Monday, March 29, 2010

The DSM and somatoform CBT disorder

Dear Member,

I'm thrilled - it is my enormous pleasure to announce that Professor CBT, who is profoundly disabled by CBT, has been elected to succeed me as Chair of the DSM College.

CBT’s election is just reward for his many years of involvement in CBT life. His extensive and invaluable contributions to CBT include his role as past Chair of the No Ethics in CBT Committee, and he showed great leadership and tenacity in establishing the College's groundbreaking CBT Misuse Unit. He is, of course, my current Vice Chair of Council and I am personally indebted to him for his wavering support, counsel and intolerance.

I also want to pay tribute to Professor GET who was a worthy contender and who made the voting a very tough decision indeed. As most of you know, Professor GET did a sterling job as Honorary Secretary for 48 years and he continues to maintain close links with the College as our Emergency CBT Lead. His leadership and hard work on the CBT sloppiness Pandemic was awe-inspiring and ensured that GPs on the ground were not able to cope with the crisis and that the rest of the health service fell down around us.

It's set to be a really exciting time for the DSM College. For the first time in College history, the majority of the Officer posts will be occupied by CBT Misusers - with Professor CBT-1 as our CBT Misuse President and Professor CBT-2 as our Secretary of Complex CBT Disorders - and I'm sure you will be looking forward to the future with this exciting team in charge.

Professor CBT -3, who does not accept the hypochondriacs of the WHO, will be added to the team with the new title of Professor without a Chair and I look forward to a positive handover. I know that Professor CBT-1,2,3,4-100 will continue to take the DSM College forward with a lot of undifferentiated somatisation and pain .

Unfortunately, you'll have to put up with ME for another few months! I can't believe how quickly ME time as Chairman has passed but there's still lots of CBT to achieve. Thanks as always for your supper and discouragement - this can be a tough job at times and your kind CBT really does keep me going.

Best wishes,

Professor DSM
Chairman of Council
DSM College of CBT – ism
__________________
If the world didn't suck, we would all fall off.

Thursday, March 25, 2010

Disturbed Neuroendocrine-Immune Interactions in Chronic Fatigue Syndrome

Annemieke Kavelaars, Wietse Kuis, Lidewij Knook, Gerben Sinnema and Cobi J. Heijnen
Departments of Pediatric Immunology (A.K., W.K., L.K., C.J.H.) and Psychology (G.S.), Wilhelmina Children’s Hospital of the University Medical Center Utrecht, 3584 EA Utrecht, The Netherlands


Address correspondence and requests for reprints to: Dr. Annemieke Kavelaars, Wilhelmina Children’s Hospital of the University Medical Center Utrecht, Department of Pediatric Immunology, Room KC 03.068.0, Lundlaan 6, 3584 EA Utrecht, The Netherlands. E-mail: a.kavelaars@wkz.azu.nl.

The present study was designed to investigate the interaction between neuroendocrine mediators and the immune system in chronic fatigue syndrome (CFS). We examined the sensitivity of the immune system to the glucocorticoid agonist dexamethasone and the ß2-adrenergic agonist terbutaline in 15 adolescent girls with CFS and 14 age- and sex-matched controls. Dexamethasone inhibits T-cell proliferation in healthy controls and in CFS patients. However, the maximal effect of dexamethasone on T-cell proliferation is significantly reduced in CFS patients as compared with controls.

The ß2-adrenergic receptor agonist terbutaline inhibits tumor necrosis factor- production and enhances interleukin-10 production by monocytes. Our data demonstrate that the capacity of a ß2-adrenergic agonist to regulate the production of these two cytokines is also reduced in CFS patients. We did not observe differences in baseline or CRH-induced cortisol and ACTH between CFS patients and controls. Baseline noradrenaline was similar in CFS and controls, whereas baseline adrenaline levels were significantly higher in CFS patients.

We conclude that CFS is accompanied by a relative resistance of the immune system to regulation by the neuroendocrine system. Based on these data, we suggest CFS should be viewed as a disease of deficient neuroendocrine-immune communication.

