Psychiatric characteristics of older persons with Medically Unexplained Symptoms, 2020, Hanssen et al

Andy

Andy

Retired committee member
Full title: Psychiatric characteristics of older persons with Medically Unexplained Symptoms; a comparison with older patients suffering from Medically Explained Symptoms
Background: Empirical studies on the clinical characteristics of older persons with Medically Unexplained Symptoms (MUS) are limited to uncontrolled pilot studies. Therefore, we aim to examine the psychiatric characteristics of older patients with MUS compared to older patients with medically explained symptoms (MES), also across healthcare settings.

Methods: A case-control study including 118 older patients with MUS and 154 older patients with MES. To include patients with various developmental and severity stages, patients with MUS were recruited in the community (n=12), primary care (n=77) and specialized health care (n=29). Psychopathology was assessed according to DSM-IV-TR criteria (Mini International Neuropsychiatric Interview) and by dimensional measures (e.g. psychological distress; hypochondriasis; depressive symptoms).

Results: A total of 69/118 (58.5%) patients with MUS met the criteria for a somatoform disorder according to DSM-IV-TR criteria, with the highest proportion among patients recruited in specialized healthcare settings (p=.008). Patients with MUS had a higher level of psychological distress and hypochondriasis compared to patients with MES. Although psychiatric disorders (beyond somatoform disorders) were more frequently found among patients with MUS compared to patients with MES (42.4% versus 24.8 %, p=.008), this difference disappeared when adjusted for age, sex and level of education (OR=1.7 [95% CI: 48 1.0 – 3.0], p=.070).

Conclusions: Although psychological distress is significantly higher among older patients with MUS compared to those with MES, psychiatric comorbidity rates hardly differ between both patient groups. Therefore, treatment of MUS in later life should primarily focus on reducing psychological distress, irrespective of the healthcare setting patients are treated in.
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Journal page, https://www.cambridge.org/core/jour...ned-symptoms/9882B332D59AE93AFAD5CE4471598C9F
Open access PDF, https://www.cambridge.org/core/serv...ffering_from_medically_explained_symptoms.pdf
 
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People carrying the burden of as yet unexplained and often debilitating physical symptoms have a higher level of psychological distress, but no higher level of psychiatric comorbidity.

That doesn't look to me like evidence for any primary psychopathology, but rather just a normal reaction to a truly shitty situation, including endless unjustified and damaging psychopathologising by psychs desperately trying to justify their incomes and power.
 
I started a post about circular thinking, and confirmation bias, and it being natural to be psychologically distressed when all around you deny your illness....
But this paper is just the usual nasty stuff, we've seen it all before.

Main thing of note, another clever acronym:
The Older Persons with medically Unexplained Symptoms (OPUS) study
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An opus is a piece of classical music by a particular composer. Opus is usually followed by a number which indicates at what point the piece was written. The abbreviation op. is also used. ... You can refer to an artistic work such as a piece of music or writing or a painting as an opus.
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Perhaps the title is more apt than they intended. This is a piece of creative fiction, not science.
 
Remember that somatoform disorder requires that the person is excessively preoccupied with symptoms. That means someone else decides whether a person is worried the right amount or too much. I don't know why someone would believe that they can tell whether a person is excessively preoccupied with symptoms because symptoms are by definition subjective.

This is of course a very useful diagnosis to limit further medical investigation.
 
Hutan said:
Here's the Whitely Index, the test for hypochondriasis that was used in this paper:
(sorry about Item 4 - that's how it appears on the link)
View attachment 11024

:facepalm:
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Those questionnaires are all so super weird and loaded. They are tailored specifically to get the answers they want based on specific circumstances they can control. I have no idea how such obviously biased attempts at outcome-seeking have made it into common practice. There is simply no quality control in clinical psychology, none whatsoever. Frankly the entire field needs to start over from scratch.
 
strategist said:
Remember that somatoform disorder requires that the person is excessively preoccupied with symptoms. That means someone else decides whether a person is worried the right amount or too much. I don't know why someone would believe that they can tell whether a person is excessively preoccupied with symptoms because symptoms are by definition subjective.

This is of course a very useful diagnosis to limit further medical investigation.
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And if you don't worry enough despite the "complaints" then you're probably emotionally stunted with low affect or some other BS. Heads they win, tails we lose. Always. It's basically scripted with only one possible outcome.
 
Although psychiatric disorders (beyond somatoform disorders) were more frequently found among patients with MUS compared to patients with MES (42.4% versus 24.8 %, p=.008), this difference disappeared when adjusted for age, sex and level of education (OR=1.7 [95% CI: 48 1.0 – 3.0], p=.070).
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These factors on their own shouldn't explain the difference, hence we can strongly suggest there are participation biases in this study and the results are not representative of the general public.
 
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