and diagnostic classification systems to overcome the body-mind dichotomy. METHOD A panel of clinical experts from different clinical services involved in providing aspects of health care for patients with functional symptoms reviewed the current care provision. This review and the results from a focus group exploration of patients with lived experience of functional symptoms were explored by the multidisciplinary expert group, and the conclusions are summarised as recommendations for best practice. RESULTS The mapping exercise and multidisciplinary expert consultation revealed five themes for service improvement and pathway development: time/access, communication, barrier-free care, choice and governance. Service users identified four meta-themes for best practice recommendations: focus on healthcare professional communication and listening skills as well as professional attributes and knowledge base to help patients being both believed and understood in order to accept their condition; systemic and care pathway issues such as stronger emphasis on primary care as the first point of contact for patients, resources to reduce the length of the patient journey from initial assessment to diagnosis and treatment. CONCLUSION We propose a novel, integrated care pathway for patients with 'functional somatic disorder', which delivers care according to and working with patients' explanatory beliefs. The therapeutic model should operate based upon an understanding of the embodied nature of patient's complaints and provide flexible access points to the care pathway.
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Affiliation(s)
- Frank Röhricht
- East London NHS Foundation Trust (ELFT), London, United Kingdom.
- Queen Mary University of London, London, United Kingdom.
| | - Carole Green
- Bedfordshire Community Health Services (BCHS), Bedford, United Kingdom
| | - Maria Filippidou
- Bedford Liaison Psychiatry Service, ELFT, Bedford, United Kingdom
| | - Simon Lowe
- Circle Bedfordshire Integrated Care Musculoskeletal Service, Bedford, United Kingdom
| | - Nicki Power
- East London NHS Foundation Trust (ELFT), London, United Kingdom
- Queen Mary University of London, London, United Kingdom
| | - Sara Rassool
- Clinical Health Psychology Services Bedfordshire & Luton, ELFT, Dunstable, United Kingdom
| | - Katherine Rothman
- Bedfordshire & Luton Community Adult Mental Health & Learning Disability Services , ELFT, Clapham, United Kingdom
| | - Meera Shah
- Clinical Health Psychology Service, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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Wilson N, Beasley MJ, Pope C, Dulake D, Moir LJ, Hollick RJ, Macfarlane GJ. UK healthcare services for people with fibromyalgia: results from two web-based national surveys (the PACFiND study). BMC Health Serv Res 2022; 22:989. [PMID: 35922796 PMCID: PMC9347075 DOI: 10.1186/s12913-022-08324-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 07/12/2022] [Indexed: 11/12/2022] Open
Abstract
Background The UK’s “Getting It Right First Time” programme recommends that management of people with fibromyalgia should centre on primary care. However, it remains unclear as to how best to organise health systems to deliver services to optimise patient outcomes. Aim To profile UK healthcare services for people with fibromyalgia: provision of National Health Services (NHS) and use of non-NHS services by people with fibromyalgia. Methods Two online open surveys (A and B) incorporating questions about diagnosis, treatment and management of fibromyalgia and gaps in healthcare services were conducted between 11th September 2019 and 3rd February 2020. These were targeted to NHS healthcare professionals consulting with people with fibromyalgia (Survey A) and people ≥16 years diagnosed with fibromyalgia using non-NHS services to manage their condition (Survey B). Descriptive statistics were used to report quantitative data. Thematic analysis was undertaken for qualitative data. Results Survey A received 1701 responses from NHS healthcare professionals across the UK. Survey B received 549 responses from people with fibromyalgia. The results show that NHS services for people with fibromyalgia are highly disparate, with few professionals reporting care pathways in their localities. Diagnosing fibromyalgia is variable among NHS healthcare professionals and education and pharmacotherapy are mainstays of NHS treatment and management. The greatest perceived unmet need in healthcare for people with fibromyalgia is a lack of available services. From the pooled qualitative data, three themes were developed: ‘a troublesome label’, ‘a heavy burden’ and ‘a low priority’. Through the concept of candidacy, these themes provide insight into limited access to healthcare for people with fibromyalgia in the UK. Conclusion This study highlights problems across the NHS in service provision and access for people with fibromyalgia, including several issues less commonly discussed; potential bias towards people with self-diagnosed fibromyalgia, challenges facing general practitioners seeking involvement of secondary care services for people with fibromyalgia, and a lack of mental health and multidisciplinary holistic services to support those affected. The need for new models of primary and community care that offer timely diagnosis, interventions to support self-management with access to specialist services if needed, is paramount. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08324-4.
