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