scholarly journals Extending Cognitive-Behavioural Theory and Therapy to Medically Unexplained Symptoms and Long-Term Physical Conditions: A Hybrid Transdiagnostic/Problem Specific Approach

2016 ◽  
Vol 33 (4) ◽  
pp. 172-192 ◽  
Author(s):  
Paul M. Salkovskis ◽  
James D. Gregory ◽  
Alison Sedgwick-Taylor ◽  
Julie White ◽  
Simon Opher ◽  
...  
Keyword(s):  
Belief Change ◽  
Medically Unexplained Symptoms ◽  
Long Term Conditions ◽  
Treatment Protocols ◽  
Specific Approach ◽  
Cognitive Behavioural ◽  
Wide Range ◽  
Medically Unexplained ◽  
Unexplained Symptoms

Medically unexplained symptoms (MUS) are not only common and distressing, but are also typically poorly managed in general medical settings. Those suffering from these problems tend to incur significantly higher health costs than the general population. There are many effective treatments for different MUS; these are almost entirely based on cognitive-behavioural approaches. However, the wide range of treatment protocols tend to be ‘syndrome specific’. As such, they do not generalise well in terms of training and application, making them expensive and difficult to disseminate, suggesting the desirability of developing a transdiagnostic approach. The general basis of such a CBT grounded transdiagnostic approach is considered, and the particular need to incorporate cognitive elements of both anxiety or health anxiety (threat) and depression (loss) is highlighted. Key empirically grounded and evidence-based processes (both specific and general) previously identified as underpinning the maintenance of MUS are delineated. The way in which these can be combined in a transdiagnostic model that accounts for most MUS presentations is presented and linked to a formulation-driven transdiagnostic treatment strategy, which is described. However, the need to take more syndrome-specific issues into account in treatment is identified, suggesting that the optimum treatment may be a hybrid transdiagnostic/specific approach with formulation, shared understanding, belief change strategies, and behavioural experiments at its heart. The generalisation of such approaches to psychological problems occurring in the context of ‘long-term conditions’ is identified as a further important development that is now within reach.

scholarly journals IAPT under the microscope

2018 ◽  
Vol 23 (9) ◽  
pp. 1131-1135 ◽  
Author(s):  
David F Marks
Keyword(s):  
Recovery Rate ◽  
Medically Unexplained Symptoms ◽  
Long Term Conditions ◽  
Recovery Rates ◽  
Expert Review ◽  
Psychological Therapies ◽  
Independent Expert ◽  
Medically Unexplained ◽  
Unexplained Symptoms

England’s flagship ‘Improving Access to Psychological Therapies’ (IAPT) service has cost around £1 billion yet Scott’s (2018a) study suggests that only 9.2% of IAPT patients recover. This leaves an enormous gap of 40.8% between the observed recovery rate and IAPT’s claimed recovery rate of 50.0%. The spotlight is on patients with ‘medically unexplained symptoms’ (MUS) and ‘long-term conditions’ (LTCs) such as ‘diabetes, COPD and ME/CFS, yet there is no way of knowing whether IAPT is capable of yielding the promised rewards or English patients are being sold an expensive pup. An urgent independent expert review of IAPT recovery rates is necessary to answer this question.

scholarly journals New models of care: a liaison psychiatry service for medically unexplained symptoms and frequent attenders in primary care

2017 ◽  
Vol 41 (6) ◽  
pp. 340-344 ◽  
Author(s):  
Janine Bestall ◽  
Najma Siddiqi ◽  
Suzanne Heywood-Everett ◽  
Charlotte Freeman ◽  
Paul Carder ◽  
...  
Keyword(s):  
Primary Care ◽  
Evidence Synthesis ◽  
Medically Unexplained Symptoms ◽  
Cost Savings ◽  
Models Of Care ◽  
Liaison Psychiatry ◽  
Long Term Conditions ◽  
Early Results ◽  
Medically Unexplained ◽  
Unexplained Symptoms

Aims and methodThis paper describes the process of setting up and the early results from a new liaison psychiatry service in primary care for people identified as frequent general practice attenders with long-term conditions or medically unexplained symptoms. Using a rapid evidence synthesis, we identified existing service models, mechanisms to identify and refer patients, and outcomes for the service. Considering this evidence, with local contingencies we defined options and resources. We agreed a model to set up a service in three diverse general practices. An evaluation explored the feasibility of the service and of collecting data for clinical, service and economic outcomes.ResultsHigh levels of patient and staff satisfaction, and reductions in the utilisation of primary and secondary healthcare, with associated cost savings are reported.Clinical implicationsA multidisciplinary liaison psychiatry service integrated in primary care is feasible and may be evaluated using routinely collected data.

