ABC of Medically Unexplained Symptoms

Distressing for the patient and difficult to deal with, medically unexplained symptoms present one of the biggest challenges in primary care.

ABC of Medically Unexplained Symptoms is a clear and practical guide to the identification and management of patients with symptoms not adequately explained by disease. It provides an overview of general principles and techniques and discusses in detail specific common symptoms such as headache, pain, breathlessness, fatigue and dizziness. It covers vital information on the assessment of symptoms, provides constructive explanations, and describes cognitive, behavioural and pharmacological approaches to treatment. Recognising the particular challenges that medically unexplained symptoms represent, it explains how to communicate with patients and involve them in managing their own symptoms.

Written by an expert author team, ABC of Medically Unexplained Symptoms is ideal for general practitioners, practice nurses and specialist nurses, medical students and others working within primary care settings.

Contributors, vii

Acknowledgements, ix

1 Introduction, 1
Chris Burton

2 Epidemiology and Impact in Primary and Secondary Care, 5
Alexandra Rolfe and Chris Burton

3 Considering Organic Disease, 7
David Weller and Chris Burton

4 Considering Depression and Anxiety, 10
Alan Carson and Jon Stone

5 Medically Unexplained Symptoms and the General Practitioner, 15
Christopher Dowrick

6 Principles of Assessment and Treatment, 18
Chris Burton

7 Palpitations, Chest Pain and Breathlessness, 22
Chris Burton

8 Headache, 27
David P. Kernick

9 Gastrointestinal Symptoms: Functional Dyspepsia and Irritable Bowel Syndrome, 31
Henriette E. van der Horst

10 Pelvic and Reproductive System Symptoms, 36
Nur Amalina Che Bakri, Camille Busby–Earle, Robby Steel and Andrew W. Horne

11 Widespread Musculoskeletal Pain, 40
Barbara Nicholl, John McBeth and Christian Mallen

12 Fatigue, 43
Alison J. Wearden

13 Neurological Symptoms: Weakness, Blackouts and Dizziness, 47
Jon Stone and Alan Carson

14 Managing Medically Unexplained Symptoms in The Consultation, 52
Avril F. Danczak

15 Cognitive Approaches to Treatment, 56
Vincent Deary

16 Behavioural Approaches to Treatment, 60
Vincent Deary

17 Pharmacological Treatment, 64
Killian A. Welch

18 Conclusion, 68
Chris Burton

Appendix: Suggestions for Reflection and Audit, 69
Chris Burton

Index, 71

Christopher Burton, Senior Lecturer in Primary Care, University of Aberdeen, UK

“The major contribution this monograph makes is to recognize that not all symptoms are readily explainable by a clear diagnosis. To young clinicians, this can be especially important as they face both the straightforward diagnosis and the conundrum. It is an easy read and another tool for working with primary care patients. ”  (Doody’s, 30 August 2013)