How our service can help you
Our service is an internationally recognised research and treatment
unit, which provides a specialist diagnostic assessment and treatment
for people with persistent physical symptoms. This includes fatigue,
pain, irritable bowel symptoms and non-cardiac chest pain. We have
developed models for understanding and treating persistent physical
symptoms and continue to be at the forefront of research and development
in this field. We offer specific treatment for chronic fatigue,
irritable bowel syndrome, fibromyalgia as well as other persistent
physical symptoms.
We also treat fatigue in the context of long-term conditions such as
cancer or if people have finished medical treatment but continue to
experience symptoms. Our evidence-based treatments are routinely evaluated. Our goal is to
increase the person’s functioning, improve quality of life and
wellbeing, reduce the severity of their symptoms and facilitate a return
to work or education where possible.
- Service Type: Specialist Adult Mental Health Services (National) Treatment type: Outpatient, Outreach
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Contact the service
Site Location: Maudsley Hospital Fax Number: 020 3228 5075 - Address: Maudsley Hospital, Mapother House De Crespigny Park,London, SE5 8AZ
- Conditions: Persistent Physical Symptoms
Other essential information
Interventions
- Specialist diagnostic clinical assessment
- Routine blood tests
- Referral to other appropriate specialists if necessary
- Outpatient specialised cognitive behavioural therapy 15 sessions
- Follow-ups at three, six, nine and 12 months
- Mindfulness meditation
- Guided self-help programme prior to face to face interventions
Eligibility criteria
- 18 years and over
- Male or female
- Persistent physical symptoms which have not responded to usual treatment (three months or more)
- Profound disability where the symptoms are impacting on several aspects of the person’s life
- People who frequently attend the GP surgery and are not responding to usual reassurance and advice
- Disturbed sleep pattern, for example the person is sleeping during the day or unable to get to sleep at night and has not responded to the usual treatment
Outcomes
- Resume daily activities
- Establish a sleep routine
- Address associated anxiety or depression
- Address problematic beliefs which interfere with progress, perfectionism or low self-esteem
- Explore an individual’s lifestyle and make changes which may help to prevent relapse
- Enable a graded return to work, addressing long-term sickness issues
- Agree a discharge plan incorporating a relapse plan
Care Options
Referrals
Presenting problems
Persistent physical symptoms (PPS) are persistent or relapsing physical symptoms of new or definite onset causing a substantial reduction in previous levels of occupational, educational, social, or personal activities. Symptoms include fatigue, pain, gastrointestinal symptoms, breathlessness.
Syndromes may include:
- fibromyalgia
- non-cardiac chest pain
- irritable bowel syndrome
- chronic pelvic pain
- persistent unexplained pain
- hyperventilation or dysfunctional breathing
- irritable bladder syndrome
- chronic fatigue syndrome: clinically evaluated, unexplained, persistent or relapsing fatigue that:
- is of new or definite onset
- is not the result of ongoing exertion
- is not substantially relieved by rest
- results in substantial reduction in previous levels of occupational, educational, social, or personal activities
- persistent physical symptoms secondary to long-term conditions
- co-morbid depression and/or anxiety disorders are common
Investigations to be completed
There is no specific diagnostic test. However, prior to referral, the following investigations should be carried out. (Please send copies of investigations with the referral - which should be carried out within two months of referral).
Required investigations
- Full blood count
- Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)
- Urea and electrolytes
- Liver function tests
- Calcium
- Albumin
- Creatine kinase
- Thyroid function tests (TSH and free T4)
- Coeliac screen (for example, Immunoglobulin A endomysial autoantibodies)
- Random blood glucose
- Urinalysis for blood, glucose and protein
Investigations that may be clinically indicated
- Epstein-Barr virus (EBV) serology
- Chest x-ray
- Rheumatoid factor
- Antinuclear factor (ANF)
- Cytomegalovirus (CMV)
- Toxoplasmosis
- HIV serology
Investigations that are usually not helpful
- Enteroviral serology
- Neuroimaging
Support and management in primary care
- Explanation of illness is often of value
- Recommend avoidance of excessive rest or excessive exercise or activity and/or sudden changes in activity
- Antidepressants are principally of value where there is a co-morbid depressive illness or clear-cut depressive symptoms
- For those with Epstein-Barr virus, glandular fever or other infections advise to engage in activities as soon as possible
- Suggest use of self-help guides
- Cognitive behaviour therapy (CBT) if available
- There is no current evidence that allergy, immune or dietary manipulation is helpful
CBT is an effective, evidence-based treatment for these conditions.
Referral criteria to Persistent Physical Symptoms Service
- Failure to respond to above measures in primary care
- More than three months’ illness
- Marked disability
- Special circumstances (for example, young children or job at risk)
- Adolescent referrals may be accepted for 11 to 18 year olds but only after assessment by a consultant paediatrician
- Referrals should not be made where the sole purpose is for second opinion for pending benefits claims
Notes
- Prior to a referral being made, patients should receive information and a general explanation of the service to which they are being referred, and the nature of the assessment and treatment or therapy that may be provided
- If after assessment, treatment is offered, the patient will be offered a specialist programme of cognitive behavioural therapy or graded exercise therapy (approximately 16 sessions), with follow up at three, six, nine and 12 months
To discuss the appropriateness of a referral, or to discuss alternative treatment options, please contact the service for advice prior to referral.
Recommended self-help guides
- ‘Coping with Chronic Fatigue’ by Trudie Chalder, Sheldon Press
- ‘Overcoming chronic fatigue’ by Mary Burgess with Trudie Chalder, Constable and Robinson
- ‘Overcoming chronic fatigue’ in Young people by Katharine Rimes and Trudie Chalder, Routledge
