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Presentation of the Multidisciplinary Guideline Medically Unexplained Physical Symptoms (MUPS) and Somatoform Disorder in the Netherlands: disease management according to risk profiles.
J Psychosom Res. 2012 Feb; 72(2):168-9.JP

Abstract

OBJECTIVE

January 2011, the Dutch Multidisciplinary Guideline for Medically Unexplained Symptoms (MUPS) and Somatoform Disorder (SD) was published. The aim was to set a standard for multidisciplinary prevention, diagnosis and treatment of MUPS and SD.

METHODS

First, the Multidisciplinary Guideline group defined a conceptual approach for the guideline. After this, a systematic literature review, followed by consensus meetings in the Multidisciplinary working group, aimed to answer the following questions: 1) What evidence exists for preventive interventions, including the patient-doctor communication in MUPS and SD? 2) How can the diagnosis of MUPS be established? 3) What effective treatments of MUPS are available? 4) Which types of treatment are most effective for which patients?

RESULTS

As conceptual approach for the guideline, based on existing literature, in this guideline MUPS are considered a category of symptoms that have many common aspects and are best approached by one, generic approach. 1) Research for preventive interventions and the patient-doctor relationship in MUPS and SD is scanty. 2) To establish the diagnosis of MUPS or SD, the GP should follow a parallel somatic-psychosocial diagnostic step plan. 3) A Systematic Review identified Cognitive Behavioral Treatment (CBT), treatment of comorbid depressive and anxiety disorder, psychiatric consultation with a Consultation Letter to General Practitioners (GPs) and stepped care as evidence based interventions for MUPS and SD. 4) In order to apply the best fitting treatment to patients, patient risk profiles were formulated to guide stepped-care treatment that should start at an appropriate level and treatment setting. Three levels are discerned: Low risk patients need reassurement by the GP. Moderate risk patients suffer from comorbidity. They need case-management and generally can be treated by the GP as well, who can be supported by psychiatric consultation. High risk patients often have long term SD and a perturbed patient-doctor relationship with their GP. For this group, specialist mental health treatment is needed.

CONCLUSION

Disease-managament based on risk profiles, providing stepped care and case management by the GP, supported by psychiatric consultation with a consultation letter, and mental health in-patient multidisciplinary treatment for severe cases, is the recommended strategy of the Dutch Multidisciplinary Guideline for MUPS and SD.

Authors+Show Affiliations

Netherlands Institute for Mental Health and Addiction, Dept. of Diagnosis and Treatment, Utrecht, The Netherlands. c.m.vdrfeltz@uvt.nlNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22281461

Citation

van der Feltz-Cornelis, Christina M., et al. "Presentation of the Multidisciplinary Guideline Medically Unexplained Physical Symptoms (MUPS) and Somatoform Disorder in the Netherlands: Disease Management According to Risk Profiles." Journal of Psychosomatic Research, vol. 72, no. 2, 2012, pp. 168-9.
van der Feltz-Cornelis CM, Hoedeman R, Keuter EJ, et al. Presentation of the Multidisciplinary Guideline Medically Unexplained Physical Symptoms (MUPS) and Somatoform Disorder in the Netherlands: disease management according to risk profiles. J Psychosom Res. 2012;72(2):168-9.
van der Feltz-Cornelis, C. M., Hoedeman, R., Keuter, E. J., & Swinkels, J. A. (2012). Presentation of the Multidisciplinary Guideline Medically Unexplained Physical Symptoms (MUPS) and Somatoform Disorder in the Netherlands: disease management according to risk profiles. Journal of Psychosomatic Research, 72(2), 168-9. https://doi.org/10.1016/j.jpsychores.2011.11.007
van der Feltz-Cornelis CM, et al. Presentation of the Multidisciplinary Guideline Medically Unexplained Physical Symptoms (MUPS) and Somatoform Disorder in the Netherlands: Disease Management According to Risk Profiles. J Psychosom Res. 2012;72(2):168-9. PubMed PMID: 22281461.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Presentation of the Multidisciplinary Guideline Medically Unexplained Physical Symptoms (MUPS) and Somatoform Disorder in the Netherlands: disease management according to risk profiles. AU - van der Feltz-Cornelis,Christina M, AU - Hoedeman,Rob, AU - Keuter,Emile J W, AU - Swinkels,Jan A, Y1 - 2011/12/09/ PY - 2011/11/02/received PY - 2011/11/09/accepted PY - 2012/1/28/entrez PY - 2012/1/28/pubmed PY - 2012/6/16/medline SP - 168 EP - 9 JF - Journal of psychosomatic research JO - J Psychosom Res VL - 72 IS - 2 N2 - OBJECTIVE: January 2011, the Dutch Multidisciplinary Guideline for Medically Unexplained Symptoms (MUPS) and Somatoform Disorder (SD) was published. The aim was to set a standard for multidisciplinary prevention, diagnosis and treatment of MUPS and SD. METHODS: First, the Multidisciplinary Guideline group defined a conceptual approach for the guideline. After this, a systematic literature review, followed by consensus meetings in the Multidisciplinary working group, aimed to answer the following questions: 1) What evidence exists for preventive interventions, including the patient-doctor communication in MUPS and SD? 2) How can the diagnosis of MUPS be established? 3) What effective treatments of MUPS are available? 4) Which types of treatment are most effective for which patients? RESULTS: As conceptual approach for the guideline, based on existing literature, in this guideline MUPS are considered a category of symptoms that have many common aspects and are best approached by one, generic approach. 1) Research for preventive interventions and the patient-doctor relationship in MUPS and SD is scanty. 2) To establish the diagnosis of MUPS or SD, the GP should follow a parallel somatic-psychosocial diagnostic step plan. 3) A Systematic Review identified Cognitive Behavioral Treatment (CBT), treatment of comorbid depressive and anxiety disorder, psychiatric consultation with a Consultation Letter to General Practitioners (GPs) and stepped care as evidence based interventions for MUPS and SD. 4) In order to apply the best fitting treatment to patients, patient risk profiles were formulated to guide stepped-care treatment that should start at an appropriate level and treatment setting. Three levels are discerned: Low risk patients need reassurement by the GP. Moderate risk patients suffer from comorbidity. They need case-management and generally can be treated by the GP as well, who can be supported by psychiatric consultation. High risk patients often have long term SD and a perturbed patient-doctor relationship with their GP. For this group, specialist mental health treatment is needed. CONCLUSION: Disease-managament based on risk profiles, providing stepped care and case management by the GP, supported by psychiatric consultation with a consultation letter, and mental health in-patient multidisciplinary treatment for severe cases, is the recommended strategy of the Dutch Multidisciplinary Guideline for MUPS and SD. SN - 1879-1360 UR - https://www.unboundmedicine.com/medline/citation/22281461/Presentation_of_the_Multidisciplinary_Guideline_Medically_Unexplained_Physical_Symptoms__MUPS__and_Somatoform_Disorder_in_the_Netherlands:_disease_management_according_to_risk_profiles_ DB - PRIME DP - Unbound Medicine ER -