Discussion in 'Action Alerts and Advocacy' started by Dx Revision Watch, Dec 10, 2009.
Who do you mean by "the public"?
I mean the general public with no particular interest in ME/CFS.
I am UK based and I have no mandate to speak/act on behalf of US patient communities.
I have also set out above that our perspective is not quite the same as the US perspective:
We are using different versions of ICD and we will move onto our respective, future versions of ICD on differing timelines.
The proposed codings for PVFS, ME and CFS for your next version of ICD differ from what is currently being used in ICD-10 in the UK.
In 2014/15 we may still have different codings to your ICD-10-CM (2013) for both Chapter VI and Chapter V.
Furthermore, DSM-V does not have the same resonance for us in the UK as it does for the US - here we use mostly ICD - but we do have the "harmonization" between DSM-V and ICD-11 Chapter V to consider and it does influence the research and literature fields.
And, until DSM-V publishes its proposals for the section currently known as "Somatoform Disorders" when it publishes its first draft, next year (assuming it is ready to do so), we will not know what its most recent proposals are going to be.
So I can set out what information is available so far and I can continue to publish new information as it becomes available - but I cannot tell you, in the US, what you should be "telling the public".
And are you thinking about what you should be telling the public generally around DSM-V, or specifically in relation to those issues that have specific relevance to the US CFS and ME patient populations?
The revision of DSM-V has been underway since 1999 - the Work Groups were set up in 2007 and announced in 2008 - I do wonder why there appears to have been so little discussion within the US patient communities around potential implications?
I don't ask that in a confrontational way...I'm just surprised that here we are with ostensibly just a few weeks before DSM-V Task Force releases its first draft, yet from what I have seen on Co-Cure and one or two other lists, there does not seem to have been very much interest in the issue of the revision of DSM within the US ME and CFS patient communities.
These are complex issues. I have tried to set them out as simply as I can - but it isn't always easy boiling down complex issues to something Twitter length.
All I can really advise you is to familarise yourselves with the revision process and what we know so far and to inform yourselves around the current status of your upcoming ICD-10-CM and to keep abreast of any moves by the DSM on your ICD-10-CM and to raise awareness of the forthcoming draft because your focus will not be the same as our focus here in the UK.
Maybe we should consider two threads?
One for the revision of DSM which is US centric and which also relates to your shift to ICD-10-CM in October 2013;
A second thread for the revision of DSM which relates to those parts of the world currently using ICD-10 and/or anticipate shifting onto ICD-11 in 2014/15?
What do you think?
I would be quite happy for any information from my site to be posted or quoted in either thread so long as it is made clear (where relevant) that the US is not using the current version of ICD (ICD-10) and that it won't be shifting to ICD-11 in 2014/15 but to a Clinical Modification for which current proposals have a different coding for CFS than for ME and PVFS.
The most recent proposals that the DSM-V Somatic Distress Disorders Work Group has published were published in June 2009.
Editorial: The proposed diagnosis of somatic symptom disorders in DSM-V to replace somatoform disorders in DSM-IV – a preliminary report by SDD Work Group Chair, Dimsdale J, and SSD Work Group member, Creed F, was published in the June 2009 issue of the Journal of Psychosomatic Research, for which Francis Creed is a co-editor.
Free access to full text and PDF versions here: http://www.jpsychores.com/article/S0022-3999(09)00088-9/fulltext
This Editorial had been e-published as "In Press" in April - so it predates the publication of the WPI study by several months.
The next set of proposals may be different.
Hi Suzy. I am fairly new to the CFS community (though not to the illness), so I can't speak to why there's been little discussion of this important topic. I suspect it may be because people are confused and daunted by its complexities. That's why I hope to put together an explanation that anyone could understand, to basically lay out *why* we in the US should care about this topic - and I think we should, particularly as the psych lobby seems to be working to reinforce its position in the face of XMRV. If that's outside the scope of your mandate, I completely understand. Thanks for bringing your expertise to this forum; it's much appreciated.
OK. I think it has been useful to merge these two threads to avoid reiterating material from the earlier thread.
I now suggest closing this thread and starting two new threads in Action Alerts! and Advocacy
DSM-V Watch One: For the US anticipating moving on to ICD-10-CM in Oct 2013
DSM-V Watch Two: For countries anticipating moving on to ICD-11 in 2014/15
They ain't exactly snappy thread titles but they contain key words for search engines.
