Psychiatric Annals

FROM THE GUEST EDITORS 

This Issue: Medically Unexplained Physical Symptoms

Stanley N. Caroff, MD; James L. Stinnett, MD

Abstract

In addition to acquiring clinical knowledge and skills, young physicians must learn to cope with three unavoidable realities associated with patient care. First, some patients will succumb to symptoms of terminal illnesses despite the doctor's best efforts. Second, many patients in practice have symptoms due to chronic conditions which can be controlled but not cured. Finally, as hard as the first two are to accept, the most perplexing reality concerns patients who attach emotional meaning to symptoms and resist being cured.

This latter group and other patients with medically unexplained physical symptoms (MUPS) comprise the subject of this issue of Psychiatric Annals. There is ample evidence that patients with MUPS are frequent and intensive consumers of primary care and specialty services, that they often are functionally impaired and severely disabled, and that the consequent costs of their conditions are staggering. Although the socioeconomic and public health burden of patients with MUPS is unquestionable, their importance extends to the professional, clinical, and scientific realms as well.

For mental health clinicians, the quandary of caring for patients with MUPS in medical settings affords an excellent opportunity to collaborate on patient care with nonpsychiatric clinicians. Discussions about the management of these patients also provide an ideal format for teaching students, interns, and residents about the importance of psychiatric principles and practice. In addition, studies of MUPS represent a key testing ground for attempts at synthesis of emerging advances in theory and practice drawn from psychosomatic medicine, neuroscience, psychoanalysis, cognitive behavioral theory, cognitive neuropsychology, and sociology.

To further awareness of research developments, we begin with a broad clinical review in “Medically Unexplained Physical Symptoms,” written by Dr. Geoffrey Neimark and the guest editors. Specific applications of work on MUPS are then illustrated by reference to selected disorders in the subsequent articles.

Drs. Bowman and Markand provide a comprehensive review of a classical conversion disorder, pseudoseizures, and discuss practical approaches to therapy in “Diagnosis and Treatment of Pseudoseizures.” Drs. Staab and Ruckenstein examine the complex interplay between psychiatric and medical causes of dizziness in “A Psychiatric Approach to Chronic Dizziness.”

Two articles on specific functional somatic syndromes also are included in our discussion. “Comorbidity Associated With Irritable Bowel Syndrome,” by Drs. Palsson and Whitehead, and “Chronic Fatigue Syndrome in Practice,” by Dr. Afari et al., provide up-to-date reviews and offer practical management strategies, while emphasizing the importance of differential diagnosis and comorbidity in relation to mechanisms underlying functional somatic syndromes.

Although the nosology and etiology of disorders characterized by MUPS remain problematic, and while patients with MUPS continue to challenge the skills and patience of even the most experienced clinicians, recent innovative research in several disciplines offers great promise for improving patient care, and for deepening understanding of the mind-body continuum.

Stanley N. Caroff, MD, is professor of psychiatry, University of Pennsylvania, and chief, Inpatient Psychiatric Service, Department of Veterans Affairs Medical Center, Philadelphia, PA. He also serves as director of the Neuroleptic Malignant Syndrome Information Service.

Dr. Caroff received his undergraduate degree from Columbia University, New York, NY, before obtaining his medical degree from the Mount Sinai School of Medicine, New York. He completed his medical internship at Roosevelt Hospital and served as a psychiatric resident at the State University of New York at Stony Brook, NY, and Montefiore Medical Center. He continued his training as a National Institute of Mental Health postdoctoral fellow in psychopharmacology at the University of Pennsylvania School of Medicine.

His area of research interest is the neurobiology and psychopharmacology of major psychotic disorders. He is internationally recognized for his work on the neuroleptic malignant syndrome and related hyperthermic and…

In addition to acquiring clinical knowledge and skills, young physicians must learn to cope with three unavoidable realities associated with patient care. First, some patients will succumb to symptoms of terminal illnesses despite the doctor's best efforts. Second, many patients in practice have symptoms due to chronic conditions which can be controlled but not cured. Finally, as hard as the first two are to accept, the most perplexing reality concerns patients who attach emotional meaning to symptoms and resist being cured.