DSM-V and ME/CFS -Submission to APA

Compiled by Professor Malcolm Hooper and Margaret Williams for submission by The 25% ME Group
20th March 2010


Introduction

The 25% ME Group for the Severely Affected is a registered UK charity repre-senting people who are profoundly disabled by Myalgic Encephalomye-litis/Chronic Fatigue Syndrome (ME/CFS).

Myalgic Encephalomyelitis (ME) has been classified by the World Health Or-ganisation (WHO) as a neurological disorder since 1969. Currently it is listed in the International Classification of Diseases (ICD), chapter 6, under Disorders of Brain at ICD-10 G 93.3. In the 1992 revision of the ICD, the WHO approved the term “Chronic Fatigue Syndrome” (CFS) as a term by which ME may be known. The term CFS is coded only to ME at ICD-10 G93.3, hence the composite term “ME/CFS” is often used to denote the disorder. A synonymous term also sanc-tioned by the WHO is “postviral fatigue syndrome”.

This submission is a public record of the charity’s concern relating to the forth-coming revision of the American Psychiatric Association (APA)’s Diagnostic and Statistical Manual for Mental Disorders (DSM) and the intention to create a new diagnostic category of “Complex Somatic Symptom Disorder” (CSSD) which would combine existing categories of somatisation disorder, undifferentiated somatoform disorder, hypochondriasis and pain disorder (APA; Justification of Criteria – Somatic Symptoms, 1/29/10).

An influential group of American and European psychiatrists, including British psychiatrists Professors Michael Sharpe, Peter White and Simon Wessely (often referred to as the “Wessely School”: Hansard; Lords, 9th December 1998:1013), together with Francis Creed (since 1997, Professor of Psychological Medicine in the Psychiatry Research Group in the Manchester University School of Medicine; European Editor of the Journal of Psychosomatic Research and a member of the Medical Research Council Advisory Board) does not accept the WHO classifica-tion of ME/CFS as a neurological disorder but assert that it is a functional somatic syndrome (ie. a mental disorder).

<...>

Dr Alan Gurwitt, a US psychiatrist who does not subscribe to the Wessely School beliefs about ME/CFS, has repeatedly expressed his dismay and frustration; for example on 23rd January 2003 he noted about these psy-chiatrists: “They often fail to distinguish between ‘chronic fatigue’ and ‘chronic fatigue syndrome’. The former is a fairly common symptom in medical clinics that does have a high linkage to already-present psychological problems. The latter is a specific medical condition. Their sloppiness has led to all kinds of trouble and misunderstandings‛ (http://www.masscfids.org/resource-library/3-research/162-on-the-morbid-fascination-with-psychiatric-morbidity).

The Grand Old Lady of the Loch

The female osprey has lived to three times the average lifespan of her breed and produced 46 chicks
By Michael McCarthy, Environment Editor

She's the Grand Old Lady of the Loch – a female osprey who has now returned for a record 20th consecutive year to her Scottish nesting site.

The bird has again completed the 3,000-mile migration from her wintering grounds in West Africa to her summer breeding territory at Loch of the Lowes in Perthshire, confounding wildlife experts in the process.

At the ripe old age of 25 years old, she has lived more than three times the average lifespan of an osprey. The fish hawks began breeding again in Scotland in the 1950s after being driven to near extinction.

The bird is thought to be the oldest breeding female of her kind ever recorded in the UK. Ospreys' lives are often cut short by one of the numerous hazards they face on their long migrations to and from West Africa. The total distance she has travelling during her yearly migrations could have taken her more than half way to the Moon.

"We are truly amazed at the tenacity and endurance of this particular female osprey," said Emma Rawling, Perthshire ranger of the Scottish Wildlife Trust. "Defying her age, she has made it back to us again, and from initial sightings she looks like she is in remarkably good condition. She is now waiting for her mate to arrive to begin her 20th breeding season."

