|Medical Unexplained Physical Symptoms|
|Human Factors and Medicine|
Fatigue, Gulf War Syndrome, mTBI, MUPS, pain, psychological distress, somatisation
The somatic consequences of exposure to the threat and horror of war have been documented for decades. The continued emergence of post-deployment syndromes has continued to dominate the discussions about the veterans of wars such as the Gulf War, the Vietnam War and is now also stretching to the most recent Afghanistan and Iraq conflicts. Somatic distress carries no stigma, weakness or psychiatric connotation. Yet, a longstanding issue which has never been fully resolved in psychiatry is the extent to which somatic distress is a distinct but inescapable dimension of a psychiatric disorder. Issues of stress, protracted guilt, shame, or other conflict may be projected on a physical domain and represent in aches, pains, or fatigue. The psychological status of lacking concentration, losing short term memory, overwhelming fatigue and bodily pains may be well captured by the expression of medically unexplained physical symptoms (MUPS). These symptoms often occur after participation in intense military operations. The symptoms may surface before, during or after the operation and affect military performance and combat readiness. As military culture appears to be rather masculine, the reporting of physical symptoms may be perceived as more easily and less career damaging than reporting psychological symptoms, which explains also the high proportion of unmet needs after deployments. For that reason military mental health professionals need to be aware of the development of medically unexplained physical symptoms and best practices for treatment.In academic research the chronic fatigue syndrome is studied carefully, so far without too much evidence for causes and cure. However, the operational needs for manning NATO operations with healthy personnel is remaining high and urges military personnel to take part in sustained and multiple deployments. New technologies for examining the mental changes and hardiness of military personnel might deliver also new possibilities for early diagnosis and intervention in medically unexplained physical symptoms.Adequate knowledge currently exists to offer affected individuals a comprehensive, multidisciplinary intervention aimed at helping them to take control of their symptoms, improve the quality of their lives, and reduce the extent to which symptoms impair their functioning and ability to work. Similar interventions with similar objectives have been implemented successfully for many patients with a wide range of chronic pain problems. As other Forces, the Netherlands has now over 20 years of experience in a blended care program focusing on MUPS.
The objective of this RTG is to organize and carry out a RTO Lecture series (RLS) on awareness of medical unexplained physical symptom presentation in the military. Objectives are:
1 The ability to prevent chronic morbidity is far greater if this group of patients are managed effectively early in their presentations (management message);
2 Identification of common (as well as personalized) elements that help patients get better;
3 Developing an awareness of recurrent patters of presentation. (sustaining the intervention).
This is a group of patients that easily are neglected by the system, and may fail to attract attention of clinicians. They easily fall in a vacuum;
4 Medicine who’s responsibility? (continuity of care). Manage prejudicial attitudes of some health providers to this group of patients;
5 Teaching health providers recognize MUPS;
6 Development of an IT system that enables registries to identify and treat patient at specific stages of MUPS progression;
7 Organizing treatment teams, blended care programs;
8 Assessment and follow up of groups;
9 Organization with insurance companies around a business plan within health care providers.
We will provide a historical perspective, discuss the no-man’s land of post deployment syndromes, and present an allostatic load review. We will also review the long-term costs of traumatic stress; the intertwined physical and psychological consequences; discuss issues and challenges in diagnosis of mTBI and MUPS in military settings and implications for clinical practice; stress related musculoskeletal pain; explanatory and pragmatic perspectives regarding idiopathic physical symptoms and related syndromes; present results from a day treatment program for MUPS; an organizational perspective in military perspective, and a multidisciplinary treatment of persistent symptoms after Gulf War service. The lectures will also recommend good practices in coping with MUPS develop awareness of the its existence.
The RLS will cover the following key topics and dimensions:
1 Medical examination of Unexplained Physical Symptoms
2 Analysis of Unmet Needs of military personnel after deployments
3 Best practices in diagnosis and treatment of Medically Unexplained Physical Symptoms
4 Effectiveness of psychiatric nurses and social workers in early interventions for MUPS.
Driving questions are:
1 Development of a NATO wide clinical framework for MUPS.
2 Construction of medical surveillance programs aiming at identification of groups at particular risk of post-deployment health issues and to identify those with health care needs. This needs to be branded as ‘Multidisciplinary Treatment Center’ for provision of specialized medical care for persistent, incompletely explained physical symptoms.
3 Identification of novel outcome parameters beyond symptom-focused approach, e.g. health-related quality of life.
4 Is there a relation between the confrontation of a moral challenge or dilemma and mental health problems among military personnel
A RTO Lecture series (RLS) will be organized and conducted; a description of existing clinical practices for all participating NATO countries; a summary of current research projects and predicted target dates for completion; identification of existing gaps in knowledge; and principles for best practices. The specific deliverables will include the development of a lecture series with slides and notes which will be conducted at two European locations and one North American location by speakers. The duration of the Technical Team will be for a period of two years.