The treatment of patients with medically unexplained symptoms in primary care: A review of the literature

Mental Health in Family Medicine

Volumn 7, Issue 4, 2011, Pages 209-221

  Edwards, Todd M ^a   Stern, Anthony ^b   Clarke, David D ^c   Ivbijaro, Gabriel ^d,e   Kasney, L Michelle ^a  

^a UNIVERSITY OF SAN DIEGO   (United States)

^b ALBERT EINSTEIN COLLEGE OF MEDICINE   (United States)

^c OREGON HEALTH AND SCIENCE UNIVERSITY   (United States)

^d Improving Access to Psychological Therapies Programme   (United Kingdom)

^e Waltham Forest Community and Family Health Services   (United Kingdom)

Author keywords

General practice; Medically unexplained symptoms; Primary care

Indexed keywords

CLINICAL ASSESSMENT; COGNITIVE THERAPY; DOCTOR PATIENT RELATION; GROUP THERAPY; HUMAN; LEISURE; MEDICALLY UNEXPLAINED SYMPTOM; MEDITATION; PATIENT CARE; PRIMARY MEDICAL CARE; PSYCHOTHERAPY; REVIEW; SYMPTOM;

EID: 79953698434     PISSN: 1756834X     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Review

References (109)

1. Kroenke K and Mangelsdorff AD. Common symptoms in ambulatory care: incidence, evaluation, therapy and outcome. American Journal of Medicine 1989;86:262-6. (Pubitemid 19081465)
2. Burton C. Beyond somatization: a review of the understanding and treatment of medically unexplained physical symptoms (MUPS). British Journal of General Practice 2003;53:233-41.
3. Katon W, Von Korff M, Lin E et al. Stepped collaborative care for primary care patients with persistent symptoms of depression: a randomized trial. Archives of General Psychiatry 1999;56:1109.
4. Kroenke K. Efficacy of treatment for somatoform disorders: a review of randomized controlled trials. Psychosomatic Medicine 2007;69:881-8. (Pubitemid 350158831)
5. Kirmayer LJ and Tailefer S. Somatoform disorders. In: Turner SM and Hersen M (eds) Adult Psychopathology and Diagnosis (3e). New York: Wiley, 1997, pp. 333-83.
6. Gonzalez J, Williams JW Jr, Noel PH et al. Adherence to mental health treatment in a primary care clinic. Journal of the American Board of Family Practice 2005;18:87-96. (Pubitemid 41664012)
7. Brown RJ. Introduction to the special issue on medically unexplained symptoms: background and future directions. Clinical Psychology Review 2007; 27:769-80. (Pubitemid 47410328)
8. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (4e, text rev.). Washington, DC: American Psychiatric Association, 2000.
9. Fava GA. Multisomatoform disorder. Archives of General Psychiatry 1998;55:756.
10. Reid S, Crayford T, Richards S et al. Recognition of medically unexplained symptoms: do doctors agree? Journal of Psychosomatic Research 1999;47:483-5.
11. Rasmussen NH, Agerter DC, Colligan RC et al. Somatization and alexithymia in patients with high use ofmedical care andmedically unexplained symptoms. Mental Health in Family Medicine 2008;5:139-48.
12. Rosendal M, Oleson F and Fink P. Management of medically unexplained symptoms. British Medical Journal 2005;330:4-5. (Pubitemid 40070465)
13. Rosendal M, Fink P, Falkoe E et al. Improving the classification of medically unexplained symptoms in primary care. European Journal of Psychiatry 2007;21:25-36. (Pubitemid 351377908)
14. Dowrick C, Gask L, Hughes JG et al. General practitioners' views on reattribution for patients with medically unexplained symptoms: a questionnaire and qualitative study. BMC Family Practice 2008;9:46.
15. Hatcher S and Arrol B. Assessment and management of medically unexplained symptoms. British Medical Journal 2008;336:1124-8. (Pubitemid 351731744)
16. Aiarzaguena J, Grandes G, Salazar A et al. The diagnostic challenges presented by patients with medically unexplained symptoms in general practice. Scandinavian Journal of Primary Health Care 2008;26:99-105. (Pubitemid 351873985)
17. Smith GR, Monson RA and Ray DC. Patients with multiple unexplained symptoms: their characteristics, functional health, and health care utilization. Archives of Internal Medicine 1986;146:69-72. (Pubitemid 16158631)
18. Waller E and Scheidt CE. Somatoform disorders as disorders of affect regulation: a development perspective. International Review of Psychiatry 2006;18:13-24. (Pubitemid 43201017)
19. De Gucht V and Heiser W. Alexithymia and somatisation: a quantitative review of the literature. Journal of Psychosomatic Research 2003;54:425-34. (Pubitemid 38367930)