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Affiliation(s)
- Nicky Wilson
- Departments of Rheumatology and Therapies, King's College Hospital NHS Foundation Trust, London, UK.
| | - Marcus J Beasley
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
| | - Catherine Pope
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Laura J Moir
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
| | - Rosemary J Hollick
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
| | - Gary J Macfarlane
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
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Röhricht F, Sattel H, Kuhn C, Lahmann C. Group body psychotherapy for the treatment of somatoform disorder - a partly randomised-controlled feasibility pilot study. BMC Psychiatry 2019; 19:120. [PMID: 31014294 PMCID: PMC6480707 DOI: 10.1186/s12888-019-2095-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 03/29/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Clinical outcomes for patients with heterogeneous somatoform disorder (bodily distress disorder, including medically unexplained symptoms) are suboptimal, new treatments are required to improve acceptance. Body-oriented psychological therapy approaches have been identified as potentially beneficial additions to the portfolio of treatments. This study was aiming to assess the acceptability, the potential benefits, and associated change processes of manualised group body psychotherapy (BPT) for outpatients with Somatoform Disorder. METHODS A randomized controlled feasibility trial was carried out with follow-up at 6 months after baseline assessments using the Primary Health Questionnaire (PHQ), Somatic Symptom Screening Scale (SOMS-7), quality of life ratings (Short-Form Health Survey-36; SF-36) and body image measures (Dresden Body Image Questionnaire). Acceptance was assessed with the Helping Alliance Scale (HAS). RESULTS A total of 24 patients were recruited to participate. Sixteen patients were randomly assigned to receive either manualised BPT or TAU, eight patients were directly assigned to BPT. Drop-out rates were acceptable, patients reported to be highly satisfied with the group intervention. Somatic symptom levels reduced significantly in the BPT group. Additionally, a significant effect on self-acceptance and the mental component of quality of life was observed. CONCLUSION Group body psychotherapy is a feasible and acceptable treatment for patients with somatoform disorder and a larger trial studying the effectiveness of BPT in these patients should be conducted. TRIAL REGISTRATION Retrospectively registered SRCTN12277345 ; Trial Registraton Date: 27/03/2019.
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Affiliation(s)
- Frank Röhricht
- Wolfson Institute of Preventive Medicine, Centre for Psychiatry, Queen Mary University of London, London, UK.
- East London NHS Foundation Trust, Trust Headquarter, Robert Dolan House, 9 Allie Street, E1 8DE, London, UK.
| | - Heribert Sattel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Christian Kuhn
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Claas Lahmann
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
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Papadopoulos NL, Röhricht F. A single case report of Body Oriented Psychological Therapy for a patient with Chronic Conversion Disorder. ARTS IN PSYCHOTHERAPY 2018. [DOI: 10.1016/j.aip.2018.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Grossert A, Meinlschmidt G, Schaefert R. A case series report of cancer patients undergoing group body psychotherapy. F1000Res 2018; 6:1646. [PMID: 29067164 PMCID: PMC5635441 DOI: 10.12688/f1000research.12262.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/23/2018] [Indexed: 12/30/2022] Open
Abstract
Background: Disturbances in bodily wellbeing represent a key source of psychosocial suffering and impairment related to cancer. Therefore, interventions to improve bodily wellbeing in post-treatment cancer patients are of paramount importance. Notably, body psychotherapy (BPT) has been shown to improve bodily wellbeing in subjects suffering from a variety of mental disorders. However, how post-treatment cancer patients perceive and subjectively react to group BPT aiming at improving bodily disturbances has, to the best of our knowledge, not yet been described. Methods: We report on six patients undergoing outpatient group BPT that followed oncological treatment for malignant neoplasms. The BPT consisted of six sessions based on a scientific embodiment approach, integrating body-oriented techniques to improve patients’ awareness, perception, acceptance, and expression regarding their body. Results: The BPT was well accepted by all patients. Despite having undergone different types of oncological treatment for different cancer types and locations, all subjects reported having appreciated BPT and improved how they perceived their bodies. However, individual descriptions of improvements showed substantial heterogeneity across subjects. Notably, most patients indicated that sensations, perceptions, and other mental activities related to their own body intensified when proceeding through the group BPT sessions. Conclusion: The findings from this case series encourage and inform future studies examining whether group BPT is efficacious in post-treatment cancer patients and investigating the related mechanisms of action. The observed heterogeneity in individual descriptions of perceived treatment effects point to the need for selecting comprehensive indicators of changes in disturbances of bodily wellbeing as the primary patient-reported outcome in future clinical trials. While increases in mental activities related to their own body are commonly interpreted as important mechanisms of therapeutic action in BPT, follow-up assessments are needed to evaluate intended and unintended consequences of these changes in cancer patients.
