Wednesday, January 23, 2013

Postexertional malaise, the pathognomonic symptom of ME, is unusual in any psychiatric condition

Despite thousands of peer-reviewed papers documenting their unique characteristics and pathophysiology, ME and FM continue to be mistaken for psychiatric conditions.

Identifying and Treating Common Psychiatric Conditions Comorbid with Myalgic Encephalomyelitis and/or Fibromyalgia

By Eleanor Stein, MD | 18. Januar 2013

Dr Stein is Clinical Assistant Professor in the department of psychiatry at the University of Calgary, Calgary, Alberta, and is in private practice dedicated to the treatment of myalgic encephalomyelitis/chronic fatigue syndrome, fibromyalgia, and multiple chemical sensitivity. She reports no conflicts of interest concerning the subject matter of this article.

This article reviews the diagnostic criteria for both myalgic encephalomyelitis (ME) (ie, chronic fatigue syndrome) and fibromyalgia (FM) and describes how to differentiate them from depressive and anxiety disorders, the psychiatric conditions with which they are most often confused. The patients in the following Case Vignettes have ME and/or FM; not all have a psychiatric condition.

Despite thousands of peer-reviewed papers documenting their unique characteristics and pathophysiology, ME and FM continue to be mistaken for psychiatric conditions. This is problematic because it can delay accurate diagnosis and appropriate treatment, often for years. Although they have some symptoms in common (eg, fatigue, cognitive problems, unrefreshing sleep), ME and FM differ from each other and from all known psychiatric conditions. Diagnostic clarity depends on knowledge of the diagnostic criteria for each condition and identifying the pathognomonic, non-overlapping symptoms.

Diagnostic criteria for myalgic encephalomyelitis

The Canadian Consensus Criteria are used for diagnosis of ME. These criteria require the concurrent presence of disabling fatigue, postexertional malaise, unrefreshing sleep, muscle or joint pain, mood or cognitive symptoms, and at least 2 of the following: autonomic, neuroendocrine, or immune symptoms (Table 1).¹ Postexertional malaise (immediate or delayed), the pathognomonic symptom of ME, is unusual in any psychiatric condition: most psychiatric patients feel better rather than worse after mental or physical exertion. Pain is not a core symptom of any common psychiatric condition but is reported to be elevated in major depression.² Autonomic, neuroendocrine, and immune symptoms are not common in any psychiatric condition.

Sunday, January 20, 2013

DSM 5 will be mislabeling millions of people with a fake mental disorder that is unsupported by science

Bad News: DSM 5 Refuses to Correct Somatic Symptom Disorder
Medical illness will be mislabeled mental disorder

Published on January 16, 2013 by Allen J. Frances, M.D. in DSM5 in Distress

Many of you will have read a previous blog prepared by Suzy Chapman and me that contained alarming information about the new DSM 5 diagnosis 'Somatic Symptom Disorder.'

SSD is defined so over inclusively by DSM 5 that it will mislabel 1 in 6 people with cancer and heart disease; 1 in 4 with irritable bowel and fibromyalgia; and 1 in 14 who are not even medically ill.

I hoped to be able to influence the DSM 5 work group to correct this in two ways: 1) by suggesting improvements in the wording of the SSD criteria set that would reduce mislabeling; and 2) by letting them know how much opposition they would face from concerned professionals and an outraged public if DSM 5 failed to slam on the brakes while there was still time.

And many of you tried to help by making clear just how important this issue is in people's lives. The blog post got many tens of thousands of views, was reposted on 70 additional sites; was widely Tweeted and Facebooked, and elicited more than 300 extremely well informed and often passionate comments- unanimously in strong opposition.

We have failed and DSM 5 has failed us. For reasons that I can't begin to fathom, DSM 5 has decided to proceed on its mindless and irresponsible course. The sad result will be the mislabeling of potentially millions of people with a fake mental disorder that is unsupported by science and flies in the face of common sense.

I suggested ... Read more>>

Sunday, January 13, 2013

The Countess of Mar, Professor Hooper and Dr Weir: The idea that ME/CFS is due to a dysfunctional psyche is a hypothesis without an evidence base

Latest Independent on Sunday correspondence

On Sunday 25th November the UK newspaper, the Independent on Sunday, published an article, "ME: bitterest row yet in a long saga" (1) which led to the publication of a letter signed by 27 signatories, which was published on the 2nd December (2).

