Medically unexplained physical symptoms

Medically unexplained physical symptoms (MUPS) are physical symptoms which trigger the sufferer to seek healthcare, but which remain unexplained after appropriate medical assessment. They are very common, and cause significant distress and disability. Relevant aetiological factors can usually be discovered by careful and sympathetic clinical interview. What doctors say and do, and the way in which the healthcare system is organized, play a key role in aetiology. Although it is important to rule out serious physical pathology when patients present with physical symptoms, early 'positive' diagnosis of MUPS may lead to better outcomes than diagnosis by exclusion. Common psychiatric disorders, including depression, anxiety, and harmful use of alcohol, should be excluded. If reassurance and simple techniques of reattribution of symptoms do not lead to symptom resolution, cognitive-behavioural therapy (CBT) and the use of antidepressants as neuromodulating agents (rather than as antidepressants per se) can be considered. © 2008 Elsevier Ltd. All rights reserved.