Medically unexplained syndromes: irritable bowel syndrome, fibromyalgia and chronic fatigue

Abstract

SUMMARYThis is a review of three of the more common medically unexplained syndromes that present for treatment to liaison psychiatry services in general medical hospitals: chronic fatigue syndrome, fibromyalgia and irritable bowel syndrome. The three are interrelated, extremely disabling and comorbid mood disorders are frequent. In general, treatment, whether psychological or medical, has very modest impact. The disputed classification of medically unexplained syndromes is also reviewed. There is a clear gulf between the views and experiences of patients with these syndromes and the medical establishment. In this article I summarise give the evidence for pharmacological, psychosocial and ‘alternative’ or ‘complementary’ interventions for a range of disorders, about which there is some dispute. I leave it to the reader to decide which interventions hold the most promise.LEARNING OBJECTIVES•To become aware of the high prevalence of medically unexplained syndromes•To review the effectiveness of treatment of medically unexplained syndromes•To be familiar with the conflict between health professionals and patients and the difficulty this continues to createDECLARATION OF INTERESTNone.