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MUS, PPS services and IAPT integration into NHS primary care - what's happening across the UK?

Skycloud

Senior Member
Messages
508
Location
UK
Has anyone come across a comprehensive list of which conditions are now lumped into the MUS agenda?
........
I heard some mention of asthma.

Possibly from this, post 580, this thread:

Here is more from the presenter et al:

https://www.intechopen.com/books/a-...chosomatics-the-new-neuroconnective-phenotype

Chapter 8


Joint Hypermobility, Anxiety, and Psychosomatics — The New Neuroconnective Phenotype

By Guillem Pailhez, Juan Castaño, Silvia Rosado, Maria Del Mar Ballester, Cristina Vendrell, Núria Mallorquí-Bagué, Carolina Baeza- Velasco and Antonio Bulbena
DOI: 10.5772/60607

Abstract: In this chapter, after summarizing the concept and diagnosis of the Joint Hypermobility (Hyperlaxity), we review case control studies in two directions: Anxiety in Joint Hypermobility and Joint Hypermobility in Anxiety disorders, studies in nonclinical samples, review papers, and one incidence study. Collected evidence tends to confirm the strength of the association described two and a half decades ago. Common mechanisms involved include genetics, autonomic nervous system dysfunctions, and interoceptive and exteroceptive processes. Considering clinical and nonclinical data, pathophysiological mechanisms, and present nosological status, we suggest a new Neuroconnective phenotype in which together around a common core Anxiety-Collagen hyperlaxity, it includes five dimensions: behavioral, psychopathology, somatic symptoms, somatosensory symptoms, and somatic illnesses. Somatic illnesses include irritable bowel, dysfunctional esophagus, multiple chemical sensitivity, dizziness or unsteadiness (central vestibular pattern), chronic fatigue, fibromyalgia, glossodynia, vulvodynia, hypothyroidism, asthma, migraine, temporomandibular dysfunction, and intolerances or food and drug hypersensitivity. It is envisaged that new descriptions of anxiety disorders and also of some psychosomatic conditions will emerge and different nosological approaches will be required.

Keywords: Anxiety disorders, joint hypermobility, hyperlaxity, psychosomatic medicine, phobic disorders

Full chapter is Open Access and there is also aPDF.

I've bolded asthma.


Personally I'm now uncertain if asthma is widely being claimed directly under MUS. (Seems a very hard sell to me!) There does seem to be a desire to bring in CBT as an adjunct to established asthma care, going by what I've seen of reviews of cbt/asthma studies on cochrane.org. I just glanced through.

From Cochrane, it seems CBT is proposed as a means of improving asthma patients compliance with monitoring and treatment, and/or also to help people with anxiety and stress which can in some cases exacerbate symptoms.
And reduced need for and more efficient use of medication thus lowering treatment cost was mentioned.
 
Last edited:
Messages
13,774
Published just in time for ME Awareness Week...
Journal of Mental Health

Editorial

“Lumping” and “splitting” medically unexplained symptoms: is there a role for a transdiagnostic approach?

Trudie Chalder & Claire Willis

Pages 1-5 | Received 03 Mar 2017, Accepted 05 Mar 2017, Published online: 09 May 2017

Full paper and PDF
http://dx.doi.org/10.1080/09638237.2017.1322187

There's a lot of annoying stuff in there. I can assume most readers will be able to see it for the junk it is, but then I remember how few people in academia seem to bother checking references.

What's the best thing to do here?!
 

Skycloud

Senior Member
Messages
508
Location
UK
There's a lot of annoying stuff in there. I can assume most readers will be able to see it for the junk it is, but then I remember how few people in academia seem to bother checking references.

What's the best thing to do here?!

Depressing, isn't it. I don't think there is anything we can do here, frustrating though it is, other than continue to push for and support biomedical research, and advocacy. As long as it offers money and careers papers like this will be published.

On the bright side, when you scroll to the bottom of the page under 'People also read' you find what has to be the answer - some papers of proper science and analysis.
 

NelliePledge

Senior Member
Messages
807
While most readers here on PR will see this for the junk it is, sadly that is unlikely to be true for their wider readership.
I would hope that the average person would at least be able to see the ridiculousness of CBT to treat cancer treatment fatigue. Surely anyone who knows someone who's had radio or chemo would get it that their fatigue is not due to psych issues.
 

Ysabelle-S

Highly Vexatious
Messages
524
Amazing and depressing how these Chalder et al have the barefaced cheek to build a whole model of treatment for PPS/MUS on the foundation of PACE etc. Deeply worrying that they are still getting away with it.

