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Neurology out-patients with symptoms unexplained by disease: illness beliefs and financial benefits predict 1-year outcome

Published online by Cambridge University Press:  23 July 2009

M. Sharpe ,
J. Stone ,
C. Hibberd ,
C. Warlow ,
R. Duncan ,
R. Coleman ,
R. Roberts ,
R. Cull ,
A. Pelosi  and
J. Cavanagh
...Show all authors
M. Sharpe*
Affiliation:
Psychological Medicine Research, School of Molecular and Clinical Medicine, University of Edinburgh, UK
J. Stone
Affiliation:
Department of Clinical Neurosciences, School of Molecular and Clinical Medicine, University of Edinburgh, UK
C. Hibberd
Affiliation:
Psychological Medicine Research, School of Molecular and Clinical Medicine, University of Edinburgh, UK
C. Warlow
Affiliation:
Department of Clinical Neurosciences, School of Molecular and Clinical Medicine, University of Edinburgh, UK
R. Duncan
Affiliation:
Institute of Neurological Sciences, Southern General Hospital, Glasgow, UK
R. Coleman
Affiliation:
Aberdeen Royal Infirmary, Aberdeen, UK
R. Roberts
Affiliation:
Ninewells Hospital, University of Dundee, Dundee, UK
R. Cull
Affiliation:
Department of Clinical Neurosciences, School of Molecular and Clinical Medicine, University of Edinburgh, UK
A. Pelosi
Affiliation:
Hairmyres Hospital, East Kilbride, UK
J. Cavanagh
Affiliation:
Sackler Institute of Psychobiological Research, Faculty of Medicine, University of Glasgow, UK
K. Matthews
Affiliation:
Ninewells Hospital, University of Dundee, Dundee, UK
R. Goldbeck
Affiliation:
Aberdeen Royal Infirmary, Aberdeen, UK
R. Smyth
Affiliation:
Royal Infirmary of Edinburgh, Edinburgh, UK
A. Walker
Affiliation:
Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
J. Walker
Affiliation:
Psychological Medicine Research, School of Molecular and Clinical Medicine, University of Edinburgh, UK
A. MacMahon
Affiliation:
Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
G. Murray
Affiliation:
School of Clinical Sciences and Community Health, University of Edinburgh, UK
A. Carson
Affiliation:
Psychological Medicine Research, School of Molecular and Clinical Medicine, University of Edinburgh, UK
*
*Address for correspondence: M. Sharpe, M.A., M.D., FRCP, FRCPsych, Psychological Medicine Research, Kennedy Tower, Royal Edinburgh Hospital, Edinburgh EH10 5HF, UK. (Email: Michael.Sharpe@ed.ac.uk)
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Abstract

Background

Patients whose symptoms are ‘unexplained by disease’ often have a poor symptomatic outcome after specialist consultation, but we know little about which patient factors predict this. We therefore aimed to determine predictors of poor subjective outcome for new neurology out-patients with symptoms unexplained by disease 1 year after the initial consultation.

Method

The Scottish Neurological Symptom Study was a 1-year prospective cohort study of patients referred to secondary care National Health Service neurology clinics in Scotland (UK). Patients were included if the neurologist rated their symptoms as ‘not at all’ or only ‘somewhat explained’ by organic disease. Patient-rated change in health was rated on a five-point Clinical Global Improvement (CGI) scale (‘much better’ to ‘much worse’) 1 year later.

Results

The 12-month outcome data were available on 716 of 1144 patients (63%). Poor outcome on the CGI (‘unchanged’, ‘worse’ or ‘much worse’) was reported by 482 (67%) out of 716 patients. The only strong independent baseline predictors were patients' beliefs [expectation of non-recovery (odds ratio [OR] 2.04, 95% confidence interval [CI] 1.40–2.96), non-attribution of symptoms to psychological factors (OR 2.22, 95% CI 1.51–3.26)] and the receipt of illness-related financial benefits (OR 2.30, 95% CI 1.37–3.86). Together, these factors predicted 13% of the variance in outcome.

Conclusions

Of the patients, two-thirds had a poor outcome at 1 year. Illness beliefs and financial benefits are more useful in predicting poor outcome than the number of symptoms, disability and distress.

Keywords

Cohort studymedically unexplained symptomsneurologyoutcome
Type
Original Articles
Information
Psychological Medicine , Volume 40 , Issue 4 , April 2010 , pp. 689 - 698
Copyright
Copyright © Cambridge University Press 2009

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