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Kuanar Baboo AG, Ranjan P, Kaur T, Rawat N, Sarkar S, Kaloiya G, Singh A, Babu N, Baitha U, Prakash B. Evaluation of Tools to Assess Symptoms and Symptom Severity in Patients With Medically Unexplained Physical Symptoms: A Systematic Review and Narrative Synthesis. Cureus 2024; 16:e56204. [PMID: 38618386 PMCID: PMC11016182 DOI: 10.7759/cureus.56204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2024] [Indexed: 04/16/2024] Open
Abstract
A substantial portion of patients presenting to healthcare settings exhibit physical symptoms lacking clear, demonstrable organic causes. Accurate assessment of symptom severity is crucial for documenting outcomes and establishing treatment efficacy. This systematic review and narrative synthesis aims to provide researchers with insights into available and validated tools for assessing medically unexplained physical symptoms (MUPS). It involved comprehensive searches across electronic databases, including PubMed, Wiley, and Cochrane, adhering to PRISMA and COSMIN guidelines. The study comprised two phases: Phase 1 systematically reviewed tools for assessing MUPS symptoms and severity, while Phase 2 conducted a narrative synthesis of their measurement properties, focusing on validity and reliability. Out of 14,459 records, 191 articles were identified, leading to the recognition of 16 validated tools for assessing MUPS symptoms and severity. Most tools demonstrated excellent internal consistency and structural validity. However, the majority lacked cross-cultural validity. The choice of tools for the assessment of MUPS will assist clinicians and researchers in determining the severity of MUPS and developing a tailored treatment plan to improve the physical and psychological functioning of these patients.
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Affiliation(s)
| | - Piyush Ranjan
- Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Tanveer Kaur
- Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Nandini Rawat
- Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Siddharth Sarkar
- Psychiatry, All India Institute of Medical Sciences, New Delhi, IND
| | | | - Amandeep Singh
- Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Natesh Babu
- Yoga, Swami Vivekananda Yoga Anusandhana Samsthana, Bangalore, IND
| | - Upendra Baitha
- Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Bindu Prakash
- Medicine, All India Institute of Medical Sciences, New Delhi, IND
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Singh A, Ranjan P, Kumari A, Kaur T, Sarkar S, Sahu A, Prakash B, Kaloiya GS, Baitha U, Rawat N, Kuanar Baboo AG. Perspectives of patients, caregivers, and healthcare professionals in Indian context: A qualitative study on Medically Unexplained Physical Symptoms (MUPS). JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:119. [PMID: 37397120 PMCID: PMC10312410 DOI: 10.4103/jehp.jehp_1513_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/10/2022] [Indexed: 07/04/2023]
Abstract
BACKGROUND Approximately one-fourth of individuals who seek treatment in outpatient medical settings have Medically Unexplained Physical Symptoms (MUPS), a prevalent medical ailment. Patients with MUPS have a considerable functional impairment, and a lower quality of life, and may also have co-occurring psychiatric conditions. MATERIALS AND METHODS Eleven Focus Group Discussions (FGDs) (four virtual and seven face-to-face) were conducted with patients, caregivers, and healthcare professionals in 2021 in a tertiary care hospital in New Delhi. Thematic analysis was carried out using QSR Nvivo software. RESULTS A total of 36 participants were recruited in the study, including patients with MUPS (n = 12), caregivers (n = 10), and healthcare professionals (n = 14) dealing with the patients of MUPS. Three themes were identified: burden of MUPS, symptom profile of patients with MUPS, and psychological profile of patients with MUPS. These were further categorized into eight sub-themes: prevalence, symptoms, course of illness, improvement with treatment, duration of symptoms, attribution of symptoms, psychological impact, and coping strategies. CONCLUSION The study helped us to gain insight into the characteristics and experiences of patients, caregivers, and healthcare professionals dealing with MUPS in an Indian setup. Greater awareness of MUPS and training of care providers about the occurrence, management, and referral of MUPS can be beneficial.
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Affiliation(s)
- Amandeep Singh
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Piyush Ranjan
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Aakansha Kumari
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Tanveer Kaur
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Siddharth Sarkar
- Department of Psychiatry and National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Anamika Sahu
- Student Wellness Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Bindu Prakash
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Gauri Shankar Kaloiya
- Department of Psychiatry and National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Upendra Baitha
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Nandini Rawat
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ananta Gopal Kuanar Baboo
- Division of Yoga and Humanities, Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru, Karnataka, India
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Muacevic A, Adler JR. Understanding Patient-Provider Interaction, Treatment Acceptance, and Outcomes in Medically Unexplained Symptoms. Cureus 2022; 14:e32915. [PMID: 36699771 PMCID: PMC9871694 DOI: 10.7759/cureus.32915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2022] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION 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. METHODS A qualitative phenomenological study was conducted to explore daily challenges and psychosocial and iatrogenic factors affecting the management of MUS. RESULTS 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. CONCLUSION 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.
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Goel A, Ranjan P, Klanidhi KB, Deb KS, Sarkar S, Kaur T, Sahu A, Baitha U, Chakrawarty A, Kumar A. Comprehensive Treatment Module for Medically Unexplained Physical Symptoms - A Guide for General Practitioners. Cureus 2021; 13:e16263. [PMID: 34414039 PMCID: PMC8364782 DOI: 10.7759/cureus.16263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2021] [Indexed: 11/19/2022] Open
Abstract
Purpose: This study was aimed to develop a comprehensive treatment module that the general physician can use to manage patients with Medically Unexplained Physical Symptoms (MUPS) at a primary care level. Methods: This comprehensive module was developed after a literature review followed by its validation by a two-step Delphi technique with experts from internal medicine, psychiatry, and clinical psychology. Results: The developed module for the patients with MUPS includes case diagnosis, initial evaluation, strategy for referral, and a comprehensive treatment module. The comprehensive treatment module includes symptom discussion, rapport establishment, physical health counselling, stress management, cognitive strategies for symptom control, comorbidities treatment, and medical management. Conclusion: The developed module has unique features, such as intensive sessions with these patients, a patient-specific treatment strategy, and a holistic approach incorporating pharmacological and non-pharmacological interventions. General Practitioners across the world can use this comprehensive treatment module for the management of patients with MUPS.
