Posts Tagged ‘Smith Dwamena’

1. Medically Unexplained Symptoms in DSM-5

Monday, February 22nd, 2010

The Bible of mental health diagnosis has a glaring omission (1).  The Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association, used worldwide as a reference for classifying and defining mental health disorders, was first published in 1952, listing 106 disorders in 130 pages.  The last major revision was released in 1994 (297 disorders, 886 pages), followed by a “text revision” in 2000 (365 disorders, 943 pages).  None of these volumes has a diagnostic term appropriate for more than a tiny fraction of Stress Illness patients.  (Stress Illness is my term for physical symptoms not fully explained by diagnostic tests that improve when psychosocial stresses are treated.)


Smith and Dwamena (2)

Friday, January 22nd, 2010

Continuing our review of the Smith and Dwamena paper (1), they describe a spectrum of severity for patients with medically unexplained symptoms (MUS).  The few patients who fully meet criteria for Somatoform Disorder (2) are severely ill.  The rest range from mild to not quite as severe as those with Somatoform Disorder.  The group with mild MUS is the largest.  Their symptoms tend to be of short duration, resolve on their own, usually don’t require much medical care and aren’t associated with significant mental health issues.  They can be managed with a Stress History (see earlier posts with this tag), observation over time and a minimum of diagnostic tests.


Smith and Dwamena (1)

Thursday, January 21st, 2010

We have seen that diagnosis and treatment of medically unexplained symptoms (MUS) in a primary care clinic is completely inadequate (see the posts tagged Kroenke and Blindspot).  Smith and Dwamena (1) agree.  They point out that MUS patients comprise half or more of all outpatients and often are subjected to the risk and cost of  “ill-advised lab testing and trial treatments” and seldom receive adequate treatment in primary care.  (If the same could be said of, say, diabetes, there would be an international uproar and diabetes isn’t half as common as MUS.)


Mental Health Professionals and Physicians (Letter)

Friday, December 4th, 2009

Building referral pathways from medical to mental health professionals will be a key part of relieving stress illness.  Here is an example of a letter written by a mental health professional  to a medical clinician offering ideas that could help.  (The references below will be discussed in more detail in a future post.)