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Alan Carson - One of the best experts on this subject based on the ideXlab platform.

  • Disability, distress and unemployment in neurology outpatients with symptoms 'unexplained by Organic Disease
    Journal of Neurology Neurosurgery and Psychiatry, 2011
    Co-Authors: Alan Carson, Jon Stone, Carina Hibberd, Gordon Murray, Rod Duncan, Richard Coleman, Charles Warlow, Richard Roberts, Anthony Pelosi, Jonathon Cavanagh
    Abstract:

    Objectives: To determine disability, distress and employment status in new neurology patients with physical symptoms unexplained by Organic Disease and to compare this with that of patients with symptoms explained by Organic Disease. Methods: As part of a cohort study ( the Scottish Neurological Symptoms Study) neurologists rated the extent to which each new patient's symptoms were explained by Organic Disease. In this paper patients whose symptoms were rated as "not at all", or only "somewhat" explained by Disease were considered cases and those whose symptoms were "largely" or "completely" explained by Disease were designated as controls. All patients completed self-ratings of disability and health status (SF-12) and emotional distress (HADS) and also reported their employment and state financial benefit status. Cases and controls were compared. Results: 3,781 patients were recruited; 1,144 (30%) were cases and 2,637 (70%) controls. Cases had slightly worse physical health status (SF12 score 42 vs 44; difference in means= -1.7 (95% CI -2.5 to -0.9)) and worse mental health status (SF12 score 43 vs 47; difference in means= -3.5 (95% CI -4.3 to -2.7). Unemployment was similar in cases and controls (50% v 50%) but cases were more likely to not to be working because of their health (54% v 37% (of the 50% not working) ; OR 2.0 (95% CI 1.6 to 2.4) and also more likely to be receiving disability related state financial benefits (27% v 22%; OR 1.3 (95% CI 1.1 to 1.6)). Conclusions: New neurology patients with symptoms unexplained by Organic Disease had greater disability, distress and more disability related state financial benefits than those whose symptoms were explained by Disease.

  • Disability, distress and unemployment in neurology outpatients with symptoms ‘unexplained by Organic Disease’
    Journal of neurology neurosurgery and psychiatry, 2011
    Co-Authors: Alan Carson, Jon Stone, Carina Hibberd, Charles Warlow, Gordon D. Murray, Roderick Duncan, Richard J Coleman, Richard C. Roberts, Anthony J. Pelosi, Jonathan Cavanagh
    Abstract:

    Objectives To determine the disability, distress and employment status of new neurology outpatients with physical symptoms unexplained by Organic Disease and to compare them with patients with symptoms explained by Organic Disease. Methods As part of a cohort study (the Scottish Neurological Symptoms Study) neurologists rated the extent to which each new patient9s symptoms were explained by Organic Disease. Patients whose symptoms were rated as ‘not at all’ or only ‘somewhat’ explained by Disease were considered cases, and those whose symptoms were ‘largely’ or ‘completely’ explained by Disease were considered controls. All patients completed self-ratings of disability, health status (Medical Outcomes Study Short Form 12-Item Scale (SF-12)) and emotional distress (Hospital Anxiety and Depression Scale) and also reported their employment and state financial benefit status. Results 3781 patients were recruited: 1144 (30%) cases and 2637 (70%) controls. Cases had worse physical health status (SF-12 score 42 vs 44; difference in means 1.7 (95% CI –2.5 to 0.9)) and worse mental health status (SF-12 score 43 vs 47; difference in means –3.5 (95% CI –4.3 to to 2.7)). Unemployment was similar in cases and controls (50% vs 50%) but cases were more likely not to be working for health reasons (54% vs 37% of the 50% not working; OR 2.0 (95% CI 1.6 to 2.4)) and also more likely to be receiving disability-related state financial benefits (27% vs 22%; (OR 1.3, 95% CI 1.1 to 1.6)). Conclusions New neurology patients with symptoms unexplained by Organic Disease have more disability-, distress- and disability-related state financial benefits than patients with symptoms explained by Disease.

