Neurology out-patients with symptoms unexplained by disease: illness beliefs and financial benefits predict 1-year outcome.
BACKGROUND
Patients whose symptoms are 'unexplained by disease' often have a poor symptomatic outcome after specialist consultation, but we know little about which patient factors predict this. We therefore aimed to determine predictors of poor subjective outcome for new neurology out-patients with symptoms unexplained by disease 1 year after the initial consultation.


METHODS
The Scottish Neurological Symptom Study was a 1-year prospective cohort study of patients referred to secondary care National Health Service neurology clinics in Scotland (UK). Patients were included if the neurologist rated their symptoms as 'not at all' or only 'somewhat explained' by organic disease. Patient-rated change in health was rated on a five-point Clinical Global Improvement (CGI) scale ('much better' to 'much worse') 1 year later.


RESULTS
The 12-month outcome data were available on 716 of 1144 patients (63%). Poor outcome on the CGI ('unchanged', 'worse' or 'much worse') was reported by 482 (67%) out of 716 patients. The only strong independent baseline predictors were patients' beliefs [expectation of non-recovery (odds ratio [OR] 2.04, 95% confidence interval [CI] 1.40-2.96), non-attribution of symptoms to psychological factors (OR 2.22, 95% CI 1.51-3.26)] and the receipt of illness-related financial benefits (OR 2.30, 95% CI 1.37-3.86). Together, these factors predicted 13% of the variance in outcome.


CONCLUSIONS
Of the patients, two-thirds had a poor outcome at 1 year. Illness beliefs and financial benefits are more useful in predicting poor outcome than the number of symptoms, disability and distress.
Sharpe
M
M
Psychological Medicine Research, School of Molecular and Clinical Medicine, University of Edinburgh, UK. Michael.Sharpe@ed.ac.uk
Stone
J
J
Hibberd
C
C
Warlow
C
C
Duncan
R
R
Coleman
R
R
Roberts
R
R
Cull
R
R
Pelosi
A
A
Cavanagh
J
J
Matthews
K
K
Goldbeck
R
R
Smyth
R
R
Walker
A
A
Walker
J
J
MacMahon
A
A
Murray
G
G
Carson
A
A
D000328:Adult; D001294:Attitude to Health; D002493:Central Nervous System Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D015331:Cohort Studies; D003469:Culture; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult