Van Weel-Baumgarten EM, Van den Hoogen HJ, Van den Bosch WJ. Chronic nervous functional symptoms: a separate ‘diagnosis’ in general practice? Huisarts Wet 2003;46(11):603-7.
Background In general practice many patients present with unexplained or functional symptoms. Without making a formal diagnosis of mental illness, in a number of these patients the physician suspects that a psychosocial background is at the root of the symptoms. Many studies show that mental illness is often overlooked in this category of patients. In an attempt to define appropriate treatment for these patients, recommendations made in such studies usually emphase the value of a specific diagnosis. The present study attempts to find an answer to the question of whether the focus should be less on specific diagnosis for a subgroup within this category of patients and more on generic treatment for all.
Objective To underpin the value of a separate diagnosis of ‘Chronic Nervous Functional Complaints’ (CNFC) by studying the characteristics of patients with these symptoms.
Methods Psychopathology, functioning and well-being, social support and coping behaviour of patients with a CNFC code were compared to patients with a history of depression and a control group of general practice patients without any known psychological symptoms. Data were collected with the SCL-90, the Rand-36, the SSL-12 and the UCL-k. All patients belonged to the 4 practices of the Continuous Morbidity Registry (CMR) of the University of Nijmegen in the Netherlands.
Results Characteristics of patients with CNFC and patients with a history of depression were very similar in all fields studied. Both categories showed a statistically significant greater level of psychopathology than the control group. Patients with CNFC reported a significantly lower health status than the control group. Their health status was also lower than that of patients with a history of depression, though the difference was not significant. No differences in coping behaviour were found. Patients with CNFC also reported significantly less daily social support than the other two groups.
Conclusions Patients with CNFC and with a history of depression both seem to belong to the same category of vulnerable patients. Taking CNFC as a diagnosis creates the opportunity of longitudinal follow-up and enables studies on the effectiveness of treatment. By applying modes of treatment effective for mental illness as well as for functional symptoms, more patients might benefit than by merely emphasising the value of a more specific diagnosis.