The association between medically unexplained physical symptoms and health care use over two years and the influence of depressive and anxiety disorders and personality traits: a longitudinal study

Boeft, Madelon den; Twisk, Jos W. R.; Terluin, Berend; Penninx, Brenda W. J. H.; Marwijk, Harm van; Numans, Mattijs E.; Wouden, Johannes C. van der; Horst, Henriëtte E. van der

doi:10.1186/s12913-016-1332-7

Cited by 33 publications

(24 citation statements)

References 39 publications

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“…For medical complaints, we found the pain of joints or muscles, allergy, problematic bowel movement, dizziness and palpitation to be the most prevalent medical complaints of all three groups. These complaints also prevailed in general population studies [49]. Note that pain prevalence of psychotic patients in the current study did not differ significantly either from controls or siblings, which was in line with the recent meta-analysis studied by Stubbs et al [50].…”

Section: Discussionsupporting

confidence: 92%

Familial liability to psychosis is a risk factor for multimorbidity in people with psychotic disorders and their unaffected siblings

et al. 2017

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Section: Discussionsupporting

confidence: 92%

Familial liability to psychosis is a risk factor for multimorbidity in people with psychotic disorders and their unaffected siblings

et al. 2017

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“…While these findings may be the consequence of the definition of uncertain VVC itself, it also could be an expression of the well-known association between MUPS and high healthcare use. 30 Given the higher number of MUPS in the uncertain VVC group, and the difficulty in diagnosing PVD as a chronic pain disorder without clear identifiable cause, the higher number of consultations and referrals may reflect the association between PVD and MUPS. A recent study showed that GPs take various characteristics like multiple MUPS, frequent and long consultations and many referrals into account when recognising MUPS in their patients.…”

Section: Discussionmentioning

confidence: 99%

“…This hypothesis would be consistent with studies that show that vulvodynia is underestimated and not recognised by GPs. 30 , 34…”

Section: Discussionmentioning

confidence: 99%

Is uncertain vulvovaginal candidiasis a marker of vulvodynia? A study in a Dutch general practice research database

Leusink¹,

Moorsel²,

Bor³

et al. 2017

BJGP Open

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BackgroundA recent Dutch study in general practice showed a clear relationship between the diagnosis of vulvovaginal candidiasis (VVC) and symptoms suggestive of provoked vulvodynia (PVD). PVD accounts for the largest group of vulvar pains, but is often not recognised by GPs.AimTo investigate whether diagnostic uncertainty about VVC in general practice could also point to the diagnosis of PVD, and whether and how this diagnostic uncertainty affects management.Design & settingAn observational study in 2014 in Dutch general practices of the NIVEL Primary Care Database.MethodWomen with an uncertain diagnosis of VVC were distinguished from those with certain VVC based on the occurrence of recurrent episodes and persisting complaints, despite treatment. Factors known to be associated with PVD were hypothesised to be more prevalent in women with uncertain VVC. Data on symptom management by GPs were collected.ResultsIn total 7066 women with VVC or uncertain VVC were included. Uncertain VVC was found to account for 28% of these patients. Compared to VVC, the group uncertain VVC included significantly more women with female genital symptoms, tiredness, irritable bowel syndrome (all P<0.001), feeling anxious, reduced sexual desire, depressive disorder, relationship problems, and micturition symptoms (all P<0.05). Compared to VVC, the group uncertain VVC included significantly higher mean numbers of telephone consultations (P<0.001), more referrals to gynaecology (P = 0.009), and higher mean numbers of prescriptions per patient (P<0.001).ConclusionThis study's findings indicate that uncertain VVC could be a marker of PVD. GPs might reconsider their diagnostics and management when women present recurrent and persistent vulvovaginal complaints, especially if accompanied by dyspareunia, functional syndromes, micturition symptoms, and psychological conditions.

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“…The illness scripts of MUS are often not only about symptom patterns, but may also include high frequency of healthcare use, loss of participation in daily activities, and social isolation as these are positively associated with MUS. 29,30 Previous research has described that, in contrast with biomedical disorders, in which GPs use an approach based on biochemistry, psychiatry is dependent on pattern recognition. 31 GPs are required to use both approaches simultaneously for patients with MUS.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

Medically unexplained symptoms: time to and triggers for diagnosis in primary care consultations

Houwen¹,

Dongelmans²,

Stappers³

et al. 2020

Br J Gen Pract

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BackgroundIt is currently not known when in the consultation GPs label symptoms as medically unexplained and what triggers this.AimTo establish the moment in primary care consultations when a GP labels symptoms as medically unexplained and to explore what triggers them to do so.Design and settingThis was a qualitative study. Data were collected in the Netherlands in 2015.MethodGPs’ consultations were video-recorded. GPs stated whether the consultation was about medically unexplained symptoms (MUS). The GP was asked to reflect on the video-recorded consultation and to indicate the moment when they labelled symptoms as MUS. Qualitative interviewing and analysis were performed to explore the triggers GPs perceived that caused them to label the symptoms as MUS.ResultsA total of 43 of the 393 video-recorded consultations (11%) were labelled as MUS. The mean time until GPs labelled symptoms as medically unexplained was about 4 minutes for newly presented symptoms and 2 minutes for symptoms for which the patients had already visited the GP before. GPs were triggered to label symptoms as MUS in the consultation by: the way patients presented their symptoms; the symptoms not fitting into a specific pattern; patients attributing the symptoms to a psychosocial context; and a discrepancy between symptom presentation and objective findings.ConclusionMost GPs labelled the presented symptoms as medically unexplained soon after the start of the consultation. GPs are triggered to label symptoms as medically unexplained by patients’ symptom presentation, symptom patterns, and symptom attribution. This suggests that non-analytical reasoning was a central component in their thought process.

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The association between medically unexplained physical symptoms and health care use over two years and the influence of depressive and anxiety disorders and personality traits: a longitudinal study

Cited by 33 publications

References 39 publications

Familial liability to psychosis is a risk factor for multimorbidity in people with psychotic disorders and their unaffected siblings

Familial liability to psychosis is a risk factor for multimorbidity in people with psychotic disorders and their unaffected siblings

Is uncertain vulvovaginal candidiasis a marker of vulvodynia? A study in a Dutch general practice research database

Medically unexplained symptoms: time to and triggers for diagnosis in primary care consultations

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