  • Symptoms 'unexplained by Organic Disease' in 1144 new neurology out-patients: how often does the diagnosis change at follow-up?
    Brain, 2009
    Co-Authors: John Stone, Alan Carson, Carina Hibberd, Charles Warlow, Gordon D. Murray, Richard J Coleman, Richard C. Roberts, Rory R. Duncan, Roger E Cull, Anthony J. Pelosi
    Abstract:

    It has been previously reported that a substantial proportion of newly referred neurology out-patients have symptoms that are considered by the assessing neurologist as unexplained by 'Organic Disease'. There has however been much controversy about how often such patients subsequently develop a Disease diagnosis that, with hindsight, would have explained the symptoms. We aimed to determine in a large sample of new neurology out-patients: (i) what proportion are assessed as having symptoms unexplained by Disease and the diagnoses given to them; and (ii) how often a neurological disorder emerged which, with hindsight, explained the original symptoms. We carried out a prospective cohort study of patients referred from primary care to National Health Service neurology clinics in Scotland, UK. Measures were: (i) the proportion of patients with symptoms rated by the assessing neurologist as 'not at all' or only 'somewhat explained' by 'Organic Disease' and the neurological diagnoses recorded at initial assessment; and (ii) the frequency of unexpected new diagnoses made over the following 18 months (according to the primary-care physician). One thousand four hundred and forty-four patients (30% of all new patients) were rated as having symptoms 'not at all' or only 'somewhat explained' by 'Organic Disease'. The most common categories of diagnosis were: (i) Organic neurological Disease but with symptoms unexplained by it (26%); (ii) headache disorders (26%); and (iii) conversion symptoms (motor, sensory or non-epileptic attacks) (18%). At follow-up only 4 out of 1030 patients (0.4%) had acquired an Organic Disease diagnosis that was unexpected at initial assessment and plausibly the cause of the patients' original symptoms. Eight patients had died at follow-up; five of whom had initial diagnoses of non-epileptic attacks. Seven other types of diagnostic change with very different implications to a 'missed diagnosis' were found and a new classification of diagnostic revision is presented. One-third of new neurology out-patients are assessed as having symptoms 'unexplained by Organic Disease'. A new diagnosis, which with hindsight explained the original symptoms, rarely became apparent to the patient's primary care doctor in the 18 months following the initial hospital consultation.

  • la belle indifference in conversion symptoms and hysteria systematic review
    British Journal of Psychiatry, 2006
    Co-Authors: Jon Stone, Alan Carson, Charles Warlow, Roger Smyth, Michael Sharpe
    Abstract:

    Background La belle indifference refers to an apparent lack of concern shown by some patients towards their symptoms. It is often regarded as typical of conversion symptoms/hysteria. Aims To determine the frequency of la belle indifference in studies of patients with conversion symptoms/hysteria and to determine whether it discriminates between conversion symptoms and symptoms attributable to Organic Disease. Method A systematic review of all studies published since 1965 that have reported rates of la belle indifference in patients with conversion symptoms and/or patients with Organic Disease. Results A total of 11 studies were eligible for inclusion. The median frequency of la belle indifference was 21% (range 0–54%) in 356 patients with conversion symptoms, and 29% (range 0–60%) in 157 patients with Organic Disease. Conclusions The available evidence does not support the use of la belle indifference to discriminate between conversion symptoms and symptoms of Organic Disease. The quality of the published studies is poor, with a lackof operational definitions and masked ratings. La belle indifference should be abandoned as a clinical sign until both its definition and its utility have been clarified.

  • Patients whom neurologists find difficult to help
    Journal of neurology neurosurgery and psychiatry, 2004
    Co-Authors: Alan Carson, Jon Stone, Charles Warlow, Michael Sharpe
    Abstract:

    Objective: To test the hypothesis that patients whose symptoms were less explained by Organic Disease would be perceived as more difficult to help. Methods: In a consecutive series of 300 new neurology outpatients, neurologists indicated on four point Likert-type scales how "difficult to help" they found the patient and to what extent the patient's symptoms were explained by Organic Disease. The patients' demographics, health status, number of somatic symptoms, and mental state were also assessed. Results: The neurologists rated 143 patients (48%) as "not at all difficult" to help, 111 (37%) as "somewhat difficult", 27 (9%) as "very difficult", and 18 (6%) as "extremely difficult". A logistic regression model was constructed and the hypothesis that patients whose symptoms were less explained by Organic Disease would be perceived as more difficult to help was supported. The only other measured variable that contributed to perceived difficulty was physical disability, but it explained only a small amount of the variance. Conclusions: Neurologists find patients whose symptoms are not explained by Organic Disease more difficult to help than their other patients.

