BMJ 1998;317:536 ( 22 August )

Letters

Prognosis of symptoms that are medically unexplained

    Every neurology service should have access to specialist liaison psychiatry
    Clinical guidelines are needed
    Psychological aspects of investigations must be addressed early
    Follow up study needs to be continued for longer

Every neurology service should have access to specialist liaison psychiatry

The first 150 words of the full text of this article appear below.

EDITOR---Crimlisk et al's report on the outcome of motor symptoms that were medically unexplained in a cohort first identified at the National Hospital for Nervous Diseases is welcomed by those interested in the psychiatry of physical illness.1 Slater's work, based on cohorts recruited in the 1950s, overestimated the likelihood of misdiagnosis in modern neurology,2 and his conclusions have dissuaded psychiatrists from becoming involved in the management of hysteria.

O'Brien's editorial on Crimlisk et al's study could have sounded two cautionary notes.3 Firstly, the study was not based on a true inception cohort, and it was recruited from a highly specialised centre. Usually, these factors lead to the finding of a worse prognosis than if only incident cases were included and the sample was less prone to recruitment bias. In this case, however, the bias may have been in the other direction. Patients seen at the National Hospital are . . . [Full text of this article]
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This article has been cited by other articles:

  • Parry, A M, Murray, B, Hart, Y, Bass, C (2006). Audit of resource use in patients with non-organic disorders admitted to a UK neurology unit. J. Neurol. Neurosurg. Psychiatry 77: 1200-1201 [Full text]  

Rapid Responses:

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Role of neuropsychiatry
Laurence Martin
bmj.com, 7 Sep 1998 [Full text]
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