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Title: Complex illness : variation and causality in persistent medically unexplained symptoms
Author: Burton, Christopher
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 2006
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Electronic diaries were used to collect data on self-reported physical symptoms and psychological variables from 26 patients with multiple medically unexplained physical symptoms who were currently managed in primary care. Data was collected twice daily for 12 weeks using visual analogue scales on handheld personal computers. The diaries were acceptable and generated data with generally good compliance and high reliability. Recordings showed strong short term autocorrelation. Correlations within individual time series were compared by meta-analysis which showed moderately strong correlations between symptom severity and low mood but weaker correlations with anxiety and illness concern. There was significant heterogeneity between individuals. Granger causality analysis showed only weak evidence for sequential cause either in a psychosomatic or somato-psychic direction. A non-linear dynamic analysis (sample entropy) showed significantly reduced inherent complexity in the time series data. Interview data confirmed the presence of chaotic narratives and a struggle for meaning and coherence through the symptom experience which contradicted conventional simple medical explanations. Patients’ daily experience refutes simple associations between day to day stress and current symptoms; however changes in mood are more strongly associated with changes in symptom. The study is the first to apply a measure of complexity to physical symptom diaries and shows it to be reduced in keeping with a “loss of complexity” hypothesis. The collection of diary data appeared to encourage constructive reflection on the contents. Participants saw the diaries as worthwhile and were generally open to explanations linking mind and body. Simple stress-illness models were neither popular nor supported by the data.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available