Charles Warlow - One of the best experts on this subject based on the ideXlab platform.

  • Disability, distress and unemployment in neurology outpatients with symptoms 'unexplained by Organic Disease
    Journal of Neurology Neurosurgery and Psychiatry, 2011
    Co-Authors: Alan Carson, Jon Stone, Carina Hibberd, Gordon Murray, Rod Duncan, Richard Coleman, Charles Warlow, Richard Roberts, Anthony Pelosi, Jonathon Cavanagh
    Abstract:

    Objectives: To determine disability, distress and employment status in new neurology patients with physical symptoms unexplained by Organic Disease and to compare this with that of patients with symptoms explained by Organic Disease. Methods: As part of a cohort study ( the Scottish Neurological Symptoms Study) neurologists rated the extent to which each new patient's symptoms were explained by Organic Disease. In this paper patients whose symptoms were rated as "not at all", or only "somewhat" explained by Disease were considered cases and those whose symptoms were "largely" or "completely" explained by Disease were designated as controls. All patients completed self-ratings of disability and health status (SF-12) and emotional distress (HADS) and also reported their employment and state financial benefit status. Cases and controls were compared. Results: 3,781 patients were recruited; 1,144 (30%) were cases and 2,637 (70%) controls. Cases had slightly worse physical health status (SF12 score 42 vs 44; difference in means= -1.7 (95% CI -2.5 to -0.9)) and worse mental health status (SF12 score 43 vs 47; difference in means= -3.5 (95% CI -4.3 to -2.7). Unemployment was similar in cases and controls (50% v 50%) but cases were more likely to not to be working because of their health (54% v 37% (of the 50% not working) ; OR 2.0 (95% CI 1.6 to 2.4) and also more likely to be receiving disability related state financial benefits (27% v 22%; OR 1.3 (95% CI 1.1 to 1.6)). Conclusions: New neurology patients with symptoms unexplained by Organic Disease had greater disability, distress and more disability related state financial benefits than those whose symptoms were explained by Disease.

  • Disability, distress and unemployment in neurology outpatients with symptoms ‘unexplained by Organic Disease’
    Journal of neurology neurosurgery and psychiatry, 2011
    Co-Authors: Alan Carson, Jon Stone, Carina Hibberd, Charles Warlow, Gordon D. Murray, Roderick Duncan, Richard J Coleman, Richard C. Roberts, Anthony J. Pelosi, Jonathan Cavanagh
    Abstract:

    Objectives To determine the disability, distress and employment status of new neurology outpatients with physical symptoms unexplained by Organic Disease and to compare them with patients with symptoms explained by Organic Disease. Methods As part of a cohort study (the Scottish Neurological Symptoms Study) neurologists rated the extent to which each new patient9s symptoms were explained by Organic Disease. Patients whose symptoms were rated as ‘not at all’ or only ‘somewhat’ explained by Disease were considered cases, and those whose symptoms were ‘largely’ or ‘completely’ explained by Disease were considered controls. All patients completed self-ratings of disability, health status (Medical Outcomes Study Short Form 12-Item Scale (SF-12)) and emotional distress (Hospital Anxiety and Depression Scale) and also reported their employment and state financial benefit status. Results 3781 patients were recruited: 1144 (30%) cases and 2637 (70%) controls. Cases had worse physical health status (SF-12 score 42 vs 44; difference in means 1.7 (95% CI –2.5 to 0.9)) and worse mental health status (SF-12 score 43 vs 47; difference in means –3.5 (95% CI –4.3 to to 2.7)). Unemployment was similar in cases and controls (50% vs 50%) but cases were more likely not to be working for health reasons (54% vs 37% of the 50% not working; OR 2.0 (95% CI 1.6 to 2.4)) and also more likely to be receiving disability-related state financial benefits (27% vs 22%; (OR 1.3, 95% CI 1.1 to 1.6)). Conclusions New neurology patients with symptoms unexplained by Organic Disease have more disability-, distress- and disability-related state financial benefits than patients with symptoms explained by Disease.

