Andy
Retired committee member
A GUIDE to assessing and managing patients under the age of 18 who are referred to secondary care
This Guide is endorsed by the Royal College of Psychiatrists (RCPsych) and the Paediatric Mental Health Association (PMHA). August 2018
Who is this guide for?
The following guide provides advice and helpful tools, primarily to secondary care doctors in the assessment and management of children and young people CYP with MUS. The aim of the guide is to minimise the risk of recurrent presentation, iatrogenic harm and destruction of the therapeutic relationship.
When should I use this guide?
This document will be most helpful to those involved in the identification and management of CYP with MUS, particularly those working without expert advice. Regardless of service set up, seeking direct input from senior paediatric colleagues, and, if available, under 18s mental health clinicians, is always advisable over sole use of this guideline
How should I use this guide?
This guide is designed to be read in sequence, as it covers a number of steps in the identification and management of MUS. So we would prefer you to read and think about it page by page. However, it may be that you need to use this guide in less leisurely circumstances.
If you are just about to see someone who you think might have MUS, go to step 2
If you are following someone up who is under investigation for unexplained symptoms, go to step 3
If you have someone on the ward or in clinic who needs managing, consider whether step 4 has happened, and if so, go straight to step 5
If you are thinking about how to organise services around these CYP, step 7 might help you
This guide is written by clinicians, for clinicians, and is designed to be a useful practical aid. So let us know if you find it helpful, or, more importantly, if you don’t.
Document attached to this post.Step 1: Opening your mind to the possibility of MUS
Just as some patients and their families may be more inclined to perceive bodily symptoms as indicative of some underlying physical disorder, so too may some doctors. Recognising that you are someone who is more comfortable having conversations based on the known, rather than unknown, recognising that you are a doctor who prefers to say yes, rather than to say no, or recognising that you are a doctor who likes to feel that you are “sorting your patient out”, may all be a prompt to make yourself consider MUS early on in your assessment process. Doctors managing their own anxiety, or that brought to them by their patients, by ordering another investigation or referring on to a specialist is a well-recognised phenomenon in the NHS.
Think about MUS if:
1. Your patient has undergone an unusual level of investigations and/or been to a significant number of hospital specialists relative to their diagnosis (remember MUS can also occur in the context of organic pathology e.g. non-epileptic seizures alongside epilepsy)
2. You experience a high level of anxiety when seeing the patient and their family, and/or feel pressured into referring for investigations or to other specialists in a way that you don’t experience with other patients in a similar clinic setting
3. You feel irritated with the patient or their family for not ‘getting better’
4. There is a family history of MUS (drawing a quick three-generational family genogram and plotting all illnesses across the generations is never time wasted in any clinic setting)
5. There is significant absence from school as a result of symptoms that appear ‘out of proportion’ to physical investigations
6. You have an experience of a parent who appears overly-invested in their child’s illness and loss of function
Source: https://paedmhassoc.files.wordpress.com/2018/11/mus-guide-with-leaflet-nov-2018.pdf, which is a 'behind the scenes" link for this webpage, https://pmha-uk.org/
Internet archive link: https://web.archive.org/web/2019102...m/2018/11/mus-guide-with-leaflet-nov-2018.pdf