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NHS Improving Access to Psychological Therapies
Medically Unexplained Symptoms/Functional Symptoms Positive Practice Guide
1.1 Medically unexplained symptoms or syndromes (MUS) is a term commonly used to describe physical symptoms which cannot be explained by disease specific, observable biomedical pathology. The symptoms can be long-lasting and can cause significant distress and impaired functioning.
1.2 These symptoms constitute a clinically, conceptually and emotionally difficult area to tackle, with clinical presentations varying greatly, from people who regularly attend GP surgeries with minor symptoms to people with recognised functional syndromes (see section 2) such as chronic fatigue syndrome who can have severe enough symptoms to be bed- bound.
1.3 MUS are common, accounting for as many as one in five new consultations in primary care1. The unexplained symptoms can cause significant distress to the patient and, in some circumstances, impair functioning.
1.4 Between 20% and 30% of consultations in primary care are with people who are experiencing MUS and have no clear medical diagnosis. It is estimated that this rises to an average of 52% in secondary care where a substantial proportion of secondary care resources are used by frequent attenders whose symptoms remain unexplained2. Most of these patients currently receive little or no effective treatment or explanation for their symptoms so continue to be high users of health care and remain both distressed and disabled by their symptoms.
1.5 A recent systematic review of the economics of MUS found two main results: first, medically unexplained symptoms cause direct excess treatment costs per patient (between 432 and 5,353 USD per annum); second, interventions targeting GP’s diagnostic and patient management skills as well as CBT for patients have the potential to improve patients’ health status and to reduce costs3.
1.6 Irritable bowel syndrome is a commonly occurring MUS. A recent Scandinavian study concluded that irritable bowel syndrome (IBS) alone, incurs substantial direct and indirect costs corresponding to a share of up to 5% of the national direct outpatient and medicine expenditures 4. A UK IBS study published over 10 years ago conservatively estimated that IBS costs the UK £200million per year but that the cost could be as high as £600 million5.
1.7 Although models exist proposing that MUS are somatised forms of depression, there is increasing evidence of distinct differences between patients with MUS and those with a primary anxiety and depressive disorders. Although it may be possible to treat anxiety and depression comorbid to MUS, treatment approaches that have shown most efficacy for people with MUS are especially formulated for these conditions (see section 4 on treatment). Treating the anxiety and depression will not necessarily treat the physical symptoms or associated disability.
1.8 Community mental health teams and primary care mental health services have not been successful in engaging with patients experiencing MUS, as patients often do not perceive their condition to be related to mental health problems, and attempting to engage them in traditional mental health approaches is often ineffective.
1.9 Commissioning treatment that focuses specifically on evidenced based treatments for MUS, offered by health professionals trained in these approaches, is likely to offer the best health and cost benefits.
1.10 Currently there are relatively few therapists skilled in this area and specific training and ongoing supervision in this area needs to be a priority so that the correct treatment is more readily available to patients who need it.
Read more: http://www.iapt.nhs.uk/silo/files/medically-unexplained-symptoms-postive-practice-guide-2014.pdf