This latter group and other patients with medically unexplained physical symptoms (MUPS) comprise the subject of this issue of Psychiatric Annals. There is ample evidence that patients with MUPS are frequent and intensive consumers of primary care and specialty services, that they often are functionally impaired and severely disabled, and that the consequent costs of their conditions are staggering. Although the socioeconomic and public health burden of patients with MUPS is unquestionable, their importance extends to the professional, clinical, and scientific realms as well.

For mental health clinicians, the quandary of caring for patients with MUPS in medical settings affords an excellent opportunity to collaborate on patient care with nonpsychiatric clinicians. Discussions about the management of these patients also provide an ideal format for teaching students, interns, and residents about the importance of psychiatric principles and practice. In addition, studies of MUPS represent a key testing ground for attempts at synthesis of emerging advances in theory and practice drawn from psychosomatic medicine, neuroscience, psychoanalysis, cognitive behavioral theory, cognitive neuropsychology, and sociology.

In This Issue

To further awareness of research developments, we begin with a broad clinical review in “Medically Unexplained Physical Symptoms,” written by Dr. Geoffrey Neimark and the guest editors. Specific applications of work on MUPS are then illustrated by reference to selected disorders in the subsequent articles.

Drs. Bowman and Markand provide a comprehensive review of a classical conversion disorder, pseudoseizures, and discuss practical approaches to therapy in “Diagnosis and Treatment of Pseudoseizures.” Drs. Staab and Ruckenstein examine the complex interplay between psychiatric and medical causes of dizziness in “A Psychiatric Approach to Chronic Dizziness.”

Two articles on specific functional somatic syndromes also are included in our discussion. “Comorbidity Associated With Irritable Bowel Syndrome,” by Drs. Palsson and Whitehead, and “Chronic Fatigue Syndrome in Practice,” by Dr. Afari et al., provide up-to-date reviews and offer practical management strategies, while emphasizing the importance of differential diagnosis and comorbidity in relation to mechanisms underlying functional somatic syndromes.

Summary

Although the nosology and etiology of disorders characterized by MUPS remain problematic, and while patients with MUPS continue to challenge the skills and patience of even the most experienced clinicians, recent innovative research in several disciplines offers great promise for improving patient care, and for deepening understanding of the mind-body continuum.

About the Guest Editors

Stanley N. Caroff, MD, is professor of psychiatry, University of Pennsylvania, and chief, Inpatient Psychiatric Service, Department of Veterans Affairs Medical Center, Philadelphia, PA. He also serves as director of the Neuroleptic Malignant Syndrome Information Service.

Dr. Caroff received his undergraduate degree from Columbia University, New York, NY, before obtaining his medical degree from the Mount Sinai School of Medicine, New York. He completed his medical internship at Roosevelt Hospital and served as a psychiatric resident at the State University of New York at Stony Brook, NY, and Montefiore Medical Center. He continued his training as a National Institute of Mental Health postdoctoral fellow in psychopharmacology at the University of Pennsylvania School of Medicine.

His area of research interest is the neurobiology and psychopharmacology of major psychotic disorders. He is internationally recognized for his work on the neuroleptic malignant syndrome and related hyperthermic and neurotoxic disorders in psychiatry.

James L. Stinnett, MD, is professor of psychiatry and director of the Psychiatry Consultation Service, Hospital of the University of Pennsylvania. He also is a senior examiner for the American Board of Psychiatry and Neurology.

Dr. Stinnett received his undergraduate degree from Princeton University, Princeton, NJ, and his medical degree from the University of Pennsylvania School of Medicine. He completed his internship and residency training at the Hospital of the University of Pennsylvania. Following 2 years in the United States Army Medical Corps, he returned to the University of Pennsylvania School of Medicine, where he is an honored member of the faculty in the Department of Psychiatry.

Authors

10.3928/00485713-20050401-02

Sign up to receive

Journal E-contents