  • Symptoms 'unexplained by Organic Disease' in 1144 new neurology out-patients: how often does the diagnosis change at follow-up?
    Brain, 2009
    Co-Authors: John Stone, Alan Carson, Carina Hibberd, Charles Warlow, Gordon D. Murray, Richard J Coleman, Richard C. Roberts, Rory R. Duncan, Roger E Cull, Anthony J. Pelosi
    Abstract:

    It has been previously reported that a substantial proportion of newly referred neurology out-patients have symptoms that are considered by the assessing neurologist as unexplained by 'Organic Disease'. There has however been much controversy about how often such patients subsequently develop a Disease diagnosis that, with hindsight, would have explained the symptoms. We aimed to determine in a large sample of new neurology out-patients: (i) what proportion are assessed as having symptoms unexplained by Disease and the diagnoses given to them; and (ii) how often a neurological disorder emerged which, with hindsight, explained the original symptoms. We carried out a prospective cohort study of patients referred from primary care to National Health Service neurology clinics in Scotland, UK. Measures were: (i) the proportion of patients with symptoms rated by the assessing neurologist as 'not at all' or only 'somewhat explained' by 'Organic Disease' and the neurological diagnoses recorded at initial assessment; and (ii) the frequency of unexpected new diagnoses made over the following 18 months (according to the primary-care physician). One thousand four hundred and forty-four patients (30% of all new patients) were rated as having symptoms 'not at all' or only 'somewhat explained' by 'Organic Disease'. The most common categories of diagnosis were: (i) Organic neurological Disease but with symptoms unexplained by it (26%); (ii) headache disorders (26%); and (iii) conversion symptoms (motor, sensory or non-epileptic attacks) (18%). At follow-up only 4 out of 1030 patients (0.4%) had acquired an Organic Disease diagnosis that was unexpected at initial assessment and plausibly the cause of the patients' original symptoms. Eight patients had died at follow-up; five of whom had initial diagnoses of non-epileptic attacks. Seven other types of diagnostic change with very different implications to a 'missed diagnosis' were found and a new classification of diagnostic revision is presented. One-third of new neurology out-patients are assessed as having symptoms 'unexplained by Organic Disease'. A new diagnosis, which with hindsight explained the original symptoms, rarely became apparent to the patient's primary care doctor in the 18 months following the initial hospital consultation.

  • la belle indifference in conversion symptoms and hysteria systematic review
    British Journal of Psychiatry, 2006
    Co-Authors: Jon Stone, Alan Carson, Charles Warlow, Roger Smyth, Michael Sharpe
    Abstract:

    Background La belle indifference refers to an apparent lack of concern shown by some patients towards their symptoms. It is often regarded as typical of conversion symptoms/hysteria. Aims To determine the frequency of la belle indifference in studies of patients with conversion symptoms/hysteria and to determine whether it discriminates between conversion symptoms and symptoms attributable to Organic Disease. Method A systematic review of all studies published since 1965 that have reported rates of la belle indifference in patients with conversion symptoms and/or patients with Organic Disease. Results A total of 11 studies were eligible for inclusion. The median frequency of la belle indifference was 21% (range 0–54%) in 356 patients with conversion symptoms, and 29% (range 0–60%) in 157 patients with Organic Disease. Conclusions The available evidence does not support the use of la belle indifference to discriminate between conversion symptoms and symptoms of Organic Disease. The quality of the published studies is poor, with a lackof operational definitions and masked ratings. La belle indifference should be abandoned as a clinical sign until both its definition and its utility have been clarified.

  • Patients whom neurologists find difficult to help
    Journal of neurology neurosurgery and psychiatry, 2004
    Co-Authors: Alan Carson, Jon Stone, Charles Warlow, Michael Sharpe
    Abstract:

    Objective: To test the hypothesis that patients whose symptoms were less explained by Organic Disease would be perceived as more difficult to help. Methods: In a consecutive series of 300 new neurology outpatients, neurologists indicated on four point Likert-type scales how "difficult to help" they found the patient and to what extent the patient's symptoms were explained by Organic Disease. The patients' demographics, health status, number of somatic symptoms, and mental state were also assessed. Results: The neurologists rated 143 patients (48%) as "not at all difficult" to help, 111 (37%) as "somewhat difficult", 27 (9%) as "very difficult", and 18 (6%) as "extremely difficult". A logistic regression model was constructed and the hypothesis that patients whose symptoms were less explained by Organic Disease would be perceived as more difficult to help was supported. The only other measured variable that contributed to perceived difficulty was physical disability, but it explained only a small amount of the variance. Conclusions: Neurologists find patients whose symptoms are not explained by Organic Disease more difficult to help than their other patients.

