Medically Unexplained Symptoms
News and presentations from today's conference researched and produced in partnership with The Tavistock and Portman NHS Foundation Trust. This important conference brings together leading practitioners to help better understand and meet the needs of people with medically unexplained symptoms/somatic symptom disorder.
Improving management and treatment of ‘medically unexplained symptoms’
Professor Frank Röhricht, Associate Medical Director, East London NHS Foundation Trust
Frank said we must remember that 'the patient is in pain, it is real'. There was discussion around labels and patient confusion about why they are being sent to mental health services when they have physical health needs. Frank went on to discuss social pain, and the brains response which doesnt differentiate between physical and social pain.
Patients with Medically Unexplained Symptoms (MUS, also referred to Bodily Distress Syndrome in newer classification systems) complain of physical symptoms that cannot be explained adequately or sufficiently by organic pathology, causing distress and functional impairment. Persistent MUS (more than 3 months) is highly prevalent and costly to patients, providers and society; patients with MUS often have unmet health needs as a result of their own health beliefs, incorrect diagnosis and consequently ineffective treatment despite frequent presentation at primary and secondary care services. GPs play an important role in assessment, engagement and sign-posting for treatment. Take-up amongst MUS sufferers through traditional referral systems and response rates for talking therapies are known to be low. New and innovative intervention strategies are necessary to achieve better health and corresponding economic outcomes.
Based upon experiences gathered in the context of a specialist somatoform disorder clinic and taking into account findings from a pilot trial and the wider evidence base regarding the efficacy of body oriented psychological therapy for MUS sufferers, we developed and evaluated a primary care intervention package.
The paper will summarise data from previous trials and present findings from a prospective cohort intervention study involving a cluster of GP surgeries providing a “One-Stop-Shop” primary care treatment service. This includes discussing the feasibility of implementing the pragmatic care package (recruitment, retention and acceptability) as well as the potential impact on clinical outcomes and service utilisation.
The care package included: Identification, Assessment, Engagement, Psychoeducation and a choice of Group Interventions (Mindfulness Based Stress Reduction/MBSR and Body Oriented Psychological Therapy/BOPT). Baseline and follow-up data on somatic symptom levels (PHQ-15), health-related quality of life (SF-36, EQ-5D) and service utilisation was analysed.
145 patients were referred and assessed for eligibility, 93 included in the study. Participants engaged well with different components of the care package and gained significant improvements in somatic symptom levels with corresponding increases of quality of life ratings and a reduction in health care utilisation (GP contacts and referrals to specialist services) as well as associated health care costs.
It will be argued that the primary care treatment package can be successfully implemented in primary care at a relatively low cost and easily adopted into routine care. The body-oriented approach is well accepted by clinicians and patients. Controlled trials should be conducted to test the efficacy of the treatment package as compared with treatment as usual.
For further information please visit the project website: www.mus.elft.nhs.uk
Developing an effective integrated holistic medically unexplained symptoms service
Dr Julian Stern, Director of Adult and Forensic Services & Consultant Psychiatrist in Psychotherapy, Tavistock & Portman NHS Foundation Trust
Tim Kent, Service Lead Primary Care, Consultant Psychotherapist and Social Worker, Tavistock & Portman NHS Foundation Trust
Ahmet Caglar, Clinical Practitioner Psychotherapist and Turkish speaking Community Project Group Therapist, Tavistock & Portman NHS Foundation Trust
Carol Sibanda, Clinical Co-ordinator and Specialist Nurse Psychotherapist PCPCPS, Tavistock & Portman NHS Foundation Trust
This session outlined some of the services provided at the Tavistock. Dr Julien Stern opened the presentation with an overview of services, and also discussed the impact IAPT has had on non CBT and long term therapies. Ahmet Caglar discussed the Turkish speaking community group which includes a horticultural gardening group, which also includes talking and some psycho education and self management within a less structured setting, and taking place on a farm. Carol Sibanda then went on to discuss some case studies of support within GP surgeries delivering an integrated holistic service.
Different strokes for different folks – The BodyMind Approach™ for supporting people with medically unexplained symptoms towards self-management in primary care
Prof Dr Helen Payne PhD; UKCP Reg.; MBACP; AVR; AMRS PH, Lecturer, University of Hertfordshire
Susan Brooks MSc; MA; MSc; MBA; CQSW; HCPC Reg.; FHEA, Retired Senior Lecturer, formerly University of Hertfordshire, Pathways2Wellbeing
This presentation will provide an overview of the characteristics of people with medically unexplained symptoms followed by the way in which the service design has accommodated these. We will offer an explanation of why the intervention is termed The BodyMind Approach™ and how it supports people to self-manage their symptoms, reducing GP/hospital visits and increasing GP capacity at a time when numbers are falling and demand for health care is growing annually. Clinical outcomes derived from standardised measurement tools will be summarised.
Joint Commissioning Panel for Mental Health: The newly published MUS Guidelines
Dr Simon Heyland, Co-chair, JCPMH MUS Expert Reference Group
The new MUS Guidelines for commissioners are available at http://www.jcpmh.info/resource/guidance-commissioners-services-people-medically-unexplained-symptoms/
Future related events:
IAPT: Improving Psychological Therapies for Older People
Implementing the NICE guidance for improving Mental Health Services For People with Learning Disabilities
Towards Zero Suicide: Preventing Suicide, Saving Lives
10 May 2017