Diagnostic outcome of patients referred to psychiatry with medically unexplained symptoms: a retrospective study

Abstract

Objective: Medically unexplained symptoms (MUS) are commonly encountered in medical practice. In psychiatry, they are classified mostly as Somatoform Disorders and are often associated with anxiety and depression. The literature suggests that, in some cases, MUS may be ascribed to Somatoform Disorders when, fact, they are “organic” syndromes that are misdiagnosed. In developing countries, with fewer resources, MUS may be more difficult to assess. Method: We undertook a retrospective chart review to examine the demographics, referral pathway, management and diagnostic outcome of subjects (n = 50) referred to psychiatry with MUS over an 18 month period. Results: Subjects with MUS accounted for only 4.5% of the total number of files reviewed. In only 38% of cases did the final diagnosis in psychiatry concur with the referral diagnosis. In 28% of cases a new “organic” diagnosis was made and in 72% of cases a new psychiatric diagnosis was made. Subjects who were diagnosed with “organic” illness were seen fewer times prior to referral to psychiatry and were significantly older than other subjects. Conclusion: In developing countries like SA, a significant number of patients with MUS may have underlying “organic” illness, and most may have psychiatric disorders. Patients with MUS, especially older patients, should be more extensively investigated. Psychiatric referral of these patients is very appropriate.

Keywords: Medically unexplained symptoms; Psychiatric disorders; Retrospective review; Somatoform disorders