They are physical symptoms that prompt the sufferer to seek health care but remain unexplained even after an appropriate medical evaluation. Various terms like functional somatic symptoms [FSS], somatisation symptoms, medically unexplained physical symptoms [MUPS] have tried to provide a label to these symptoms but none of them could clearly explain it.
MUPS are associated with a high proportion of population wide disability and health care utilization. A US study has shown that the total incremental cost spent on MUS/somatization is around $256 billion per year (Vs $132 billion spent on diabetes).
PSYCHIATRIST OR PHYSICIAN?
General practice has a key role in the management as at least 20-30% of primary care patients have MUS. Many of the known syndromes are evaluated by the different medical specialties.
Whether MUS-A primary phenomenon? Or is it a substitute for psychological distress?
There is a parallel increase in the number of medically unexplained symptoms and degree of overt psychological distress reported by the patients.
Assessment for MUS?
First t is to rule out an organic cause as evidence suggests that only 4% of the symptoms become explainable in conversion disorders. List out the complaints, look through the evolution and course of symptoms, set the target symptoms and always keep a differential diagnosis.
How many investigations can actually rule out organicity for sure???
Do negative results really help??
It is how we communicate the result to the patient that matters. Problems of Over investigation and treatment can lead to increased ‘illness behavior’.
Engaging patients with somatic symptom disorder with any psychological management is challenging. Their quest for medical cause behind physical symptoms and doubts about the relevance of psychological intervention interfere with treatment compliance.
Is there any other emotional distress presenting as physical distress?
LET THE PATIENT SPEAK
COMMUNICATING WITH THE PATIENT
WHAT TO TELL THEM AND WHAT NOT?
HOW TO MANAGE MUS?
BEHAVIORAL ACTIVATION TRAINING - Graded activity training
PHYSICAL ACTIVITY TRAINING-Supervised aerobic exercise training and yoga
Dr. Ariya R Nair, Resident
Centre for Psychiatry and Clinical Psychology
Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala.