Patients with medically unexplained symptoms are common all over the world in primary care, specialist clinics and inpatient care. They can be transient or chronic. The patients are usually distressed, disabled, dissatisfied and heavily investigated. They are overusers of health services and incur heath care costs disproportionate to their income. Therefore this morbidity has implications for the patient, family, society, care providers and the health care system.
People who have faced disasters describe more physical symptoms than those who have not.
An effective intervention should not only contribute to the clinical outcome of the patients and their families. It should also reduce the direct and indirect health care costs incurred.
Neither physicians nor psychiatrists are well trained for the task of managing these patients. Nonpsychiatric physicians lack assessment skills and psychiatrists are often unable to negotiate treatment with patients whose concerns are somatic.
Patients with medically unexplained symptoms should be detected at the level of presentation and preferably managed at the same point of care.
A comprehensive assessment including history, physical examination, and patient explanatory model using SEMI should be done. This alone can be therapeutic.
Anti-depressants, structured care, and CBT can be effective in managing these patients.
Instead of being concerned with the possible causes of illness, cognitive behavioural therapies focus on teaching people how to deal with their present complaints of disturbed emotions, thoughts and behaviour. In large part its success has come out of the simplicity of one of its basic premises: that a person’s thoughts, ideas, and beliefs underpin their emotional reactions and behaviour.
This book provides an evidence-based approach following three research projects conducted in Sri Lanka, including two randomised controlled clinical trials which are the only ones reported from the developing world.