What do general practice patients want when they present medically unexplained symptoms
, and why do their doctors feel pressurized.
Our findings suggest a need for more in-depth research on potential biases that drive medical overuse, as part of an overall strategy to improve physicians' approach to medically unexplained symptoms
. (17) Remedies may require training, practice and failure feedback, quality improvement tools, and innovative management strategies.
Psychological stress has been invoked as a potential modifier of the symptomatic responses that are characteristic of medically unexplained symptoms
(MUSs) attributed to low-level chemical exposures, including Gulf War illness, multiple chemical sensitivity, and sick building syndrome (Kipen and Fiedler 1999, 2002a, 2002b).
A proposed classification, medically unexplained symptoms
spectrum disorder, attempts to categorize patients with MUPS based on severity and duration of symptoms, as well as medical and/or psychiatric comorbidities (Table).
They found that acupuncture had a significant and sustained benefit for these patients and consequently acupuncture could be safely added to the therapies used by practitioners when treating frequently attending patients with medically unexplained symptoms
"There are many people with very stressful jobs who do suffer from medically unexplained symptoms
that can't be ignored."
Medically unexplained symptoms
and chronic functional syndromes are common but few health care professionals have had formal training about their connection to psychosocial issues.
The book is divided into four sections: EMDR treatment of military populations, the EMDR protocol for military populations, EMDR treatment for chronic war/traumatic stress injuries (medically unexplained symptoms
, traumatic grief, interpersonal violence, and others), and special considerations (ethical and medico-legal issues, enhancing resilience, self-care for practitioners).
Although medically unexplained symptoms
are common in these patients, most who complain of "chronic" Lyme disease have no evidence of ever having had the disease, based on history or serologic tests, he said.
Engel, a psychiatric epidemiologist who has been instrumental in helping the departments of Veterans Affairs and Defense develop guidelines for depression, PTSD, and medically unexplained symptoms
Multiple medically unexplained symptoms
increase the likelihood of a co-existing psychiatric diagnosis, with as many as half of patients having an anxiety disorder, and two-thirds a depressive disorder.3,5,7-9 Moreover, there is some evidence that functional impairment is higher in somatoform disorder with a co-morbid depressive or anxiety disorder.