Somatoform disorders in general practice Medical or public

Somatoform disorders in general practice Medical or public health problem? Dr Albert M van Hemert Parnassia Group, The Hague Leiden University Medical Centre The Netherlands

Media: epidemic of MUPS p Legionella epidemic in the Netherlands p Pollution of coca-cola in Belgium

SOmatisation study University Leiden SOUL 1999 -2006 p Ingrid Arnold p Margot de Waal p p Comprehensive prevalence and treatment study in primary care

Main questions p Magnitude of the problem of medically unexplained physical symptoms? p Is a psychological intervention helpful? p Should we advocate psychological treatment for MUPS in primary care?

Previous study 1988 -1994 p Anne Speckens p Internal Medicine outpatient clinic p CBT for unexplained symptoms p

Main findings (1988 -1994) p 50% MUPS in an internal medicine outpatient popualtion p CBT has a significant effect to improve MUPS Speckens et al. BMJ 1995; 311: 1328 -32

Move on General population Primary care Clinic

SOUL p p p Two-phase prevalence study consecutive consultations in General Practice 6 months natural course 5 sessions of adapted CBT by GP n n p Making collaborative contact Activation, relaxation, CBT Sample size n n n Main study: 1. 778 patients Total number: 5. 766 patients Treatment study: 65 patients

Prevalence p 30% of consultations unexplained p 16% Somatoform disorders n n n p 13% undifferentiated 2% pain disorders 1% hypochondriasis 8% anxiety or depressive disorders De Waal et al. Br J Psychiatry 2004; 184: 470 -6

Prevalence

Magnitude of the problem p Frequency of GP consultations in the Netherlands: 4. 2 person per year 67 million total anual GP consultations p 20 million for MUPS p 11 million for somatoform disorders p 9 million for undifferentiated somatoform disorders p

Magnitude of the problem - Cost Medically Unexplained Physical Symptoms p General Practice: 1. 7 billion euro p Hospital care (5%? ): 0. 7 billion euro p Loss of productivity: ++

Treatment Internal VAS Medicine GP

Are psychological interventions helpful? p Perhaps a little p Costs will be high; drop in a bucket? p What can we do?

Media

Media p Behavior is under control of attributions p Behavior can be induced by media attention

Media Campaign Low Back Pain p Rachelle Buchbinder et al; Australia p Public Health Campaign 1997 -1998 Pre- post design p Intervention and control area p

Media Campaign Low Back Pain More positive beliefs on back pain p In patients and doctors p p Decline in n p claims for back pain rates of days compensated Medical payments for claims for back Some effects sustained over several years

Disability claims Buchbinder at al. BMJ 2001; 322: 1516 -20

Summary p The problem of MUPS in terms of prevalence and costs is considerable p CBT may have some effect on reducing MUPS p It could be useful to develop public health campaings to help reduce the burden of MUPS

Further information on SOUL i. a. arnold@lumc. nl m. w. m. de_waal@lumc. nl