Skip to main content Accessibility help
  • Get access
    Check if you have access via personal or institutional login
  • Cited by 1
  • Print publication year: 2011
  • Online publication date: August 2011

10 - Achieving optimal treatment organisation in different countries


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.

Related content

Powered by UNSILO


1. KroenkeK, ZhongX, TheobaldD, WuJW, TuWZ, CarpenterJS. Somatic symptoms in patients with cancer experiencing pain or depression prevalence, disability, and health care use. Archives of Internal Medicine 2010; 170(18): 1686–94.
2. PevelerR, HouseA. Developing services in liaison psychiatry. In: PevelerR, FeldmanE, FriedmanT, eds. Liaison Psychiatry. Planning Services for Specialist Settings. London: Gaskell; 2000: 1–13.
3. HenningsenP, ZipfelS, HerzogW. Management of functional somatic syndromes. The Lancet 2007; 369(9565): 946–55.
4. BerminghamSL, CohenA, HagueJ, ParsonageM. The cost of somatisation among the working-age population in England for the year 2008–2009. Mental Health in Family Medicine 2010; 7: 71–84.
5. National Institute for Health and Clinical Excellence. Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: Diagnosis and Management of CFS/ME in Adults and Children. London: NICE; 2007.
6. National Institute for Health and Clinical Excellence. Irritable Bowel Syndrome in Adults. Diagnosis and Management of Irritable Bowel Syndrome in Primary Care. London: NICE; 2008.
7. PetrieKJ, MullerJT, SchirmbeckF, DonkinL, BroadbentE, EllisCJet al. Effect of providing information about normal test results on patients’ reassurance: randomised controlled trial. British Medical Journal 2007; 334(7589): 352–4.
8. QuigleyEM, BytzerP, JonesR, MearinF, QuigleyEMM, BytzerPet al. Irritable bowel syndrome: the burden and unmet needs in Europe. Digestive and Liver Disease 2006; 38(10): 717–23.
9. JacksonJL, KroenkeK, ChamberlinJ. Effects of physician awareness of symptom-related expectations and mental disorders – a controlled trial. Archives of Family Medicine 1999; 8(2): 135–42.
10. NHS Plymouth. Medically Unexplained Symptoms (MUS): A Whole Systems Approach in Plymouth. NHS Plymouth, 2009.
11. ReidS, WesselyS, CrayfordT, HotopfM. Medically unexplained symptoms in frequent attenders of secondary health care: retrospective cohort study. British Medical Journal 2001; 322(7289): 767–9.
12. SalmonP, PetersS, StanleyI. Patients’ perceptions of medical explanations for somatisation disorders: qualitative analysis. British Medical Journal 1999; 318(7180): 372–6.
13. SalmonP, HumphrisGM, RingA, DaviesJC, DowrickCF. Primary care consultations about medically unexplained symptoms: patient presentations and doctor responses that influence the probability of somatic intervention. Psychosomatic Medicine 2007; 69(6): 571–7.
14. EngelCC, LiuX, McCarthyBD, MillerRF, UrsanoR. Relationship of physical symptoms to posttraumatic stress disorder among veterans seeking care for Gulf War- related health concerns. Psychosomatic Medicine 2000; 62(6): 739–45.
15. PageLA, WessleyS. Medically unexplained symptoms: exacerbating factors in the doctor–patient encounter. Journal of the Royal Society of Medicine 2003; 96: 223–7.
16. ReidS, WesselyS, CrayfordT, HotopfM. Frequent attenders with medically unexplained symptoms: service use and costs in secondary care. British Journal of Psychiatry 2002; 180: 248–53.
17. FinkP, RosendalM, ToftT. Assessment and treatment of functional disorders in general practice: the extended reattribution and management model – an advanced educational program for nonpsychiatric doctors. Psychosomatics 2002; 43(2): 93–131.
18. ChitnisA, DowrickC, ByngR, TurnerP, ShiersD. Guidance for health professionals on medically unexplained symptoms (MUS). 2011; Available at: (Accessed, 3 April, 2011).
19.NHS Evidence – commissioning. Medically unexplained symptaus (MUS): a whole systems approach in Plymouth. Improving access to Psychological Therapies (IAPT); 2009. Available at: (Accessed 3 April, 2011).
20. KatholRG, ButlerM, McAlpineDD, KaneRL. Barriers to physical and mental condition integrated service delivery. Psychosomatic Medicine 2010; 72(6): 511–18.
21. HamiltonJ, CamposR, CreedF. Anxiety, depression and management of medically unexplained symptoms in medical clinics. Journal of the Royal College of Physicians of London 1996; 30(1): 18–20.
22. MangwanaS, BurlinsonS, CreedF. Medically unexplained symptoms presenting at secondary care – a comparison of white Europeans and people of south Asian ethnicity. International Journal of Psychiatry in Medicine 2009; 39(1): 33–44.