Patterns of referral in patients with medically unexplained motor symptoms

J Psychosom Res. 2000 Sep;49(3):217-9. doi: 10.1016/s0022-3999(00)00167-7.


Objective: To investigate the pattern and reasons for referrals in 64 patients with a stable diagnosis of motor conversion symptoms who had been assessed at the National Hospital for Neurology and Neurosurgery (NHNN).

Method: Patients were interviewed on average 6 years after their original admission to the NHNN. Hospital notes and GP records were consulted.

Results: Psychiatrists at the NHNN saw 75% of patients. Treatment was initiated in 60% of these. During the 6-year follow up, many patients continued to be referred to neurologists and other specialists, but subsequent psychiatric referral was rare. Many changed their GP after discharge from the NHNN and a disproportionate number of re-referrals was made by GPs who had known their patients for less than 6 months. Psychological attribution of symptoms was rare and did not appear to be related to the pattern of referrals.

Conclusion: The pattern of care of these patients was inconsistent and many felt dissatisfied with the treatment they received. This led to further referrals, unnecessary use of valuable resources and unnecessary exposure to iatrogenic damage. Further studies should aim to assist GPs and other clinicians in deciding when referral is likely to be beneficial.

MeSH terms

  • Adult
  • Allergy and Immunology / statistics & numerical data
  • Conversion Disorder / complications
  • Conversion Disorder / diagnosis*
  • Conversion Disorder / psychology*
  • Family Practice / statistics & numerical data
  • Female
  • Follow-Up Studies
  • Humans
  • Internal Medicine / statistics & numerical data
  • Male
  • Medicine* / statistics & numerical data
  • Middle Aged
  • Movement Disorders / etiology*
  • Movement Disorders / psychology
  • Neurology / statistics & numerical data
  • Orthopedics / statistics & numerical data
  • Outcome Assessment, Health Care
  • Psychiatry / statistics & numerical data
  • Referral and Consultation / statistics & numerical data*
  • Retrospective Studies
  • Sampling Studies
  • Specialization*
  • United Kingdom