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Affiliation(s)
- Astrid Grossert
- Department of Medical Oncology, University Hospital Basel, Basel, Switzerland.,Department of Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Gunther Meinlschmidt
- Department of Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland.,Faculty of Medicine, Ruhr-University Bochum, Bochum, Germany.,Faculty of Medicine, University of Basel, Basel, Switzerland.,Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland.,Division of Clinical Psychology and Cognitive Behavioral Therapy, International Psychoanalytic University, Berlin, Germany
| | - Rainer Schaefert
- Department of Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
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Abstract
SummaryPatients with severe and enduring somatoform disorders (SESD) characteristically present with multiple, recurrent and frequently changing physical symptoms that have usually been present for several years before referral to a psychiatrist/psychologist. Many patients report long histories of contact with both primary and tertiary care services, have undergone repeated fruitless investigations and have high levels of disability. SESD are responsible for disproportionately high healthcare costs and are the third most common cause of workplace absence. Identification of patients with SESD by psychiatrists requires particular skills: collaboration with colleagues is vital and there are risks of iatrogenic harm. We describe the obstacles encountered in identifying these patients as well as methods of assessment and management. Treatment pathways best suited to managing this large and as yet untended group of patients are described.
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Sharma M, Singh SM, Avasthi A, Varma SC, Sharma A, Suri V. Medically unexplained physical symptoms in patients attending a medical outpatient clinic in a tertiary hospital in North India. Asian J Psychiatr 2018; 32:99-104. [PMID: 29222988 DOI: 10.1016/j.ajp.2017.11.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 10/31/2017] [Accepted: 11/27/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Medically unexplained physical symptoms (MUPS) are commonly seen across health care settings. Earlier studies have focussed on prevalence, cost-utilization and burden. Data from India is scarce. Patients with persistent MUPS have more impairment and psychological distress. This study was designed to assess psychological morbidity, health anxiety (HA), somatic symptom load, disability, quality of life (QOL) in patients with persistent MUPS presenting to a general medical outpatient service and compare it with patients with medically explained physical symptoms (MEPS). METHODS The study was conducted in the outpatient service of the Department of Internal Medicine in a tertiary hospital in North India. Persistent MUPS was defined as physical symptoms of at least 3 months duration leading to dysfunction and with no identifiable medical cause. 70 patients with persistent MUPS and MEPS each were recruited. Psychiatric morbidity was assessed using the Mini International Neuropsychiatric interview, somatic symptom load with Patient Health Questionniare-15 (PHQ-15), HA with Whiteley Index, disability with WHODAS 2.0 and QOL with WHOQOL-Bref. RESULTS Both the groups were comparable on socio-demography and length of symptoms. Prevalence of psychiatric disorders and HA was significantly greater in MUPS. Patients with persistent MUPS had significantly more health care utilization, number and burden of somatic symptoms, greater disability and worse QOL. CONCLUSIONS Patients with persistent MUPS have a different profile when compared to MEPS. There is a need to screen and identify patients with MUPS and manage them keeping in mind the psychological factors and chronic nature and number of symptoms.
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Affiliation(s)
- Mohit Sharma
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - Shubh Mohan Singh
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - Ajit Avasthi
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - Subhash C Varma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - Aman Sharma
- Postgraduate Institute of Medical Education and Research, Chandigarh 16012, India.
| | - Vikas Suri
- Postgraduate Institute of Medical Education and Research, Chandigarh 16012, India.