20. Duddu V, Isaac MK and Chaturvedi SK. Alexithymia in somatoform and depressive disorders. Journal of Psychosomatic Research 2003;54:435-8. (Pubitemid 38367931)
21. Mattila AK, Kronholm E, Jula A et al. Alexithymia and somatization in general population. Psychosomatic Medicine 2008;70:716-22.
22. Bach M, Bach D, Bohmer F et al. Alexithymia and somatization: relationship to DSM-III-R diagnoses. Journal of Psychosomatic Research 1994;38:529-38. (Pubitemid 24256711)
23. Martin A, Rauh E, Ficher M et al. A one-session treatment for patients suffering from medically unexplained symptoms in primary care: a randomised clinical trial. Psychosomatics 2007;48:294-303. (Pubitemid 47001262)
24. Hiller W, Fichter M and Reif W. A controlled treatment study of somatoform disorders including analysis of healthcare utilisation and cost-effectiveness. Journal of Psychosomatic Research 2003;54:369-80. (Pubitemid 38366002)
25. Swartz M, Landerman R, George L et al. Somatization disorder. In: Robins LN and Regier DA (eds) Psychiatric Disorders in America. New York: Free Press, 1991, pp. 220-57.
26. Smith GR. The course of somatization and its effects on utilization of health care resources. Psychosomatics 1994;35:263-7.
27. Barsky AJ, Ettner SL, Horsky J et al. Resource utilization of patients with hypochondriacal health anxiety and somatization. Medical Care 2001;39:705-15. (Pubitemid 33610095)
28. Zoccolillo M and Cloninger C. Somatization disorder: psychologic symptoms, social disability and diagnosis. Comprehensive Psychiatry 1986;27:65-73. (Pubitemid 16161151)
29. Bermingham SL, Cohen A, Hague J et al. The cost of somatisation among the working-age population in England for the year 2008-2009. Mental Health in Family Medicine 2010;7:71-84.
30. Dwamena FC, Lyles JS, Frankel RM et al. In their own words: qualitative study of high-utilizing primary care patients with medically unexplained symptoms. BMC Family Practice 2009;10:67.
31. Drossman DA, Talley NJ, Leserman J et al. Sexual and physical abuse and gastrointestinal illness. Review and recommendations. Annals of Internal Medicine 1995;123:782-94.
32. Drossman DA, Leserman J, Nachman G et al. Sexual and physical abuse in women with functional or organic gastrointestinal disorders. Annals of Internal Medicine 1990;113:828-33.
33. Kirmayer LJ and Robbins JM. Patients who somatize in primary care: a longitudinal study of cognitive and social characteristics. Psychological Medicine 1996;26:937-51. (Pubitemid 26305995)
34. Waitzkin H and Magana H. The black box in somatization: unexplained physical symptoms, culture, and narratives of trauma. Social Science and Medicine 1997;45:811-25. (Pubitemid 27341670)
35. Salmon P, Peters S and Stanley I. Patients' perceptions of medical explanations for somatization disorders: qualitative analysis. British Medical Journal 1999;318:372-6. (Pubitemid 29192087)
36. McWhinney IR, Epstein RM and Freeman TR. Rethinking somatization. Annals of Internal Medicine 1997;126:747-50.
37. Sumathipala A, Siribaddana S Hewege S et al. Understanding the explanatory model of the patient on their medically unexplained symptoms and its implication on treatment development research: a Sri Lanka Study. BMC Psychiatry 2008;8:54-64.
38. Hahn SR. Physical symptoms and physician-experienced difficulty in the physician-patient relationship. Annals of Internal Medicine 2001;134:897-904. (Pubitemid 32405698)
39. Wileman L, May C and Chew-Graham CA. Medically unexplained symptoms and the problem of power in the primary care consultation: a qualitative study. Family Practice 2002;19:178-82. (Pubitemid 34257780)
40. Olde Hartman TC, Hassink-Franke LJ, Lucassen PL et al. Explanation and relations. How do general practitioners deal with patients with persistent medically unexplained symptoms: a focus group study. BMC Family Practice 2009;10:68.
41. Kappen T and van Dulmen S. General practitioners' responses to the initial presentation of medically unexplained symptoms: a quantitative analysis. BioPsychoSocial Medicine 2008;2:22.
42. Salmon P, Ring A, Dowrick CF et al. What do general practice patients want when they present medically unexplained symptoms, and why do their doctors feel pressurized? Journal of Psychosomatic Research 2005;59:255-60.
