Nishiyama Junji, Abe Tetsuya, Imaizumi Sumito, Yamane Akira, Fukunaga Mikihiko
Department of Psychosomatic and General Internal Medicine Kansai Medical University Hirakata Japan.
Clinic of General Medicine Kansai Medical University Hospital Hirakata Japan.
J Gen Fam Med. 2022 Apr 5;23(4):268-274. doi: 10.1002/jgf2.543. eCollection 2022 Jul.
The term medically unexplained symptoms (MUS) is unhelpful for both patients and physicians, and more acceptable illness categories are needed as substitutes for MUS. While some potential substitutes are characterized by excessive psychological burden related to somatic symptoms, "functional somatic syndromes" (FSS) is a category that focuses on physical dysfunction and emphasizes similarities among individual syndromes. Examples of FSS include irritable bowel syndrome, functional dyspepsia, and fibromyalgia syndrome. This study aimed to distinguish FSS from MUS and compare the somatic and psychobehavioral characteristics of FSS with those of other diseases.
This study included 1975 first-visit outpatients at a Japanese university hospital's general medicine clinic. According to their first-listed diagnosis, they were classified as having FSS, acute infection, organic disease (OD), psychiatric disorder, and unknown condition (UC). The somatic symptom burden and health-related quality of life (HRQoL) were assessed using the Somatic Symptom Scale-8 and EuroQol-5 Dimension, respectively; the involvement of psychobehavioral factors affecting somatic symptoms was also evaluated.
Overall, 33% of patients were included in the FSS category, and 93% of the supposed MUS (FSS and UC) were diagnosed with FSS. Compared with OD, FSS showed more severe somatic symptom burden, similar reduced HRQoL, and higher involvement of psychobehavioral factors.
It can be useful to improve FSS diagnostic skills for the reduction of MUS misdiagnosis. Psychobehavioral factors might be less associated with MUS (in the narrow sense of the term) than FSS.
“医学上无法解释的症状”（MUS）这一术语对患者和医生都没有帮助，需要更合适的疾病类别来替代MUS。虽然一些潜在的替代类别具有与躯体症状相关的过度心理负担的特征，但“功能性躯体综合征”（FSS）是一个专注于身体功能障碍并强调个体综合征之间相似性的类别。FSS的例子包括肠易激综合征、功能性消化不良和纤维肌痛综合征。本研究旨在区分FSS与MUS，并比较FSS与其他疾病的躯体和心理行为特征。
本研究纳入了日本一所大学医院普通内科门诊的1975名初诊患者。根据他们的首诊诊断，将他们分为患有FSS、急性感染、器质性疾病（OD）、精神障碍和未知情况（UC）。分别使用躯体症状量表-8和欧洲五维度健康量表评估躯体症状负担和健康相关生活质量（HRQoL）；还评估了影响躯体症状的心理行为因素。
总体而言，33%的患者被纳入FSS类别，93%的疑似MUS（FSS和UC）被诊断为FSS。与OD相比，FSS表现出更严重的躯体症状负担、相似的HRQoL降低以及更高的心理行为因素参与度。
提高FSS诊断技能有助于减少MUS误诊。心理行为因素与MUS（狭义上）的关联可能比与FSS的关联更小。
