We have seen that diagnosis and treatment of medically unexplained symptoms (MUS) in a primary care clinic is completely inadequate (see the posts tagged Kroenke and Blindspot). Smith and Dwamena (1) agree. They point out that MUS patients comprise half or more of all outpatients and often are subjected to the risk and cost of “ill-advised lab testing and trial treatments” and seldom receive adequate treatment in primary care. (If the same could be said of, say, diabetes, there would be an international uproar and diabetes isn’t half as common as MUS.)
Mental health professionals (MHP) also struggle with MUS. For example, the classification of this disorder in the Diagnostic and Statistical Manual (DSM) used by MHPs is completely inadequate. As a first step to initiate change, Smith and Dwamena propose an improvement in classification. They reject using only the current DSM terms, Somatoform Disorder (and its subtypes), because few patients meet the definition (2). For example, a study (3) of 206 MUS patients who came to clinic often, found only 4% met criteria for a Somatoform Disorder and even an abridged definition was met by only another 19%. Smith and Dwamena contend that the other 77% have been “completely overlooked” by research in this field. (For this to be the case as recently as 2007 is embarrassing and sad.) To be continued in my next post…
1. Smith R and Dwamena F. Classification and Diagnosis of Patients with Medically Unexplained Symptoms. J Gen Int Med 22:685-691. 2007. (From Michigan State University)
2. Definition of Somatoform Disorder: of many years duration, begins before age 30, is more common in women, and has (over a lifetime) at least four pain symptoms, two gastrointestinal symptoms, one sexual symptom, and one pseudoneurological symptom.
3. Smith RC, Gardiner JC, Lyles JS, et al. Exploration of DSM-IV Criteria in primary care patients with medically unexplained symptoms. Psychosom Med. 2005;67:123–9.
Tags: Blind Spot, Kroenke, Smith Dwamena, Somatoform Disorder
