The power and pitfalls of omics part 2: epigenomics, transcriptomics and ME/CFS
Simon McGrath concludes his blog about the remarkable Prof George Davey Smith's smart ideas for understanding diseases, which may soon be applied to ME/CFS.
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Mood and Anxiety Disorders in Chronic Fatigue Syndrome, Fibromyalgia, and Irritable Bowel Syndrome

Discussion in 'Latest ME/CFS Research' started by Dolphin, Aug 1, 2015.

  1. Dolphin

    Dolphin Senior Member

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    I didn't find it that exciting but as I read it, I thought I'd post it with some comments and data not in the abstract.
     
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  2. Dolphin

    Dolphin Senior Member

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    There is a 3-circle Venn diagram:

    CFS / [Fibromyalgia U IBS] = 713 (0.8% prevalence)
    CFS & FMS / {IBS} = 126 (0.1%)
    CFS & IBS / FMS = 221 (0.2%)
    CFS & IBS & FMS = 106 (0.1%)

    Fibromyalgia / {CFS U IBS} = 1705 (1.9% prevalence)
    Fibromyalgia & IBS / CFS = 828 (0.9%)

    IBS / {CFS U FMS} = 7703 (8.5%)

    / = less than
    U = union of
     
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  3. Dolphin

    Dolphin Senior Member

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    They used lifetime diagnoses which aren't perfect.

    This is what they said on this, for what it's worth.

     
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  4. Dolphin

    Dolphin Senior Member

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    One important issue is that the diagnoses weren't checked.
    A prevalence of 1.3% for CFS seems quite high especially when a lot of people in the population who have it don't know they have it.

    So I wonder whether the sample includes some people who have chronic fatigue and believe that means they have chronic fatigue syndrome.
     
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  5. Dolphin

    Dolphin Senior Member

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    They don't give a break down for all the CFS categories, just only CFS along with 2 FSSs (which may not include CFS) and 3 FSSs, so I'll give the figures for the ones that definitely have CFS.

    Only CFS:

    Major Depressive Disorder: 10.7% (74)
    Core Symptoms Depression: 8.6% (59)
    Dysthymia: 6.5% (39)
    Generalized Anxiety Disorder: 12.5% (86)
    Social Phobia: 3.6% (29)
    Panic Disorder with Agoraphobia: 1.9% (13)
    Panic Disorder without Agoraphobia: 4.6% (65)
    Agoraphobia without panic disorder: 8.9% (61)

    Any Mood Disorder: 17.2%
    Any Anxiety Disorder: 24.0%

    [They don't give combined figures for these two last categories but we have some information from another paper on the same cohort (see here: http://forums.phoenixrising.me/inde...d-irritable-bowel-syndrome.39057/#post-625179) (I'm not sure why the figures don't match exactly):
    Mood Disorder: 17%
    Anxiety Disorder: 23%
    Mood and/or Anxiety Disorder: 26.4%]

    ========================

    3 FSSs (i.e. CFS, FMS & IBS)

    Major Depressive Disorder: 19.0% (20)
    Core Symptoms Depression: 13.3% (14)
    Dysthymia: 8.3% (7)
    Generalized Anxiety Disorder: 28.6% (30)
    Social Phobia: 4.8% (5)
    Panic Disorder with Agoraphobia: 5.7% (6)
    Panic Disorder without Agoraphobia: 5.7% (6)
    Agoraphobia without panic disorder: 14.3% (15)

    Any Mood Disorder: 29.1% (27)
    Any Anxiety Disorder: 40.6% (43)
     
    Last edited: Aug 1, 2015
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  6. Dolphin

    Dolphin Senior Member

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    So 69.1% of those with CFS were female and 30.9% male.
     
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  7. Dolphin

    Dolphin Senior Member

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    It's good they dealt with this issue:

    (Note that Table 2 only gives one set of figures, presumably not the approach when they just used the two core symptoms of MDD).

    ---
    They also say:

     
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  8. Dolphin

    Dolphin Senior Member

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    This is good

    The preceding sentences aren't so good:
    I tend to be sceptical of claims of many claims about risk factors. People with FSSs such as CFS often take a while to be diagnosed. In the intervening period, they may incorrectly be seen as having a mood and/or anxiety disorder and/or may develop one secondary to being ill (esp. when they're not diagnosed and thus often not in a position to reduce their workload or get support from others/the state).
     