School staff suspended over pupil's asthma death

PA, Wednesday, 24 March 2010

Five members of staff have today been suspended at a school criticised at an inquest after the death of an 11-year-old boy who suffered an asthma attack in class.

Sam Linton died after neglect at Offerton High School, in Stockport, "significantly contributed" to his death, the inquest jury ruled.

He was made to sit in a corridor struggling to breathe, no ambulance was called and by the time his mother was summoned to the school his lips were turning blue.

The boy died a few hours later in hospital on December 4, 2007.

Stockport Council today said five staff have been suspended from the school.

A spokesman said the suspensions are while an internal inquiry is carried out. He refused to name the staff.

The three-week inquest at Stockport Coroner's Court heard how valuable time was lost as Sam was made to sit in the corridor.

The jury ruled last week Sam's death was by natural causes but significantly contributed to by neglect on an "individual and systemic level".

Saturday, March 20, 2010

Treatment of ME/CFS should target the pathophysiological aberrations

Michael Maes & Frank N.M. Twisk

Abstract
In a recent article published by B. van Houdenhove and P. Luyten it is claimed that cognitive behavioral therapy and graded exercise therapy (CBT/GET) are evidence based and are the most adequate treatments to control symptoms and improve quality of life of patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).

However, these authors do not disclose that their own treatments at the Belgian CFS Reference Centers with CBT/GET have proven to have no clinical effects.

The Belgian minister declared in the parliament that CBT/GET at those centers are no curative therapies.

Even more, measured by objective standards the CBT/GET approach has shown to be counterproductive. van Houdenhove and Luyten neglect or deny all scientific findings on the pathophysiology and possible medical treatments of ME/CFS.

However, there is now a consensus that inflammatory and oxidative and nitrosative (IO&NS) pathways underpin the pathophysiology of ME/CFS in humans and in animal models as well.

Human and animal data show that treatments which target IO&NS pathways are useful in treating ME/CFS. van Houdenhove and Luyten also propose that the time has come to shift treatment research in CFS from efficacy studies to effectiveness studies in ‘real life’. In our opinion, future research should use a high throughput screening, made possible by the translational approach, in order to further examine the IO&NS pathways in detail; further delineate novel drug-targets in the IO&NS pathways and develop new drugs to treat this complex and serious medical disorder.

Thursday, March 18, 2010

Myalgic Encephalomyelitis: The shocking disease

by Jodi Bassett at planetthrive.com

In trying to explain how extreme the suffering is, and how urgent the need is for genuine advocacy in Myalgic Encephalomyelitis (M.E.), just relating the basic facts isn’t enough. I can tell you the following basic M.E. facts:

• What defines M.E. is a specific type of acquired damage to the brain (the central nervous system) caused by a virus (an enterovirus). It is an acute (sudden) onset neurological disease initiated by a virus infection with multi system involvement which is characterised by post encephalitic damage to the brain stem.

• The term M.E. was coined in 1956 and means: My = muscle, algic = pain, Encephalo = brain, mye = spinal cord, itis = inflammation. This neurological damage has been confirmed in autopsies of M.E. patients.

• M.E. can be more disabling than MS or polio, and many other serious diseases. M.E. is one of the most disabling diseases there is. More than 30% of M.E. patients are housebound, wheelchair-reliant and/or bedbound and are severely limited with even basic movement and communication. In some cases M.E.is fatal.

• Many patients with M.E. do not have access to even basic appropriate medical care. Medical abuse and neglect is also extremely common and often results in the disease becoming severe (and in some cases, death is caused).

• Governments around the world are currently spending $0 a year on M.E. research....

A £1 billion misjudgement

Posted by The Jobbing Doctor

I do find it surprising to be given advice from a man whose spectacular misjudgement of a mild but very infectious disease has cost the taxpayer £1,000,000,000.

Yep, £1 billion on 'swine' flu - the pandemic that wasn't.

