Anthrax Exposure, Belief in Exposure, and Postanthrax Symptoms Among Survivors of a Bioterrorist Attack on Capitol Hill

2018 ◽  
Vol 13 (03) ◽  
pp. 555-560
Author(s):  
Stephanie Chiao ◽  
Howard Kipen ◽  
William K. Hallman ◽  
David E. Pollio ◽  
Carol S. North
Keyword(s):  
Medically Unexplained Symptoms ◽  
Physical Symptoms ◽  
Care Utilization ◽  
Physical Injury ◽  
Multivariate Models ◽  
Diagnostic Interviews ◽  
Capitol Hill ◽  
High Incidence ◽  
Medically Unexplained ◽  
Unexplained Symptoms

ABSTRACTBackgroundFollowing chemical, biological, radiological, and nuclear disasters, medically unexplained symptoms have been observed among unexposed persons.ObjectivesThis study examined belief in exposure in relation to postdisaster symptoms in a volunteer sample of 137 congressional workers after the 2001 anthrax attacks on Capitol Hill.MethodsPostdisaster symptoms, belief in exposure, and actual exposure status were obtained through structured diagnostic interviews and self-reported presence in offices officially designated as exposed through environmental sampling. Multivariate models were tested for associations of number of postdisaster symptoms with exposure and belief in exposure, controlling for sex and use of antibiotics.ResultsThe sample was divided into 3 main subgroups: exposed, 41%; unexposed but believed they were exposed, 17%; and unexposed and did not believe that they were exposed, 42%. Nearly two-thirds (64%) of the volunteers reported experiencing symptoms after the anthrax attacks. Belief in anthrax exposure was significantly associated with the number of ear/nose/throat, musculoskeletal, and all physical symptoms. No significant associations were found between anthrax exposure and the number of postdisaster symptoms.ConclusionsGiven the high incidence of these symptoms, these data suggest that even in the absence of physical injury or illness, there may be surges in health care utilization. (Disaster Med Public Health Preparedness.2019;13:555-560)

Learning to provide patient-centered care with patients with medically unexplained symptoms: a grounded theory study in Australian general practice.

2015 ◽  
Vol 4 (3) ◽  
pp. 173-179
Author(s):  
Louise Stone ◽  
Jill Gordon
Keyword(s):  
General Practice ◽  
Grounded Theory ◽  
Medically Unexplained Symptoms ◽  
Patient Centered Care ◽  
Physical Symptoms ◽  
Patient Centered ◽  
Grounded Theory Study ◽  
Centered Care ◽  
Medically Unexplained ◽  
Unexplained Symptoms

Background Culture shapes the way illness is experienced and disease is understood. Patients with medically unexplained symptoms describe feeling their suffering is not valued because they lack a “legitimate” diagnosis. Doctors also describe feeling frustrated with these patients. This is particularly problematic for young general practitioners (GPs) who lack experience in managing patients with medically unexplained symptoms in primary care settings.Objectives To explore how general practice supervisors help registrars to provide patient-centered care for patients with medically unexplained. Methods A constructivist grounded theory study was undertaken with 24 general practice registrars and supervisors from Australian GP training practices in urban, rural and remote environments. Participants were asked to describe patients with mixed emotional and physical symptoms without an obvious medical diagnosis. Results Registrars came from hospital posts into general practice equipped with skills to diagnose and manage organic disease but lacked a framework for assessing and managing patients with medically unexplained symptoms. They described feelings of helplessness, frustration and sometimes hostility. Because these feelings were inconsistent with their expressed value systems, they were uncomfortable and confronting. The registrars valued interactions that helped them explore this area. Conclusions In hospital practice, biomedical language and explanations predominate, but in general practice patients bring different explanatory illness models to the consultation, using their own language, beliefs and cultural frameworks. Medically unexplained symptoms occupy a contested space in both the social and medical worlds of the doctor and patient. Negative feelings and a lack of diagnostic language and frameworks may prevent registrars from providing patient-centered care.

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 Encouraging clinicians to work effectively with people with medically unexplained symptoms - is a change in underlying attitudes required?

