A qualitative analysis of explanatory models in medically unexplained physical symptoms presenting to a tertiary health care psychiatric facility in South India

Abstract

Background:

Knowledge about subjective perceptions and explanatory models has the potential to inform clinical evaluation and lead to development of patient-friendly treatment models in medically unexplained physical symptoms (MUPS).

Aim:

To collect qualitative data about explanatory models in MUPS.

Methods:

A cross-sectional observational study was done among patients with MUPS presenting over a 2-year period to a specialty psychosomatic clinic. The Short Explanatory Model of Illness interview was used to gather qualitative data about explanatory models which were subsequently recoded using standard manuals.

Results:

A total of 123 subjects were evaluated. The nature of symptoms was most commonly reported as ‘non-specific’ (n = 102, 82.9%) but of moderate to severe intensity (n = 87, 73.8%). Getting cured or showing improvement was the most common expectation from treatment (n = 58, 47.9%). Moderate to severe impact of symptoms was reported on work output (n = 100, 84%), emotional life (n = 85, 71.4%) and physical mobility (n = 59, 49.1%). A considerable proportion was either dissatisfied (n = 61, 50%) or frankly unhappy (n = 38, 31.4%) with treatment received.

Conclusion:

There is a need to re-calibrate the clinical approach to people with MUPS to enhance treatment satisfaction. Our findings could assist in evolving culturally sensitive conceptualizations of illness and in developing patient-centred models for therapy in MUPS patients.