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Abstracts from psychosomatics conference

Discussion in 'Latest ME/CFS Research' started by Esther12, Jun 13, 2012.

  1. Esther12

    Esther12 Senior Member

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    From Tom Kindlon's twitter:

    http://t.co/LefyLSmJ

    European Liaison Psychiatry & Psychosomatics June '12 conference abstracts

    Here are some of the ones I picked out. I tried to keep the CFS specific ones at the top. Then some general ones, a patch related to the new DSM, and then a few I picked out because of my own interests.























    I find some of the whiplash stuff interesting, particularly in the social context of the current legislative changes that insurance companies are pushing for in the UK:






    Some ones on personality/attitude I find a bit interesting, as an indication of the sort of people psychiatry sees as problematic:


    Sean and oceanblue like this.
  2. Dolphin

    Dolphin Senior Member

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    Thanks for posting the different abstracts, Esther12.

    This abstract is pretty rubbish in terms of giving info from the PACE trial on cost-effectiveness and economic outcomes. He added very little not in the Lancet (Feb/March 2011) paper.
  3. user9876

    user9876 Senior Member

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    Do they publish papers or just abstracts. I would have thought the way they monitise that gains from the different treatments would be really interesting since this should reflect reductions in cost associated with illness along with gains through employment etc.It should also look at the dangers of treatments and additional costs due to relapses. It would be nice if they also talked about how uncertainty of the outcomes lead ot uncertainty in the decision making.


    Ok I would be very surprised if they had done anything more than say CBT and GET allow 1/3 of people to get back to "normal" and cost this much. I doubt if they even amortise the cost of endless expensive trials into their costs. But to do the job properly they need to do more.
  4. user9876

    user9876 Senior Member

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    This abstract amused me. Basically they are trying to disassociate the idea of fatigue from the ability to do physical stuff. Its interesting since they report that people give better survey results after CBT but the actigraphy results show no increase in activity.

    I particularly like the statement "the structural equation model indicated that increases in self-efficacy, perceived activity and selfreported physical functioning, as well as decreases in focusing on fatigue were associated with a decrease in fatigue" what they forget is that their measure of fatigue is based on perceived and reported fatigue hence you would expect it to be highly correlated with how people perceive fatigue.

    There overall theme is to look at the process by which CBT may work. I'm alarmed that they do this by getting people to fill in surveys. I don't see how this could ever help them understand mechanism.

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  5. Enid

    Enid Senior Member

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    Psychosomatics - bit if a switch off - haven't they given up yet with their constant appealing to all things "psycho". OK I didn't know the day it was collapsed in A&E ( and frankly between passing out one could't care less). About time these idiots got their own comeuppence -oh yes fatigue secondary like all other ilnesses of course. Quite obvious to find the illness in the first place springs to mind.
  6. Dolphin

    Dolphin Senior Member

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    Initially I thought the appended abstract was just the data from Wiborg et al. (2010). However, the number of patients who started CBT is too big (156 for the studies covered by Wiborg et al. (2010) - see Table 1)!

    http://forums.phoenixrising.me/inde...-activity-levels-in-3-dutch-cfs-studies.1587/


  7. oceanblue

    oceanblue Senior Member

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    Definitely different (and from the 2012 paper too) as this time they have data collected during treatment, which at least gives them a chance of identifying any causal relationships
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  8. Dolphin

    Dolphin Senior Member

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    Yes, forgot to say checked this paper also:

    This looks at the data from Knoop et al. (2008), one of the three studies that were looked at together in Wiborg et al. (2010). 64 people who did CBT analysed in Wiborg et al. (2012).
  9. oceanblue

    oceanblue Senior Member

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    Don't think this one has been posted but is of interest as I think Simon Wessely has claimed CBT is good for diabetes. This study says it isn't:

    Petrak F
    Clinic of Psychosomatic Medicine and Psychotherapy, LWL-University Clinic Bochum, Ruhr-University
    Bochum, Germany

    Cognitive behavioural therapy vs. sertraline in patients with depression and poorly controlled diabetes: a multicentre randomised controlled trial

    Objective: To compare the efficacy of diabetes-specific cognitive behavioral group therapy (CBT) vs.
    sertraline (SER) in patients with poorly controlled diabetes and depression.

    Methods: Multicentre randomised controlled trial comparing SER vs. CBT in 251 patients with type1 or type
    2 diabetes with HbA1c values >7.5%. After 12 weeks of therapy, only the treatment-responders (50%
    reduction in the Hamilton Depression Rating Scale, HAMD) were included in the one-year phase.
    Diabetological treatment as usual was given to both groups. CBT-responders received no further
    treatment, while SER-responders received a sustained SER regimen. Group differences in HbA1c (primary
    outcome) and HAMD (secondary outcome) between 1-year follow-up and baseline were analysed
    controlling for baseline values. Subgroup analyses were conducted for type of diabetes.

