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17 results

  • Chapter 7 - Functional Somatic Symptoms

  • Edited by Rachel Thomasson, Manchester Centre for Clinical Neurosciences, Elspeth Guthrie, Leeds Institute of Health Sciences, Allan House, Leeds Institute of Health Sciences
  • Book:
    Seminars in Consultation-Liaison Psychiatry
    Published online:
    04 January 2024
    Print publication:
    18 January 2024, pp 97-116

  • Summary

    In the absence of defined disease, but also on top of it, functional somatic symptoms indicate subjective distress. They have multidimensional, individual origins and their course is heterogeneous. We do not understand their exact psychophysiological pathways yet, but we know that stressors, attention/expectation and the way we handle them matter a lot. This applies especially to consultation-liaison psychiatry, where patients rarely have one single and simple problem, and there are frequent mismatches between the subjective symptom burden and objective findings.

    Management of functional somatic symptoms should be interdisciplinary, mixing diagnostic and therapeutic, physical and psychological techniques. Treatment is based on empathy, psychoeducation, activation and the development of a bio-psycho-social explanatory model. Symptom relief and co-morbid illness can require medication, but passive interventions should only be temporary, with weighted risks and benefits. More severe cases need a multimodal approach or psychotherapy, carefully addressing the embodied self with all its experiences, attitudes and resources.

Medically Unexplained Symptoms, Somatisation and Bodily Distress
  • Developing Better Clinical Services
  • Edited by Francis Creed, Peter Henningsen, Per Fink
  • Published online:
    05 August 2011
    Print publication:
    14 July 2011
  • Medically unexplained symptoms and somatisation are the fifth most common reason for visits to doctors in the USA, and form one of the most expensive diagnostic categories in Europe. The range of disorders involved includes irritable bowel syndrome, chronic widespread pain and chronic fatigue syndrome. This book reviews the current literature, clarifies and disseminates clear information about the size and scope of the problem, and discusses current and future national and international guidelines. It also identifies barriers to progress and makes evidence-based recommendations for the management of medically unexplained symptoms and somatisation. Written and edited by leading experts in the field, this authoritative text defines international best practice and is an important resource for psychiatrists, clinical psychologists, primary care doctors and those responsible for establishing health policy.

  • 5 - Barriers to improving treatment

  • Edited by Francis Creed, University of Manchester, Peter Henningsen, Technische Universität München, Per Fink, Aarhus Universitet, Denmark
  • Book:
    Medically Unexplained Symptoms, Somatisation and Bodily Distress
    Published online:
    05 August 2011
    Print publication:
    14 July 2011, pp 124-131

  • Summary

    This chapter reviews barriers to improved treatment of patients with bodily distress. The dualistic context of medical care provides a frame work for dualistic encounters between doctors and patients. Patients with bodily distress actually seek more emotional support from their doctors than patients with symptoms attributable to disease. Within the problematic context of a fundamentally dualistic healthcare system, medical doctors in both primary and secondary care find patients with bodily distress difficult to help. There is a huge gap between the great clinical and societal significance of bodily distress syndromes on the one hand and the limited efforts to understand and better treat them on the other. It is evident that the barriers directly related to the individual doctor-patient encounter as well as the more general ones of the problematic status of this significant health problem require the knowledge and skills of both medicine and psychiatry/psychology.

  • 10 - Achieving optimal treatment organisation in different countries

  • Edited by Francis Creed, University of Manchester, Peter Henningsen, Technische Universität München, Per Fink, Aarhus Universitet, Denmark
  • Book:
    Medically Unexplained Symptoms, Somatisation and Bodily Distress
    Published online:
    05 August 2011
    Print publication:
    14 July 2011, pp 236-252

  • Summary

    This chapter provides an overview of the current state of evidence regarding treatment of medically unexplained symptoms, somatisation and the functional somatic syndromes. Both primary and secondary care studies have been performed to assess the efficacy of psychological interventions, most commonly cognitive behaviour therapy administered by a mental health professional, or antidepressants, prescribed by the patient's usual doctor. Thirteen trials evaluated cognitive behaviour therapy, five evaluated antidepressants, four the effect of a consultation letter to the general practitioner (GP) and three the training of GPs. The chapter reviews psychological treatments and the use of antidepressants. It uses three systematic reviews to provide an overview of the evidence of efficacy of interventions for functional somatic symptoms. The evidence is stronger for some pharmacological treatments than for psychological treatments partly because of the universal use of placebo tablets and the lack of an attention-placebo in psychological treatment trials.

