Skip to main content Accessibility help
×
×
Home

Medically unexplained symptoms in primary care

  • Else Guthrie
Abstract

Adult patients with medically unexplained symptoms (somatisation) in primary care are numerous and make disproportionately high demands on health services. Most of these individuals are open to the suggestion that their illness reflects psychological needs. Empowering explanations from doctors can enable patient and doctor to work collaboratively in managing the problem and can reduce healthcare contacts. Parental medically unexplained symptoms, sexual and physical abuse in childhood and childhood neglect are associated with a greater risk of medically unexplained symptoms in adulthood. The overall prognosis for the majority of primary care patients with medically unexplained symptoms is very good. The two most common approaches to dealing with medically unexplained symptoms in primary care are stepped-care approaches and teaching general practitioners new skills to manage consultations more effectively.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Medically unexplained symptoms in primary care
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Medically unexplained symptoms in primary care
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Medically unexplained symptoms in primary care
      Available formats
      ×
Copyright
References
Hide All
Aiarzaguena, J. M., Grandes, G., Gaminde, I. et al (2007) A randomized controlled clinical trial of a psychosocial and communication intervention carried out by GPs for patients with medically unexplained symptoms. Psychological Medicine, 37, 283294.
Barsky, A. J. & Borus, J. F. (1999) Functional somatic syndromes. Annals of Internal Medicine, 130, 910921.
Bennett, E. J., Tennant, C. C., Piesse, C. et al (1998) Level of chronic life stress predicts clinical outcome in irritable bowel syndrome. Gut, 43, 256261.
Blankenstein, A. H., van der Horst, H. E., Schilte, A. F. et al (2002) Development and feasibility of a modified reattribution model for somatising patients applied by their own general practitioners. Patient Education and Counseling, 47, 229235.
Buchwald, D. & Garrity, D. (1994) Comparison of patients with chronic fatigue syndrome, fibromyalgia, and multiple chemical sensitivities. Archives of Internal Medicine, 154, 20492053.
Campo, J. V., Bridge, J., Ehmann, M. et al (2004) Recurrent abdominal pain, anxiety, and depression in primary care. Pediatrics, 113, 817824.
Craig, T. K., Boardman, A. P., Mills, K. et al (1993) The South London Somatisation Study. I: Longitudinal course and the influence of early life experiences. British Journal of Psychiatry, 163, 579588.
Craig, T. K., Cox, A. D. & Klein, K. (2002) Intergenerational transmission of somatization behaviour: a study of chronic somatizers and their children. Psychological Medicine, 32, 805816.
Creed, F. & Barsky, A. (2004) A systematic review of the epidemiology of somatisation disorder and hypochondriasis. Journal of Psychosomatic Research, 56, 391408.
Dowrick, C., Bellón, J. & Gómez, M. (2000) GP frequent attendance in Liverpool and Granada: the impact of depressive symptoms. British Journal of General Practice, 50, 361365.
Dowrick, C. F., Ring, A., Humphris, G. M. et al (2004) Normalisation of unexplained symptoms by general practitioners: a functional typology. British Journal of General Practice, 54, 165–70.
Eminson, D. M., Benjamin, S., Shortall, A. et al (1996) Physical symptoms and illness attitudes in adolescents: an epidemiological study. Journal of Child Psychology and Psychiatry, 37, 519528.
Frostholm, L., Fink, P., Oernboel, E. et al (2005) The uncertain consultation and patient satisfaction: the impact of patients' illness perceptions and a randomized controlled trial on the training of physicians' communication skills. Psychosomatic Medicine, 67, 897905.
Frostholm, L., Oernboel, E., Christensen, K. S. et al (2007) Do illness perceptions predict health outcomes in primary care patients? A 2-year follow-up study. Journal of Psychosomatic Research, 62, 129138.
Huibers, M. J. H., Beurskens, A. J. H. M., Bleijenberg, G. et al (2007) Psychosocial interventions by general practitioners. Cochrane Database of Systematic Reviews, issue 3, CD003494.
Jones, G. T., Watson, K. D., Silman, A. J. et al (2003) Predictors of low back pain in British schoolchildren: a population-based prospective cohort study. Paediatrics, 111, 822828.
Kapur, N., Hunt, I., Lunt, M. et al (2004) Psychosocial and illness related predictors of consultation rates in primary care – a cohort study. Psychological Medicine, 34, 719728.
Kapur, N., Hunt, I., Lunt, M. et al (2005) Primary care consultation predictors in men and women: a cohort study. British Journal of General Practice, 55, 108113.
Katon, W. & Walker, E. A. (1998) Medically unexplained symptoms in primary care. Journal of Clinical Psychiatry, 59, 1521.
Kirmayer, L. J., Groleau, D., Looper, K. J. et al (2004) Explaining medically unexplained symptoms. Canadian Journal of Psychiatry, 49, 663671.
Larisch, A., Schweickhardt, A., Wirsching, M. et al (2004) Psychosocial interventions for somatizing patients by the general practitioners: a randomized controlled trial. Journal of Psychosomatic Research, 57, 507514.
