How to take care of adolescents with Medically Unexplained Somatic Symptoms? (Invited lecture)

Medically unexplained symptoms (MUS) have both short and long term impact on school and education trajectories, social life, health care structures and costs. They are also a high cause of suffering for the patient, their relatives and even health care providers. They cover a broad range of situations often defined as psychosomatic illness, somatisation, functional disorders, somatoform disease, etc. This lack of accepted definition explains that their prevalence differs widely, from around 3 to 15%. Unexplained symptoms include pain most of the time, chronic fatigue and also, less often, losses of movement or sensation.

The way the investigation is conducted is important. Firstly, convince the adolescent in the fact that you believe that the symptoms are really experienced, not imagined. Second, understand that signs of anxiety or depression often represent both a cause and a consequence of the somatic symptoms. Third, adopt a holistic view of the situation and investigate both its somatic and psychological aspects, while limiting the number of biological and physical investigations, whose addition may reinforce the belief of a serious underlying illness. Finally, identify precipitating factors such as violence and victimization.

The treatment and care of the patient with MUS should start early, even before the completion of all investigations and should primarily aim at improving the daily functioning of the patient. The support of an inter professional team is essential. Often, the patient herself or himself, if invited to do so, can imagine or bring solutions to overcome her or his problematic state. The therapeutic approach should include cognitive behavioural methods, relaxation and mindfulness techniques and encounters with the family as well as social and educational measures that can be introduced in a progressive way.