Today, in response to this, the following letter has been published in the Independent on Sunday, in both the hard copy and on-line:

http://www.independent.co.uk/voices/letters/ios-letters-emails--online-postings-13-january-2013-8449260.html

Scientific understanding always depends upon sound evidence. According to Sir Paul Nurse FRS: "The John Maddox Prize is an exciting new initiative to recognise bold scientists who battle to ensure that sense, reason and evidence base play a role in the most contentious debates." For scientific understanding to prevail, the extensive biomedical evidence base of ME/CFS [myalgic encephalomyelitis/chronic fatigue syndrome] must now be recognised by all researchers in the field.

The idea that ME/CFS is due to a dysfunctional psyche is a hypothesis without an evidence base. The Maddox Prize was thereby awarded to the defender of a hypothesis with no evidence base rather than to someone who was upholding true scientific inquiry. Personal attacks against Professor Sir Simon Wessely do not advance the cause, but it is scientifically legitimate to direct criticism at the hypothesis both he and Professor White continue to espouse.

The Countess of Mar
Professor Malcolm Hooper
Dr William Weir
House of Lords, London SW1

.........................

A longer version, too long for the printed edition, is expected to appear on the IoS website:

Sir,

Professor Peter White, on behalf of himself and his 26 co-signatories, has apologized to the three of us following the publication of their letter on 2 December 2012. He made it clear that he did not intend to imply that we were harassing Professor (now Sir) Simon Wessely. We were not harassing him. None of us believes that harassment is a means of advancing scientific debate, and certainly not in promoting a greater understanding of the causes of ME/CFS.

In the IoS article of 25 November 2012 we were criticizing the award of the Maddox Prize to Professor Wessely because it is axiomatic that the progress of scientific understanding depends upon sound evidence. Sir Paul Nurse, President of the Royal Society, has said: “The John Maddox Prize is an exciting new initiative to recognize bold scientists who battle to ensure that sense, reason and evidence base play a role in the most contentious debates.”

We are in complete agreement with Sir Paul. We would wish the scientific process to prevail, whereby the extensive peer reviewed biomedical evidence base on ME/CFS is acknowledged and used by all researchers in the field to advance the understanding of the disorder, and we have been calling for this for many years.

There can be no doubt that the cause of ME/CFS is a contentious issue and that there remain many unanswered questions. Both Professor White and Sir Simon Wessely have promoted an hypothesis that ME/CFS is due to an abnormal illness belief; that it is perpetuated by dysfunctional beliefs and coping behaviours, and that cognitive behavior therapy (CBT) and graded exercise therapy (GET) are effective treatments for the condition. In an attempt to prove this hypothesis Professor White, principal investigator, and colleagues, including Sir Simon, conducted what has become known as the PACE trial, published in February 2011 in The Lancet, at a cost of some £5m to the taxpayer. No data on recovery rates and positive outcomes have been released and a FOI request to Queen Mary University of London revealed that: “The requested data relating to recovery rates and positive outcomes do not exist. That is to say that such analyses have not been done and there is no intention to do so. The reason for this is that the analysis strategy has changed from the original protocol.”

There has been no attempt by Professor White to correct the misapprehension in respected journals as well as the popular press that the PACE trial demonstrated recovery rates of between 30% and 40%. The release of all the data relating to the PACE trial would be the most telling indication of the efficacy of CBT and GET and would contribute very effectively to the evidence base that precise scientific enquiry demands.

In our view, the idea that ME/CFS owes its origins to a dysfunctional psyche is an hypothesis that lacks any scientific evidence base. We are therefore at a loss to understand why the Maddox Prize was awarded to the defender of that hypothesis rather than to someone who was upholding the spirit of true scientific enquiry.

Our main interest is in advancing the scientific understanding of the cause of a frequently devastating and debilitating condition which blights the lives of many thousands of people. We do not believe that personal attacks directed against Professor Sir Simon Wessely will advance the cause, but reserve the right to direct criticism at the hypothesis both he and Professor White continue to espouse. We believe that a proper scientific understanding of the cause(s) of ME/CFS will emerge in the fullness of time.

The Countess of Mar
Professor Malcolm Hooper
Dr William Weir
House of Lords
London SW1

(1) http://www.independent.co.uk/news/science/me-bitterest-row-yet-in-a-long-saga-8348389.html

(2) http://www.independent.co.uk/voices/letters/ios-letters-emails--online-postings-2-december-2012-8373777.html