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36 - Developing links with primary care

from Part V - Different treatment settings

Published online by Cambridge University Press:  10 December 2009

By
Richard Morriss ,
Linda Gask ,
Christopher Dowrick ,
Peter Salmon  and
Sarah Peters
Edited by
Geoffrey Lloyd  and
Elspeth Guthrie
Geoffrey Lloyd
Affiliation:
Priory Hospital, London
Elspeth Guthrie
Affiliation:
University of Manchester
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Summary

Introduction

Most liaison psychiatry is practised in the general-hospital setting, but increasingly services for the physically ill are becoming community based. Family practitioners play a key role in identifying patients with comorbid physical and psychological distress. This chapter describes the developments over the last 10 years in the detection and treatment of patients with medically unexplained symptoms in a primary-care setting.

Medically unexplained symptoms in primary care

Medically unexplained symptoms (MUS) are defined as physical symptoms that doctors cannot explain by physical pathology, which distress or impair the functioning of the patient (Peveler et al. 1997). Patients with MUS seek help from the family doctor and are frequently unwilling to consult mental health professionals or non-medical personnel because many of these patients believe that they have a physical health problem (Kirmayer & Robbins 1996). Around 75% of patients with MUS persisting for more than six months (persistent medically unexplained symptoms or PMUS) are still distressed and/or functionally impaired by them 12 months later (Kroenke & Spitzer 1998; Moore et al. 2000). Persistent MUS is the most common reason for frequent attendance to the family doctor (Jyvasjarvi et al. 1998), and a frequent source of family doctor frustration (Mathers & Gash 1995). Family doctors express lower satisfaction with care for patients with PMUS than patients with psychological problems (Hartz et al. 2000).

Keywords

liaison psychiatrymedically unexplained symptomspersistant medically unexplained symptomsphysical pathologyrandomized controlled trialsprimary-care settingpsychological distress
Type
Chapter
Information
Handbook of Liaison Psychiatry , pp. 847 - 870
Publisher: Cambridge University Press
Print publication year: 2007

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