Medically unexplained symptoms

This in-person afternoon meeting will explore medically unexplained symptoms, functional somatic symptoms and the relationship between physical and psychological health through a series of expert presentations:

1.30 pm
Coffee and registration

2.00 pm
Brief Annual General Meeting of the Section of Psychiatry followed by:

2.05 pm           
The Gut and the Brain
Professor Peter Whorwell, Professor of Medicine and Gastroenterology, University of Manchester and Director of South Manchester Functional Bowel Service 

Synopsis:

Medically unexplained gastrointestinal symptoms account for up to 50% of the gastroenterologist’s workload and for many years have been referred to as functional gastrointestinal disorders. All of us know, from personal experience, that there is a strong connection between the gut and the brain and, consequently, the term ‘disorders of gut brain interaction’ has been recommended as a better way of describing these conditions, especially as the word functional has often been used in a somewhat derogatory way in the past.

It has been suggested that these disorders should be subdivided according to the anatomical location from where symptoms are thought to arise leading to a series of named conditions such as functional dyspepsia, non-cardiac chest pain and irritable bowel syndrome (IBS). IBS is by far the most common of these conditions and will be used as an exemplar for the purposes of this presentation.

The majority of patients with IBS have relatively mild symptoms which settle with conventional treatment. However, a sizeable minority suffer from very severe symptoms where they bounce round the healthcare system having multiple consultations and investigations but making no progress, with some even becoming suicidal.

Our understanding of these conditions has gradually improved over time with some of the mechanisms involved in symptom generation being identified, although the story is far from complete. It is also clear that the pathophysiology is multifactorial meaning that it unlikely that a single treatment is likely to be effective making a biopsychosocial approach to management the most appropriate option.

Many years ago, we introduced gut directed hypnotherapy to treat these patients with considerable success and have also shown that it can actually modify some of the mechanisms involved in symptom generation. However, it should not be regarded as a stand-alone treatment but combined with a multifaceted approach involving education, pharmacology and dietary manipulation.

Learning objectives:

• To better understand the disorders of gut brain interaction and how they affect the sufferer.
• To learn about the complex pathophysiology of these conditions.
• To realise that there is not a ‘one size fits all’ solution to these conditions.

 2.45 pm
Coffee break and networking

3.05 pm
Functional Somatic Symptoms - Aetiology and Assessment
Dr Rob Cleaver, Consultant Liaison Psychiatrist and Strategic Medical Lead - Physical Health in Mental Health Services, Pennine Care NHS FT

Learning objectives:

• Define Functional Somatic Symptoms and distinguish them from related clinical presentations.
• Explain the biopsychosocial factors associated with the development and maintenance of Functional Somatic Symptoms.
• Undertake a patient-centred assessment of Functional Somatic Symptoms, including exploration of psychosocial factors and comorbid mental illness.

3.45 pm
Managing persistent physical symptoms (or MUS) in the community
Dr Julia Hose, Consultant Psychiatrist and Strategic Medical Lead for Psychological Medicine, Pennine Care NHS Foundation Trust

Learning objectives:

• To learn tips on managing PPS in the clinical encounter linking to proposed aetiology
• To develop understanding of the emotional impact of working with people with PPS
• To think about how to recruit the wider service to support management for people with complex needs

4.25 pm
Closing comments
 

CPD certificates will be awarded to attendees