Outcome

The majority of studies addressing outcome in somatoform illness have concentrated either on conversion disorder or on somatization disorder, and research explicitly addressing other forms of somatoform illness is rare. It is nevertheless likely that studies investigating the outcome of conditions such as chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome, and chronic pain conditions are implicitly addressing other aspects of somatoform illness. A review of the substantial literature concerning these conditions is beyond the scope of this article.

One of the earliest follow-up studies of unexplained symptoms was conducted in the mid-19th century by Paul Briquet, who studied 430 patients with a variety of symptoms over a period of 10 years. In about half of these patients, symptoms followed a course of progressive, chronic deterioration and recurrent episodes were common; in other cases, recovery occurred after 3-6 months. Briquet identified many factors associated with outcome in these patients. For example, onset during adolescence carried a poor prognosis, whereas a favorable change in social circumstances was associated with a positive outcome.

Several recent studies have provided information concerning outcome in adult patients with unexplained neurological symptoms and identified many prognostic indicators. Given the heterogeneity of the samples studied, it is not surprising that reported remission rates vary considerably; that notwithstanding, a relatively good prognosis has been found in most studies. On average, complete recovery of the index symptom is observed in about two-thirds of acute cases, whereas little or no improvement is observed in up to 20%. The chances of recovery in acute patients are increased in cases in which symptoms have been precipitated by traumatic events. Evidence suggests that between one-fourth and one-third of patients with chronic neurological symptoms receiving inpatient treatment show complete remission of the index symptom; moreover, between 20 and 60% show some improvement at follow-up. Evidence suggests that patients are most likely to recover during the period of hospital admission; after this time, recovery is much less likely. The findings of such outcome studies should be interpreted with caution, however. Most studies conducted in this domain report improvement for the index symptom only; information concerning other symptoms and subsequent referral patterns is rarely provided.

Younger patients tend to have a better prognosis than older patients; indeed, children with unexplained neurological symptoms of recent onset have a particularly favorable outcome. Other factors predicting outcome include the presence of comorbid psychopa-thology and personality disorders. The presence of comorbid personality disorder typically carries a poor prognosis, although there is no apparent association between outcome and any specific personality type. Conversely, the presence of comorbid anxiety and depression are associated with a good prognosis.

Outcome is broadly similar across the range of unexplained symptoms; the same prognostic factors (e.g., duration of symptoms) are relevant in all cases.

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