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Unexplained physical symptoms: outcome, utilization of medical care and associated factors

Published online by Cambridge University Press:  09 July 2009

A. E. M. Speckens*
Affiliation:
Department of Psychiatry and Department of General Medicine, University Hospital Leiden, The Netherlands
A. M. Van Hemert
Affiliation:
Department of Psychiatry and Department of General Medicine, University Hospital Leiden, The Netherlands
J. H. Bolk
Affiliation:
Department of Psychiatry and Department of General Medicine, University Hospital Leiden, The Netherlands
H. G. M. Rooijmans
Affiliation:
Department of Psychiatry and Department of General Medicine, University Hospital Leiden, The Netherlands
M. W. Hengeveld
Affiliation:
Department of Psychiatry and Department of General Medicine, University Hospital Leiden, The Netherlands
*
1Address for correspondence: Dr Anne E. M. Speckens, Department of Psychiatry, B1-P, University Hospital Leiden, Post Box 9600, 2300 RC Leiden, The Netherlands

Synopsis

The aim of the study was to investigate the recovery and frequency of physician contact in patients with unexplained physical symptoms and to identify factors associated with persistent disorder. Of 100 consecutive patients who presented with medically unexplained symptoms to a general medical out-patient clinic, 81 participated in a follow-up study. The mean follow-up time was 15·2 months (S.D. 4·0). At follow-up, many of the patients with unexplained physical symptoms reported that they had recovered (30%) or improved (46%) with regard to their presenting symptoms. Female sex and a high number of symptoms predicted a bad outcome in terms of recovery. Persistence of symptoms was not related to the duration of the symptoms, type of presenting complaint or the presence of psychiatric disorder. Forty per cent of patients with unexplained symptoms did not visit their general practitioner on their own initiative in the year following the initial visit to the clinic. Medical care utilization appeared to be associated with female sex, age, number and duration of symptoms, fatigue and psychiatric disorder, especially somatoform disorders. However, the association of a high frequency of physican contact with female sex and psychiatric disorder was not sustained after controlling for possible confounding factors.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 1996

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References

REFERENCES

American Psychiatric Association (1987). Diagnostic and Statistical Manual of Mental Disorders 3rd edn, revised. American Psychiatric Association: Washington, DC.Google Scholar
Barsky, A. J., Wyshak, G. & Klerman, G. L. (1986). Medical and psychiatric determinants of outpatient medical utilization. Medical Care 24, 548560.CrossRefGoogle ScholarPubMed
Bass, C. & Benjamin, S. (1993). The management of chronic somatisation. British Journal of Psychiatry 162, 7280.CrossRefGoogle ScholarPubMed
Cathébras, P. J., Robbins, J. M., Kirmayer, L. J. & Hayton, B. C. (1992). Fatigue in primary care. Journal of General Internal Medicine 7, 276286.CrossRefGoogle ScholarPubMed
Craig, T. K. J., Boardman, A. P., Mills, K., Daly-Jones, O. & Drake, H. (1993). The South-London somatisation study. I. Longitudinal course and the influence of early life experiences. British Journal of Psychiatry 163, 579588.CrossRefGoogle Scholar
Fowlie, S., Eastwood, M. A. & Ford, M. J. (1992). Irritable bowel syndrome: the influence of psychological factors on the symptom complex. Journal of Psychosomatic Research 36, 169173.CrossRefGoogle ScholarPubMed
Huisman, S. (1981). The Development of a ‘Self-report Questionnaire on Well-being and Daily Activities’ (in Dutch). Master's thesis, Psychological Laboratory, University of Amsterdam.Google Scholar
Kellner, R. & Sheffield, B. F. (1971). The relief of distress following attendance at a clinic. British Journal of Psychiatry 118, 195198.CrossRefGoogle ScholarPubMed
Kisely, S. R., Creed, F. H. & Cotter, L. (1992). The course of psychiatric disorder associated with non-specific chest pain. Journal of Psychosomatic Research 36, 329335.CrossRefGoogle ScholarPubMed
McCullagh, P. & Nelder, J. A. (1989). Generalized Linear Models. Chapman & Hall: London.CrossRefGoogle Scholar
Mayou, R., Bryant, B., Forfar, C. & Clark, D. (1994). Non-cardiac chest pain and benign palpitations in the cardiac clinic. British Heart Journal 72, 548553.CrossRefGoogle ScholarPubMed
Miranda, J., Pérez-Stable, E. J., Muñoz, R. F., Hargreaves, W. & Henke, C. J. (1991). Somatization, psychiatric disorder, and stress in utilization of ambulatory medical services. Health Psychology 10, 4651.CrossRefGoogle ScholarPubMed
Morris, C., Chapman, R. & Mayou, R. (1992). The outcome of unexplained dyspepsia. A questionnaire follow-up study of patients after endoscopy. Journal of Psychosomatic Research 36, 751757.CrossRefGoogle ScholarPubMed
Sackett, D. L., Haynes, R. B., Guyatt, G. H. & Tugwell, P. (eds.) (1991). The clinical examination. In Clinical Epidemiology. A Basic Science for Clinical Medicine, 2nd edn, pp. 2531. Little, Brown & Company: Boston.Google Scholar
Sharpe, M., Hawton, K., Seagroatt, V. & Pasvol, G. (1992). Follow-up of patients presenting with fatigue to an infectious diseases clinic. British Medical Journal 305, 147152.CrossRefGoogle Scholar
Slooff, C. J., Mulder-Hajonides van der Meulen, W. R. E. H. & Van den Hoofdakker, R. H. (1983). The Dutch translation of the Present State Examination, 9th edn. I. Aspects of reliability (in Dutch). Tijdschrift voor Psychiatrie 25, 151163.Google Scholar
Smith, T. C. & Thompson, T. L. (1993). The inherent, powerful therapeutic value of a good physician–patient relationship. Psychosomatics 34, 166170.CrossRefGoogle ScholarPubMed
Speckens, A. E. M., Van Hemert, A. M., Spinhoven, Ph., Hawton, K. E., Bolk, J. H. & Rooijmans, H. G. M. (1995). Cognitive behavioural therapy for medically unexplained physical symptoms: a randomized controlled trial. British Medical Journal 311, 13281332.CrossRefGoogle Scholar
Stewart, A. L., Ware, J. E. & Brook, R. H. (1981). Advances in the measurement of functional status: construction of aggregate indexes. Medical Care 19, 473488.CrossRefGoogle ScholarPubMed
Van Hemert, A. M., Hengeveld, M. W., Bolk, J. H., Rooijmans, H. G. M. & Vandenbroucke, J. P. (1993). Psychiatric disorders in relation to medical illness among patients of a general medical outpatient clinic. Psychological Medicine 23, 167173.CrossRefGoogle Scholar
Vázquez-Barquero, J. L., Wilkinson, G., Williams, P., Diez-Mantrique, J. F. & Pena, C. (1990). Mental health and medical consultation in primary care settings. Psychological Medicine 20, 681694.CrossRefGoogle ScholarPubMed
Warwick, H. M. C. & Salkovskis, P. M. (1985). Reassurance. British Medical Journal 290, 1028.CrossRefGoogle ScholarPubMed
Wing, J. K., Cooper, J. & Sartorius, N. (1974). The Measurement and Classification of Psychiatric Symptoms. Cambridge University Press: Cambridge.Google Scholar