Medically unexplained symptoms

Medically unexplained symptoms

May 29, 2016 0
emergency,General medicine,onthepods,psychiatry

James talks to Dr Joanne Ferguson about medically unexplained symptoms, also known as MUPS or MUS.

Summary  Writer:  Antonia Clarke

Editor:  James Edwards

Interviewee: Joanne Ferguson

About Dr Joanne Ferguson

Joanne Ferguson is a Clinical Associate Lecturer, Psychiatry and Addictions, Croydon Community Health Centre, Concord Clinical School. Staff Specialist Psychiatrist, Drug Health Services, Rozelle and Concord Hospitals.

Medically unexplained symptoms

With Dr Joanne Ferguson, Psychiatrist and Addiction Medicine Specialist, Croydon Community Health, New South Wales, Australia

Introduction

Medically unexplained symptoms (MUPS) are symptoms for which a treating physician or other healthcare providers have found no medical cause, or whose cause remains contested. There is usually some associated functional impact. MUPS can occur in all sub-specialties of medicine, including surgery. It is estimated that 15-30% of all primary care consultations relate to MUPS, those presentations most commonly being musculoskeletal pain, ear, nose, and throat symptoms, abdominal pain and gastrointestinal symptoms, fatigue and dizziness (Kirmayer et al, 2004). It can also be used to describe syndromes where the aetiology is unclear, for example, chronic fatigue syndrome or fibromyalgia.

MUPS has some similarities with psychiatric syndromes including conversion disorder, which involves symptoms of altered voluntary or sensory function inconsistent with recognised medical syndromes. Illness-anxiety disorder is a different entity, where a patient is preoccupied with acquiring a diagnosis, without necessarily having somatic symptoms.

What is the aetiology or risk factors for developing MUPS?

  • Most patients presenting to healthcare providers have real symptoms, even if the cause is not known e.g. multiple sclerosis, bipolar disorder.
  • Underlying mood disturbances (e.g. anxiety, depression) are common when patients have physical symptoms, including MUPS.
  • A person’s presentation is an interaction of their previous personal and illness experiences and cultural background.
  • Irrespective of aetiology, physical symptoms are associated with poorer psychosocial and functional outcomes.

Case

You are a junior doctor working with a Registrar in a busy Rheumatology Clinic. You are asked to see a patient who has presented with generalised muscle pain, fatigue and pain sensitivity.

  • Include in your history:
    • Timeframe and onset of symptoms and any associated life stressors
    • Personal developmental history
    • Social and drug use history
    • Assess for features of psychological stress and how severe those stressors are
    • What is the functional impact of these symptoms on the patient’s life
  • A full range of medically appropriate investigations should be performed at least once and should be fully documented.
    • Include the context in which the investigations were taken (e.g. what were the symptoms at the time of investigation).

You discuss the case with your Registrar and no cause is found for the patient’s presentation after thorough investigations.

  • Determine whether there is need for referral to another specialist (e.g. another medical specialist or psychiatrist).
  • Comprehensive explanation of the findings to the patient, allowing for the possibility for clarity of diagnosis in the future.
  • Include your findings and discussion in a letter to the General Practitioner on discharge to ensure safe transfer of care.
    • Include a guide for ongoing management that focuses on symptom control.
    • The most important thing is to reduce risk of harm through further unnecessary investigations or treatments.
  • Management should be focused on rehabilitation and symptom control.
  • Cognitive Behavioural Therapy can be useful in some syndromes.
  • If the patient has a comorbid psychiatric condition e.g. depression, treatment with pharmacotherapy (e.g. an SSRI) may be of assistance.
  • A significant amount of people will have a diagnosis at some point.
  • MUPS is an evolving issue for the patient and can have a significant functional impact.
  • The issue is about mitigation of impact until a diagnosis has been found or the symptoms have ameliorated.
  • The focus is on a long-term approach.

Related Podcasts

Tags: #chronic fatigue,#diagnosis,#differential diagnosis,#dizziness,#functional impact,#medically unexplained symptoms,#mental health,#MUPS,#muskoskeletal pain,#patient care,#patient safety

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