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.
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