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unexplained symptom
also see hypochondriasm & somatoform disorder
History:
- what is your main concern?
- what made you come in now?
- is there something particular you hope I could do for you?
- encourage discussion of psychsocial issures
- elements of standard history including chart review
- assess or screen for anxiety disorder
- assess of screen for depression
- who are the patient's supporters?
Physical examination:
- assess for signs of disease
Laboratory:
- as indicated by signs & symptoms
- repeated testing not indicated if no change in clinical status [1,5]
Management:
- goals
- restoration of function
- acquisition of coping mechanisms
- diminished focus on symptoms [1]
- treatment plan
- treat anxiety disorder & depression
- cognitive behavioral therapy [1]
- regular follow-up [1]
- adherence & response to negotiated treatment plan
- change in health status
- patient education
- negotiate new treatment plan
Related
hypochondriasm; illness anxiety disorder
somatoform (psychosomatic) disorder; somatic symptom & related disorders (SSRD)
General
sign/symptom
References
- Medical Knowledge Self Assessment Program (MKSAP) 17, 18
American College of Physicians, Philadelphia 2015, 2018.
- Edwards TM, Stern A, Clarke DD, Ivbijaro G, Kasney LM.
The treatment of patients with medically unexplained symptoms
in primary care: a review of the literature.
Ment Health Fam Med. 2010 Dec;7(4):209-21.
PMID: 22477945 Free PMC Article
- Hatcher S, Arroll B.
Assessment and management of medically unexplained symptoms.
BMJ. 2008 May 17;336(7653):1124-8. Review.
PMID: 18483055 Free PMC Article
- Smith RC, Lyles JS, Gardiner JC et al
Primary care clinicians treat patients with medically
unexplained symptoms: a randomized controlled trial.
J Gen Intern Med. 2006 Jul;21(7):671-7.
PMID: 16808764 Free PMC Article
- Isaac ML, Paauw DS.
Medically unexplained symptoms.
Med Clin North Am. 2014 May;98(3):663-72. Review.
PMID: 24758967