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Strategies to Protect the Health of Deployed U.S. Forces Medical Surveillance, Record Keeping, and Risk Reduction (1999) / Chapter Skim
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3 Medically Unexplained Symptoms
Pages 31-40

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From page 31...
... Continued effort and an emphasis on preventive measures against these hazards are required, but the study team does not believe that it can provide additional expert advice about them. In contrast, the experiences of the Gulf War and the illnesses reported in its wake point to an area where additional effort is needed: medically unexplained symptoms.
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From page 32...
... The study team believes that increased attention to prevention and treatment of the medically unexplained symptoms among military populations during and after deployment is warranted because of their prevalence and attendant potential disability. The section that follows draws heavily upon the paper, Unexplained Physical Symptoms in Primary Care and the Community: What Might We Learn for Prevention in the Military?
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From page 33...
... Katon and colleagues have found that the relationship of physical symptoms to common anxiety and depressive disorders is linear. As the number of anxiety and depressive symptoms or lifetime episodes of these disorders increases, so does the prevalence and number of medically unexplained symptoms (Katon et al., 1991 b)
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From page 34...
... PREDISPOSING FACTORS There is a large body of literature about predisposing factors for medically unexplained symptoms. These factors fall into categories of hereditary differences, physiological differences, adversity in early life, chronic medical illness, and chronic or recurrent psychiatric illness.
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From page 35...
... Sleep deprivation and depression are associated with elevated and flattened diurnal HPA function, and "burn out" from job or other intense experiences is associated with a flattened and lower HPA function Activation of the HPA axis and the sympathetic nervous system during acute stress is linked to behaviors and physiological responses, including increased heart rate, sweating, focused attention, and decreased vegetative functions, such as feeding and reproductive behavior (Sternberg, 1998b)
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From page 36...
... Inherent or developed differences in the responsiveness of the HPA axis could underlie some of the differences in symptoms or illnesses that individuals experience, including thus far medically unexplained symptoms. Although studies of the relationship between differences in the responsiveness of the HPA axis and human disease are not as far advanced as they are for animals, associations have been observed between a blunted or relatively low HPA axis response and rheumatoid arthritis (Neeck et al., 1990; Cash et al., 1992)
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From page 37...
... A 2-year prospective cohort study examining the natural history of medically unexplained symptoms found that persistent unexplained symptoms were significantly associated with patient reports of poor parental care in childhood, chronic parental medical illness, and chronic medical illness (Craig et al., 1993~. Chronic Medical Illness Social learning theory holds that people learn behaviors and patterns of communication from those around them beginning very early in life.
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From page 38...
... Existing evidence suggests that recognition and successful treatment of panic disorder also reduces physical symptoms and physical health concerns (Kellner et al., 1986; Noyes et al., 1986~. Early interventions for patients with panic disorder and major depressive disorder may prevent exposure to perpetuating factors that increase the likelihood of acute medically unexplained physical symptoms becoming chronic with associated disability (Engel and Katon, 1999~.
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From page 39...
... Nevertheless, caution is indicated in applying such thinking to any individual. PROGNOSTIC INDICATORS Although the predisposing, precipitating, and perpetuating factors described above as influencing the natural history of medically unexplained symptoms are based on theory to provide a heuristic model, prognostic indicators are developed empirically.
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From page 40...
... Empirically tested prognostic indicators for medically unexplained symptoms include indicators of prior level of use of the health care system, psychiatric manifestations, physical symptoms, and levels of functioning (Engel and Katon, 1999~. The prognostic spectrum of medically unexplained symptoms includes acute, recurrent, and chronic subtypes.
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Key Terms

  • medically unexplained
  • hpa axis
  • physical symptoms
  • natural history
  • perpetuating factors

  • life events
  • depressive disorders
  • unexplained illness
  • psychiatric disorders
  • unexplained physical

  • panic disorder
  • medical illness
  • predisposing factors
  • physiological differences
  • persistent unexplained

  • associated disability
  • care utilization
  • chronic medically
  • acute onset
  • prolong medically

  • heuristic model
  • hpa function
  • chronic medical
  • psychosocial distress
  • precipitating factors

  • physical illness
  • frequently lead
  • traumatic life
  • prognostic indicators
  • enhanced susceptibility


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