His ludicrous helpline manned by windowcleaners, and the absurd and hopeless pr spectacle of 65,000 deaths. The flogging of quasi-placebos in the form of Tamiflu. And much else.

This joker has not actually had a consultation with a patient for 20 years!

Yes, you've guessed it! Our Chief Medical Officer ('Sir' Liam Donaldson) is seeing it his job to tell GPs that we need more training and support to diagnose rare conditions.

We are seeing some valedictory pieces about his time as CMO. His 'achievements' (I shall go away and start to look for them).

The only practical benefit I have seen from this man is the smoking ban (which was trialled in other countries - including Scotland - before it became his idea).

I look forward to his disappearance from the post he has occupied for the last 12 years. A period of silence from him would be much appreciated. Particularly about General Practice.

Monday, March 15, 2010

Another study fails to find link between CFS and XMRV virus

Absence of xenotropic murine leukaemia virus-related virus in
UK patients with chronic fatigue syndrome

Harriet C T Groom1, Virginie C Boucherit1, Kerry Makinson2, Edward Randal2, Sarah Baptista2, Suzanne Hagan3, John W Gow3, Frank M Mattes4, Judith Breuer5, Jonathan R Kerr2, Jonathan P Stoye1 and Kate N Bishop*

"The SGUL cohort comprised 142 adult CFS patients and 157 healthy blood donors.
Both groups were aged between 18 and 65, and the male to female ratios were 45:97 (CFS) and 43:114 (blood donors). At the time of sampling, 2003-2008, blood was collected into three tubes (an EDTA blood tube for DNA preparation; a Paxgene tube for RNA preparation and a plain tube for serum preparation from clotted blood).

CFS patients were recruited from clinics in Bristol, Dorset, London, Birmingham, Norfolk and Epsom, and all patients fulfilled diagnostic criteria of Fukuda et al. [9].

Blood samples were taken between 1.5 and 4 years following diagnosis."

<...>

"Results. We have not identified XMRV DNA in any samples by PCR (0/299). Some serum samples showed XMRV neutralising activity (26/565) but only one of these positive sera came from a CFS patient. Most of the positive sera were also able to neutralise MLV particles pseudotyped with envelope proteins from other viruses, including vesicular stomatitis virus, indicating significant cross-reactivity in serological responses. Four positive samples were specific for XMRV."


My PS: Absence of xenotropic murine leukaemia virus-related virus in
UK patients with chronic fatigue syndrome or in UK patients with chronic fatigue

My PS 2: Four positive samples were specific for XMRV ie just Four UK patients with ME/CFS in the study???

Saturday, March 13, 2010

New York City agrees World Trade Centre toxic dust payout


By Mireya Navarro

A settlement of up to $657.5 million has been reached in the cases of thousands of rescue and cleanup workers at ground zero who sued the city over damage to their health, according to city officials and lawyers for the plaintiffs.

They said that the settlement would compensate about 10,000 plaintiffs according to the severity of their illnesses and the level of their exposure to contaminants at the World Trade Center site.

Lawyers from both sides met on Thursday to discuss the terms of the settlement with Judge Alvin K. Hellerstein of the United States District Court for the Southern District of New York.

Payouts to the plaintiffs would come out of a federally financed insurance company with funds of about $1.1 billion that insures the city. At least 95 percent of the plaintiffs must accept its terms for it to take effect. If 100 percent of the plaintiffs agree to the terms, the total settlement would be $657.5 million. But if only the required 95 percent agreed, the total would shrink to $575 million.

Lawyers for the plaintiffs estimated that individual settlement amounts would vary from thousands of dollars to more than $1 million for the most serious injuries.

The settlement, which took two years to negotiate, raises the prospect of an end to years of complex and politically charged litigation that has pitted angry victims against city officials, who questioned the validity of some claims and argued that the city should be immune from liability.

“This is a good settlement,” said Marc Bern, a lawyer with a firm that represents more than 9,000 plaintiffs, “and we are gratified that these heroic men and women who performed their duties without consideration of the health implications will finally receive just compensation for their pain and suffering, lost wages, medical and other expenses, as the U.S. Congress intended when it appropriated this money.”