As I've already said - I would be quite happy for any information from my site to be posted or quoted in either thread with the caveat (where relevant) that the US is not using the current version of ICD (ICD-10) and that it won't be shifting to ICD-11 in 2014/15 but to a Clinical Modification for which current proposals have a different coding for CFS than for ME and PVFS which differs from ICD-10.
In no way am I seeking to be divisive - there will be much common ground between the two - but it may be difficult and may possibly lead to confusion if DSM-V is discussed in the context of WHO Geneva ICD-11 revision in the same thread as DSM-V in the context of the adoption of the ICD-10-CM Clinical Modification, when there is disparity between the adoption dates and the codings, and also responsibility for their respective development.
Incidently, I note that the APA's press release is using "DSM-5". Unless the DSM website adopts DSM-5 as a "house style" for the next DSM, I shall continue to use "DSM-V".
The WHO Revision Style Guide for ICD-11 proposes that chapter headings in ICD-11 should be "Chapter 5", "Chapter 6" rather than "Chapter V" and "Chapter VI" as is currently used in ICD-10.
What do folk/mods think?
Thank you for your kind words.
The UK is a small country and the pool of active ME and CFS patients and carers is tiny.
These forums of Cort's have a large membership base - there are getting on for 900 members here - many of whom will be US patients and carers.
Perhaps you will be able to link up with two or three others who can help you generate interest in the US and raise awareness of the imminent DSM-V draft from the US perspective.
You are very welcome to snitch anything published on my site - the DSM-V and ICD-11 reports (which date from 30 January 2009) are collated on a stand alone page here:
In March, I compiled a Word file "DSM-V and ICD-11 Revision Directory" of key links and information to assist the ME and CFS community navigate through these two complex revision processes (but not ICD-10-CM).
If you Google around these issues, you will find other diseases and disorders being discussed within US patient communities but remarkably little that I am aware of from the US CFS and ME community - and I wouldn't say we have huge interest, either, in the UK.
Since October, a lot of the focus has been on XMRV. That is understandable, but DSM and ICD revisions plough on...and until we have replication studies, XMRV is not necessarily going to have too much impact on ICD-11 and ICD-10-CM.
This afternoon I have registered this site:
Over the holiday period I will start shifting key material on my ME agenda site onto this new site - there is nothing on it at the moment. That should help make it easier to locate information.
Given the differences between the US and UK health systems, the different versions of ICD that we are using and the greater importance in the US of DSM - it really does need people monitoring from the US perspective and that is not something that I can undertake.
I think there is too much to read here for this to be in Action Alerts. It should be somewhere else as an informational background information. When there is something to act on, that should be posted in Action Alerts in a brief way. And with a link pointing back here for background about the DSM etc.
As for me, I'm not sure I can keep up with this anymore.
I didn't think I could handle it either, but I found one source that made the basic issues clearer to me:
I already posted about this on the thread fresh eyes started for US PWCs...
Good thoughts, Andrew. We're working on making this info easier to follow.
Documents by Lesley Ben for Jody Basset's site
This document that "Dr Yes" has flagged up, authored by Lesley Ben, sets out current classifications and codings for various versions of ICD, including current and proposed US Clinical Modifications.
It touches briefly on the DSM revision process, which had been the original subject of this thread, not the specific issue of ICD codings.
It is based on a longer document available from the same website. Both documents have been considered controversial by some UK ME and CFS patients for the opinions expressed within the "Recommendations" section.
Would readers please note that although I am acknowledged in the "Long version" (29 pages) of the document as having been an advisor to the author for the section on the DSM revision and on the CISSD Project that the views and opinions expressed around DSM, ICD and the CISSD Project and in the Recommendations section of these two documents are the views and opinions of the author, Ms Ben, and not mine and that they are not necessarily reflective of the views of all UK ME and CFS patients.
Please also note that in relation to the ICD and DSM revision processes that the document is no longer up to date.
Ms Ben also states that:
"There is concern among many people in the M.E. and ‘CFS’ communities that the revision process may result in ‘CFS’ (and possibly M.E.) being classified as mental disorder in ICD-11."
I should like to make it clear that I do not consider that the WHO is intending to classify either "CFS" or "ME" as mental disorders and that I have not expressed this view in any of the material that I have published since the beginning of this year.
