ABC of Medically Unexplained Symptoms.
- 1st ed.
- 1 online resource (172 pages)
- New York Academy of Sciences Series .
- New York Academy of Sciences Series .
Intro -- 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.