Jon Stone - One of the best experts on this subject based on the ideXlab platform.

  • Disability, distress and unemployment in neurology outpatients with symptoms 'unexplained by Organic Disease
    Journal of Neurology Neurosurgery and Psychiatry, 2011
    Co-Authors: Alan Carson, Jon Stone, Carina Hibberd, Gordon Murray, Rod Duncan, Richard Coleman, Charles Warlow, Richard Roberts, Anthony Pelosi, Jonathon Cavanagh
    Abstract:

    Objectives: To determine disability, distress and employment status in new neurology patients with physical symptoms unexplained by Organic Disease and to compare this with that of patients with symptoms explained by Organic Disease. Methods: As part of a cohort study ( the Scottish Neurological Symptoms Study) neurologists rated the extent to which each new patient's symptoms were explained by Organic Disease. In this paper patients whose symptoms were rated as "not at all", or only "somewhat" explained by Disease were considered cases and those whose symptoms were "largely" or "completely" explained by Disease were designated as controls. All patients completed self-ratings of disability and health status (SF-12) and emotional distress (HADS) and also reported their employment and state financial benefit status. Cases and controls were compared. Results: 3,781 patients were recruited; 1,144 (30%) were cases and 2,637 (70%) controls. Cases had slightly worse physical health status (SF12 score 42 vs 44; difference in means= -1.7 (95% CI -2.5 to -0.9)) and worse mental health status (SF12 score 43 vs 47; difference in means= -3.5 (95% CI -4.3 to -2.7). Unemployment was similar in cases and controls (50% v 50%) but cases were more likely to not to be working because of their health (54% v 37% (of the 50% not working) ; OR 2.0 (95% CI 1.6 to 2.4) and also more likely to be receiving disability related state financial benefits (27% v 22%; OR 1.3 (95% CI 1.1 to 1.6)). Conclusions: New neurology patients with symptoms unexplained by Organic Disease had greater disability, distress and more disability related state financial benefits than those whose symptoms were explained by Disease.

  • Disability, distress and unemployment in neurology outpatients with symptoms ‘unexplained by Organic Disease’
    Journal of neurology neurosurgery and psychiatry, 2011
    Co-Authors: Alan Carson, Jon Stone, Carina Hibberd, Charles Warlow, Gordon D. Murray, Roderick Duncan, Richard J Coleman, Richard C. Roberts, Anthony J. Pelosi, Jonathan Cavanagh
    Abstract:

    Objectives To determine the disability, distress and employment status of new neurology outpatients with physical symptoms unexplained by Organic Disease and to compare them with patients with symptoms explained by Organic Disease. Methods As part of a cohort study (the Scottish Neurological Symptoms Study) neurologists rated the extent to which each new patient9s symptoms were explained by Organic Disease. Patients whose symptoms were rated as ‘not at all’ or only ‘somewhat’ explained by Disease were considered cases, and those whose symptoms were ‘largely’ or ‘completely’ explained by Disease were considered controls. All patients completed self-ratings of disability, health status (Medical Outcomes Study Short Form 12-Item Scale (SF-12)) and emotional distress (Hospital Anxiety and Depression Scale) and also reported their employment and state financial benefit status. Results 3781 patients were recruited: 1144 (30%) cases and 2637 (70%) controls. Cases had worse physical health status (SF-12 score 42 vs 44; difference in means 1.7 (95% CI –2.5 to 0.9)) and worse mental health status (SF-12 score 43 vs 47; difference in means –3.5 (95% CI –4.3 to to 2.7)). Unemployment was similar in cases and controls (50% vs 50%) but cases were more likely not to be working for health reasons (54% vs 37% of the 50% not working; OR 2.0 (95% CI 1.6 to 2.4)) and also more likely to be receiving disability-related state financial benefits (27% vs 22%; (OR 1.3, 95% CI 1.1 to 1.6)). Conclusions New neurology patients with symptoms unexplained by Organic Disease have more disability-, distress- and disability-related state financial benefits than patients with symptoms explained by Disease.

