2nd February 2024

An approach to medically unexplained symptoms: a Summary

1. Detailed history of complaints 
2. Detailed information about physical complaints 
3. Detailed mental health assessment 
4. Detailed psychological formulation, which includes precipitating, perpetuating, predisposing and perpetuating factors about his complaints- detailed stress factors 
5. Thorough physical examination to identify any physical illness  
6. Special tests as per individual diagnosis (Hoover’s sign) 
7. Blood investigations, radiological imaging 
8. Bio-psycho-social approach 
9. Agree on treatment goals and make a consistent plan 
10. Non- confrontational approach 
11. Medication should not be the first choice in treatment. Psychoeducation and psychological therapies need to be offered initially unless associated with mental illness. 
12. Cognitive behavioural therapy- therapist emphasises one’s thoughts, feelings and behaviour. Hence, they can help one to develop a better understanding of the illness and avoid maladaptive behaviours. 
13. Graded exercise therapy involves gradually increasing physical activity and thus improving their function. This especially would be helpful in chronic fatigue syndrome. 
14. Mindfulness-based therapy 
15. Pharmacotherapy- includes antidepressants and, if needed, antipsychotics depending upon the comorbidities such as anxiety, depression and psychosis.

References:

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