If you read the Recommendations section, you will see that Ms Ben calls for the separation of PVFS and ME, and also for the separation of ME and CFS, or for CFS not to appear in ICD-11, at all.
Since most research into ME and CFS is published under the term "CFS" (including that of the WP Institute); since many patients in the UK and US are diagnosed only under the term "CFS" and since many of our UK NHS clinics and GPs only use the term "CFS", the recommendations within these two papers have been considered controversial.
One further point, Jody Basset for whose website these two documents have been produced, and who holds very robust views around the use of the term "CFS" has spoken out most negatively on her own Yahoo! message board against the study published by the Whittemore Peterson Institute as having no relevance whatsoever to patients diagnosed with "ME" - a view which I do not support, myself.
10. Recommendations for Future
The classification for M.E. should be G93.3 Myalgic Encephalomyelitis under Diseases of the nervous system.
The name currently given first at G93.3 in ICD-10 and ICD-10 CM (USA), ‘Postviral fatigue syndrome,’ should be removed. It is not correct: M.E. is not a syndrome. Fatigue is not a defining symptom of M.E.; it is frequently but not necessarily present, and when present it may be only a minor symptom.
Fatigue following viral infection is not a neurological disease and should be classified elsewhere as appropriate.
The current term ‘Benign’ should be deleted from before ‘Myalgic encephalomyelitis.’ It is not correct.
The term ‘benign’ (meaning ‘not fatal’) was originally introduced in the context of the WHO’s efforts to categorise epidemic diseases, and indicated that a disease did not kill more than a certain percentage of its victims.
However, this usage is not consistent throughout the ICD.
The term misleadingly obscures the fact that M.E. can be fatal.
The term also contributes to the public misunderstanding of M.E. Some people interpret ‘benign’ to mean that M.E. is not a serious illness. This is unfortunate considering the degree of severe disability and suffering which may be experienced by M.E. patients.
There should be no ICD listing for ‘CFS’ as a valid disease term. ‘CFS’ does not exist and should not be given the status of a real disease.
However, many patients are diagnosed with ‘CFS’ and need the protection of an ICD listing.
‘CFS’ could be classified in the ICD within a new category containing invalid disease terms. This would acknowledge that while patients are in practice diagnosed with the term, it is not valid.
The ICD-10 already accepts that patients are in practice diagnosed with ‘imprecise and undesirable term’ for ‘ill-defined conditions,’ in that such terms are given in the index.
A category of invalid disease terms would make explicit what is already implicit in categories such as ‘Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified’: not that the disease is not real, but that the patient requires a better diagnosis.
Failing the proposal above or similar, ‘CFS’ should not be classified in the ICD.
The false disease category of ‘CFS’ does not serve the best interests of patients. All patients would be better off with an accurate classification of a real disease, whether they suffer from M.E. or from another condition. Accurate classification would facilitate not only insurance and welfare claims, but also appropriate treatment.
ICD classification of ‘CFS’ as a valid disease is not the way forward; it harms M.E. patients as well as those suffering from undiagnosed conditions who have been falsely classified with ‘CFS.’
The fault in the online search facility for ICD-10 should be corrected so that the default ‘full search option’ which is supposed to include a search of the index, should indeed find terms in the index.
All rather than only part of the WHO ICD should be published on the WHO website. The WHO should publish the Alphabetical index of the current ICD-10 online. If this is impossible for some reason, the WHO website should call attention to its omission. All of the future ICD-11 should be published online.
If the WHO ICD is truly to serve its worldwide constituency, it must be available online in its entirety.
Would you be willing to lay out your opinion on the WHO's intention? I apologize if you've already summed this up elsewhere - if so, just point me in the right direction.
I don't have the time/energy at the moment to read this thread but MEAgenda and possibly others may be interested in an article by Sartorius in Advances in Psychiatric Treatment 2010 v. 16.
I'm showing search results for fatigue. CFS is mentioned in three articles in the edition and they don't look too good. No free full access unfortunately
For fresh_eyes with apologies for the late response...
Because the bulk of discussion about DSM-V and ICD issues has been going on the thread you started here:
the psych lobby strikes again: DSM-5 v. WHO's ICD in the US
I haven't been checking back to this thread very often for new postings, so I did not spot your question until yesterday - so sorry about that.
