Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-17T15:02:27.248Z Has data issue: false hasContentIssue false
  • English
  • Français

Neurology out-patients with symptoms unexplained by disease: illness beliefs and financial benefits predict 1-year outcome

Published online by Cambridge University Press:  23 July 2009

M. Sharpe ,
J. Stone ,
C. Hibberd ,
C. Warlow ,
R. Duncan ,
R. Coleman ,
R. Roberts ,
R. Cull ,
A. Pelosi  and
J. Cavanagh
...Show all authors
M. Sharpe*
Affiliation:
Psychological Medicine Research, School of Molecular and Clinical Medicine, University of Edinburgh, UK
J. Stone
Affiliation:
Department of Clinical Neurosciences, School of Molecular and Clinical Medicine, University of Edinburgh, UK
C. Hibberd
Affiliation:
Psychological Medicine Research, School of Molecular and Clinical Medicine, University of Edinburgh, UK
C. Warlow
Affiliation:
Department of Clinical Neurosciences, School of Molecular and Clinical Medicine, University of Edinburgh, UK
R. Duncan
Affiliation:
Institute of Neurological Sciences, Southern General Hospital, Glasgow, UK
R. Coleman
Affiliation:
Aberdeen Royal Infirmary, Aberdeen, UK
R. Roberts
Affiliation:
Ninewells Hospital, University of Dundee, Dundee, UK
R. Cull
Affiliation:
Department of Clinical Neurosciences, School of Molecular and Clinical Medicine, University of Edinburgh, UK
A. Pelosi
Affiliation:
Hairmyres Hospital, East Kilbride, UK
J. Cavanagh
Affiliation:
Sackler Institute of Psychobiological Research, Faculty of Medicine, University of Glasgow, UK
K. Matthews
Affiliation:
Ninewells Hospital, University of Dundee, Dundee, UK
R. Goldbeck
Affiliation:
Aberdeen Royal Infirmary, Aberdeen, UK
R. Smyth
Affiliation:
Royal Infirmary of Edinburgh, Edinburgh, UK
A. Walker
Affiliation:
Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
J. Walker
Affiliation:
Psychological Medicine Research, School of Molecular and Clinical Medicine, University of Edinburgh, UK
A. MacMahon
Affiliation:
Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
G. Murray
Affiliation:
School of Clinical Sciences and Community Health, University of Edinburgh, UK
A. Carson
Affiliation:
Psychological Medicine Research, School of Molecular and Clinical Medicine, University of Edinburgh, UK
*
*Address for correspondence: M. Sharpe, M.A., M.D., FRCP, FRCPsych, Psychological Medicine Research, Kennedy Tower, Royal Edinburgh Hospital, Edinburgh EH10 5HF, UK. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Patients whose symptoms are ‘unexplained by disease’ often have a poor symptomatic outcome after specialist consultation, but we know little about which patient factors predict this. We therefore aimed to determine predictors of poor subjective outcome for new neurology out-patients with symptoms unexplained by disease 1 year after the initial consultation.

Method

The Scottish Neurological Symptom Study was a 1-year prospective cohort study of patients referred to secondary care National Health Service neurology clinics in Scotland (UK). Patients were included if the neurologist rated their symptoms as ‘not at all’ or only ‘somewhat explained’ by organic disease. Patient-rated change in health was rated on a five-point Clinical Global Improvement (CGI) scale (‘much better’ to ‘much worse’) 1 year later.

Results

The 12-month outcome data were available on 716 of 1144 patients (63%). Poor outcome on the CGI (‘unchanged’, ‘worse’ or ‘much worse’) was reported by 482 (67%) out of 716 patients. The only strong independent baseline predictors were patients' beliefs [expectation of non-recovery (odds ratio [OR] 2.04, 95% confidence interval [CI] 1.40–2.96), non-attribution of symptoms to psychological factors (OR 2.22, 95% CI 1.51–3.26)] and the receipt of illness-related financial benefits (OR 2.30, 95% CI 1.37–3.86). Together, these factors predicted 13% of the variance in outcome.

Conclusions

Of the patients, two-thirds had a poor outcome at 1 year. Illness beliefs and financial benefits are more useful in predicting poor outcome than the number of symptoms, disability and distress.

