5 results
6 - Medically unexplained symptoms
-
- By Elspeth Guthrie, Manchester Royal Infirmary, Manchester, UK, Ayanangshu Nayak, Sheffield Health & Social Care NHS Foundation Trust, Sheffield, UK
- Edited by Elspeth Guthrie, Sanjay Rao, Melanie Temple
-
- Book:
- Seminars in Liaison Psychiatry
- Published by:
- Royal College of Psychiatrists
- Published online:
- 25 February 2017, pp 66-85
-
- Chapter
- Export citation
-
Summary
The term medically unexplained symptoms refers to physical symptoms for which there is either no or insufficient evidence of any underlying conventional disease/disorder process. There is a wide spectrum of severity ranging from essentially normal experience (e.g. an occasional headache) to symptoms which result in severe and long-standing disability. Where symptoms group together in clusters suggestive of a link to a particular bodily system, they have been termed functional somatic syndromes. The term somatoform disorders refers to a specific set of formal psychiatric diagnoses involving conditions which predominantly present with physical symptoms or a worry about physical disease. Only people at the more severe end of the medically unexplained symptoms spectrum meet criteria for one of the somatoform disorders and there is considerable dissatisfaction with the current psychiatric classification system for these conditions, which is discussed later in this chapter.
Functional somatic syndromes
By the time most people with medically unexplained symptoms are referred to a liaison psychiatrist, they are likely to have picked up a label of one or more of the functional somatic syndromes (e.g. irritable bowel syndrome, functional dyspepsia, fibromyalgia). Many different functional syndromes have been described over the past 30 years according to different symptom clusters (Table 6.1). There is considerable overlap in symptoms between different functional conditions and somatoform disorders, yet most of these syndromes are studied as if they are discrete conditions within particular medical specialties, with a focus on the specific set of somatic symptoms, which are specialty specific.
There is still uncertainty as to the degree of overlap of these conditions and the relative common factors they may share. In one study, Fink et al (2007) studied 978 patients admitted to hospital from primary care and a medical and neurological department who scored highly on somatic screening measures. They found that patients complained of a median of five functional somatic symptoms (women six and men four). Principal component analysis identified three symptom groups explaining 37% of the variance: cardiopulmonary, musculoskeletal and gastrointestinal. Further analysis showed that the symptom groups were not discrete and patients were likely to report symptoms from different groups, suggesting that the groups were different manifestations of a common latent phenomenon: bodily distress.
28 - Liaison psychiatry
- from Section III - Psychiatric specialties and physical health
-
- By Elspeth Guthrie, Manchester Royal Infirmary, Ayanangshu Nayak, Sheffield Health and Social Care NHS Foundation Trust, Sheffield, UK
- Edited by Irene Cormac, David Gray
-
- Book:
- Essentials of Physical Health in Psychiatry
- Published by:
- Royal College of Psychiatrists
- Published online:
- 25 February 2017, pp 383-392
-
- Chapter
- Export citation
5 - Psychological reaction to physical illness
-
- By Elspeth Guthrie, Manchester Royal Infirmary, Manchester, UK, Ayanangshu Nayak, Sheffield Health & Social Care NHS Foundation Trust, Sheffield, UK
- Edited by Elspeth Guthrie, Sanjay Rao, Melanie Temple
-
- Book:
- Seminars in Liaison Psychiatry
- Published by:
- Royal College of Psychiatrists
- Published online:
- 25 February 2017, pp 51-65
-
- Chapter
- Export citation
-
Summary
Physical illness is stressful. However, given time and appropriate help and support, most people can adjust to even the most serious, disabling and life-threatening conditions. Coping with illness is a dynamic process and people have to make a series of adjustments as they assimilate new information, manage their emotions and make appropriate adjustments to their family life and social situation. Chronic illness usually involves having to go through this process many times as different complications of the illness arise over time.
Approximately a quarter of people with physical illness develop mental health problems as a consequence of the ‘stress’ of their physical condition. The process of adjustment fails and people develop depression, anxiety, panic or some other form of mental disorder. If anxiety and depression develop in the context of physical illness, recovery from the physical condition is impeded, pain can become more difficult to control, confidence to participate in rehabilitation programmes is reduced, and in extreme cases the patient can come to believe that they are a burden on their family or the hospital and would be better off dead. Physical illness in the elderly is a major risk factor for suicide.
Factors which influence response to illness
Illness perception
One of the most important determinants of coping with illness is how individuals perceive their illness. Leventhal's self-regulation model of health and illness is a useful framework for understanding people's response to illness (Leventhal et al, 1980). In this model the formation of a cognitive representation of an illness is viewed as the critical first step prior to the adoption of coping behaviours to manage that health threat. Leventhal et al define illness representations as patients’ own implicit common sense beliefs about their illnesses. The representation is viewed as a schema that is formed, activated and modified in response to stimulus information about the illness. Information sources may include symptoms, lay information from personal or vicarious experience, and expert information from medical practitioners. Illness representations are considered to be multidimensional, comprising five main components: identity, perceived consequences, timeline, perceived cause, and control/cure (Box 5.1).
