[Medically unexplained symptoms in older adults: a combination of physical, psychiatric and psychological factors].
3 women aged 75, 75 and 65 years, respectively, were referred to an outpatient clinic for medically unexplained symptoms (MUS). These cases illustrate the heterogeneity and complexity of MUS in elderly patients, which requires broad, multidisciplinary clinical examination by a geriatrician, psychiatrist and psychologist. The first patient presented with persistent pain in the lower back and legs. Examination revealed a spinal stenosis, which was treated surgically; symptoms subsequently resolved. The second patient had chronic abdominal pain and constipation in combination with depression. She was diagnosed with a severe depressive disorder. After adequate drug treatment, her mood improved and the somatic symptoms disappeared. The third patient complained of headache and feared that she may have a brain tumour. There was no somatic diagnosis. She underwent cognitive behavioural group therapy, which substantially improved her functioning. These cases illustrate the diversity and complexity of MUS in elderly patients and underscore the diagnostic appropriateness of the biopsychosocial paradigm. A specialised multidisciplinary examination ensures accurate diagnosis and cognitive behavioural therapy.
Hilderink
P H
PH
GGZ Nijmegen, Circuit Ouderen, Nijmegen. philderink@ggznijmegen.nl
Benraad
C E M
CE
van Driel
T J W
TJ
Olde Rikkert
M G M
MG
D000368:Aged; D003865:Major Depressive Disorder / Q000150:complications / Q000175:diagnosis / Q000523:psychology; D003937:Diagnosis, Differential; D005260:Female; D015577:Geriatric Assessment; D005852:Geriatric Psychiatry; D005853:Geriatrics / Q000379:methods*; D006801:Humans; D011602:Psychophysiologic Disorders / Q000175:diagnosis* / Q000628:therapy; D013130:Spinal Stenosis / Q000175:diagnosis / Q000601:surgery; D016896:Treatment Outcome