Psychological Medicine

Original Articles

Neurology out-patients with symptoms unexplained by disease: illness beliefs and financial benefits predict 1-year outcome

M. Sharpea1 c1, J. Stonea2, C. Hibberda1, C. Warlowa2, R. Duncana3, R. Colemana4, R. Robertsa5, R. Culla2, A. Pelosia6, J. Cavanagha7, K. Matthewsa5, R. Goldbecka4, R. Smytha8, A. Walkera9, J. Walkera1, A. MacMahona9, G. Murraya10 and A. Carsona1

a1 Psychological Medicine Research, School of Molecular and Clinical Medicine, University of Edinburgh, UK

a2 Department of Clinical Neurosciences, School of Molecular and Clinical Medicine, University of Edinburgh, UK

a3 Institute of Neurological Sciences, Southern General Hospital, Glasgow, UK

a4 Aberdeen Royal Infirmary, Aberdeen, UK

a5 Ninewells Hospital, University of Dundee, Dundee, UK

a6 Hairmyres Hospital, East Kilbride, UK

a7 Sackler Institute of Psychobiological Research, Faculty of Medicine, University of Glasgow, UK

a8 Royal Infirmary of Edinburgh, Edinburgh, UK

a9 Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK

a10 School of Clinical Sciences and Community Health, University of Edinburgh, UK


Background Patients whose symptoms are ‘unexplained by disease’ often have a poor symptomatic outcome after specialist consultation, but we know little about which patient factors predict this. We therefore aimed to determine predictors of poor subjective outcome for new neurology out-patients with symptoms unexplained by disease 1 year after the initial consultation.

Method The Scottish Neurological Symptom Study was a 1-year prospective cohort study of patients referred to secondary care National Health Service neurology clinics in Scotland (UK). Patients were included if the neurologist rated their symptoms as ‘not at all’ or only ‘somewhat explained’ by organic disease. Patient-rated change in health was rated on a five-point Clinical Global Improvement (CGI) scale (‘much better’ to ‘much worse’) 1 year later.

Results The 12-month outcome data were available on 716 of 1144 patients (63%). Poor outcome on the CGI (‘unchanged’, ‘worse’ or ‘much worse’) was reported by 482 (67%) out of 716 patients. The only strong independent baseline predictors were patients' beliefs [expectation of non-recovery (odds ratio [OR] 2.04, 95% confidence interval [CI] 1.40–2.96), non-attribution of symptoms to psychological factors (OR 2.22, 95% CI 1.51–3.26)] and the receipt of illness-related financial benefits (OR 2.30, 95% CI 1.37–3.86). Together, these factors predicted 13% of the variance in outcome.

Conclusions Of the patients, two-thirds had a poor outcome at 1 year. Illness beliefs and financial benefits are more useful in predicting poor outcome than the number of symptoms, disability and distress.

(Received April 23 2009)

(Revised June 08 2009)

(Accepted June 16 2009)

(Online publication July 23 2009)


c1 Address for correspondence: M. Sharpe, M.A., M.D., FRCP, FRCPsych, Psychological Medicine Research, Kennedy Tower, Royal Edinburgh Hospital, Edinburgh EH10 5HF, UK. (Email: