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Occupational factors and unexplained physical symptoms

Published online by Cambridge University Press:  02 January 2018

Matthew Hotopf
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Liaison psychiatrists are frequently asked to see people with chronic, debilitating and unexplained physical symptoms, in particular chronic pain and chronic fatigue. People with these conditions have often seen many doctors and received multiple medical investigations, but rarely have had any effective treatment or even explanation for their symptoms. There are many reasons for focusing on occupational factors in this patient group. First, many people may attribute their symptoms to workplace exposures. For example, back pain may commonly be put down to accidents; upper limb disorders to use of keyboards or repetitive manual tasks; and headaches and fatigue to visual display units or air conditioning. These attributions have prognostic and legal implications, and are likely to affect the course of treatment. Second, for those who have had prolonged sickness absence, it is often necessary to make decisions regarding return to work or to help them negotiate the often lengthy and complex medical retirement process. This may be a major stumbling block in managing such people. Finally, psychiatrists are frequently invited to write medico-legal reports regarding the role of occupational factors in causing unexplained physical symptoms. This article aims to address these issues and provide some practical guidance to clinicians.

Type
Research Article
Information
Advances in Psychiatric Treatment , Volume 4 , Issue 3 , May 1998 , pp. 151 - 158
Copyright
Copyright © The Royal College of Psychiatrists 1998 

References

American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders (4th edn)(DSM–IV). Washington, DC: APA.Google Scholar
Aylward, M. & Locascio, J. J. (1995) Problems in the assessment of psychosomatic conditions in social security benefits and related commercial schemes. Journal of Psychosomatic Reserach, 39, 755–765.CrossRefGoogle ScholarPubMed
Bigos, S. J., Battie, M. C., Spengler, D. M. et al (1991) A prospective study of work perceptions and psychosocial factors affecting the report of back injury. Spine, 16, 1–6.Google Scholar
Bongers, P. M., De Winter, C. R., Kompier, M. A. J. et al (1993) Psychosocial factors at work and musculoskeletal disease. Scandinavian Journal of Work, Environment and Health, 19, 297–312.CrossRefGoogle ScholarPubMed
Craig, T. K. J., Boardman, A. P., Mills, K. et al (1993) The South London somatisation study. I: Longitudinal course and the influence of early life experiences. British Journal of Psychiatry, 163, 579–588.Google Scholar
Croft, P. R., Papageorgiou, A. C., Ferry, S. et al (1996) Psychologic distress and low back pain: evidence from a prospective study in the general population. Spine, 20, 2731–2737.Google Scholar
Crook, J., Rideout, E. & Browne, G. (1984) The prevalence of pain complaints in a general population. Pain, 18, 299-14.Google Scholar
Deale, A., Chalder, T., Marks, I. et al (1997) A randomised controlled trial of cognitive behaviour versus relaxation therapy for chronic fatigue syndrome. American Journal of Psychiatry, 154, 408–414.Google Scholar
Dworkin, R. H., Hartstein, G., Rosner, H. L. et al (1992) A high-risk method for studying psychosocial antecedents of chronic pain: the prospective investigation of Herpes Zoster. Journal of Abnormal Psychology, 101, 200–205.Google Scholar
Frank, A. (1993) Low back pain. British Medical Journal, 306, 901–909.CrossRefGoogle ScholarPubMed
Goldberg, D. P. & Bridges, K. (1988) Somatic presentation of psychiatric illness in primary care setting. Journal of Psychosomatic Research, 32, 137–144.Google Scholar
Guthrie, E., Creed, F., Dawson, D. et al (1993) A randomised controlled trial of psychotherapy in patients with refractory irritable bowel syndrome. British Journal of Psychiatry, 163, 315–321.Google Scholar
Gwee, K. A., Graham, J. C., McKendrick, M. W. et al (1996) Psychometric scores and persistence of irritable bowel after infectious diarrhoea. Lancet, 347, 150–153.Google Scholar
Hannay, D. R. (1978) Symptom prevalence in the community. Journal of the Royal College of General Practitioners, 28, 492–499.Google Scholar
Hathaway, S. R. & McKinley, J. C. (1967) Minnesota multiphasic personality inventory: manual for administration and scoring. New York: Psychological Corporation.Google Scholar
Hotopf, M. H., Noah, N. & Wessely, S. (1996) Chronic fatigue and psychiatric morbidity following viral meningitis: a controlled study. Journal of Neurology, Neurosurgery and Psychiatry, 60, 504–509.Google Scholar
Hotopf, M. H. & Wessely, S. (1997) Stress in the workplace: unfinished business. Journal of Psychosomatic Research, 43, 1–6.Google Scholar
Joyce, J., Hotopf, M. & Wessely, S. (1997) The prognosis of chronic fatigue and chronic fatigue syndrome: a systematic review. Quarterly Journal of Medicine, 90, 223–233.Google Scholar
Kouyanou, K., Pither, C. & Wessely, S. (1997) Iatrogenic factors in chronic pain: a prospective study. Psychosomatic Medicine, 59, 597–604.CrossRefGoogle Scholar
Kroenke, K. & Mangelsdorff, A. D. (1989) Common symptoms in ambulatory care: incidence, evaluation, therapy, and outcome. American Journal of Medicine, 86, 262–266.Google Scholar
Kroenke, K., Spitzer, R. L., Williams, J. B. W. et al (1994) Physical symptoms in primary care. Archives of Family Medicine, 3, 774–779.Google Scholar
Lipowski, Z. J. (1988) Somatization: the concept and its clinical applications. American Journal of Psychiatry, 145, 1358–1368.Google Scholar
MacFarlane, G. J., Thomas, E., Papageorgiou, A. C. et al (1997) Employment and physical work activities as predictors of future low back pain. Spine, 22, 1143–1149.Google Scholar
Main, C. J. & Spanswick, C. C. (1995) “Functional overlay”, and illness behaviour in chronic pain: distress or malingering? Conceptual difficulties in medico-legal assessment of personal injury claims. Journal of Psychosomatic Research, 39, 737–753.Google Scholar
Mayou, R., Bass, C. & Sharpe, M. (1995) Treatment of Functional Somatic Symptoms. Oxford: Oxford University Press.Google Scholar
Mountstephen, A. & Sharpe, M. (1997) Chronic fatigue syndrome and occupational health. Occupational Medicine, 47, 217–227.Google Scholar
Powell, R., Dolan, R. & Wessely, S. (1990) Attributions and self-esteem in depression and chronic fatigue syndromes. Journal of Psychosomatic Research, 34, 665–673.Google Scholar
Sharpe, M., Hawton, K., Simkin, S. et al (1996) Cognitive therapy for chronic fatigue syndrome: a randomised controlled trial. British Medical Journal, 312, 22–26.Google Scholar
Svensson, H. O. & Andersson, G. B. J. (1989) The relationship of low-back pain, work history, work environment, and stress: a retrospective cross-sectional study of 38–64-year-old women. Spine, 14, 517–522.Google Scholar
Wessely, S. (1995) Liability for psychiatric illness. Journal of Psychosomatic Reserach, 39, 659–669.Google Scholar
Wessely, S. & Powell, R. (1989) Fatigue syndromes: a comparison of chronic “postviral” fatigue with neuromuscular and affective disorders. Journal of Neurology, Neurosurgery and Psychiatry, 52, 940–948.Google Scholar
World Health Organization (1992) The Tenth Revision of the International Classification of Diseases and Related Health Problems. (ICD–10). Geneva: WHO.Google Scholar
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