2017 ◽  
Vol 5 (3) ◽  
pp. 389
Author(s):  
Marta J Buszewicz
Keyword(s):  
Clinical Practice ◽  
Health Service ◽  
Secondary Care ◽  
Medically Unexplained Symptoms ◽  
Physical Symptoms ◽  
Normal Function ◽  
Negative Consequences ◽  
Postgraduate Level ◽  
Medically Unexplained ◽  
Unexplained Symptoms

Medically unexplained symptoms are defined as physical symptoms for which there is no clear diagnosis of organic pathology, including after relevant investigations. Several other terms are also used to describe such symptoms and will be briefly described, although none is ideal. The present paper summarizes the current research, illustrating how patients consulting clinicians in both primary and secondary care often present with symptoms which, while undoubtedly distressing for the patient, do not link with any clear organic pathology. This raises difficult issues for clinicians in terms of how much they should investigate and how to manage the patient’s problems in a way which will be helpful and mean they will feel their symptoms have been appropriately recognised and addressed. Failure to do this can lead to many negative consequences, including a breakdown in trust between patients and clinicians, over-investigation or inappropriate treatments, a loss of normal function for the patient and significant costs to the health service and economy. Despite this, the evidence is that doctors receive very little if any training about how to manage such symptoms at either the undergraduate or postgraduate level. This paper will focus on the attitudes of both junior and more senior doctors across a range of specialities to working with people with unexplained symptoms and how these may affect their management. The implications for clinical practice and recommendations for future training will be discussed and in particular the need to consider the psychosocial as well as the biomedical aspects of patients’ presentations from the outset.

Medically unexplained symptoms

2020 ◽  
pp. 6460-6462
Author(s):  
Michael Sharpe
Keyword(s):  
Cognitive Behaviour Therapy ◽  
Psychological Treatment ◽  
Medically Unexplained Symptoms ◽  
Physical Symptoms ◽  
Behaviour Therapy ◽  
Cognitive Behaviour ◽  
Medically Unexplained ◽  
Unexplained Symptoms ◽  
Iatrogenic Harm ◽  
Complex Cases

Physical symptoms are not always associated with disease. In secondary medical care as many as a third of patients present with symptoms unexplained by disease. Such ‘medically unexplained symptoms’ pose a challenge for clinical services that focus on identifying and treating disease. The principles of effective management are to: (a) avoid overinvestigation and giving speculative treatment for disease; (b) take a positive approach with the patient, accepting the reality of the symptoms while explaining clearly that they do not indicate disease; (c) identify and provide treatment for associated depression and anxiety disorders; (d) refer for psychiatric or psychological treatment when required. Complex cases with multiple persistent medically unexplained symptoms are at particular risk of iatrogenic harm and require active multidisciplinary management. Psychological treatments such as cognitive behaviour therapy may be effective.

Neurological and Medical Factors

2017 ◽  
Author(s):  
Victoria S. S. Wong ◽  
Martin Salinsky
Keyword(s):  
Medically Unexplained Symptoms ◽  
Chronic Fatigue ◽  
Physical Symptoms ◽  
Health Care Use ◽  
Psychogenic Nonepileptic Seizures ◽  
Medical Factors ◽  
Fatigue Syndrome ◽  
Medically Unexplained ◽  
Nonepileptic Seizures ◽  
Unexplained Symptoms

This chapter addresses the neurological and medical factors associated with psychogenic nonepileptic seizures (PNES). PNES can occur concurrently with epilepsy in 5 to 20% of patients. Traumatic brain injury (TBI) is a major cause of epilepsy, but it is also commonly cited by patients with PNES as the primary cause of their seizures. PNES are also overrepresented in patients with intellectual and learning disabilities. Patients with PNES usually have additional subjective neurological and medical complaints. Pain complaints are overrepresented in patients with PNES and are a major contributor to health care use. Cognitive complaints are also common, with a patient’s mood playing a larger role than objective cognitive dysfunction. Medically unexplained symptoms such as fibromyalgia and chronic fatigue syndrome are overrepresented in patients with PNES. Their occurrence increases the likelihood of diagnosing PNES over epilepsy. These observations reveal a complex pattern of susceptibility to the development of PNES. PNES are thus best viewed as only one symptom of a heterogeneous disorder characterized by multiple physical symptoms used to express psychological distress.