Keywords

Cohort studymedically unexplained symptomsneurologyoutcome
Type
Original Articles
Information
Psychological Medicine , Volume 40 , Issue 4 , April 2010 , pp. 689 - 698
Copyright
Copyright © Cambridge University Press 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Atlas, SJ, Chang, Y, Keller, RB, Singer, DE, Wu, YA, Deyo, RA (2006). The impact of disability compensation on long-term treatment outcomes of patients with sciatica due to a lumbar disc herniation. Spine 31, 3061–3069.CrossRefGoogle ScholarPubMed
Barsky, AJ, Ahern, DK, Bailey, ED, Delamater, BA (1996). Predictors of persistent palpitations and continued medical utilization. Journal of Family Practice 42, 465–472.Google ScholarPubMed
Binder, LM, Rohling, ML (1996). Money matters: a meta-analytic review of the effects of financial incentives on recovery after closed-head injury. American Journal of Psychiatry 153, 7–10.Google ScholarPubMed
Bombardier, CH, Buchwald, DS (1995). Outcome and prognosis of patients with chronic fatigue vs chronic fatigue syndrome. Archives of Internal Medicine 155, 2105–2110.CrossRefGoogle ScholarPubMed
Carson, AJ, Best, S, Postma, K, Stone, J, Warlow, C, Sharpe, M (2003). The outcome of neurology outpatients with medically unexplained symptoms: a prospective cohort study. Journal of Neurology, Neurosurgery and Psychiatry 74, 897–900.CrossRefGoogle ScholarPubMed
Carson, AJ, Ringbauer, B, Stone, J, McKenzie, L, Warlow, C, Sharpe, M (2000). Do medically unexplained symptoms matter? A prospective cohort study of 300 new referrals to neurology outpatient clinics. Journal of Neurology, Neurosurgery and Psychiatry 68, 207–210.CrossRefGoogle Scholar
Cassidy, JD, Carroll, LJ, Cote, P, Lemstra, M, Berglund, A, Nygren, A (2000). Effect of eliminating compensation for pain and suffering on the outcome of insurance claims for whiplash injury. New England Journal of Medicine 342, 1179–1186.CrossRefGoogle ScholarPubMed
Cole, DC, Mondloch, MV, Hogg-Johnson, S (2002). Listening to injured workers: how recovery expectations predict outcomes – a prospective study. Canadian Medical Association Journal 166, 749–754.Google ScholarPubMed
Couprie, W, Wijdicks, EF, Rooijmans, HG, van Gijn, J (1995). Outcome in conversion disorder: a follow up study. Journal of Neurology, Neurosurgery and Psychiatry 58, 750–752.CrossRefGoogle ScholarPubMed
Craig, TK, Drake, H, Mills, K, Boardman, AP (1994). The South London Somatisation Study. II. Influence of stressful life events, and secondary gain. British Journal of Psychiatry 165, 248–258.CrossRefGoogle ScholarPubMed
Crimlisk, HL, Bhatia, K, Cope, H, David, A, Marsden, CD, Ron, MA (1998). Slater revisited: 6 year follow up study of patients with medically unexplained motor symptoms. British Medical Journal 316, 582–586.CrossRefGoogle ScholarPubMed
Ettinger, AB, Devinsky, O, Weisbrot, DM, Ramakrishna, RK, Goyal, A (1999). A comprehensive profile of clinical, psychiatric, and psychosocial characteristics of patients with psychogenic nonepileptic seizures. Epilepsia 40, 1292–1298.CrossRefGoogle ScholarPubMed
Foster, NE, Bishop, A, Thomas, E, Main, C, Horne, R, Weinman, J, Hay, E (2008). Illness perceptions of low back pain patients in primary care: what are they, do they change and are they associated with outcome? Pain 136, 177–187.CrossRefGoogle ScholarPubMed
Frostholm, L, Oernboel, E, Christensen, KS, Toft, T, Olesen, F, Weinman, J, Fink, P (2007). Do illness perceptions predict health outcomes in primary care patients? A 2-year follow-up study. Journal of Psychosomatic Research 62, 129–138.CrossRefGoogle ScholarPubMed
Gureje, O, Simon, GE, Ustun, TB, Goldberg, DP (1997). Somatization in cross-cultural perspective: a World Health Organization study in primary care. American Journal of Psychiatry 154, 989–995.Google ScholarPubMed
Guy, W (1976). Clinical Drug Evaluation (ECDEU) Assessment Manual. National Institute of Mental Health: Rockville, MD.Google Scholar
Holm, LW, Carroll, LJ, Cassidy, JD, Skillgate, E, Ahlbom, A (2008). Expectations for recovery important in the prognosis of whiplash injuries. PLoS Medicine 5, e105.CrossRefGoogle ScholarPubMed
Jackson, J, Fiddler, M, Kapur, N, Wells, A, Tomenson, B, Creed, F (2006). Number of bodily symptoms predicts outcome more accurately than health anxiety in patients attending neurology, cardiology, and gastroenterology clinics. Journal of Psychosomatic Research 60, 357–363.CrossRefGoogle ScholarPubMed
Jackson, JL, Passamonti, M (2005). The outcomes among patients presenting in primary care with a physical symptom at 5 years. Journal of General Internal Medicine 20, 1032–1037.CrossRefGoogle ScholarPubMed
