ABC of Medically Unexplained Symptoms E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Serie: ABC Series
• Sprache: Englisch

Seitenzahl: 235

Veröffentlichungsjahr: 2012

Beschreibung

This brand new title addresses the complex issues faced by primary health care practitioners in treating and managing patients with ‘medically unexplained symptoms'. It aims to develop guidelines and principles to help identify patients with medically unexplained symptoms, as they are typically underdiagnosed, and to manage symptoms more effectively with active patient involvement.

Leseprobe

Table of Contents

Series Page

Title Page

Copyright

Contributors

Acknowledgements

Chapter 1: Introduction

Aim

An approach to MUS

What do we mean by medically unexplained symptoms?

What causes MUS?

What should we call MUS?

How to use this book

Further Reading

Chapter 2: Epidemiology and Impact in Primary and Secondary Care

Epidemiology

Impact of MUS

Conclusion

Further Reading

Chapter 3: Considering Organic Disease

Introduction

How commonly does MUS turn out to be organic disease?

What are the factors associated with practitioner delay in diagnosing serious illness?

What are the commonest diagnostic errors?

Cognitive processing errors

Principles for safe practice with suspected MUS

Summary

Further Reading

Chapter 4: Considering Depression and Anxiety

Introduction

Diagnosis

Family history, childhood and recent stress

Suicide and self-harm

Patients' beliefs

Questionnaires

Investigations

Explaining the diagnosis

Further Reading

Chapter 5: Medically Unexplained Symptoms and the General Practitioner

MUS and diagnostic confusion

The frustration of MUS

Patients' expectations of GPs

How GPs can make the situation worse

Living with uncertainty

Further Reading

Chapter 6: Principles of Assessment and Treatment

Introduction

Listening to the patient

Considering the possibility of MUS

Look for typical features of organic and functional conditions

Target your examination and investigations

Give constructive explanations

Link the explanation to action

Set appropriate expectations and safety nets

Setting safety nets

Bringing it all together

Further Reading

Chapter 7: Palpitations, Chest Pain and Breathlessness

Introduction

Palpitations

Chest pain

Breathlessness

Conclusion

Further Reading

Chapter 8: Headache

Introduction

Epidemiology in primary care

GP assessment

Typical features of functional symptoms

Typical features of organic symptoms

History and examination tips

The examination

Clinical decision

Explanation

Specific treatment

Further Reading

Chapter 9: Gastrointestinal Symptoms: Functional Dyspepsia and Irritable Bowel Syndrome

Introduction

Functional dyspepsia

Irritable bowel syndrome

Other functional gut syndromes

Conclusion

Further Reading

Chapter 10: Pelvic and Reproductive System Symptoms

Introduction

Chronic pelvic pain

Vulvodynia

Dyspareunia

Other pelvic and reproductive symptoms

Further Reading

Chapter 11: Widespread Musculoskeletal Pain

Introduction

Epidemiology in primary care

Typical features of functional symptoms

Typical features of organic symptoms

History and examination tips

Investigations

Explanation

Specific management

Summary

Further Reading

Chapter 12: Fatigue

Epidemiology in primary care

GP assessment

Typical features of functional symptoms

Typical features of organic symptoms and red flag symptoms

History and examination tips

Referral and investigations

Clinical decision

Explanation

Specific treatment

Conclusion

Further Reading

Chapter 13: Neurological Symptoms: Weakness, Blackouts and Dizziness

Introduction

Functional weakness

Blackouts/dissociative (non-epileptic attacks)

Dizziness

Further Reading

Chapter 14: Managing Medically Unexplained Symptoms in The Consultation

Introduction

Getting the consultation off to a good start

Deep listening skills

Avoiding the problem of ‘The doctor thinks I am imagining it’

Breaking good news

Planning care and follow-up

Working on the relationship

Further Reading

Chapter 15: Cognitive Approaches to Treatment

CBT—‘it's NOT all in your mind’

A CBT formulation

Developing and sharing a formulation

Using a formulation to introduce treatment

Engaging patients

Working on specific thoughts

Beliefs about cause

Beliefs about symptom meaning and management

Beliefs about self and self-standards

Beliefs of others

Further Reading

Chapter 16: Behavioural Approaches to Treatment

Introduction

CBT, it is NOT just ‘do more exercise’

Know where you are going

Activity management(s)

Monitoring activity

Activity scheduling

Graded activity

Sleep management

Summary

Further Reading

Chapter 17: Pharmacological Treatment

Introduction

How drugs appear to work for symptoms

Choosing which drug to use

Explaining treatment

Reviewing and discontinuing drugs

Addiction to prescribed treatment

Side effects and the nocebo response

Treatment of less common psychiatric disorders

Further Reading

Chapter 18: Conclusion

Appendix: Suggestions for Reflection and Audit

Index

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Library of Congress Cataloging-in-Publication Data

ABC of medically unexplained symptoms / edited by Chris Burton.

p. ; cm.

Includes bibliographical references and index.

ISBN 978-1-119-96725-5 (pbk.)

I. Burton, Chris, 1958-

[DNLM: 1. Signs and Symptoms. 2. Diagnosis. 3. Primary Health Care–methods. WB 143]

616.07′5–dc23

2012032698

A catalogue record for this book is available from the British Library.

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.

Cover image: Sickle cell disease clinic C0105521 Copyright © 2011 LIFE IN VIEW/SCIENCE PHOTO LIBRARY

Cover design by: Meaden Creative

Contributors

Chris Burton

Senior Lecturer in Primary Care, University of Aberdeen, Aberdeen, UK

Camille Busby-Earle

Consultant Gynaecologist, Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, UK

Alan Carson

Senior Lecturer in Psychiatry, Robert Fergusson Unit, University of Edinburgh, Edinburgh, UK

Nur Amalina Che Bakri

MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK

Avril F. Danczak

Primary Care Medical Educator, Central and South Manchester Speciality Training Programme for General Practice, North Western Deanery and Principal, The Alexandra Practice, Manchester, UK

Vincent Deary

Senior Lecturer in Psychology, Department of Psychology, University of Northumbria, Newcastle, UK

Christopher Dowrick

Professor of Primary Care, Department of Mental and Behavioural Health Sciences, University of Liverpool, Liverpool, UK

Andrew W. Horne

Senior Lecturer and Consultant Gynaecologist, MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK

David P. Kernick

General Practitioner, St Thomas Medical Group, Exeter, UK

Christian Mallen

Professor of General Practice, Arthritis Research UK Primary Care Centre, Keele University, Keele, UK

John McBeth

Reader in Chronic Pain Epidemiology, Arthritis Research UK Primary Care Centre, Keele University, Keele, UK

Barbara Nicholl

Research Associate, Arthritis Research UK Primary Care Centre, Keele University, Keele, UK

Alexandra Rolfe

Academic Clinical Fellow in General Practice, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK

Robby Steel

Consultant Psychiatrist, Department of Psychological Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK

Jon Stone

Consultant Neurologist and Honorary Senior Lecturer in Neurology, Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK

Henriëtte E. van der Horst

Professor, Head of General Practice Department. VU Medical Centre, Amsterdam, The Netherlands

Alison J. Wearden

Professor of Health Psychology, School of Psychological Sciences, Astley Ainslie Hospital & University of Manchester, Manchester, UK

Killian A. Welch