43. Peters S, Stanley I, Rose M et al. Patients with medically unexplained symptoms: sources of patients' authority and implications for demands on medical care. Social Science and Medicine 1998;46:559-65. (Pubitemid 28024895)
44. Kirmayer LJ and Robbins JM. Three forms of somatization in primary care: prevalence, co-occurrence, and sociodemographic characteristics. The Journal of Nervous and Mental Disease 1991;179:647-55.
45. Salmon P, Ring A, Humphris GM et al. Primary care consultations about medically unexplained symptoms: how do patients indicate what they want? Journal of General Internal Medicine 2009:24:450-6.
46. Nordin TA, Hartz AJ, Noyes R Jr et al. Empirically identified goals for the management of unexplained symptoms. Family Medicine 2006;38:476-82. (Pubitemid 44291114)
47. Epstein RM, Shields CG, Meldrum SC et al. Physicians' responses to patients' medically unexplained symptoms. Psychosomatic Medicine 2006;68:269-76. (Pubitemid 43740131)
48. Epstein RM, Hadee T, Carroll J et al. 'Could this be something serious?' Reassurance, uncertainty, and empathy in response to patients' expressions of worry. Journal of General Internal Medicine 2007;22:1731-9. (Pubitemid 50000143)
49. Sumathipala A. What is the evidence for the efficacy of treatments for somatoform disorders? A critical review of previous intervention studies. Psychosomatic Medicine 2007;69:889-900. (Pubitemid 350161711)
50. Blanchard EB and Scharff L. Psychosocial aspects of assessment and treatment of irritable bowel syndrome in adults and recurrent abdominal pain in children. Journal of Consulting and Clinical Psychology 2002;70:725-38. (Pubitemid 34640739)
51. Witthöft Mand Hiller W. Psychological approaches to origins and treatments of somatoform disorders. Annual Review of Clinical Psychology 2010;6:257-83.
52. Kroenke K and Swindle R. Cognitive-behavioral therapy for somatization and symptom syndromes: a critical review of controlled clinical trials. Psychotherapy and Psychosomatics 2000;69:205-15. (Pubitemid 30413214)
53. Smith R, Lyles J, Gardiner J et al. Primary care clinicians treat patients with medically unexplained symptoms: a randomized controlled trial. Journal of General Internal Medicine 2006;21:671-7. (Pubitemid 43973548)
54. Smith R, Gardiner J, Luo Z et al. Primary care physicians treat somatization. Journal of General Internal Medicine 2009;24:829-32.
55. Luo Z, Goddeeris J, Gardiner J et al. Costs of an intervention for primary care patients with medically unexplained symptoms: a randomized controlled trial. Psychiatric Services 2007;58:1079-86. (Pubitemid 47290866)
56. Smith R, Lein C, Collins C et al. Treating patients with medically unexplained symptoms in primary care. Journal of General Internal Medicine 2003;18:478-89. (Pubitemid 36836678)
57. Watson WH and McDaniel SH. Relational therapy in medical settings: working with somatizing patients and their families. Journal of Clinical Psychology 2000;56:1065-82.
58. Dowrick CF, Ring A, Humphris GM et al. Normalisation of unexplained symptoms by general practitioners: a functional typology. British Journal of General Practice 2004;54:165-70. (Pubitemid 38279485)
59. Rief W, Heitmuller AM, Reisberg K et al. Why reassurance fails in patients with unexplained symptoms: an experimental investigation of remembered probabilities. PLoS Medicine 2006;269:1266-72. (Pubitemid 44338364)
60. Deary V, Chalder T and Sharpe M. The cognitive behavioural model of medically unexplained symptoms: a theoretical and empirical review. Clinical Psychology Review 2007;27:781-97. (Pubitemid 47422313)
61. Abbass A, Campbell S, Magee K et al. Intensive short-term dynamic psychotherapy to reduce rates of emergency department return visits for patients with medically unexplained symptoms: preliminary evidence from a prepost intervention study. CJEM: the Journal of the Canadian Association of Emergency Physicians 2009;11:529-34.
62. Walker EA, Unutzer J and Katon WJ. Understanding and caring for the distressed patient with multiple medically unexplained symptoms. Journal of the American Board of Family Practice 1998;11:347-56.
63. Morriss R, Dowrick C, Salmon P et al. Turning theory into practice: rationale, feasibility and external validity of an exploratory randomized controlled trial of training family practitioners in reattribution to manage patients with medically unexplained symptoms (the MUST). General Hospital Psychiatry 2006;28:343-51. (Pubitemid 43949526)