  • la belle indifference in conversion symptoms and hysteria systematic review
    British Journal of Psychiatry, 2006
    Co-Authors: Jon Stone, Alan Carson, Charles Warlow, Roger Smyth, Michael Sharpe
    Abstract:

    Background La belle indifference refers to an apparent lack of concern shown by some patients towards their symptoms. It is often regarded as typical of conversion symptoms/hysteria. Aims To determine the frequency of la belle indifference in studies of patients with conversion symptoms/hysteria and to determine whether it discriminates between conversion symptoms and symptoms attributable to Organic Disease. Method A systematic review of all studies published since 1965 that have reported rates of la belle indifference in patients with conversion symptoms and/or patients with Organic Disease. Results A total of 11 studies were eligible for inclusion. The median frequency of la belle indifference was 21% (range 0–54%) in 356 patients with conversion symptoms, and 29% (range 0–60%) in 157 patients with Organic Disease. Conclusions The available evidence does not support the use of la belle indifference to discriminate between conversion symptoms and symptoms of Organic Disease. The quality of the published studies is poor, with a lackof operational definitions and masked ratings. La belle indifference should be abandoned as a clinical sign until both its definition and its utility have been clarified.

  • Patients whom neurologists find difficult to help
    Journal of neurology neurosurgery and psychiatry, 2004
    Co-Authors: Alan Carson, Jon Stone, Charles Warlow, Michael Sharpe
    Abstract:

    Objective: To test the hypothesis that patients whose symptoms were less explained by Organic Disease would be perceived as more difficult to help. Methods: In a consecutive series of 300 new neurology outpatients, neurologists indicated on four point Likert-type scales how "difficult to help" they found the patient and to what extent the patient's symptoms were explained by Organic Disease. The patients' demographics, health status, number of somatic symptoms, and mental state were also assessed. Results: The neurologists rated 143 patients (48%) as "not at all difficult" to help, 111 (37%) as "somewhat difficult", 27 (9%) as "very difficult", and 18 (6%) as "extremely difficult". A logistic regression model was constructed and the hypothesis that patients whose symptoms were less explained by Organic Disease would be perceived as more difficult to help was supported. The only other measured variable that contributed to perceived difficulty was physical disability, but it explained only a small amount of the variance. Conclusions: Neurologists find patients whose symptoms are not explained by Organic Disease more difficult to help than their other patients.

Anthony J. Pelosi - One of the best experts on this subject based on the ideXlab platform.

  • Disability, distress and unemployment in neurology outpatients with symptoms ‘unexplained by Organic Disease’
    Journal of neurology neurosurgery and psychiatry, 2011
    Co-Authors: Alan Carson, Jon Stone, Carina Hibberd, Charles Warlow, Gordon D. Murray, Roderick Duncan, Richard J Coleman, Richard C. Roberts, Anthony J. Pelosi, Jonathan Cavanagh
    Abstract:

    Objectives To determine the disability, distress and employment status of new neurology outpatients with physical symptoms unexplained by Organic Disease and to compare them with patients with symptoms explained by Organic Disease. Methods As part of a cohort study (the Scottish Neurological Symptoms Study) neurologists rated the extent to which each new patient9s symptoms were explained by Organic Disease. Patients whose symptoms were rated as ‘not at all’ or only ‘somewhat’ explained by Disease were considered cases, and those whose symptoms were ‘largely’ or ‘completely’ explained by Disease were considered controls. All patients completed self-ratings of disability, health status (Medical Outcomes Study Short Form 12-Item Scale (SF-12)) and emotional distress (Hospital Anxiety and Depression Scale) and also reported their employment and state financial benefit status. Results 3781 patients were recruited: 1144 (30%) cases and 2637 (70%) controls. Cases had worse physical health status (SF-12 score 42 vs 44; difference in means 1.7 (95% CI –2.5 to 0.9)) and worse mental health status (SF-12 score 43 vs 47; difference in means –3.5 (95% CI –4.3 to to 2.7)). Unemployment was similar in cases and controls (50% vs 50%) but cases were more likely not to be working for health reasons (54% vs 37% of the 50% not working; OR 2.0 (95% CI 1.6 to 2.4)) and also more likely to be receiving disability-related state financial benefits (27% vs 22%; (OR 1.3, 95% CI 1.1 to 1.6)). Conclusions New neurology patients with symptoms unexplained by Organic Disease have more disability-, distress- and disability-related state financial benefits than patients with symptoms explained by Disease.

