By Suleiman Tajudeen
…Continued from last week
CITIZENS COMPASS—…individual, family, and health system.
Chronic disability: Patients reduce activity, leading to deconditioning, job loss, and dependence.
Comorbid depression and anxiety: 50 to 70 percent of patients with severe MUS meet criteria for mood or anxiety disorders.
Social isolation: Friends and family grow tired of complaints, leading to loneliness.
Financial strain: Repeated consultations, tests, and traditional healers drain family income.
Polypharmacy and adverse effects: Patients receive multiple drugs without a clear diagnosis, risking side effects.
Unnecessary procedures and surgery: Appendectomy, spinal surgery, and other interventions are done without benefit.
Frustration for healthcare workers: Nurses and doctors feel helpless, leading to burnout.
Doctor-shopping: Patients move from hospital to hospital seeking a real diagnosis.
Strained family relationships: Spouses may accuse patients of laziness or exaggeration.
Strain on Nigerian health system: OPD overcrowding and wasted resources on low-yield investigations.
Prevention
Prevention focuses on early recognition and avoiding escalation into chronic disability.
Early psychosocial screening: Ask about sleep, stress, mood, and life events when patients present with persistent symptoms.
Effective first consultation: Spend time listening. A good explanation on the first visit reduces doctor-shopping.
Avoid unnecessary investigations: One negative test is enough. More tests often increase anxiety.
Clear communication: Use plain language. Tests show no dangerous disease. This means your body is safe, but your nervous system is over-sensitive.
Health education in schools and PHC: Teach that stress and emotions cause real physical symptoms.
Reduce stigma around mental health: Community programs help patients seek counseling early.
Promote a healthy lifestyle: Exercise, sleep hygiene, and stress management prevent sensitization.
Train Primary Health Care (PHC) workers: Nurses and CHOs should recognize red flags versus MUS early.
Limit sick role reinforcement: Encourage normal activity even when symptoms persist.
Integrated care: Link medical and counseling services in PHC to catch psychological causes early.
Management
Management uses a biopsychosocial model. The goal is improved function, not elimination of all symptoms.
Build a therapeutic alliance: Acknowledge symptoms are real. Give a positive diagnosis: Label it as functional headache or Irritable Bowel Syndrome (IBS) instead of nothing is wrong.
In the context of “unexplained symptoms illness”, IBS is one of the most common functional gastrointestinal disorders. It’s diagnosed when someone has chronic abdominal pain, bloating, and changes in bowel habits like diarrhea, constipation, or both, but routine tests don’t show structural damage or disease.
Provide a clear explanation: Use simple models like your pain system is like a faulty alarm that keeps ringing.
Cognitive Behavioral Therapy (CBT): Helps patients change unhelpful thoughts and behaviors around symptoms. Most evidence-based treatment.
Graded activity and physiotherapy: Slowly increase activity to reverse deconditioning without worsening symptoms.
Sleep and stress management: Sleep hygiene, relaxation, and breathing exercises reduce nervous system sensitivity.
Judicious medication use: Avoid opioids. Use low-dose antidepressants like amitriptyline for pain and sleep if indicated.
Family involvement: Educate the family to support normal activity and avoid over-protection.
Regular follow-up with one clinician: Continuity reduces anxiety and prevents doctor-shopping.
Referral for psychiatric or psychological care: When depression, PTSD, or severe health anxiety is present, refer early.
Conclusion
In PHC and wards, 1 in 3 patients with chronic pain or weakness may have Medically Unexplained Symptoms. Your role as medical personnel is to listen without dismissing, explain in simple terms, avoid over-investigation, and link to counseling early. This saves money, reduces suffering, and improves trust among the medical practitioners.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, (5th ed.). Arlington, VA: American Psychiatric Publishing.
Creed, F., Guthrie, E., Fink, P., Henningsen, P., Rief, W., Sharpe, M., & White, P. (2010). Is there a better term than “medically unexplained symptoms”? Journal of Psychosomatic Research, 68(1), 5–8. https://doi.org/10.1016/j.jpsychores.2009.09.004
Onyebueke, G. C., Onwuekwe, I. O., & Eze, C. O. (2018). Somatoform Disorders in a Nigerian tertiary hospital: Prevalence and clinical correlates. Nigerian Journal of Clinical Practice, 21(3), 345–350. https://doi.org/10.4103/njcp.njcp_238_17
World Health Organization. (2016). mhGAP Intervention Guide for mental, neurological, and substance use disorders in non-specialized health settings: Version 2.0. Geneva: World Health Organization.
For questions and medical consultations, contact: Dr. Suleiman Tajudeen, CEO and Director of Clinical Psychology, Clear Mind Psychological Consult, Km 15, Badagry Expressway, Ojo, Lagos. +234 803 402 4457