Do you still plan to launch a website for US centric DSM-V and ICD issues?
You have asked:
A preamble to answering your question:
On this page of my new site:
I have set out the current codings in ICD-10 for Postviral fatigue syndrome; [Benign] myalgic encephalomyelitis and Chronic fatigue syndrome
For new readers to this thread, note that this information refers specifically to ICD-10 - not to Clinical Modifications of ICD. The US currently uses a Clinical Modification of ICD-9. The US will be implementing a Clinical Modification of ICD-10, called ICD-10-CM, in October 2013 and will not be moving on to ICD-11 (or a modification of ICD-11) for many years. So it is proposals for the US ICD-10-CM that have immediate relevance for the US.
The Introduction to ICD-10 Volume 3: The Alphabetical Index Version for 2006 lists several possible relationships between a term included in the Alphabetical Index and a term included in the Tabular List to which it is indexed:
The terms included in the category of the Tabular List are not exhaustive; they serve as examples of the content of the category or as indicators of its extent and limits. The Index, on the other hand, is intended to include most of the diagnostic terms currently in use. Nevertheless, reference should always be made back to the Tabular List and its notes, as well as the guidelines provided in Volume 2, to ensure that the code given by the Index fits with the information provided by a particular record.
Because of its exhaustive nature, the Index inevitably includes many imprecise and undesirable terms. Since these terms are still occasionally encountered on medical records, coders need an indication of their assignment in the classification, even if this is to a rubric for residual or ill-defined conditions. The presence of a term in this volume, therefore, should not be taken as implying approval of its usage.
and, according to a February 2009 response from WHO HQ Classifications, Terminology and Standards Team, terms that are listed in the Index may be:
a synonym to the label (title) of a category of ICD;
a sub-entity to the disease in the title of a category;
or a best coding guess.
ICD-10 does not specify how, in indexing Chronic fatigue syndrome at G93.3, it views the relationship between Chronic fatigue syndrome, Postviral fatigue syndrome and Benign myalgic encephalomyelitis. Nor does ICD-10 specify how it views the relationship between Postviral fatigue syndrome and Benign myalgic encephalomyelitis.
As far as I am aware, WHO Geneva has never set out a clarification of how it views the relationship between these three terms. That is, does it view "Chronic fatigue syndrome" as a synonym to "Postviral fatigue syndrome" and/or "(Benign) myalgic encephalomyelitis" or having one of the other various relationships?
On the same page on my new site, I have quoted from some of the statements that have been made in the past by Dr B Saraceno, WHO HQ, Geneva and by Andre l'Hours, formerly WHO HQ.
In January and February 2009, Dr Robert Jakob, WHO Classifications, Terminology and Standards Team, reaffirmed that these statements made in the past by Dr Saraceno and Mr lHours regarding coding and classification which I have quoted on my site are still valid. He also added:
there is no evidence that any change should be made to this in ICD-11;
the same principles will apply to ICD-11.
Note that none of these responses from WHO classification experts, that are collated on my site, specifies ICD-10s view of the relationship between Chronic fatigue syndrome, Postviral fatigue syndrome and Benign myalgic encephalomyelitis, and that ICD-10 provides no definitions for any of these terms.
In the absence of specification within ICD-10 and in the absence of clarification by WHO HQ, Geneva, classification experts, I make no assumptions about how ICD-10 views the relationship between these three terms.
What have the ICD Topic Advisory Groups proposed so far?
None of the ICD Revision Topic Advisory Groups have so far issued any reports that mention any proposals for changing the current classification and codings of Postviral fatigue syndrome or [Benign] myalgic encephalomyelitis, or any changes to the current indexing of Chronic fatigue syndrome at G93.3.
As you know, ICD-11 is being drafted via an electronic collaborative authoring tool called the iCAT. The iCAT has not yet been publicly launched. When it has launched, members of the public will be able to view the progress of any proposals for changes to existing codings and classifications, proposals for additional terms, and proposals for textual definitions, descriptions etc.
You can view 9 brief video reports on the operation of the iCAT here: http://dxrevisionwatch.wordpress.com/icd-11/icd-11-sub-page-2/
The first draft of ICD-11 (the Alpha Draft) is currently scheduled for May 2010.
