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

Sharpe MC, Stone JC, Hibberd C, Warlow CP, Duncan RDD, Coleman RJ, Roberts RC, Cull RE, Pelosi AJ, Cavanagh JTO, Matthews KB, Goldbeck R, Smyth R, Walker A, Walker JK, MacMahon AD, Murray G & Carson AJ (2010) Neurology out-patients with symptoms unexplained by disease: Illness beliefs and financial benefits predict 1-year outcome, Psychological Medicine, 40 (4), pp. 689-698.


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.

Cohort study; medically unexplained symptoms; neurology; outcome

Subject headings
Nursing Research;Experiential research;Phenomenology;Medical care Research.

AuthorsSharpe Michael C, Stone Jon C, Hibberd Carina, Warlow Charles P, Duncan Roderick D D, Coleman Richard J, Roberts Richard C, Cull Roger E, Pelosi Anthony J, Cavanagh Jonathan T O, Matthews Keith B, Goldbeck Rainer, Smyth Roger, Walker Andrew, Walker Jane K, MacMahon A D, Murray Gordon, Carson Alan J
Publication date04/2010
PublisherCambridge University Press
ISSN 0033-2917

Psychological Medicine: Volume 40, Issue 4 (APR 2010)

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