  • Symptoms 'unexplained by Organic Disease' in 1144 new neurology out-patients: how often does the diagnosis change at follow-up?
    Brain, 2009
    Co-Authors: John Stone, Alan Carson, Carina Hibberd, Charles Warlow, Gordon D. Murray, Richard J Coleman, Richard C. Roberts, Rory R. Duncan, Roger E Cull, Anthony J. Pelosi
    Abstract:

    It has been previously reported that a substantial proportion of newly referred neurology out-patients have symptoms that are considered by the assessing neurologist as unexplained by 'Organic Disease'. There has however been much controversy about how often such patients subsequently develop a Disease diagnosis that, with hindsight, would have explained the symptoms. We aimed to determine in a large sample of new neurology out-patients: (i) what proportion are assessed as having symptoms unexplained by Disease and the diagnoses given to them; and (ii) how often a neurological disorder emerged which, with hindsight, explained the original symptoms. We carried out a prospective cohort study of patients referred from primary care to National Health Service neurology clinics in Scotland, UK. Measures were: (i) the proportion of patients with symptoms rated by the assessing neurologist as 'not at all' or only 'somewhat explained' by 'Organic Disease' and the neurological diagnoses recorded at initial assessment; and (ii) the frequency of unexpected new diagnoses made over the following 18 months (according to the primary-care physician). One thousand four hundred and forty-four patients (30% of all new patients) were rated as having symptoms 'not at all' or only 'somewhat explained' by 'Organic Disease'. The most common categories of diagnosis were: (i) Organic neurological Disease but with symptoms unexplained by it (26%); (ii) headache disorders (26%); and (iii) conversion symptoms (motor, sensory or non-epileptic attacks) (18%). At follow-up only 4 out of 1030 patients (0.4%) had acquired an Organic Disease diagnosis that was unexpected at initial assessment and plausibly the cause of the patients' original symptoms. Eight patients had died at follow-up; five of whom had initial diagnoses of non-epileptic attacks. Seven other types of diagnostic change with very different implications to a 'missed diagnosis' were found and a new classification of diagnostic revision is presented. One-third of new neurology out-patients are assessed as having symptoms 'unexplained by Organic Disease'. A new diagnosis, which with hindsight explained the original symptoms, rarely became apparent to the patient's primary care doctor in the 18 months following the initial hospital consultation.

Carina Hibberd - One of the best experts on this subject based on the ideXlab platform.

  • Disability, distress and unemployment in neurology outpatients with symptoms 'unexplained by Organic Disease
    Journal of Neurology Neurosurgery and Psychiatry, 2011
    Co-Authors: Alan Carson, Jon Stone, Carina Hibberd, Gordon Murray, Rod Duncan, Richard Coleman, Charles Warlow, Richard Roberts, Anthony Pelosi, Jonathon Cavanagh
    Abstract:

    Objectives: To determine disability, distress and employment status in new neurology patients with physical symptoms unexplained by Organic Disease and to compare this with that of patients with symptoms explained by Organic Disease. Methods: As part of a cohort study ( the Scottish Neurological Symptoms Study) neurologists rated the extent to which each new patient's symptoms were explained by Organic Disease. In this paper patients whose symptoms were rated as "not at all", or only "somewhat" explained by Disease were considered cases and those whose symptoms were "largely" or "completely" explained by Disease were designated as controls. All patients completed self-ratings of disability and health status (SF-12) and emotional distress (HADS) and also reported their employment and state financial benefit status. Cases and controls were compared. Results: 3,781 patients were recruited; 1,144 (30%) were cases and 2,637 (70%) controls. Cases had slightly worse physical health status (SF12 score 42 vs 44; difference in means= -1.7 (95% CI -2.5 to -0.9)) and worse mental health status (SF12 score 43 vs 47; difference in means= -3.5 (95% CI -4.3 to -2.7). Unemployment was similar in cases and controls (50% v 50%) but cases were more likely to not to be working because of their health (54% v 37% (of the 50% not working) ; OR 2.0 (95% CI 1.6 to 2.4) and also more likely to be receiving disability related state financial benefits (27% v 22%; OR 1.3 (95% CI 1.1 to 1.6)). Conclusions: New neurology patients with symptoms unexplained by Organic Disease had greater disability, distress and more disability related state financial benefits than those whose symptoms were explained by Disease.