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Novel primary care treatment package for patients with medically unexplained symptoms: a cohort intervention study. BJGP Open 2017; 1:bjgpopen17X101121. [PMID: 30564684 PMCID: PMC6181103 DOI: 10.3399/bjgpopen17x101121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 04/28/2017] [Indexed: 12/13/2022] Open
Abstract
Background Existing care models for patients with persistent medically unexplained symptoms (MUS) do not adequately address the needs of these patients. New and innovative intervention strategies are necessary to achieve better health and corresponding economic outcomes. Aim To explore the feasibility of implementing a pragmatic care package that provides primary care treatment for patients with persistent MUS and to evaluate recruitment, retention, and acceptability as well as the potential impact on clinical outcomes and service utilisation. Design & setting Prospective cohort intervention study involving a cluster of seven GP surgeries in Newham, East London, providing a 'One-Stop-Shop' primary care treatment service. Method The care package included: identification, assessment, engagement, psychoeducation, and a choice of group interventions (mindfulness-based stress reduction [MBSR] and body-oriented psychological therapy [BOPT]). Baseline and follow-up data on somatic symptom levels (PHQ-15), health-related quality of life (SF-36, EQ-5D) and service utilisation was analysed. Results In total, 145 patients were referred and assessed for eligibility, and 93 were included in the study. Participants engaged well with different components of the care package and gained significant improvements in somatic symptom levels with corresponding increases of quality-of-life ratings and a reduction in healthcare utilisation (GP contacts and referrals to specialist services) as well as associated healthcare costs. Conclusion The primary care treatment package can be successfully implemented in primary care at a relatively low cost and easily adopted into routine care. The body-oriented approach is well accepted by clinicians and patients. Controlled trials should be conducted to test the efficacy of the treatment package.
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Menon V, Rajan TM, Kuppili PP, Sarkar S. Cognitive Behavior Therapy for Medically Unexplained Symptoms: A Systematic Review and Meta-analysis of Published Controlled Trials. Indian J Psychol Med 2017; 39:399-406. [PMID: 28852229 PMCID: PMC5559983 DOI: 10.4103/ijpsym.ijpsym_17_17] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Medically unexplained symptoms (MUS) commonly present across the board in medical specialties and are often challenging to treat. Our objective was to assess the efficacy for cognitive-behavior therapy (CBT) in MUS. Electronic search of databases was carried out for published controlled trials in English language peer-reviewed journals from inception till August 2016. Effect sizes for the trials were computed using standardized mean difference, and I2 test was used to assess sample heterogeneity. Pooled mean effect sizes were derived using a random-effects model. Critical appraisal of studies was done using the Cochrane risk of bias assessment tool. A total of 11 trials involving 1235 subjects were included in the study. Ten trials used standard CBT techniques while one studied the efficacy of mindfulness-based CBT technique. The control arms were treatment as usual in five trials, augmented care in four and waitlisted controls in two trials. The pooled mean effect size for CBT was 0.388 (range 0.055-0.806, 95% confidence intervals 0.316-0.461). The I2 value was 0 using a random effects model indicating low heterogeneity among studies. Risk of bias was noted in many included studies. Egger plot intercept indicated potential publication bias. CBT was superior to the waiting list, treatment as usual or enhanced usual care with moderate effect sizes in the treatment of MUS. These findings are impacted by the limited number of studies in this area and questionable methodological rigor of included studies.
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Affiliation(s)
- Vikas Menon
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Tess Maria Rajan
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Pooja Patnaik Kuppili
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Siddharth Sarkar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
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Menon V, Shanmuganathan B, Babu Arun A, Thamizh JS, Selvakumar N, Sarkar S. A qualitative analysis of explanatory models in medically unexplained physical symptoms presenting to a tertiary health care psychiatric facility in South India. Int J Soc Psychiatry 2016; 62:608-615. [PMID: 27609766 DOI: 10.1177/0020764016662294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Knowledge about subjective perceptions and explanatory models has the potential to inform clinical evaluation and lead to development of patient-friendly treatment models in medically unexplained physical symptoms (MUPS). AIM To collect qualitative data about explanatory models in MUPS. METHODS A cross-sectional observational study was done among patients with MUPS presenting over a 2-year period to a specialty psychosomatic clinic. The Short Explanatory Model of Illness interview was used to gather qualitative data about explanatory models which were subsequently recoded using standard manuals. RESULTS A total of 123 subjects were evaluated. The nature of symptoms was most commonly reported as 'non-specific' ( n = 102, 82.9%) but of moderate to severe intensity ( n = 87, 73.8%). Getting cured or showing improvement was the most common expectation from treatment ( n = 58, 47.9%). Moderate to severe impact of symptoms was reported on work output ( n = 100, 84%), emotional life ( n = 85, 71.4%) and physical mobility ( n = 59, 49.1%). A considerable proportion was either dissatisfied ( n = 61, 50%) or frankly unhappy ( n = 38, 31.4%) with treatment received. CONCLUSION There is a need to re-calibrate the clinical approach to people with MUPS to enhance treatment satisfaction. Our findings could assist in evolving culturally sensitive conceptualizations of illness and in developing patient-centred models for therapy in MUPS patients.