Until the Alpha Draft has been published, it won't be known what proposals might have been made either internally by ICD-11 Revision Steering Group and Topic Advisory Group Managing Editors or externally by stakeholders and other interested parties who have already submitted proposals. (Proposals made so far via the ICD Update and Revision Platform can be viewed if a log in account is set up.)
So as far as the revision of ICD-10 goes, it is too early to establish what ,if any, changes ICD Revision might be proposing for the three terms of relevance to us.
So it is not possible for me to make an informed opinion about the "WHO's intentions".
I make no assumptions, either, as to whether ICD Revision intends to classify "Myalgic encephalopathy" in ICD-11, and if so, under what code.
For ICD-11, all three Volumes of ICD will be electronically published and integrable. It is not yet known whether the ICD Revision Steering Group will propose including Chronic fatigue syndrome (currently included in in Volume 3: The Alphabetical Index, only) in Volume 1: The Tabular List for ICD-11.
My site makes no assumptions about what proposals might be made by any of the Topic Advisory Groups for the inclusion of Chronic fatigue syndrome in Volume 1: The Tabular List, in ICD-11.
What my site will be doing is to monitor the progress of the revision of ICD-10 Chapter VI: Diseases of the nervous system (the Neurological chapter) with specific reference to the classifications coded at G93.3 in Volume 1: The Tabular List: Postviral fatigue syndrome; Benign myalgic encephalomyelitis; and indexed at G93.3 in Volume 3: The Alphabetical Index: Chronic fatigue syndrome.
Content in ICD-11 will be populated in accordance with the Content Model Style Guide. There is the potential for considerably more textual content to be included for diseases, disorders and syndromes in ICD-11 than appears in ICD-10. It is not yet known how much additional content might be included in ICD-11 for the entities currently classified at G93.3. My site makes no assumptions about the nature and extent of the textual content that might be proposed by any of the Topic Advisory Groups for inclusion in those categories of relevance.
My site will be monitoring the population of content proposed for inclusion in ICD-11 for these three entities.
My site makes no assumptions about what proposals might be made by the Topic Advisory Group for Mental and Behavioural Disorders (TAG MH) for the revision of the Somatoform Disorders section in Chapter V; or whether, and to what extent, the Topic Advisory Group for Mental and Behavioural Disorders might seek to achieve congruency between category names, glossary descriptions and criteria in Chapter V with those within a restructured DSM Somatoform Disorders section (or whatever name might eventually be adopted for this section in DSM-V).
My site will be monitoring the progress of the revision of Chapter V: Somatoform Disorders section with specific reference to those categories currently classified between F45 F48.0 and also monitor the revision of the corresponding DSM-IV Somatoform Disorders section which the DSM-5 Somatic Symptom Disorders Work Group is proposing to rename and potentially restructure.
So the short answer is, there is insufficient information at the moment on which to base an informed opinion on proposals - other than that Dr Jakob has said that clarifications and statements that have been made in the past by Dr Saraceno and Mr lHours regarding coding and classification, and on classification principles, are still valid.
So if you see people on forums claiming that "The WHO wants to move 'CFS' or ME or "CFS/ME" into the Mental Health Chapter" I suggest that you challenge them to set out the basis for their claims and to provide you with the documentary evidence on which they base their claims. I don't make any claims in the material that I publish since my policy is to raise awareness and disseminate documented information - not speculation.
Will new readers to this thread please note the information above refers to the revision of ICD-10 to ICD-11.
The US currently uses a Clinical Modification based on ICD-9. But instead of moving onto ICD-11, once the revision of ICD-10 has been completed, the US will be implementing a Clinical Modification of ICD-10 called ICD-10-CM, in October 2013.
There are disparities between some of the proposed codings for the forthcoming US Clinical Modification and those in the current ICD-10: for example, the classification and codings for Postviral fatigue syndrome, (Benign) myalgic encephalomyelitis and Chronic fatigue syndrome differ between ICD-10 and the current proposed codings and classifications for the forthcoming US ICD-10-CM.
Current proposals for the US Clinical Modification ICD-10-CM, scheduled for implementation in October 2013, propose classifying Chronic fatigue syndrome at R53.82.
For most recent ICD-10-CM proposals see:
CDC site: International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM)
The 2010 update of ICD-10-CM is now available here and replaces the July 2009 version:
 Although this release of ICD-10-CM is now available for public viewing, the codes in ICD-10-CM are not currently valid for any purpose or use. The effective implementation date for ICD-10-CM (and ICD-10-PCS) is October 1, 2013. Updates to this version are anticipated prior to implementation of ICD-10-CM.