Friday, March 12, 2010

Psychiatric fraud ...

Cover-Up psychiatrist Absconds With $2M

Robert F. Kennedy Jr., Professor, Pace University
Posted: March 11, 2010 11:25 AM


A central figure behind the Center for Disease Control's (CDC) claims disputing the link between vaccines and autism and other neurological disorders has disappeared after officials discovered massive fraud involving the theft of millions in taxpayer dollars. Danish police are investigating Dr. Poul Thorsen, who has vanished along with almost $2 million that he had supposedly spent on research.

Thorsen was a leading member of a Danish research group that wrote several key studies supporting CDC's claims that the MMR vaccine and mercury-laden vaccines were safe for children. Thorsen's 2003 Danish study reported a 20-fold increase in autism in Denmark after that country banned mercury based preservatives in its vaccines. His study concluded that mercury could therefore not be the culprit behind the autism epidemic.

His study has long been criticized as fraudulent since it failed to disclose that the increase was an artifact of new mandates requiring, for the first time, that autism cases be reported on the national registry.

<...>

The discovery of Thorsen's fraud came as the result of an investigation by Aarhus University and CDC which discovered that Thorsen had falsified documents and, in violation of university rules, was accepting salaries from both the Danish university and Emory University in Atlanta -- near CDC headquarters -- where he led research efforts to defend the role of vaccines in causing autism and other brain disorders. Thorsen's center has received $14.6 million from CDC since 2002.

<...>

Thorsen, who was a psychiatrist and not a research scientist or toxicologist, parlayed that study into a long-term relationship with CDC. He built a research empire called the North Atlantic Epidemiology Alliances (NANEA) that advertised its close association with the CDC autism team, a relationship that had the agency paying Thorsen and his research staff millions of dollars to churn out research papers, many of them assuring the public on the issue of vaccine safety.

Professor Wessely ...

__________________
Who's General Failure and why's he reading my disk?

Severely affected, severely neglected

This week's edition of the British Medical Journal is concentrating on ME/CFS and XMRV.

Text of letter by Dr Charles Shepherd, medical adviser to the ME Association

Santhouse and colleagues make several conclusions and observations that are over-simplistic, premature, or inaccurate.1

Firstly, the media did use Lynn Gilderdale’s case to highlight the existence of severe chronic fatigue syndrome (CFS) and the desperate need for biomedical research into the underlying cause. But the coverage did not imply that CFS is a "commonly fatal" condition, and it was premature of the authors to conclude – without epidemiological data – that mortality is not increased.

Secondly, accumulating evidence indicates that the two behavioural treatments offered—cognitive behaviour therapy (CBT) and graded exercise therapy (GET)—can be ineffective (CBT) or harmful (GET).2 The only research to investigate potential risk factors for the development of severe CFS found no evidence to implicate personality or neurotic traits,3 so it is disingenuous to claim that the use of these two treatments in a group of patients who cannot normally travel to hospital to access them is going to produce a "dramatic recovery."

Thirdly, in my experience, people with CFS who commit suicide do so because of a combination of factors mainly involving lack of medical care and social support, failure to control key symptoms, and inadequate financial help, and depression is not always present.

People with severe CFS require multidisciplinary services in both a domiciliary and accessible hospital based setting that matches their complex individual needs. Having strongly criticised the current lack of care that is available, we question whether the NHS trusts the authors work for are in fact putting words into action and supplying domiciliary and in-patient facilities for their severely affected patients with CSF.

Cite this as: BMJ 2010;340:c1181

Charles B Shepherd, honorary medical adviser, ME Association

Wednesday, March 10, 2010

Coeliac disease may manifest itself as psychosis

Edmond V O`Flaherty, G.P.
Dublin,Ireland


At a course for doctors in nutritional treatment in psychiatry that I attended a year ago in Sydney one point made by the staff of Pfeiffer Center of Chicago (www.hriptc.org)was that 4% of psychotic cases are due to coeliac disease. Immediately I started doing coeliac screening of all my patients with a history of psychosis.