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Affiliation(s)
- Vikas Menon
- 1 Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Balasubramanian Shanmuganathan
- 1 Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Anand Babu Arun
- 1 Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Jaiganesh Selvapandian Thamizh
- 1 Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Nivedhitha Selvakumar
- 1 Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Siddharth Sarkar
- 2 Department of Psychiatry, National Drug Dependence and Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
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Lee K, Johnson MH, Harris J, Sundram F. The resource utilisation of medically unexplained physical symptoms. SAGE Open Med 2016; 4:2050312116666217. [PMID: 27635250 PMCID: PMC5011389 DOI: 10.1177/2050312116666217] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 07/26/2016] [Indexed: 12/31/2022] Open
Abstract
Objectives: As patients with medically unexplained physical symptoms may present frequently to hospital settings and receive potentially unnecessary investigations and treatments, we aimed to assess the frequency and type of medically unexplained physical symptoms presentations to clinical services and estimate the associated direct healthcare costs. Methods: This study was undertaken at the largest district health board in New Zealand. All patients with a diagnosed presentation of medically unexplained physical symptoms in 2013 were identified using the district health board’s clinical coding system. The clinical records (medical and psychiatric) of 49 patients were examined in detail to extricate all medically unexplained physical symptoms–related secondary care activity within 6 months before or after their medically unexplained physical symptoms presentation. Standardised national costing methodology was used to calculate the associated healthcare costs. Results: In all, 49% of patients attended hospital settings at least twice during 2013. The majority of presentations were for neurological or respiratory concerns. The total cost for the sample was GBP89,636 (median: GBP1,221). Costs were most significant in the areas of inpatient admissions and emergency care. Conclusion: Medically unexplained physical symptoms result in frequent presentations to hospital settings. The costs incurred are substantial and comparable to the costs of chronic medical conditions with identifiable pathology. Improving recognition and management of medically unexplained physical symptoms has potential to offer more appropriate and cost-effective healthcare outcomes.
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Affiliation(s)
| | - Malcolm H Johnson
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Julie Harris
- Decision Support, Waitemata District Health Board, Auckland, New Zealand
| | - Frederick Sundram
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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van Geelen SM, Fuchs CE, van Geel R, Luyten P, van de Putte EM. The Self beyond Somatic Symptoms: A Narrative Approach to Self-Experience in Adolescent Chronic Fatigue Syndrome. Psychopathology 2015; 48:278-86. [PMID: 26361007 DOI: 10.1159/000431258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 05/08/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND The self and self-experience are often assumed to play an important role in adolescent patients presenting with severe somatic symptoms and bodily distress. Nonetheless, most empirical work on this subject is confined to studies of personality and patients' experience of negative emotionality. This study aims to move beyond mere descriptions of symptoms, traits and distress, and consequently adopts a narrative approach to self-experience in adolescent chronic fatigue syndrome (CFS). SAMPLING AND METHODS The self-confrontation method (SCM) is a well-validated instrument to systematically analyze narrative self-experience. The SCM was used to study 42 adolescents with CFS, compared to 36 adolescents with juvenile idiopathic arthritis (JIA) and 25 matched healthy controls. The Child Health Questionnaire (CHQ-CF87) was used to assess mental health, self-esteem, and physical and psychosocial functioning. RESULTS Both patient groups reported significantly less positive self-experience of autonomy and success compared to healthy controls. Furthermore, patients with CFS described significantly more negative self-experience of powerlessness, isolation and unfulfilled longing. In the CHQ-CF87, both patient groups scored significantly lower on physical functioning than controls. Adolescents with CFS also scored significantly lower on mental health and self-esteem. CONCLUSIONS Adolescent CFS entails a serious threat to the self, which might be inherent to the condition. Not only are patients more impaired in mental health, self-esteem, and physical and psychosocial functioning than patients with JIA, they also suffer from a distinct combination of high negative and low positive self-experience. These findings stress the need for strategies that empower patients towards a 'management of the self'.
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Affiliation(s)
- Stefan M van Geelen
- Centre for Research on Child and Adolescent Mental Health, Karlstad University, Karlstad, Sweden
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Bromley JS, Turner A. A proactive and acceptable clinic solution for patients with medically unexplained symptoms. PSYCHIATRIC BULLETIN (2014) 2014; 38:307-308. [PMID: 25505638 PMCID: PMC4248174 DOI: 10.1192/pb.38.6.307a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Unigwe C, Rowett M, Udo I. Reflections on the management of medically unexplained symptoms. PSYCHIATRIC BULLETIN 2014; 38:252. [PMID: 25285230 DOI: 10.1192/pb.38.5.252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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