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  9. SOC

    SOC

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    Since when do research studies on a specific patient group consider self-diagnosis as legitimate diagnosis for inclusion in the patient cohort? o_O Can I get in a research study on MS just by walking in and saying, "Yeah, I think I have MS"? This is especially problematic when even trained physicians have difficulty making an accurate ME/CFS diagnosis based on established criteria.

    Oh yeah, this is psychology/psychosomatic theory research where actual scientific methods are not considered necessary. Ya know, stuff like selecting a correct cohort, minimizing confounding factors and accounting for those you can't eliminate, and doing background research on the subject you are claiming to research so you have some idea what you're talking about. :rolleyes: Do these people even know what ME/CFS is?

    What utter nonsense.
     
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  10. A.B.

    A.B. Senior Member

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    It's flawed logic to assume that symptoms that appear early are causing the later symptoms. They could be both expression of subtle biological dysfunction. It could also be that some symptoms are just more noticeable than others.

    It's a waste of time to even discuss causality when one has no means to test for it. Worst case people end up convincing themselves they understand the cause when they actually don't understand it, leading to inappropriate interventions that are likely to make the situation for the patient even worse.
     
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  11. barbc56

    barbc56 Senior Member

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    Thanks @Dolphin

    A very important point that is often missed!

    Would the term idiopathic be more applicable for me/cfs as well as many other FSS disorders since the latter implies a psychiatric cause. But then the medical community would have to accept that a psychiatric condition can be comorbid but it's not what causes us to be sick!
    :bang-head::bang-head::bang-head::bang-head::bang-head::bang-head::bang-head::bang-head::bang-head::bang-head::bang-head::bang-head::bang-head::bang-head::bang-head::bang-head:

    Maybe I'm confusing medical terms?

    Barb
     
  12. Hip

    Hip Senior Member

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    Could you explain what you mean when you say the diagnoses were not checked? I understand that the diagnoses of depressions and anxieties were determined by the Mini International Neuropsychiatric Interview. What does being checked mean in this context?



    The diagnoses of depressions and anxieties were determined by the Mini International Neuropsychiatric Interview, which is not self-diagnosis, but a 15 minute interview process.

    Don't forget that this is how ME/CFS is diagnosed, by a doctor asking you questions.



    If we add these two types of depression together (assuming they were mutually exclusive, so that we can add them), we get a total of 16.2% of ME/CFS patients with depression.

    That is low in comparison to the forum poll which was done recently, asking ME/CFS patients whether they had depression; in this poll, 32.5% of ME/CFS patients said they were suffering from depression.

    But I guess that forum poll may have included people who had mild depression, and these people may not be included in the selection for Major Depressive Disorder.



    So around 26% of ME/CFS patients anxiety and/or mood disorders.

    However I think the total percentage of ME/CFS patients with psychiatric disorders is much higher than this: there are other psychiatric conditions that ME/CFS patients can have that are not included in the anxiety or mood disorders tested for, such as psychosis, depersonalization and derealization, blunted affect, SAD, bipolar, etc.

    This study found that 57% of ME/CFS patients have at least one psychiatric comorbidity. So hat study suggests it is more common to have comorbid psychiatric problems in ME/CFS than not to have them. And that 57% does not include the ME/CFS patients who have psychiatric symptoms as part of their ME/CFS (eg: emotional liability, emotional sensitivity, irritability, which are ME/CFS symptoms).



    That is very true; however, are the authors assuming it, or are they just suggesting the possibility? Because certainly the possibility is there.

    Also, even if certain psychiatric conditions were one day proven to be a risk factor for the development of ME/CFS, that does not automatically imply that it is the psychiatric mental symptoms that are posing the risk; it could instead be some underlying biological dysfunction that causes the psychiatric symptoms which is the actual risk factor and the actual factor playing a causal role in the development of ME/CFS.

    For example, if a psychiatric condition were underpinned by brain inflammation, then it may be the brain inflammation rather than the actual psychiatric mental symptoms that is playing a causal role in the development of ME/CFS.
     