64. Peters S, Rogers A, Salmon P et al. What do patients choose to tell their doctors? Qualitative analysis of potential barriers to reattributing medically unexplained symptoms. Journal of General Internal Medicine 2008;24:443-9.
65. Aiarzaguena JM, Gaminde I, Grandes G et al. Somatization in primary care: experiences of primary care physicians involved in a training program and in a randomised controlled trial. BMC Family Practice 2009;10:73.
66. Morriss R, Dowrick C, Salmon P et al. Cluster randomized controlled trial of training practices in reattribution for medically unexplained symptoms. British Journal of Psychiatry 2007;191:536-42. (Pubitemid 350273215)
67. Aiarzaguena J, Grandes G, Gaminde I et al. A randomized controlled clinical trial of a psychosocial and communication intervention carried out by GPs for patients with medically unexplained symptoms. Psychological Medicine 2007;3:283-94. (Pubitemid 46158169)
68. Smith GR. The epidemiology and treatment of depression when it coexists with somatoform disorders, somatization, or pain. General Hospital Psychiatry 1992;14:265-72.
69. O'Malley PG, Jackson JL, Tomkins G et al. Antidepressant therapy for unexplained syndromes: a critical review. Journal of Family Practice 1999;48:980-93.
70. Muller T, Mannel M, Murek H et al. Treatment of somatoform disorders with St John's wort: a randomised, double-blind and placebo-controlled trial. Psychosomatic Medicine 2004;66:5384-7.
71. Volz HP, Moller HJ, Reimann I et al. Opipramol for the treatment of somatoform disorders results from a placebo-controlled trial. European Neuropsychopharmacology 2000;10:211-17. (Pubitemid 30227622)
72. Phillips KA, Albertini RS and Rasmussen SA. A randomised placebo-controlled trial of fluoxetine in body dysmorphic disorder. Archives of General Psychiatry 2002;59:381-8. (Pubitemid 34275257)
73. Ivbijaro GO, Kolkiewicz LA, Palazidou E et al. Look, listen and test. Mental health assessment. Primary Care Mental Health 2005;3:145-7.
74. Speckens AEM, Van Hemert AM, Spinhoven P et al. Cognitive behavioural therapy for medically unexplained physical symptoms: a randomised controlled trial. British Medical Journal 1995;311:1328.
75. Sharpe M, Hawton K, Simkin S et al. Cognitive behaviour therapy for the chronic fatigue syndrome: a randomized controlled trial. British Medical Journal 1996;312:22.
76. Escobar J, Gara M, Diaz-Martinez A et al. Effectiveness of a time-limited cognitive behavior therapytype intervention among primary care patients with medically unexplained symptoms. Annals of Family Medicine 2007;5:328-35. (Pubitemid 47294849)
77. Blankenstein AH. Somatising Patients in General Practice. Reattribution, a promising approach. (PhD thesis). Amsterdam: Vrije Universiteit, 2001.
78. Nezu AM, Nezu CM and Lombardo ER. Cognitive behavioural therapy for medically unexplained symptoms: a critical review of the treatment. Behavior Therapy 2001;32:537-83. (Pubitemid 33001006)
79. Looper K and Kirmayer L. Behavioral medicine approaches to somatoform disorders. Journal of Consulting and Clinical Psychology 2002;70:810-27. (Pubitemid 34640745)
80. Allen L, Escobar J, Lehrer M et al. Psychosocial treatment of multiple explained physical symptoms: a review of the literature. Psychosomatic Medicine 2002;64:939-50. (Pubitemid 35417137)
81. Raine R, Haines A, Sensky T et al. Systematic review of mental health interventions for patients with common somatic symptoms: can research evidence from secondary care be extrapolated to primary care? British Medical Journal 2002;325:1082-93.
82. Klimes I, Mayou RA, Pearce MJ et al. Psychological treatment for atypical noncardiac chest pain: a controlled evaluation. Psychological Medicine 1990;20:605.
83. Sharpe M, Peveler R and Mayou R. The psychological treatment of patients with functional somatic symptoms: a practical guide. Journal of Psychosomatic Research 1992;36:515.
84. Arnold IA, de Waal MWM, Eekhof JAH et al. Medically unexplained physical symptoms in primary care: a controlled study on the effectiveness of cognitive-behavioral treatment by the family physician. Psychosomatics 2009;50:515-24.
