Primary care interventions focus on the consultation style adopted by professionals rather than defined psychological interventions (summarised in Improving Access to Psychological Therapies (IAPT) guidance7 and the recent Forum for Mental Health in Primary Care guidelines8.
Symptom reattribution has been found to be a successful form of intervention for people with PES (‘MUS’). This is a structured consultation delivered by GPs which provides a psychological explanation to patients with somatised disorder9. However, while it does improve doctor-patient communication, it may not improve patient outcomes10.
Identification and management of symptoms and treatment of any associated symptoms of depression or anxiety in accordance with the relevant National Institute for Health and Clinical Excellence (NICE) guidelines can be beneficial to those disorders. However, successful psychological treatment is usually dependent on treatment models specific to the PES (‘MUS’) delivered by therapists with training in this area.
Specialist services where persistent symptoms present are more successful where they focus on specific syndromes, e.g. chronic fatigue syndrome or irritable bowel syndrome.
Liaison teams provide multidisciplinary care for patients presenting with more complex PES (‘MUS’) including associated high levels of disability and high levels of distress11.
Pain, fatigue or more generic clinics, e.g. rheumatology or G-I, may have psychological intervention integrated within them; this collaborative model may be more acceptable to patients presenting and improve identification and management
A meta-analysis of treatment for chronic fatigue syndrome suggests that both CBT and graded exercise therapy are promising treatments, with CBT possibly the more effective treatment in patients who have co-morbid anxiety and depressive symptoms12.
Psychological treatments are effective for irritable bowel syndrome (including CBT and psychotherapy, either alone or in conjunction with antidepressant medications)13, fibromyalgia,14 and multisomatoform disorder (brief psychodynamic psychotherapy)15.
Positive outcomes depend on:
Provision of empowering ‘normalising’ physiological explanations of symptoms in primary, community and secondary care16.
- Where symptoms persist, offering prompt intervention using ‘low intensity’ or ‘high intensity’ psychological interventions based on a clear biopsychosocial understanding and formulation of these conditions
- Availability of specialist services (e.g. fatigue or pain services) or psychiatric liaison teams for further care especially where physical illness complicates, restoration of function has not occurred or where substantial acute service resources being used.