  • 2 - Terminology, classification and concepts

  • Edited by Francis Creed, University of Manchester, Peter Henningsen, Technische Universität München, Per Fink, Aarhus Universitet, Denmark
  • Book:
    Medically Unexplained Symptoms, Somatisation and Bodily Distress
    Published online:
    05 August 2011
    Print publication:
    14 July 2011, pp 43-68

  • Summary

    This chapter discusses the terminology, stressing the difficulties of the words and concept of medically unexplained symptoms (MUS), and discussing the pros and cons of alternative terms. A fundamental problem with the concept underlying medically unexplained symptoms is the dualism it fosters. The chapter provides the empirical foundation of positive psychobehavioural descriptors, and refers to their suitability as diagnostic criteria in more detail. It has been shown that patients with chronic unexplained symptoms report a negative self-concept of being weak, not tolerating stress and not tolerating any physical challenges. Avoidance of physical activities was the most powerful discriminator between patients with somatic complaints needing medical help and feeling disabled, and those with somatic complaints but without healthcare needs or disability. An important conceptual issue concerns the influence on classification of the psychophysiological models for the experience of disabling bodily symptoms.

  • 3 - Evidence-based treatment

  • Edited by Francis Creed, University of Manchester, Peter Henningsen, Technische Universität München, Per Fink, Aarhus Universitet, Denmark
  • Book:
    Medically Unexplained Symptoms, Somatisation and Bodily Distress
    Published online:
    05 August 2011
    Print publication:
    14 July 2011, pp 69-96

  • Summary

    This chapter provides an overview of the current state of evidence regarding treatment of medically unexplained symptoms, somatisation and the functional somatic syndromes. Both primary and secondary care studies have been performed to assess the efficacy of psychological interventions, most commonly cognitive behaviour therapy administered by a mental health professional, or antidepressants, prescribed by the patient's usual doctor. Thirteen trials evaluated cognitive behaviour therapy, five evaluated antidepressants, four the effect of a consultation letter to the general practitioner (GP) and three the training of GPs. The chapter reviews psychological treatments and the use of antidepressants. It uses three systematic reviews to provide an overview of the evidence of efficacy of interventions for functional somatic symptoms. The evidence is stronger for some pharmacological treatments than for psychological treatments partly because of the universal use of placebo tablets and the lack of an attention-placebo in psychological treatment trials.

  • Chapter 14 - Anxiety

  • Edited by Bettina Schmitz, Barbara Tettenborn, Johannes Gutenberg Universität Mainz, Germany, Donald L. Schomer, Harvard University, Massachusetts
  • Book:
    The Paroxysmal Disorders
    Published online:
    06 December 2010
    Print publication:
    09 September 2010, pp 180-187

  • Summary

    Phenomenological differentiation of delusions into illusions and hallucinations is generally useful. Different forms of visual delusions have typical clinical characteristics, which presumably account for different pathophysiological correlates. All forms of visual perseveration occur paroxysmally, if they are the result of a brain lesion, and are usually unilateral and then contralateral to the lesion. Various casuistic data reveals how different the pathogenesis of visual palinopsia can be: epilepsy, intracranial tumor, cerebral infarction, migraine, traumatic brain injury and so on. Polyopia presents special type of visual perseveration. Photopsias, also called phosphenes or photomes, appear in different diseases. Before a neurological disorder is taken into consideration, diseases of the eye or intoxication and side effects of medicine should be excluded. The pathogenesis of the hallucinations is diverse; the visual hallucinations in epilepsy are most frequently the result of traumatic brain injury, cerebral hemorrhage or, occasionally, cerebral ischemia or tumor.