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Affiliation(s)
- Aastha Goel
- Internal Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Piyush Ranjan
- Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Kamal B Klanidhi
- Internal Medicine: Geriatrics, All India Institute of Medical Sciences, New Delhi, IND
| | | | - Siddharth Sarkar
- Psychiatry, All India Institute of Medical Sciences, New Delhi, IND
| | - Tanveer Kaur
- Psychology, All India Institute of Medical Sciences, New Delhi, IND
| | - Anamika Sahu
- Psychiatry, All India Institute of Medical Sciences, New Delhi, IND
| | - Upendra Baitha
- Internal Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Avinash Chakrawarty
- Internal Medicine • Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Arvind Kumar
- Internal Medicine, All India Institute of Medical Sciences, New Delhi, IND
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Baitha U, Ranjan P, Deb KS, Bauddh NK, Singh V, Kaloiya G, Kumar A, Sahu A. Association of Somatic Symptom Severity With Sociodemographic Parameters In Patients With Medically Unexplained Physical Symptoms: A Cross-Sectional Study From a Tertiary Care Center in India. Cureus 2020; 12:e9250. [PMID: 32821596 PMCID: PMC7430686 DOI: 10.7759/cureus.9250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background There is a paucity of studies assessing the severity of somatic symptoms in medically unexplained physical symptoms (MUPS) from Medicine outpatient department (OPD). Methodology This cross-sectional study was conducted in Medicine OPD of a tertiary care hospital in India, in which 245 MUPS-diagnosed patients out of 976 consecutive screened patients were evaluated for the severity of somatic symptoms (by administering the Patient Health Questionnaire-15) and its sociodemographic correlates. Results Out of 245 recruited patients, three-fourth had a significant severity level of somatic symptoms. High level of somatic symptom severity was more common in females (p ≤ 0.001), married patients (p = 0.011), rural dwellers (p = 0.035), less educated (p = 0.003), and those with lower socioeconomic status (p = 0.001). Conclusions Patients with MUPS have a high level of somatic symptom severity with certain sociodemographic correlates. Further research should be conducted to investigate the reasons for this and to formulate a cost-effective treatment strategy.
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Affiliation(s)
- Upendra Baitha
- Medicine, All India Institute of Medical Sciences, Delhi, IND
| | - Piyush Ranjan
- Medicine, All India Institute of Medical Sciences, Delhi, IND
| | | | | | - Vishwajeet Singh
- Biostatistics, All India Institute of Medical Sciences, Delhi, IND
| | | | - Arvind Kumar
- Medicine, All India Institute of Medical Sciences, Delhi, IND
| | - Anamika Sahu
- Psychiatry, All India Institute of Medical Sciences, Delhi, IND
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Baitha U, Deb KS, Ranjan P, Mukherjee A, Bauddh NK, Kaloiya GS, Kumar A, Jadon RS. Estimated prevalence of medically unexplained physical symptoms in the medicine outpatient department of a tertiary care hospital in India. Gen Hosp Psychiatry 2019; 61:47-52. [PMID: 31710858 DOI: 10.1016/j.genhosppsych.2019.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 10/16/2019] [Accepted: 10/16/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE There is a paucity of scientific evidence from the Indian subcontinent regarding the magnitude and burden of Medically Unexplained Physical Symptoms (MUPS). This study aims to fill the evidence gap by assessing the prevalence and pattern of MUPS amongst patients attending the Medicine Out-Patient Department (OPD). METHODOLOGY The study assessed all consecutive new patients, presenting to the Medicine OPD of a tertiary care center in India over a period of nine months. All consenting patients, between 18 and 60 years of age, irrespective of their reason for consultation were included for the study. The diagnosis in subjects was established by a combination of clinical history, physical examination, and relevant investigations. A diagnosis of MUPS was made in cases with no demonstrable organic cause, and after agreement in the opinion of two independent physicians. All recruited patients with MUPS were subsequently evaluated on a pre-validated symptom checklist of 23 symptoms. RESULTS Out of 976 subjects included, a diagnosis of MUPS was established in 24.6% [95% CI = 21.9-27.3] of the sample. An additional 20.6% met the criteria of persistent MUPS (symptoms >2 months), and 19.7% of subjects had symptom duration of more than three months, meeting the stricter definition for 'persistent MUPS'. Prevalence was significantly higher in females (p = 0.02), and patients of MUPS were significantly younger (p = 0.004) than patients with other diagnoses. MUPS patients on average complained of 13 ± 5 symptoms and sought multiple medical consultations [Median (IQR) = 3 (2 - 6)] in the last one year. Non-specific, general symptoms (94.6%) and various types of pain (93.7%) were the most frequent complaints. Pain symptoms, genitourinary symptoms, palpitation, and nausea were more frequent in females as compared to males. DISCUSSION Medically unexplained symptoms are as common in India as in the west and therefore pose a significant burden on the healthcare delivery systems. There is a need to sensitize the medical fraternity and policymakers for this condition to develop effective services.
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Affiliation(s)
| | | | | | - Aparna Mukherjee
- Wellcome Trust- India Alliance, Department of Pediatrics, AIIMS, New Delhi, India
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