Liaison Psychiatry and Organic Illness

2014 ◽  
Author(s):  
Andrew Horton ◽  
Mark Broadhurst
Keyword(s):  
Medically Unexplained Symptoms ◽  
Physical Symptoms ◽  
Mental Illnesses ◽  
Working Relationships ◽  
Liaison Psychiatry ◽  
Medically Unexplained ◽  
Unexplained Symptoms ◽  
The Uk

Liaison psychiatry is a subspecialty of psychiatry which involves the diag­nosis, treatment, and management of psychiatric illness in patients who have physical illnesses or present with physical symptoms. There is considerable overlap between psychiatric and medical condi­tions which requires close working relationships with medical colleagues. Liaison psychiatry is a fascinating area where the range of psychiatric presentations is wide, every case is different, and there is opportunity to keep up to date with medicine as it evolves. Within the UK there are different models practiced in different areas, ranging from assessment and signposting services to services with provi­sion for long-term outpatient follow-up. There is increasing interest in the provision of liaison services in primary care because of the challenges faced by GPs in treating patients with medically unexplained symptoms. Another driver is the hugely increased morbidity and mortality rates seen in patients with co-morbid physical and mental illnesses who receive the majority of their treatment in secondary care.

scholarly journals A CBT-based approach to medically unexplained symptoms

2009 ◽  
Vol 15 (2) ◽  
pp. 146-151 ◽  
Author(s):  
Catriona Kent ◽  
Graham McMillan
Keyword(s):  
Medically Unexplained Symptoms ◽  
Behavioural Therapy ◽  
Liaison Psychiatry ◽  
General Psychiatry ◽  
Cognitive Behavioural ◽  
Medically Unexplained ◽  
Unexplained Symptoms ◽  
The Common ◽  
Common Problems ◽  
Set Up

SummaryThis article discusses a cognitive–behavioural therapy (CBT) approach to the treatment of medically unexplained symptoms that is based on the ‘five areas’ model of CBT. We describe a typical course of therapy and some of the common problems encountered during treatment. Emphasis is placed on the practical management of these conditions, and the focus is on symptoms as opposed to cause. We believe that this approach is widely applicable and could be used in a large range of settings to tackle these debilitating conditions. In writing this article we intended to provide an overview of patients with medically unexplained symptoms. The article would be of interest to staff within liaison psychiatry departments looking to set up a medically unexplained symptoms service and general psychiatry teams who may have contact with patients presenting with somatic symptoms. Psychiatric teams without access to a liaison department may also find this article interesting.

scholarly journals Cognitive-behavioural therapyv.structured care for medically unexplained symptoms: randomised controlled trial

2008 ◽  
Vol 193 (1) ◽  
pp. 51-59 ◽  
Author(s):  
A. Sumathipala ◽  
S. Siribaddana ◽  
M. R. N. Abeysingha ◽  
P. De Silva ◽  
M. Dewey ◽  
...  
Keyword(s):  
Primary Care ◽  
Cognitive Behavioural Therapy ◽  
Primary Care Physicians ◽  
Medically Unexplained Symptoms ◽  
Behavioural Therapy ◽  
Randomised Control Trial ◽  
Structured Care ◽  
Cognitive Behavioural ◽  
Medically Unexplained ◽  
Unexplained Symptoms

BackgroundA pilot trial in Sri Lanka among patients with medically unexplained symptoms revealed that cognitive-behavioural therapy (CBT) administered by a psychiatrist was efficaciousAimsTo evaluate CBT provided by primary care physicians in a comparison with structured careMethodA randomised control trial (n=75 in each arm) offered six 30 min sessions of structured care or therapy. The outcomes of the two interventions were compared at 3 months, 6 months, 9 months and 12 monthsResultsIn each arm, 64 patients (85%) completed the three mandatory sessions. No difference was observed between groups in mean scores on the General Health Questionnaire or the Bradford Somatic Inventory, or in number of complaints or patient-initiated consultations at 3 months. For both groups, all outcome measures improved at 3 months, and remained constant in the follow-up assessmentsConclusionsCognitive–behavioural therapy given by primary care physicians after a short course of training is no more efficacious than structured care. Natural remission is an unlikely explanation for improvements in people with chronic medically unexplained symptoms, but lack of a ‘treatment as usual’ arm limits further conclusions. Further research on enhanced structured care, medical assessment and structured care incorporating simple elements of CBT principles is worthy of consideration

scholarly journals CBT to reduce healthcare use for medically unexplained symptoms: systematic review and meta-analysis

2019 ◽  
Vol 69 (681) ◽  
pp. e262-e269 ◽  
Author(s):  
Brittni Jones ◽  
Amanda C de C Williams
Keyword(s):  
Systematic Review ◽  
Healthcare Costs ◽  
Meta Analysis ◽  
Medically Unexplained Symptoms ◽  
Psychological Interventions ◽  
Healthcare Use ◽  
Cognitive Behavioural ◽  
Medically Unexplained ◽  
Unexplained Symptoms ◽  
Medical Investigations

BackgroundStudies have reported that medically unexplained symptoms (MUS) tend to be associated with increased healthcare use, which is demanding of resources and potentially harmful to patients. This association is often used to justify the funding and study of psychological interventions for MUS, yet no systematic review has specifically examined the efficacy of psychological interventions in reducing healthcare use.AimTo conduct a systematic review and meta-analysis to evaluate the effectiveness of cognitive behavioural therapies (CBT) for MUS in reducing healthcare use.Design and settingSystematic review and meta-analysis.MethodThe search from a previous systematic review was updated and expanded. Twenty-two randomised controlled trials reported healthcare use, of which 18 provided data for meta-analysis. Outcomes were healthcare contacts, healthcare costs, medication, and medical investigations.ResultsSmall reductions in healthcare contacts and medication use were found for CBT compared with active controls, treatment as usual, and waiting list controls, but not for medical investigations or healthcare costs.ConclusionCognitive behavioural interventions show weak benefits in reducing healthcare use in people with MUS. The imprecise use of MUS as a diagnostic label may impact on the effectiveness of interventions, and it is likely that the diversity and complexity of these difficulties may necessitate a more targeted approach.

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