Functional and dissociative disorders in neurology

2018 ◽  
Author(s):  
Jon Stone ◽  
Alan Carson
Keyword(s):  
Medically Unexplained Symptoms ◽  
Conversion Disorder ◽  
Physical Symptoms ◽  
Neurological Symptoms ◽  
Dissociative Disorders ◽  
Medically Unexplained ◽  
Unexplained Symptoms

In this chapter, the focus is on patients who present with physical symptoms, such as weakness, or seizures, which can be positively identified as inconsistent with pathological diseases. These are called functional and dissociative neurological symptoms, although there are many other terms that could be used, such as conversion disorder, psychogenic symptoms, somatization, hysterical symptoms, medically unexplained symptoms, non-organic symptoms, and pseudoseizures, to name a few.

scholarly journals Medically unexplained symptoms in children: an experimental investigation of the impact of internet searching on parental responses

2020 ◽  
pp. 1-13
Author(s):  
Tyler Hughes ◽  
Francesca Meredith ◽  
Sabrina Monteregge ◽  
Sophie D. Bennett ◽  
Roz Shafran
Keyword(s):  
Medically Unexplained Symptoms ◽  
Young Person ◽  
Physical Symptoms ◽  
Internet Searching ◽  
Adult Participants ◽  
Medically Unexplained ◽  
Unexplained Symptoms ◽  
Free Search ◽  
The Impact ◽  
Parental Responses

Abstract Background: Medically unexplained symptoms (MUS) are symptoms for which no medical cause can be identified. For children and adolescents, symptoms can be maintained through parental responses. Aims: The present study investigated the impact that internet searching of symptoms has on parental responses to MUS. Method: One hundred and twenty-seven adult participants read a vignette in which they were asked to imagine they were a parent of a young person with MUS and completed visual analogue scales (VAS) reporting their beliefs, emotions and behavioural intentions about the MUS. Participants were then randomly assigned to one of three conditions: searching reputable websites for further information about the symptoms (n = 47), free search of any websites for further information about the symptoms (n = 38) or a control condition (n = 42) during which participants spent 10 minutes doing their usual behaviour on the internet, for example checking email and social media. Participants then completed the VAS for a second time. Results: Searching reputable websites led to a significantly greater decrease in behaviour VAS scores compared with the free search condition [F (1,123) = 11.374, p < .001], indicating that participants were less likely to seek a second opinion and to advise the child to avoid usual activities. Conclusions: This study demonstrated that internet searching reputable sites for information regarding physical symptoms can be positive and it may therefore be advisable for health professionals meeting children with MUS to provide the family with information links to reputable sources.

scholarly journals SOMATIZATION AND MEDICALLY UNEXPLAINED SYMPTOMS – PREVALENCE AND CORRELATES AMONG WOMEN AT NAHAQI – KPK, PAKISTAN

2019 ◽  
Vol 26 (07) ◽  
pp. 1042-1050
Author(s):  
Ali Raza ◽  
Hajira Zainab
Keyword(s):  
Medically Unexplained Symptoms ◽  
Cross Sectional Study ◽  
Physical Symptoms ◽  
Social Model ◽  
Anxiety And Depression ◽  
Psychiatric Evaluation ◽  
Cross Sectional ◽  
Severe Impairment ◽  
Medically Unexplained ◽  
Unexplained Symptoms

