Somatisation of Mental Illness?

Somatisation of Mental Illness?

Letters 527 References Conn, P M (1995). Neuroscience in Medicine, Lippincott. Crofford, L J and Demitrack, M A (1996). ‘Evidence that abnormalities...

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Letters

527

References Conn, P M (1995). Neuroscience in Medicine, Lippincott. Crofford, L J and Demitrack, M A (1996). ‘Evidence that abnormalities of central neurohormonal systems are key to understanding fibromyalgia and chronic fatigue syndrome’, Rheumatic Disease Clinics of North America, 22, 2, 267-283. Di Fabio, R (1995). ‘Efficacy of comprehensive rehabilitation

Somatisation of Mental Illness? THE recent article ‘Wrong problem, wrong treatment’ (Rose et al, 1999) alerts the reader to somatisation of psychosocial problems among primary care patients who were referred to physiotherapy, and warns that in this situation physiotherapy may do more harm than good by reinforcing patients’ somatic orientation. They suggest a local protocol between the physiotherapists and the general practitioners to refer back the inappropriate referrals, for ‘appropriate intervention’. However an analysis of the brief purposive sample of case histories presented as an illustration of somatisation of mental illness (page 325) suggests otherwise, ie a clear pattern of pain that is consistent with mechanical origin from the spine. Although these patients may now have a number of coexisting symptoms such as fatigue, muscle pains, anxiety and

programmes and back school for patients with low back pain: A meta-analysis,’ Physical Therapy, 75, 10, 865-878. Mannion, A F, Dolan, P and Adams, M H (1996). ‘Psychological questionnaires: Do abnomal scores precede or follow first time low back pain?’ Spine, 21, 22, 2603-11. Morgan, W P (1997). Physical Activity and Mental Health, Taylor and Francis, London.

depression, considering their long history of pain these symptoms may well be secondary to the physical disability. Rightly, Rose et al acknowledge that it is debatable and doubtful whether depression is primary or secondary to perceived disability. However, they appear to have used only a combination of Hospital Anxiety and Depression (HAD) scores and subjective examination to support their view, as opposed to a comprehensive assessment, which might have revealed the sequence and the possible source of these symptoms. Besides, patients with primary mental illness do suffer from osteoarthritis, spondylitis and musculoskeletal problems as well! Rose et al leaned heavily towards psychology/psychiatry. Therefore the suggestion that physiotherapy would do more harm than good should be considered with great caution. Doctors’ explanations of musculoskeletal symptoms are often at odds with patients’ thinking (Salmon et al, 1999) and patients perceive the doctors as inexpert and incompetent in identifying

Scalzatti, D A (1997). ‘Screening for psychological factors in patients with low back problems: Waddell’s non-organic signs’, Physical Therapy, 77, 306-312. Waddell, G (1998). The Back Pain Revolution, Churchill Livingstone, Edinburgh. Wessely, S, Hotopf, M and Sharpe, M (1998). Chronic Fatigue and its Syndromes, Oxford University Press.

persistent physical symptoms (Peters et al, 1998). Therefore physiotherapists are best placed to identify, and to offer an explanation for these physical symptoms. Referring the patients back to their GPs would not benefit the patients. Instead, where appropriate a multidisciplinary team approach should be adopted. Hannan Mohammad Ali MPhil MIAP MCSP Gartnavel General Hospital, Glasgow

References Peters, S, Stanley, I, Rose, M and Salmon, P (1998). ‘Patients with medically unexplained symptoms: Source of patients’ authority and implications for demands on medical care’, Journal of Social Science and Medicine, 46, 559-565. Salmon, P, Peters, S and Stanley, I (1999). ‘Patients’ perception of medical explanation for somatisation disorders: Qualitative analysis’, British Medical Journal, 318, 372-376.

The subject of debate: Rose, M, Stanley, I, Peters, S, Salmon, P, Stott, T and Crook, P (1999). ‘Wrong problem, wrong treatment: Unrecognised inappropriate referral to physiotherapy’, Physiotherapy, 85, 6, 322-328.

Physiotherapy September 1999/vol 85/no 9