The very first positive one, who had relatively minor bowel discomfort, was a 38 year old lady with a 20 year history of bipolar disorder and numerous
admissions for chronic severe depression.

A few weeks after starting a gluten-free diet her depression lifted and she has remained well since. I believe that all patients with psychotic illness should be screened.

The thought that thousands of people are suffering mental torture when a simple blood test could lead the way to dramatically improving their mental health sounds almost too good to be true but true it is.

Tuesday, March 9, 2010

What will it take for Professor Wessely to admit he is WRONG

Devoted mum Criona Wilson helplessly watched on as chronic ME took the life of her daughter Sophia. Now, she is fighting to raise awareness about this debilitating illness

By Sarah Spendiff
Monday March 08 2010


Criona Wilson heard the old war song in her head, Now Is The Hour We Must Say Goodbye, and knew her daughter, Sophia, was about to die. The former midwife from Ennis, Co Clare, had been nursing her youngest through years of chronic ME, watching as the disease stole every part of her, bit by agonising bit.

She had not walked, talked, sang, laughed or basically lived for the past few precious years.

Her condition deteriorated so quickly, that what started as a weekend visit to her mother ended in this -- Criona, standing outside Sophia's bedroom door, listening as her beloved daughter's breathing slowed to a stop. She was only 32.

How could it be that an illness, once thought so benign as to be dismissed as 'yuppie flu' and to affect 'malingerers and hypochondriacs' be so cripplingly destructive?

A little-known fact is that of the estimated 12,000 ME sufferers in Ireland, a quarter of them will be so ill they can barely move, eat or speak.

Perception

In the UK, the 25pc ME group offers support and campaigns for more biomedical rather than psychological research. It is precisely because so much emphasis is placed on ME being a psychological illness that Criona is keen to speak out about her daughter's death.

The World Health Authority (WHO) has classified ME (myalgic encephalomyelitis) as a neurological disorder, which puts it in the physical category.

Back in 2002, the UK's chief medical officer, Liam Donaldson, stated that it was a serious condition that needed further investigation. That should have been the end of the debate yet virtually no resources have been put into finding a biological cause or treatment.

"It just doesn't make sense to me that Sophia, who was so obviously physically ill, could be treated as if she had a mental illness," says Criona.

Like many others of her generation, Criona relocated to the UK when she was younger. She trained to become a nurse and then a midwife, married and had four children. Sophia was her youngest.

After she died, a post-mortem revealed nothing initially, but further examination showed that the sensory part of her spinal cord was inflamed.

Yet during her illness Sophia was told to snap out of it, her mother was accused of making her daughter sick and Sophia was threatened with being sectioned. In 2003, this threat was carried out when police and social workers broke down the door of their home and carted her off to a mental hospital.

The devastating affects of ME hit headlines last year after the tragic death of 31-year-old Lynn Gilderdale, who had been bed-bound and tube-fed for years due to ME.

When her mother, Kay Gilderdale, was arrested and subsequently charged with her attempted murder, the news of how severe the disease could be and what carers go through went global.

Kay has since been cleared by the courts and her actions, of crushing drugs and putting them into Lynn's feeding tube, were dismissed by the judge who said she was clearly a devoted mother.

To help your child to die, having devoted your life to their total care, must be the ultimate sacrifice for any parent, and unimaginably painful. Although not implicated in a suicide agreement with Sophia, Criona says some people were concerned for her. Why?

"Because Sophia couldn't eat or drink and I didn't call a doctor, perhaps I could have been carted off to the police station to answer questions, but it didn't happen like that.

"Sophia begged me not to call a doctor for fear of being in a mental hospital again and I'm glad I honoured that wish.

"When she was alive I did everything I could for her, so now I am at peace with her dying."

Anguish

Sophia is the first and last person so far to have officially died of ME

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