6 - Medically unexplained symptoms
-
- By Elspeth Guthrie, Professor of Psychological Medicine and Medical Psychotherapy, Manchester Royal Infirmary, Manchester, UK, Ayanangshu Nayak, Consultant Psychiatrist, Longley Centre, Sheffield Health ' Social Care NHS Foundation Trust, Sheffield, UK
- Edited by Elspeth Guthrie, Sanjay Rao, Melanie Temple
-
- Book:
- Seminars in Liaison Psychiatry
- Published online:
- 02 January 2018
- Print publication:
- 01 March 2012, pp 66-85
-
- Chapter
- Export citation
-
Summary
The term medically unexplained symptoms refers to physical symptoms for which there is either no or insufficient evidence of any underlying conventional disease/disorder process. There is a wide spectrum of severity ranging from essentially normal experience (e.g. an occasional headache) to symptoms which result in severe and long-standing disability. Where symptoms group together in clusters suggestive of a link to a particular bodily system, they have been termed functional somatic syndromes. The term somatoform disorders refers to a specific set of formal psychiatric diagnoses involving conditions which predominantly present with physical symptoms or a worry about physical disease. Only people at the more severe end of the medically unexplained symptoms spectrum meet criteria for one of the somatoform disorders and there is considerable dissatisfaction with the current psychiatric classification system for these conditions, which is discussed later in this chapter.
Functional somatic syndromes
By the time most people with medically unexplained symptoms are referred to a liaison psychiatrist, they are likely to have picked up a label of one or more of the functional somatic syndromes (e.g. irritable bowel syndrome, functional dyspepsia, fibromyalgia). Many different functional syndromes have been described over the past 30 years according to different symptom clusters (Table 6.1). There is considerable overlap in symptoms between different functional conditions and somatoform disorders, yet most of these syndromes are studied as if they are discrete conditions within particular medical specialties, with a focus on the specific set of somatic symptoms, which are specialty specific.
There is still uncertainty as to the degree of overlap of these conditions and the relative common factors they may share. In one study, Fink et al (2007) studied 978 patients admitted to hospital from primary care and a medical and neurological department who scored highly on somatic screening measures. They found that patients complained of a median of five functional somatic symptoms (women six and men four). Principal component analysis identified three symptom groups explaining 37% of the variance: cardiopulmonary, musculoskeletal and gastrointestinal. Further analysis showed that the symptom groups were not discrete and patients were likely to report symptoms from different groups, suggesting that the groups were different manifestations of a common latent phenomenon: bodily distress.
5 - Psychological reaction to physical illness
-
- By Elspeth Guthrie, Professor of Psychological Medicine and Medical Psychotherapy, Manchester Royal Infirmary, Manchester, UK, Ayanangshu Nayak, Consultant Psychiatrist, Longley Centre, Sheffield Health ' Social Care NHS Foundation Trust, Sheffield, UK
- Edited by Elspeth Guthrie, Sanjay Rao, Melanie Temple
-
- Book:
- Seminars in Liaison Psychiatry
- Published online:
- 02 January 2018
- Print publication:
- 01 March 2012, pp 51-65
-
- Chapter
- Export citation
-
Summary
Physical illness is stressful. However, given time and appropriate help and support, most people can adjust to even the most serious, disabling and life-threatening conditions. Coping with illness is a dynamic process and people have to make a series of adjustments as they assimilate new information, manage their emotions and make appropriate adjustments to their family life and social situation. Chronic illness usually involves having to go through this process many times as different complications of the illness arise over time.
Approximately a quarter of people with physical illness develop mental health problems as a consequence of the ‘stress’ of their physical condition. The process of adjustment fails and people develop depression, anxiety, panic or some other form of mental disorder. If anxiety and depression develop in the context of physical illness, recovery from the physical condition is impeded, pain can become more difficult to control, confidence to participate in rehabilitation programmes is reduced, and in extreme cases the patient can come to believe that they are a burden on their family or the hospital and would be better off dead. Physical illness in the elderly is a major risk factor for suicide.
Factors which influence response to illness
Illness perception
One of the most important determinants of coping with illness is how individuals perceive their illness. Leventhal's self-regulation model of health and illness is a useful framework for understanding people's response to illness (Leventhal et al, 1980). In this model the formation of a cognitive representation of an illness is viewed as the critical first step prior to the adoption of coping behaviours to manage that health threat. Leventhal et al define illness representations as patients’ own implicit common sense beliefs about their illnesses. The representation is viewed as a schema that is formed, activated and modified in response to stimulus information about the illness. Information sources may include symptoms, lay information from personal or vicarious experience, and expert information from medical practitioners.