Medically unexplained symptoms

Question 1

How common?

Answer 1

8% of GP patients have 3 or more MUS
Collectively cost billions of dollars
More money spent on MUS than dementia

Question 2

What are MUS?

Answer 2

Symptoms without a clear physical illness

Symptoms may be inducible with a suggestion

Question 3

Common approaches to managing MUS

Answer 3

1. Validation
   Acknowledge that the symptoms are real and distressing
   Acknowledge that medicine has limits and the uncertainty is frustrating
2. Explanation
   Consider and record physical, psychiatric and psychosocial diagnoses and symptoms
   Craft explanations that include the body and the mind
   Always consider the role of past or current trauma, psychosocial stress and personal vulnerabilities
3. Coordination of care and advocacy
   Coordinate care to avoid duplication of investigations and exacerbation of iatrogenic harm
4. Symptom management
   Offer symptom relief and practical support to address disability (eg home help, workplace assessment)
   Encourage physical therapies (eg massage, physiotherapy, hydrotherapy)
   Manage comorbidities as effectively as possible
5. Broadening the agenda beyond physical symptom management
   Encourage psychological care to address the impact of illness and underlying issues that may exacerbate symptoms
   Address healthy lifestyle goals
6. Harm minimisation
   Check for new diagnoses when the illnesses changes significantly (eg the emergence of a new symptom) or during a yearly health check
7. Empathy
   Manage the therapeutic relationship carefully and seek support if it becomes unhelpful

Question 4

Rubber hand illusion

Answer 4

In the Rubber Hand Illusion, the feeling of ownership of a rubber hand displaced from a participant’s real occluded hand is evoked by synchronously stroking both hands with paintbrushes. A change of perceived finger location towards the rubber hand (proprioceptive drift) has been reported to correlate with this illusion

the feeling that a rubber hand belongs to one’s body (feeling of ownership) is brought about by stroking a visible rubber hand synchronously to the participant’s own occluded hand. In the first work describing this phenomenon,