Joyce, J, Hotopf, M, Wessely, S (1997). The prognosis of chronic fatigue and chronic fatigue syndrome: a systematic review. Quarterly Journal of Medicine 90, 223–233.CrossRefGoogle ScholarPubMed
Kroenke, K (2003). Patients presenting with somatic complaints: epidemiology, psychiatric co-morbidity and management. International Journal of Methods in Psychiatric Research 12, 34–43.CrossRefGoogle ScholarPubMed
Kroenke, K, Jackson, JL (1998). Outcome in general medical patients presenting with common symptoms: a prospective study with a 2-week and a 3-month follow-up. Family Practice 15, 398–403.CrossRefGoogle ScholarPubMed
Kroenke, K, Spitzer, RL, Williams, JB (2002). The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms. Psychosomatic Medicine 64, 258–266.CrossRefGoogle ScholarPubMed
Kroenke, K, Swindle, R (2000). Cognitive-behavioral therapy for somatization and symptom syndromes: a critical review of controlled clinical trials. Psychotherapy and Psychosomatics 69, 205–215.CrossRefGoogle ScholarPubMed
Landers, MR, Cheung, W, Miller, D, Summons, T, Wallmann, HW, McWhorter, JW, Druse, T (2007). Workers' compensation and litigation status influence the functional outcome of patients with neck pain. Clinical Journal of Pain 23, 676–682.CrossRefGoogle ScholarPubMed
Lempert, T, Dieterich, M, Huppert, D, Brandt, T (1990). Psychogenic disorders in neurology: frequency and clinical spectrum. Acta Neurologica Scandinavica 82, 335–340.CrossRefGoogle ScholarPubMed
Lipowski, ZJ (1987). Somatization: the experience and communication of psychological distress as somatic symptoms. Psychotherapy and Psychosomatics 47, 160–167.CrossRefGoogle ScholarPubMed
Mayou, R, Kirmayer, LJ, Simon, G, Kroenke, K, Sharpe, M (2005). Somatoform disorders: time for a new approach in DSM-V. American Journal of Psychiatry 162, 847–855.CrossRefGoogle ScholarPubMed
Mondloch, MV, Cole, DC, Frank, JW (2001). Does how you do depend on how you think you'll do? A systematic review of the evidence for a relation between patients' recovery expectations and health outcomes. Canadian Medical Association Journal 165, 174–179.Google Scholar
Petrie, KJ, Jago, LA, Devcich, DA (2007). The role of illness perceptions in patients with medical conditions. Current Opinion in Psychiatry 20, 163–167.CrossRefGoogle ScholarPubMed
Reuber, M, Burness, C, Howlett, S, Brazier, J, Grünewald, R (2007 a). Tailored psychotherapy for patients with functional neurological symptoms: results of a pilot study. Journal of Psychosomatic Research 63, 625–632.CrossRefGoogle ScholarPubMed
Reuber, M, Howlett, S, Khan, A, Grünewald, R (2007 b). Non-epileptic seizures and other functional neurological symptoms: predisposing, precipitating and perpetuating factors. Psychosomatics 48, 230–238.CrossRefGoogle ScholarPubMed
Reuber, M, Mitchell, AJ, Howlett, S, Elger, CE (2005). Measuring outcome in psychogenic nonepileptic seizures: how relevant is seizure remission? Epilepsia 46, 1788–1795.CrossRefGoogle ScholarPubMed
Sharpe, M (2002). Medically unexplained symptoms and syndromes. Clinical Medicine 2, 501–504.Google ScholarPubMed
Sharpe, M, Mayou, R, Walker, J (2006). Bodily symptoms: new approaches to classification. Journal of Psychosomatic Research 60, 353–356.CrossRefGoogle ScholarPubMed
Speckens, AE, Spinhoven, P, Sloekers, PP, Bolk, JH, Van Hemert, AM (1996 a). A validation study of the Whitely Index, the Illness Attitude Scales, and the Somatosensory Amplification Scale in general medical and general practice patients. Journal of Psychosomatic Research 40, 95–104.CrossRefGoogle ScholarPubMed
Speckens, AE, Van Hemert, AM, Bolk, JH, Rooijmans, HG, Hengeveld, MW (1996 b). Unexplained physical symptoms: outcome, utilization of medical care and associated factors. Psychological Medicine 26, 745–752.CrossRefGoogle ScholarPubMed
Vercoulen, JH, Swanink, CM, Fennis, JF, Galama, JM, Van der Meer, JW, Bleijenberg, G (1996). Prognosis in chronic fatigue syndrome (CFS): a prospective study on the natural course. Journal of Neurology, Neurosurgery and Psychiatry 60, 489–494.CrossRefGoogle ScholarPubMed
Waddell, G, Burton, K, Aylward, M (2007). Work and common health problems. Journal of Insurance Medicine 39, 109–120.Google ScholarPubMed
Ware, J Jr., Kosinski, M, Keller, SD (1996). A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Medical Care 34, 220–233.CrossRefGoogle ScholarPubMed
Weinman, J, Petrie, KJ, Moss-Morris, R, Horne, R (1996). The illness perception questionnaire: a new method for assessing the cognitive representation of illness. Psychology and Health 11, 431–445.CrossRefGoogle Scholar
Zigmond, AS, Snaith, RP (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica 67, 361–370.CrossRefGoogle ScholarPubMed