Medically Unexplained Symptoms and Psychologically Impacted Illness

Medically Unexplained Symptoms and Psychologically Impacted Illness

Supporting patients with physical long-term conditions through psychological interventions

For the last two years, a national Pathfinder has been running in the ThamesValley which builds on the work done through the IAPT programme. Originally launched in 2008, the Improving Access to Psychological Therapies (IAPT) programme is a large-scale initiative that aims to increase the availability of NICE-recommended psychological treatments for depression and anxiety disorders. People with long-term physical health conditions – the most frequent users of health care services – commonly experience mental health problems such as depression and anxiety.  As a result of these co-morbid problems, the prognosis for their long-term condition and the quality of life they experience can both deteriorate markedly, unless they are supported in an integrated way. For example, 40{79f878acaa41f375dcd804cc8c058b5459a5482f20a3b9f87269b26c8734749b} of patients locally with diabetes show symptoms of psychological distress.

This includes patients with Medically Unexplained Symptoms (MUS) and Psychologically Impacted Illness (PII).


The term “medically unexplained symptoms” (MUS)  is used for conditions for which no physical diagnosis is made despite adequate investigation.

The symptoms are very real and can vary in intensity from relatively minor to extremely debilitating.  MUS are common and may account for up to 20{79f878acaa41f375dcd804cc8c058b5459a5482f20a3b9f87269b26c8734749b} of primary care contacts and in some secondary care specialties can account for over half of all referrals. Many people with MUS find interventions aimed at managing anxiety or depression (or both) helpful. All age groups can be affected.


Psychologically Impacted Illness is also common particularly amongst patients with long term conditions.  People with long term physical illness may manifest anxiety or depression and, as in the case of MUS,  strategies aimed at tackling these are often helpful in improving  both their psychological condition and the control of their long term condition.


Each of our local projects is focusing on patients with a different long-term condition.  In Berkshire, the aim is to provide a specialist psychological service for patients with diabetes, as a component of improving their general well-being.  In Oxfordshire, patients with cardiac disease/cardiac failure are receiving integrated physical and mental support in both community and hospital settings.  In Buckinghamshire, an integrated physical and psychological stepped care model is being implemented for patients with chronic respiratory conditions.  Finally, the fourth project, which is running in Berkshire, is concerned with patients who have medically unexplained symptoms, which may have a physical, or a psychological basis, but where no diagnosis has yet been made.  This latter project offers a multi-agency stepped care pathway across primary care, psychological services and liaison psychiatry.

The Project report can be viewed HERE


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