| Abstrakt: |
BACKGROUND: Symptoms are common and often remain medically unexplained. OBJECTIVE: To assess 5-year symptom outcomes, determine how often symptoms remain unexplained and assess their relationship with menial disorders. DESIGN: Prospective cohort study. PARTICIPANTS: Five hundred consecutive patients presenting to a medicine clinic with physical symptoms, MEASUREMENTS PREVISIT: Mental disorders, symptom characteristics, stress, expectations, illness worry, and functional status. Post visit (immediately, 2 weeks, 8 months, 5 years): unmet expectations, satisfaction, symptom outcome, functional status, and stress. RESULTS: While most subjects (81%) experienced symptom improve sent by 5 years, resolution rates were lower (56%), with 55% of symptoms remained medically unexplained. Most patients with medically unexplained symptoms (MUS) did not have a mental disorder. Mood or anxiety disorders were not associated with MUS (relative risks [RR]: 0.94, 95% confidence interval [CI]: 0.79 to 1.13), or with lower rates of symptom improvement (RR: 1.14, 95% CI: 0.60 to 2.2). In contrast, most patients with somatoform disorders had MUS and were unlikely to improve. Worse functioning (RR: 0.95, 95% CI: 0.91 to 0.99), longer duration of symptom at presentation (RR: 0.5, 95% CI: 0.28 to 0.87), illness worry at presentation (RR: 0.56, 95% CI: 0.35 to 0.89), or lack of resolution by 3 months (RR: 0.47, 95% CI: 0.26 to 0.86) reduced the likelihood of symptom improvement at 5 years. CONCLUSIONS: More than half of patients presenting with a physical symptom resolve by 5 years, while a third remain medically unexplained. Most patients whose symptom remained unexplained had no mental disorder. While mood and anxiety disorders were not associated with MUS or worse outcomes, most patients wit h somatoform disorders had MUS and were unlikely to improve. [ABSTRACT FROM AUTHOR] |
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