    Results: After 12 weeks 115 (45.8%) patients responded to the treatments (CBT 53, SER 62). In the 1-year
    follow-up the HbA1c changed from 9.3±1.6 to 9.2±1.7 after CBT and from 9.2±1.4 to 9.4±1.4 under SER
    with no significant treatment difference (p= 0.129). HAMD scores improved significantly after CBT from
    18.0±4.6 to 7.8±6.5 and from 18.9±5.1 to 5.5±5.7 under SER (p=0.020). Subgroup analyses revealed
    significant differences within the CBT group regarding HbA1c (difference 0.73) favoring type 2 diabetes
    (HbA1c reduction: -0.40 vs. +0.32 for type1, p=0.0036).

    Conclusions: Both treatments showed considerable and sustained reduction of depression with a small but
    significant advantage of sertraline. But, no substantial improvement could be obtained for glycemic control
    independently of the type of treatment.
  10. Enid

    Enid Senior Member

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    Wizard of Oz land all of this - yes one tries, yes one (surprising tries) to make Docs around feel better after their interest knowing all along they know nothing but hoping they might. Empathy for them seems to play a big part. (Oh that it were the other way round).

    But if this their way of learning "biology" pathology basics at the expense of ill patients we are all back decades where specialist medical findings now point to causes and cures.
  11. oceanblue

    oceanblue Senior Member

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    This abstract might explain why Simon Wessely and colleagues were so interested in cortisol diurnal rhythmsin CFS. And why they might be looking down the wrong end of the telescope (again):

    Diurnal cortisol rhythm: Associated with anxiety and depression, or just an indication of lack of energy?
    Harris A, Uni Research, Uni health, Krinkelkroken 1, Bergen, Norway

    Dysregulation of hypothalamus pituitary adrenal activity has been associated with chronic low back pain (LBP). The underlying mechanisms are not fully explained, but psychological mechanisms are considered important.

    [Method]Psychiatric symptoms measured with three different instruments, and the diurnal rhythm of cortisol was examined in 305 patients, sick-listed 2 to 10 months due to non-specific LBP. Psychiatric disorders were assessed by MINI. The Hospital Anxiety and depression Scale (HADS), and The Hopkins Symptom Checklist-25 (HSCL-25) were used to screen for psychological symptoms. Saliva cortisol was measured on two consecutive days; at awakening, 30 minutes later, at 3pm and 10pm.

    [Results] There were no associations between any of the main diagnostic categories from the MINI-interview, or levels of anxiety and/or depression measured with HADS and HSCL-25, and the cortisol awakening response (CAR), cortisol decrease during the day or cortisol levels in the evening.

    However, significant associations were found between low CAR [cortisol awakening response] and low cortisol decrease during the day and the somatization scale from HSCL- 25 (dizziness, lack of energy, lack of sexual interest, the feeling that everything requires substantial efforts, difficulties to fall a sleep, and headache).

    [Conclusion] The results indicate that cortisol are not directly associated with psychopathology, such as anxiety and depression, but are associated with one dimension of the psychopathology; namely the lack of energy. This should be explored further to assess whether cortisol is just a measure of awakening or if it is associated to other symptoms of fatigue.
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  12. Esther12

    Esther12 Senior Member

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    Thanks for looking through too OB... there were quite a few abstracts I considered posting, but also worried that I was creating such a massive post.

    re CBT for diabetes: surely a 'skilled therapist' could interact with patients in a way that would lead to them taking better care of themselves... but this seems like such an uninteresting point! It amazes me that some see this as having any particular biopsychosocial significance.

    Surely a 'skilled therapist' (sensible person) could help almost any group of people behave more sensible manner compared to another group in an RCT. This could be used to argue that all those with the most power and influence should have their cognitions and behaviour medicalised, so as to improve social outcomes, but instead we seem to be focusing much more upon medicalising those with the least power and influence. Perhaps this is more about imposing will than clarifying cognitive distortions or pursuing truth.

    [edit] That HPA paper does look interesting too OB. I don't know how I missed that one.

    Thanks for all the comments people. It will be interesting to see some new actigraphy data - I wonder if they've started focusing more upon trying to improve these?
    Sean likes this.
  13. Dolphin

    Dolphin Senior Member

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    Thanks oceanblue, interesting.

    The list of items which makes up the somatization scale from HSCL- 25 (above) is an example of why the name put on a set of questions may be misleading/far from ideal.
  14. Dolphin

    Dolphin Senior Member

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    Interesting points, Esther12.