The bulk of the discussion around DSM-V, ICD-10 revision and the ICD-10-CM "Clinical Modification" has been going on this thread:
the psych lobby strikes again: DSM-5 v. WHO's ICD in the US
It was agreed to split the threads into two threads to try and mitigate confusion arising out of the differences between codings in ICD-10 and proposed codings for the forthcoming US "Clinical Modification" ICD-10-CM.
Yes, I've seen this editorial. There is also an article of interest (both subscription papers). Here are the Abstracts:
Advances in Psychiatric Treatment (2010) 16: 2-9. doi: 10.1192/apt.bp.109.007138
2010 The Royal College of Psychiatrists
Revision of the classification of mental disorders in ICD–11 and DSM–V: work in progress
Norman Sartorius is President of the Association for the Improvement of Mental Health Programmes and holds professorial appointments at the Universities of London, Prague and Zagreb and at several other universities in the USA and China. Dr Sartorius was a member of the WHO’s Topic Advisory Group for ICD–11 and a consultant to the American Psychiatric Research Institute, which supports the work on the DSM–V. He has also served as Director of the Division of Mental Health of the WHO and was the principal investigator of several major international studies on schizophrenia, on depression and on health service delivery. He is a past President of the World Psychiatric Association and of the Association of European Psychiatrists.
Correspondence: Correspondence Professor N. Sartorius, 14, chemin Colladon, 1209 Geneva, Switzerland. Email: email@example.com
This editorial summarises the work done to prepare ICD–11 and DSM–V (which should be published in 2015 and 2013 respectively). It gives a brief description of the structures that have been put in place by the World Health Organization and by the American Psychiatric Association and lists the issues and challenges that face the two organisations on their road to the revisions of the classifications. These include dilemmas about the ways of presentation of the revisions (e.g. whether dimensions should be added to categories or even replace them), about different versions of the classifications (e.g. the primary care and research versions), about ways to ensure that the best of evidence as well as experience are taken into account in drafting the revision and many other issues that will have to be resolved in the immediate future.
Advances in Psychiatric Treatment (2010) 16: 14-19. doi: 10.1192/apt.bp.109.007120
2010 The Royal College of Psychiatrists
The classification of mental disorder: a simpler system for DSM–V and ICD–11
Sir David Goldberg is Professor Emeritus and a Fellow of King’s College London. He has devoted his professional life to improving the teaching of psychological skills to doctors of all kinds, and to improving the quality of services for people with severe mental illness. After completing his psychiatric training at the Maudsley Hospital, he went to Manchester, where for 24 years he was Head of the Department of Psychiatry and Behavioural Science. In 1993 he returned to the Maudsley as Professor of Psychiatry and Director of Research and Development.
Correspondence: Correspondence Professor Sir David Goldberg, Institute of Psychiatry, King’s College London, De Crespigny Park, London SE5 8AF, UK. Email: David.Goldberg@iop.kcl.ac.uk
This article proposes a simplification to the chapter structure of current classifications of mental disorder, which cause unnecessary estimates of ‘comorbidity’ and pay major attention to symptom similarity as a criterion for deciding on groupings. A simpler system, taking account of recent developments in aetiology, is proposed. There is at present no simple solution to the problems posed by the structure of our classification, but the advantages as well as the shortcomings of changing our approach to diagnosis are discussed
I'd like to refer readers of this thread to this posting which represents the most recent information coming out of the DSM-5 Work Group for Somatic Symptom Disorders, and provides the URLs for three November DSM-5 SSD Work Group related presentations.
the psych lobby strikes again: DSM-5 v. WHO's ICD in the US
Post #111 22 January
I have been in touch with The Academy of Psychosomatic Medicine to see whether transcripts might be available in order to set the slides into better context, but The Academy of Psychosomatic Medicine does not have transcripts and can only suggest contacting Creed and Wulsin.
ICD-11 and DSM-V (DSM-5) focussed editorials and articles in January 2010 edition of Advances in Psychiatric Treatment
for more info on what was said around "Chronic fatigue syndrome" in these editorials and articles.
You can also try a Google Site Search
Separate names with a comma.