Leiknes, K. A., Finset, A., Moum, T. et al (2007) Course and predictors of medically unexplained pain symptoms in the general population. Journal of Psychosomatic Research, 62, 119128.
Levy, R. L., Whitehead, W. E., Von Korff, M. R. et al (2000) Intergenerational transmission of gastrointestinal illness behaviour. American Journal of Gastroenterology, 95, 451456.
Levy, R. L., Jones, K. R., Whitehead, W. E. et al (2001) Irritable bowel syndrome in twins: heredity and social learning etiology. Gastroenterology, 121, 799804.
Lidbeck, J. (1997) Group therapy somatization disorders in general practice: effectiveness of a short cognitive–behavioural treatment model. Acta Psychiatrica Scandinavica, 96, 1424.
Luo, Z., Goddeeris, J., Gardiner, J. C. et al (2007) Costs of an intervention for primary care patients with medically unexplained symptoms: a randomised controlled trial. Psychiatric Services, 58, 10791086.
Martin, A., Rauh, E., Fichter, M. et al (2007) A one-session treatment for patients suffering from medically unexplained symptoms in primary care: a randomized clinical trial. Psychosomatics, 48, 294303.
Morriss, R., Dowrick, C., Salmon, P. et al (2006) Turning theory into practice: rationale, feasibility and external validity of an exploratory randomized controlled trial of training family practitioners in reattribution to manage patients with medically unexplained symptoms (the MUST). General Hospital Psychiatry, 28, 343351.
Neal, R. D., Heywood, P. L., Morley, S. et al (1998) Frequency of patients' consulting in general practice and workload generated by frequent attenders: comparison between practices. British Journal of General Practice, 48, 895898.
O'Malley, P. G., Jackson, J. L., Santoro, J. et al (1999) Antidepressant therapy for unexplained symptoms and symptom syndromes. Journal of Family Practice, 48, 980990.
Reid, S., Whalley, D., Crayford, T. et al (2001) Medically unexplained symptoms – GP's attitudes towards their cause and management. Family Practice, 18, 519523.
Ring, A., Dowrick, C. F., Humphris, G. M. et al (2005) The somatising effect of clinical consultation: what patients and doctors say and do not say when patients present medically unexplained physical symptoms. Social Science and Medicine, 61, 15051515.
Rosendal, M., Bro, F., Fink, P. et al (2003) Diagnosis of somatisation: effect of an educational intervention in a cluster randomised controlled trial. British Journal of General Practice, 53, 917922.
Salmon, P., Peters, S. & Stanley, I. (1999) Patients' perceptions of medical explanations for somatisation disorders: qualitative analysis. BMJ, 318, 372376.
Salmon, P., Dowrick, C., Rine, A. et al (2004) Voiced but unheard agendas: qualitative analysis of the psychosocial cues that patients with unexplained symptoms present to general practitioners. British Journal of General Practice, 54, 171176.
Salmon, P., Humphris, G. M., Ring, A. et al (2006) Why do primary care physicians propose medical care to patients with medically unexplained symptoms? A new method of sequence analysis to test theories of patient pressure. Psychosomatic Medicine, 68, 570577.
Schilte, A. F., Portegijs, P. J., Blankenstein, A. H. et al (2001) Indicators of childhood adversity in somatisation in general practice. Scandinavian Journal of Primary Health Care, 19, 232236.
Sensky, T., MacLoed, A. K. & Rigby, M. F. (1996) Causal attributions about common somatic sensations among frequent general practice attenders. Psychological Medicine, 26, 641646.
Sheehan, B., Bass, C., Briggs, R. et al (2003) Somatisation among older primary care attenders. Psychological Medicine, 33, 867877.
Sheehan, B., Bass, C., Briggs, R. et al (2004) Do general practitioners believe that their older patients' physical symptoms are somatised? Journal of Psychosomatic Research, 56, 313316.
Shorter, E. (1995) Sucker-punched again! Physicians meet the disease of the month syndrome. Journal of Psychosomatic Research, 39, 115118.
Smith, R. C., Lyles, J. S., Gardiner, J. C. et al (2006) Primary care clinicians treat patients with medically unexplained symptoms: a randomized controlled trial. Journal of General Internal Medicine, 21, 671677.
Stanley, I. M., Peters, S. & Salmon, P. (2002) A primary care perspective on prevailing assumptions about persistent medically unexplained physical symptoms. International Journal of Psychiatry in Medicine, 32, 125140.
Stimson, G. V. (1974) Obeying doctor's orders: a view from the other side. Social Science and Medicine, 8, 97104.
Vedsted, P., Fink, P., Olesen, F. et al (2001) Psychological distress as a predictor of frequent attendance in family practice: a cohort study. Psychosomatics, 42, 416422.
Walker, L. S. & Heflinger, C. A. (1998) Quality of life predictors in paediatric abdominal pain patients: findings at initial assessment and five years. In Measuring Health-related Quality of Life in Children and Adolescents: Implications for Research and Practice (ed Drotar, D. D.) pp. 237252. Lawrence Erlbaum.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

BJPsych Advances
  • ISSN: 1355-5146
  • EISSN: 1472-1481
  • URL: /core/journals/bjpsych-advances
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Medically unexplained symptoms in primary care

  • Else Guthrie
Submit a response

eLetters

No eLetters have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *