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A primary care perspective on prevailing assumptions about persistent medically unexplained physical symptoms
Ian M Stanley1, Sarah Peters, Peter Salmon
1University of Liverpool, Department of Clinical Psychology, England.
International Journal of Psychiatry in Medicine
|September 25, 2002
Summary
Medically unexplained physical symptoms in primary care patients rarely form discrete syndromes. Health care use does not reflect mental state or disability, challenging somatization assumptions.
Area of Science:
- Psychiatry
- General Practice
- Somatic Symptom Disorders
Background:
- Medically unexplained physical symptoms (MUPS) are common in primary care.
- The prevailing view links MUPS to somatization of mental illness, forming discrete syndromes.
- This study questions the validity of discrete somatic syndromes in primary care.
Purpose of the Study:
- To investigate the assumption that medically unexplained physical symptoms constitute discrete syndromes.
- To examine the relationship between disability, mental state, and healthcare utilization in patients with persistent MUPS.
Main Methods:
- A cohort of 223 primary care patients with MUPS lasting over one year was studied.
- Data included patient self-reports, general practitioner assessments, and medical records.
- Analysis focused on correlations between disability, symptoms, mental state, and healthcare use.
Main Results:
- Few correlations supported the existence of discrete symptom syndromes.
- While most patients experienced depression and/or anxiety, 14% did not.
- Disability and healthcare use were elevated but weakly correlated; healthcare use was unrelated to mental state.
Conclusions:
- Evidence for discrete somatic syndromes was limited in this primary care sample.
- Healthcare use is not indicative of mental state or disability.
- Depression/anxiety may be consequences of disability, not necessarily its cause.
- Doctor-patient collaboration may inadvertently legitimize unverified syndromes.