It's lucrative and career enhancing, and we are a serious threat to their empire building. They know we know their trial is a shambles, and one of the biggest scandals in UK medicine of late. The whole edifice would come tumbling down if the truth about the trial was exposed. They're going way beyond ME now, and that is why they are so utterly desperate and ruthless in promoting their junk science. The field seems to be marinating in rampant ableism and neoliberal models of healthcare that serve anyone but the actual patients.
 

MeSci

ME/CFS since 1995; activity level 6?
Messages
8,231
Location
Cornwall, UK
It's lucrative and career enhancing, and we are a serious threat to their empire building. They know we know their trial is a shambles, and one of the biggest scandals in UK medicine of late. The whole edifice would come tumbling down if the truth about the trial was exposed. They're going way beyond ME now, and that is why they are so utterly desperate and ruthless in promoting their junk science. The field seems to be marinating in rampant ableism and neoliberal models of healthcare that serve anyone but the actual patients.
What would happen if one of them came down with ME...?
 
Messages
2,125
Just following up on IAPT services in UK. (IAPT is run by the NHS in England and offers NICE-approved therapies for treating people with depression or anxiety.)

I don't think this is in relation to MUS yet (think the rollout started last year?), but thought the stats people here might like to take a look at some of the data.
Have skimmed thro a few bits and found that those who use the data say that they find the Monthly Activity Data file the most useful...........
http://www.content.digital.nhs.uk/catalogue/PUB24016

the most recent I can find is for Feb 2017:

http://www.content.digital.nhs.uk/catalogue/PUB24016/iapt-month-feb-2017-final-data.csv

It's an excel/csv file. The totals for all IAPT service providers are at the top; one interesting under DI CBT appts:
the total is 118,802.

sure this must be posted somewhere but for ref:
http://www.nhs.uk/conditions/medically-unexplained-symptoms/Pages/Somatisation.aspx


Too much for my brain
 

SamanthaJ

Senior Member
Messages
219
Do you feel your symptoms are stopping you from living life the way you would like to?
Are you suffering from low mood as a result of the impact the symptoms are having on your life?
Are you having to stop taking pain medication, or would like to stop?
Is it me or does that sound like the start of a dodgy advert?
 

TiredSam

The wise nematode hibernates
Messages
2,677
Location
Germany
Blimey, GETSET Julie is real:

upload_2017-7-14_1-6-32.png


https://ppss.cumbria.nhs.uk/patient-stories

Two glowing video testimonials from her, she went from bedridden to fellwalking. As she seems to be a real person I don't mean to be disrespectful or doubt her experience, although the longer video does sound rather like a scripted sales presentation in places. Sounds like she learnt to pace and went from severe to in remission.
 

IreneF

Senior Member
Messages
1,552
Location
San Francisco
Possibly from this, post 580, this thread:



I've bolded asthma.


Personally I'm now uncertain if asthma is widely being claimed directly under MUS. (Seems a very hard sell to me!) There does seem to be a desire to bring in CBT as an adjunct to established asthma care, going by what I've seen of reviews of cbt/asthma studies on cochrane.org. I just glanced through.

From Cochrane, it seems CBT is proposed as a means of improving asthma patients compliance with monitoring and treatment, and/or also to help people with anxiety and stress which can in some cases exacerbate symptoms.
And reduced need for and more efficient use of medication thus lowering treatment cost was mentioned.
Asthma used to be considered "psychosomatic" and it was undertreated. People died.
https://www.karger.com/Article/ShowPic/287307/?image=000287307-1.jpg
 

Skycloud

Senior Member
Messages
508
Location
UK
Haven't time to watch just yet @TiredSam, but thanks for posting. Like you also surprised that Julie is a real person. Not knowing that I now have some regret that I've poked fun the way I have, and am glad for her as an individual that she is enjoying better health. I still think it was cynical to use her as an example when she is a minority.
 

Skycloud

Senior Member
Messages
508
Location
UK
@ Irene - very true, and myself and my sister (asthmatic) are just old enough to have experienced that attitude from the medical profession and others. My sister was not taken seriously by the GP and denied treatment as a very young child and ended up in an oxygen tent - she was lucky. I'm interested to read your link later, thanks.

I do think things have thankfully changed now. No one is going to get away with claiming my asthma is somehow my mum's fault.
I also think that the system already in place in the UK using asthma nurses in GP surgeries (I don't know if it's universal)is likely to make spending resources on the approach in the cochrane report a nonstarter for asthma.