  • Disability, distress and unemployment in neurology outpatients with symptoms ‘unexplained by Organic Disease’
    Journal of neurology neurosurgery and psychiatry, 2011
    Co-Authors: Alan Carson, Jon Stone, Carina Hibberd, Charles Warlow, Gordon D. Murray, Roderick Duncan, Richard J Coleman, Richard C. Roberts, Anthony J. Pelosi, Jonathan Cavanagh
    Abstract:

    Objectives To determine the disability, distress and employment status of new neurology outpatients with physical symptoms unexplained by Organic Disease and to compare them with patients with symptoms explained by Organic Disease. Methods As part of a cohort study (the Scottish Neurological Symptoms Study) neurologists rated the extent to which each new patient9s symptoms were explained by Organic Disease. Patients whose symptoms were rated as ‘not at all’ or only ‘somewhat’ explained by Disease were considered cases, and those whose symptoms were ‘largely’ or ‘completely’ explained by Disease were considered controls. All patients completed self-ratings of disability, health status (Medical Outcomes Study Short Form 12-Item Scale (SF-12)) and emotional distress (Hospital Anxiety and Depression Scale) and also reported their employment and state financial benefit status. Results 3781 patients were recruited: 1144 (30%) cases and 2637 (70%) controls. Cases had worse physical health status (SF-12 score 42 vs 44; difference in means 1.7 (95% CI –2.5 to 0.9)) and worse mental health status (SF-12 score 43 vs 47; difference in means –3.5 (95% CI –4.3 to to 2.7)). Unemployment was similar in cases and controls (50% vs 50%) but cases were more likely not to be working for health reasons (54% vs 37% of the 50% not working; OR 2.0 (95% CI 1.6 to 2.4)) and also more likely to be receiving disability-related state financial benefits (27% vs 22%; (OR 1.3, 95% CI 1.1 to 1.6)). Conclusions New neurology patients with symptoms unexplained by Organic Disease have more disability-, distress- and disability-related state financial benefits than patients with symptoms explained by Disease.

  • Symptoms 'unexplained by Organic Disease' in 1144 new neurology out-patients: how often does the diagnosis change at follow-up?
    Brain, 2009
    Co-Authors: John Stone, Alan Carson, Carina Hibberd, Charles Warlow, Gordon D. Murray, Richard J Coleman, Richard C. Roberts, Rory R. Duncan, Roger E Cull, Anthony J. Pelosi
    Abstract:

    It has been previously reported that a substantial proportion of newly referred neurology out-patients have symptoms that are considered by the assessing neurologist as unexplained by 'Organic Disease'. There has however been much controversy about how often such patients subsequently develop a Disease diagnosis that, with hindsight, would have explained the symptoms. We aimed to determine in a large sample of new neurology out-patients: (i) what proportion are assessed as having symptoms unexplained by Disease and the diagnoses given to them; and (ii) how often a neurological disorder emerged which, with hindsight, explained the original symptoms. We carried out a prospective cohort study of patients referred from primary care to National Health Service neurology clinics in Scotland, UK. Measures were: (i) the proportion of patients with symptoms rated by the assessing neurologist as 'not at all' or only 'somewhat explained' by 'Organic Disease' and the neurological diagnoses recorded at initial assessment; and (ii) the frequency of unexpected new diagnoses made over the following 18 months (according to the primary-care physician). One thousand four hundred and forty-four patients (30% of all new patients) were rated as having symptoms 'not at all' or only 'somewhat explained' by 'Organic Disease'. The most common categories of diagnosis were: (i) Organic neurological Disease but with symptoms unexplained by it (26%); (ii) headache disorders (26%); and (iii) conversion symptoms (motor, sensory or non-epileptic attacks) (18%). At follow-up only 4 out of 1030 patients (0.4%) had acquired an Organic Disease diagnosis that was unexpected at initial assessment and plausibly the cause of the patients' original symptoms. Eight patients had died at follow-up; five of whom had initial diagnoses of non-epileptic attacks. Seven other types of diagnostic change with very different implications to a 'missed diagnosis' were found and a new classification of diagnostic revision is presented. One-third of new neurology out-patients are assessed as having symptoms 'unexplained by Organic Disease'. A new diagnosis, which with hindsight explained the original symptoms, rarely became apparent to the patient's primary care doctor in the 18 months following the initial hospital consultation.