    Yes, I wouldn't find it that amazing if some sort of therapy could improve outcomes in diabetes, particularly type 2 diabetes. A lot of people with type 2 diabetes won't have the best lifestyles, in terms of diet and exercise, which partly or solely resulted in the diabetes. It's not hard to imagine that not all of them will then all live "perfect diabetic lifestyles". I have a (distant) relative who seems to live a "pretty bad diabetic lifestyle" (e.g. he eats quite a lot of (sugared) sweets (=candy)), and it seems a least partly in his case because he's widower who suffers from depression or at least still grieves for his dead wife and hasn't adjusted to new scenario.

    I think diabetes is different from ME/CFS where, for the latter, it's far from clear that graded activity/exercise, a significant element of many/most CBT programs, is the best management strategy.
  15. Snow Leopard

    Snow Leopard Senior Member

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    The most (only) interesting presentation to me is the one from Hotopf. Of course we know that CFS in these studies was merely self-reported and the measurements used were not originally intended for the purposes used in the studies.

    Contradictory is exactly the word to explain the longitudinal data:

    http://www.ncbi.nlm.nih.gov/pubmed/15469945 (2004)
    2/3 based on non-specific measures is not at all 'consistent'.


    The problem with these studies (a) they are questionnaire based and the questions don't exactly measure what we want to measure. (b) any associations made tend to have extremely poor specificity and sensitivity (so poor that these terms aren't even discussed), leading to questions of whether these are in fact key contributing factors or not.

    As for "Why does positive attitude make you live longer? Positive affect and survival in the Heart & Soul", the results can be spun in the opposite way, since physical activity was associated with survival, since physical activity is a strong predictor of physical health, then perhaps it is better health that predicts positive affect and in parallel, greater physical activity was associated with improved survival rates?
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  16. Esther12

    Esther12 Senior Member

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    I find it hard not to sound like an adolescent leftist when talking briefly about the potential for power to corrupt... but it's always relevant!

    It seems to me that one of the main reasons that some diabetics do not follow medical advice is that they feel doctors have a tendency to exaggerate their certainty about matters and try to take unreasonable amounts of control over the lives of others (this is only based upon one person I've known, and three or four interviews with fat American comedians... mixed in with my own beliefs about medical practice). I reckon that the most effective way to encourage people to follow medical advice would be to ensure that when incorrect advice is given, those responsible share some of the burden and cost of following it. As you say, the key problem with CFS is that we have so little understanding of the condition of how to best respond to it.

    The best way to improve respect for the medical profession and their guidelines is to cut down on quackery. I've become way more sceptical of all medical advice since I started looking more closely at CFS stuff, and saw how the results from PACE were spun.
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  17. Simon

    Simon

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    This is perhaps more revealing than I realised. It appears to provide very little evidence for cognitive behavioural mediators of improvements in fatiuge, despite being fairly well set up to find any that existed.

    How to establish 'true' mediators
    Mediators are things that explain the mechanism of action of a treatment, specifically things that directly cause the treatment effect. A cross-sectional study can never do that, but here they looked at baseline, treatment outcome and also at three time points along the way. If they could show that, say, focusing on fatigue (a goal of CBT) reduced first, then perceived fatigue reduced later, that would be evidence of a causal relationship where reducing fatigue-focusing meditated the effect of CBT on fatiuge.

    Otherwise you just end up with a correlation eg' focusing on fatigue' reduces and so does fatigue: well, if fatigue severity declined you would expect fatigue focusing to decline too, just as pain focusing reduces as pain fades away.

    No evidence of 'true' mediators
    The study found a correlation between potential mediators and the reduced fatigue but they didn't find evidence that the mediators changed before fatiuge ie no evidence of a causal relationship:
    So sometimes fatigue reduced first then fatigue focusing reduced. Sometimes they happened at the same time (ie within the same 6-week measurement interval) and other times fatigue focusing reduced first. In other words, no clear pattern at all.

    Given that the PACE Trial too are struggling to find any mediators of CBT and GET, it does look like investigators are not able to find evidence to back up the model of change they have proposed for these therapies.

  18. Esther12

    Esther12 Senior Member

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    Isn't another important point that: We don't have a good measure for fatigue. Isn't it slightly absurd for them to say that cognitions about fatigue and activity are related to a decrease in fatigue (which is measured via a questionnaire which will reflect patient's cognitions about fatigue and activity).

    Especially as they also say:

    If it is 'fatigue' which is restricting people's activity levels, then a reduction in fatigue really should be association with an increase in activity.
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