Disability, distress and unemployment in neurology outpatients with symptoms 'unexplained by organic disease'

Alan Carson (1) , Jon Stone (1) , Carina Hibberd (1) , Gordon Murray (1) , Rod Duncan (2) , Richard Coleman (3) , Charles Warlow (1) , Richard Roberts (4) , Anthony Pelosi (5) , Jonathon Cavanagh (6) , Keith Matthews (4) , Rainer Goldbeck (3) , Christain Hansen (1) , Michael Sharpe (1)

1 Edin. - University of Edinburgh
2 Southern General Hospital, Glasgow
3 Aberdeen Royal Infirmary, Aberdeen
4 University of Dundee School of Medicine
5 Hairmyres Hospital, East Kilbride
6 University of Glasgow

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.

Mots clés: CLINICAL NEUROLOGY; HYSTERIA; PSYCHIATRY; SOMATISATION DISORDER

Alan Carson, Jon Stone, Carina Hibberd, Gordon Murray, Rod Duncan, et al.. Disability, distress and unemployment in neurology outpatients with symptoms 'unexplained by organic disease'. Journal of Neurology, Neurosurgery and Psychiatry, 2011, 82 (7), pp.810. ⟨10.1136/jnnp.2010.220640⟩. ⟨hal-00610054⟩