'Medically unexplained symptoms' in patients with suspected allergies: The role of psychiatric comorbidity and patient-doctor-interaction
"Medically unexplained symptoms" in patients with suspected allergies: The role of psychiatric comorbidity and patient-doctor-interaction Background: We aimed to describe characteristics of the patient-doctor-interaction in patients with "medically unexplained symptoms (MUS)" attributed to allergies. Methods: 204 patients hospitalized for an allergy work-up were interviewed and completed a set of self-rating questionnaires covering various aspects of illness perception, as well as screening questionnaires for the detection of mental disorders. After the interview, the patient-doctor-interaction was evaluated by the interviewing psychiatrist. Finally, allergists independently reviewed the results of all diagnostic tests and rated organic symptom explicability, and patients with MUS were compared to patients with medically explained symptoms. Results: The presenting symptoms of 148 patients were rated as medically explained and of 56 patients as medically unexplained. In logistic regression analysis, psychiatric comorbidity (OR 3.72; CI 1.77 - 7.79; p = 0.001), female sex (OR 3.02; Cl 1.26 - 7.24; p = 0.01) and dissatisfaction with care (OR 1.08 for each 1-point-increase on the test scale; CI 1.01 - 1.14; p = 0.02) independently predicted MUS. When the psychiatrist's perspective was added to the model, a problematic countertransference independently predicted MUS (OR 1.50 for every 1-point-increase; CI 1.22 - 1.84; p< 0.001). Conclusions: Short screening for mental disorders that tend to present with physical symptoms should become a part of allergy work-ups. A difficult patient-doctor-interaction may predict medically unexplained symptoms. Thus, it should receive more clinical and scientific attention.
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Klinik und Poliklinik für Dermatologie und Allergologie; Toxikologische Abteilung; Institut für Molekulare Allergologie und Umweltforschung