Short reportPatterns of referral in patients with medically unexplained motor symptoms
Introduction
Unexplained physical symptoms are a common presentation of psychiatric disorder in primary care [1]. Such patients are perceived as difficult to help [2] but are often referred for multiple consultations and use a disproportionate amount of health resources [3], [4].
We studied a group of patients with neurologically unexplained motor symptoms and found evidence that the diagnosis of conversion disorder is stable over time [5], but the patients studied continued to be referred for costly and unnecessary investigations. We have examined here the pattern of referrals in a sample of previously reported patients with unexplained motor symptoms in whom the diagnosis of conversion disorder remained stable 6 years later [5]. We have investigated some of the factors leading to new consultations and examined the role of illness attribution on referral patterns.
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Methods
Sixty-four subjects (33 men and 31 women) were included in the study. The three patients from our original study [5] who had developed neurological disorders at follow up were excluded. During the 6-year follow up, subjects underwent a semistructured interview and were re-assessed by a neurologist. Data were collected from hospital and GP records.
The patients' attribution of symptoms was graded into three categories: (1) psychological factors brought on symptoms; (2) psychological factors may
Source and reasons for initial referral
Forty-one (64%) had been referred to the NHNN by their GP, 19 (30%) by a neurologist, and four (6%) by another specialist. Over half (56%) of the referrals by GPs were for a “second opinion.” The referral letter made it clear that in 39 (61%), the diagnosis was thought to be entirely or predominantly non-organic. Fourteen (22%) referral letters expressed concern about an organic disorder, and in the remaining 11 (17%), no mention was made of the possible aetiology.
Pattern of management before admission
The mean age of patients was
Discussion
The aim of this study was to examine the patterns of referral in patients with medically unexplained motor symptoms and the possible factors leading to multiple consultations. As previously reported [5], 6 years after admission to the NHNN, the presenting symptoms had improved in half of our patients and very few had acquired new neurological or psychiatric diagnosis. Most patients had previously been extensively investigated by neurologists and other specialists and conversion disorder was
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Functional dystonia
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