Diagnostic outcome of patients referred to psychiatry with medically unexplained symptoms: a retrospective study

Objective: Medically unexplained symptoms (MUS) are commonly encountered in medical practice. In psychiatry; they are classified mostly as Somatoform Disorders and are often associated with anxiety and depression. The literature suggests that; in some cases; MUS may be ascribed to Somatoform Disorders when; fact; they are ""organic"" syndromes that are misdiagnosed. In developing countries; with fewer resources; MUS may be more difficult to assess. Method: We undertook a retrospective chart review to examine the demographics; referral pathway; management and diagnostic outcome of subjects (n = 50) referred to psychiatry with MUS over an 18 month period. Results: Subjects with MUS accounted for only 4.5of the total number of files reviewed. In only 38of cases did the final diagnosis in psychiatry concur with the referral diagnosis. In 28of cases a new ''organic"" diagnosis was made and in 72of cases a new psychiatric diagnosis was made. Subjects who were diagnosed with ""organic"" illness were seen fewer times prior to referral to psychiatry and were significantly older than other subjects. Conclusion: In developing countries like SA; a significant number of patients with MUS may have underlying ""organic"" illness; and most may have psychiatric disorders. Patients with MUS; especially older patients; should be more extensively investigated. Psychiatric referral of these patients is very appropriate."

Psychiatric disorders and general medical conditions: implications for the clinician

Patients with severe mental illness have higher than expected prevalence rates of co-morbid general medical conditions; particularly metabolic and cardiovascular disease. They are also at increased risk of contracting HIV. Conversely; these and other medical disorders also increase the risk of developing mental disorders. Mental illness and general medical conditions have mutually adverse effects on long-term outcome. This interaction of diseases contributes significantly to the excess morbidity in and higher than expected standard mortality ratios for patients with mental illness. As medical practice becomes more specialized and arguably compartmentalized it may increasingly fail to integrate health care for patients with severe mental illness. In this paper we discuss the high co-morbidity of mental illness with other medical disorders as well some of the potential mechanisms involved. We furthermore argue that the bidirectional relationship between mental and medical disorders should be considered in the planning of treatment for either group of disorders. The central role of the psychiatrist in co-ordinating and integrating the health care of patients with severe mental illness is emphasized