Background: Medically unexplained physical symptoms or somatization accounts for about half of the OPD visits in primary care setup. These are unclear symptoms and cannot be explained by medical or neurologic conditions. They are associated with significant stigma and over burden utilization of medical services, and results in frustration both for clinician and for the patient. The study is aimed to determine the prevalence of somatization and its association with anxiety and depression among women at Nahaqi - Charsadda and also to find out the medically unexplained symptoms among women at Nahaqi. Study Design: Comparative cross sectional study. Setting: Village Nahaqi at Nahaqi Emergency Satellite Hospital (NESH) Charsadda – KPK, Pakistan. Period: September 2016 to March, 2017. Methodology: 100 females were included in this study after informed consent. American Psychiatric Association, Level 1 Cross-cutting Symptom Measure and Level 2 – Somatic Symptoms Adult Measure containing 23 and 15 questions respectively were used. Data were collected through interviews; entered and analyzed in SPSS. The study was conducted from September 2016 to March 2017. Results: 100 out of 120 women in the age range of 15 to 65 years, mean age 37.09 ± 12.08 years responded with response rate of 83.3%. Majority were illiterate (79 %), married (81 %) women. 86 % women reported unexplained body aches and pains. The prevalence of anxiety and depression among women at Nahaqi was 50 and 57 % respectively and all items were highly significant (P < 0.000) with somatic score categories (Minimal, Low, Medium, High). The prevalence of medically unexplained symptoms was found out to be 84 %, which includes all high and medium score cases. 59 women had 5 or more mild to moderate somatic complaints, while 49 reported 5 or more severe complaints. The most frequent complaints were aches and pains (headache, backache and musculo-skeletal aches and pains) followed by lack of energy, general asthenia. Conclusion: Nearly every second women was noted to have unexplained aches and pains, which shows that somatization is a frequent complaint in primary health settings. Majority cases were milder, however, patients showing severe impairment or more complaints they need particular attention. Although MUS result in extra stress on health services utilization in women visiting a rural health facility – Nahaqi; those with serious impairment shall be referred for psychiatric evaluation. A comprehensive medical, psycho-social model that involves community shall be formulated to address this issue.

scholarly journals Assessment of Somatization and Medically Unexplained Symptoms in Later Life

Assessment ◽  
2017 ◽  
Vol 25 (3) ◽  
pp. 374-393 ◽  
Author(s):  
T. J. W. van Driel ◽  
P. H. Hilderink ◽  
D. J. C. Hanssen ◽  
P. de Boer ◽  
J. G. M. Rosmalen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Older Persons ◽  
Large Scale ◽  
Somatic Symptom ◽  
Medically Unexplained Symptoms ◽  
Physical Symptoms ◽  
Brief Symptom Inventory ◽  
Persistent Symptoms ◽  
Medically Unexplained ◽  
Unexplained Symptoms

The assessment of medically unexplained symptoms and “somatic symptom disorders” in older adults is challenging due to somatic multimorbidity, which threatens the validity of somatization questionnaires. In a systematic review study, the Patient Health Questionnaire–15 (PHQ-15) and the somatization subscale of the Symptom Checklist 90-item version (SCL-90 SOM) are recommended out of 40 questionnaires for usage in large-scale studies. While both scales measure physical symptoms which in younger persons often refer to unexplained symptoms, in older persons, these symptoms may originate from somatic diseases. Using empirical data, we show that PHQ-15 and SCL-90 SOM among older patients correlate with proxies of somatization as with somatic disease burden. Updating the previous systematic review, revealed six additional questionnaires. Cross-validation studies are needed as none of 46 identified scales met the criteria of suitability for an older population. Nonetheless, specific recommendations can be made for studying older persons, namely the SCL-90 SOM and PHQ-15 for population-based studies, the Freiburg Complaint List and somatization subscale of the Brief Symptom Inventory 53-item version for studies in primary care, and finally the Schedule for Evaluating Persistent Symptoms and Somatic Symptom Experiences Questionnaire for monitoring treatment studies.

Travelling at a hundred miles an hour and not being able to get off: Examining a patient’s journey from medically unexplained symptoms

2018 ◽  
Vol 6 (3) ◽  
pp. 400
Author(s):  
Kelvin Leung ◽  
Foluke Odeyale ◽  
Itoro Udo
Keyword(s):  
Mental Health ◽  
Mental Health Treatment ◽  
Medically Unexplained Symptoms ◽  
Severity Of Illness ◽  
Physical Symptoms ◽  
Mental Wellbeing ◽  
Liaison Psychiatry ◽  
Patient’S Experience ◽  
Medically Unexplained ◽  
Unexplained Symptoms

Objectives: To understand a patient’s experience of treatment and recovery from medically unexplained tremors affecting hand and neck. The patient attended a Liaison Psychiatry Outpatient Clinic.Method: A case study using interview method focusing on the nature and severity of illness; effects of symptoms; expectations of treatment; changes observed and the patient’s expectation of services.Results: The patient was “extremely” stressed about his symptoms and “apprehensive” about attending mental health services. He experienced resolution of physical symptoms and improvements in mental wellbeing. Mental health treatment comprised medications and psychological therapies.Conclusions: Persons experiencing medically unexplained symptoms deserve positive experiences of well-funded specialist healthcare.

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