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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.
This chapter considers three groups, medically unexplained symptoms, somatoform disorders, and functional somatic syndromes. Describing the nature of these groups, it talks about their prevalence in cross-sectional studies in primary, secondary care and population-based studies. Medically unexplained symptoms are very common both in the general population and in primary and secondary care, but at least in the first two settings most are transient. Systematic reviews of the prevalence of irritable bowel syndrome in population-based samples have indicated that the prevalence varies considerably with the definition of the syndrome. Functional somatic syndromes are also common but only some patients with these syndromes also have numerous somatic symptoms. There is little doubt that somatoform disorders, or bodily distress syndromes, are an important and challenging group of conditions that are expensive in terms of healthcare use and time missed from work.
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.
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.