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Patterns of referral in patients with medically unexplained motor symptoms
H L Crimlisk1, K P Bhatia, H Cope
1Neuropsychiatry Section, Department of Clinical Neurology, Institute of Neurology, Queen Square, WC1N 3BG, London, UK.
Objective:
To investigate the pattern and reasons for referrals in 64 patients with a stable diagnosis of motor conversion symptoms who had been assessed at the National Hospital for Neurology and Neurosurgery (NHNN).
Method:
Patients were interviewed on average 6 years after their original admission to the NHNN. Hospital notes and GP records were consulted.
Results:
Psychiatrists at the NHNN saw 75% of patients. Treatment was initiated in 60% of these. During the 6-year follow up, many patients continued to be referred to neurologists and other specialists, but subsequent psychiatric referral was rare. Many changed their GP after discharge from the NHNN and a disproportionate number of re-referrals was made by GPs who had known their patients for less than 6 months. Psychological attribution of symptoms was rare and did not appear to be related to the pattern of referrals.
Conclusion:
The pattern of care of these patients was inconsistent and many felt dissatisfied with the treatment they received. This led to further referrals, unnecessary use of valuable resources and unnecessary exposure to iatrogenic damage. Further studies should aim to assist GPs and other clinicians in deciding when referral is likely to be beneficial.