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首页> 外文期刊>BMC Family Practice >“Medically unexplained” symptoms and symptom disorders in primary care: prognosis-based recognition and classification
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“Medically unexplained” symptoms and symptom disorders in primary care: prognosis-based recognition and classification

机译：初级保健中的“医学上无法解释的”症状和症状障碍：基于预后的识别和分类

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Background Many patients consult their GP because they experience bodily symptoms. In a substantial proportion of cases, the clinical picture does not meet the existing diagnostic criteria for diseases or disorders. This may be because symptoms are recent and evolving or because symptoms are persistent but, either by their character or the negative results of clinical investigation cannot be attributed to disease: so-called “medically unexplained symptoms” (MUS). MUS are inconsistently recognised, diagnosed and managed in primary care. The specialist classification systems for MUS pose several problems in a primary care setting. The systems generally require great certainty about presence or absence of physical disease, they tend to be mind-body dualistic, and they view symptoms from a narrow specialty determined perspective. We need a new classification of MUS in primary care; a classification that better supports clinical decision-making, creates clearer communication and provides scientific underpinning of research to ensure effective interventions. Discussion We propose a classification of symptoms that places greater emphasis on prognostic factors. Prognosis-based classification aims to categorise the patient’s risk of ongoing symptoms, complications, increased healthcare use or disability because of the symptoms. Current evidence suggests several factors which may be used: symptom characteristics such as: number, multi-system pattern, frequency, severity. Other factors are: concurrent mental disorders, psychological features and demographic data. We discuss how these characteristics may be used to classify symptoms into three groups: self-limiting symptoms, recurrent and persistent symptoms, and symptom disorders. The middle group is especially relevant in primary care; as these patients generally have reduced quality of life but often go unrecognised and are at risk of iatrogenic harm. The presented characteristics do not contain immediately obvious cut-points, and the assessment of prognosis depends on a combination of several factors. Conclusion Three criteria (multiple symptoms, multiple systems, multiple times) may support the classification into good, intermediate and poor prognosis when dealing with symptoms in primary care. The proposed new classification specifically targets the patient population in primary care and may provide a rational framework for decision-making in clinical practice and for epidemiologic and clinical research of symptoms.
机译：背景技术许多患者会因出现身体症状而咨询其全科医生。在相当多的病例中，临床表现不符合疾病或障碍的现有诊断标准。这可能是因为症状是最近发生且不断发展的，或者是由于症状持续存在，但无论是其特征还是临床研究的阴性结果均不能归因于疾病：所谓的“医学上无法解释的症状”（MUS）。在初级保健中对MUS的认识，诊断和管理不一致。 MUS的专业分类系统在初级保健环境中带来了几个问题。该系统通常需要非常确定是否存在身体疾病，它们往往是心身二元的，并且它们从狭窄的专业确定的角度查看症状。我们需要在初级保健中对MUS进行新的分类。该分类可以更好地支持临床决策，建立更清晰的沟通并为研究提供科学依据以确保有效的干预措施。讨论我们建议对症状进行分类，从而更加重视预后因素。基于预后的分类旨在对患者出现持续症状，并发症，因症状而增加医疗保健使用或残疾的风险进行分类。当前证据表明可以使用几个因素：症状特征，例如：数量，多系统模式，频率，严重性。其他因素是：并发性精神障碍，心理特征和人口统计数据。我们讨论了如何使用这些特征将症状分为三类：自限性症状，反复发作和持续性症状以及症状障碍。中层人群在初级保健中尤其重要。因为这些患者的生活质量通常会下降，但往往无法识别，并有医源性伤害的风险。所呈现的特征并不立即包含明显的切入点，并且对预后的评估取决于多种因素的组合。结论三个标准（多种症状，多种系统，多次）可以支持在初级保健中处理症状时分为好，中，差预后。拟议的新分类专门针对基层医疗的患者人群，并且可以为临床实践中的决策以及症状的流行病学和临床研究提供合理的框架。

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