85. Sumathipala A, Siribaddana S, Abeysingha M et al. Cognitive-behavioural therapy v. structured care for medically unexplained symptoms: randomised controlled trial. British Journal of Psychiatry 2008;193:51-9. (Pubitemid 351946808)
86. Hayes S, Strosahl K and Wilson K. Acceptance and Commitment Therapy: an experiential approach to behavior change. New York: Guilford, 1999.
87. Linehan MM. Cognitive Behavioral Treatment of Borderline Personality Disorder. New York: Guilford, 1993.
88. Kohlenberg RJ and Tsai M. Functional Analytic Psychotherapy. New York: Springer, 1991.
89. Cohen-Posey K. Brief Therapy Client Handouts. New York: John Wiley and Sons, 2000.
90. Cohen-Posey K. More Brief Therapy Client Handouts. New York: John Wiley and Sons, 2010.
91. Keefer L and Blanchard EB. The effects of relaxation response meditation on the symptoms of irritable bowel syndrome: results of a controlled treatment study. Behaviour Research and Therapy 2001;39:801.
92. Benson H. The Relaxation Response. New York: William Morrow and Company Inc., 1975.
93. Kashner TM, Rost K, Cohen B et al. Enhancing the health of somatization disorder patients. Effectiveness of short-term group therapy. Psychosomatics 1995;36:462-70.
94. Maunder R and Hunter J. An integrated approach to the formulation and psychotherapy of medical unexplained symptoms: meaning- and attached-based intervention. American Journal of Psychotherapy 2004;58:17-33. (Pubitemid 38470571)
95. National Collaborating Centre for Mental Health. Depression: the NICE guideline on the treatment and management of depression in adults. London: The British Psychological Society and The Royal College of Psychiatrists, 2010.
96. The Canadian Medical Protective Association. Collaborative Care: a medical liability perspective. Ottowa: Candian Medical Protective Association, 2007.
97. Bower P, Gilbody S, Richards D et al. Collaborative care for depression in primary care: making sense of a complex intervention. Systematic review and meta-regression. The British Journal of Psychiatry 2006;189:484-93. (Pubitemid 44876866)
98. Collins C, Hewson DL, Munger R et al. Evolving Models of Behavioral Health Integration in Primary Care. New York: Milbank Memorial Fund, 2010.
99. Smith GR, Rost K and Kashner TM. A trial of the effect of a standardized psychiatric consultation on health outcomes and costs in somatizing patients. Archives of General Psychiatry 1995;52:238-43.
100. Rost K, Kashner TM and Smith GR. Effectiveness of psychiatric intervention with somatization disorder patients: improved outcomes at reduced costs. General Hospital Psychiatry 1994;16:381-7. (Pubitemid 24355863)
101. Kashner TM, Rost K, Smith GR et al. An analysis of panel data. The impact of a psychiatric consultation letter on the expenditures and outcomes of care for patients with somatization disorder. Medical Care 1992;30:811-21.
102. Rasmussen NH, Furst JW, Swenson-Dravis DM et al. Innovative reflecting interview: effect on high-utilizing patients with medically unexplained symptoms. Disease Management 2006;6:349-59. (Pubitemid 44904296)
103. Brown RJ, Schrag A and Trimble MR. Dissociation, childhood interpersonal trauma, and family functioning in patients with somatization disorder. American Journal of Psychiatry 2005;162:899-905. (Pubitemid 40676202)
104. Hilbert A, Martin A, Zech T et al. Patients with medically unexplained symptoms and their significant others: illness attributions and behaviors as predictors of patient functioning over time. Journal of Psychosomatic Research 2010;68:253-62.
105. Rolland J. Families, Illness, and Disability: an integrative treatment model. New York: Basic Books, 1994.
106. McDaniel SH, Hepworth J and Doherty WJ. Medical Family Therapy: a biopsychosocial approach to families with health problems. New York: Basic Books, 1992.
107. Kirmayer LJ, Groleau D, Looper KJ et al. Explaining medically unexplained symptoms. Canadian Journal of Psychiatry 2004;49:663-71.
108. Kirmayer JL and Young A. Culture and somatization: clinical, epidemiological, and ethnograhic perspectives. Psychosomatic Medicine 1998;60:420-30.
109. Whitley R, Kirmayer LJ and Groleau D. Public pressure, private protest: illness narratives of West Indian immigrants in Montreal with medically unexplained symptoms. Anthropology and Medicine 2006;13:193-205. (Pubitemid 44359563)