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  13. Hip

    Hip Senior Member

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    @A.B.
    Actually, reading it more closely, they found evidence for depression and anxiety being risk factors for functional somatic syndromes like ME/CFS, fire and IBS in longitudinal studies. See Dolphin's quote:
    It is not flawed logic to say that anxiety and depression are risk factors for ME/CFS, if they were using longitudinal studies to determine this relationship. Though I agree the causal factor may not be the actual symptoms of depression or anxiety, but may be some underlying biological dysfunction(s) that causes both a propensity to depression or anxiety, as well as a propensity to ME/CFS.

    @Dolphin, would you know the title of the paper they are referring to here, the longitudinal study paper?
     
  14. Dolphin

    Dolphin Senior Member

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    I'm referring to the FSS diagnoses i.e. CFS, FMS and IBS. They just asked them did they ever have them but didn't assess them themselves.
     
    Last edited: Aug 3, 2015
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  15. Dolphin

    Dolphin Senior Member

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    That study used the flawed empiric criteria (Reeves et al., 2005). Here's a published letter in reply to that study criticising the criteria used:
    http://s3.amazonaws.com/academia.edu.documents/30271514/article-2010kindlon-criteria.pdf?AWSAccessKeyId=AKIAJ56TQJRTWSMTNPEA&Expires=1438611343&Signature=d94rWHQpAjFI5Y4jpE7dqnef9is=&response-content-disposition=inline

    If that link doesn't work, try:
    https://scholar.google.com/scholar?cluster=16133355348507066158&hl=en&as_sdt=0,5 and click on pdf link with academia.edu
     
    Last edited: Aug 3, 2015
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  16. Dolphin

    Dolphin Senior Member

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    34. Janssens KAM, Rosmalen JGM, Ormel J, van Oort FVA, Oldehinkel AJ. Anxiety and depression are risk factors rather than consequences of functional somatic symptoms in a general population of adolescents: the TRAILS study. J Child Psychol Psychiatry 2010;51:304–12.

    Full paper is available here: https://www.rug.nl/research/portal/files/14547770/02c2.pdf

    In this case, FSS refers to functional somatic symptoms rather than functional somatic syndromes:
     
  17. Hip

    Hip Senior Member

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    OK, understood. Thanks.



    That's interesting, I was not aware of that.

    Your link does not seem to work, but I presume the issue here is that the empirical definition may also select patients with major depression.

    Would you know of any other studies that have examined the incidence of the full range of possible psychiatric comorbidities in ME/CFS patients, using more robust ME/CFS selection criteria?



    One of the things I have been meaning to do is to set up a poll on this forum asking ME/CFS patients which psychiatric comorbidities they may have. However this poll would be a bit of an undertaking, as there are dozens of psychiatric conditions that would need to be listed in the poll answer options, and the poll would really need to list the symptoms of each psychiatric condition (as it is possible that patients may be unaware that they have a psychiatric condition until they read its symptoms — this happened to me, where I was unaware that I had social anxiety until I happened upon a good description of this condition).

    Just for anxiety disorders alone, you have around 7 different types (see this article which lists anxiety disorder types). And there are many forms of depression: major depression, dysthymia, seasonal affective disorder (SAD), atypical depression, bipolar I, bipolar II, premenstrual dysphoric disorder.

    Then you would need to include autism-spectrum disorders, schizophrenia-spectrum disorders, and all sorts of other stuff: ADD, ADHD, dyslexia, anorexia nervosa, etc.



    Many thanks for that link. I am particularly interested in ME/CFS comorbidities, both physical and mental, that may be playing a role in the development of ME/CFS, as I think these comorbidities should be able to throw some light on the biochemical nature of ME/CFS.

    I think it is great they have been able to prove that anxiety and depression are risks factors for somatic symptoms. Often with comorbidities, you don't know whether they are a cause or consequence of the main disease (or neither, and that both disease and comorbidity result from some third factor).

    I wish someone would perform a longitudinal study to try to determine whether IBS is a risk factor for ME/CFS. IBS I think is very interesting, because it is probably the most common comorbidity in ME/CFS.

    I had IBS-D for 5 years before later developing ME/CFS from a viral infection. Generalized anxiety disorder also appeared alongside my IBS, probably as a consequence of the IBS (although I cannot prove this). So I had both IBS and anxiety for some time before the virus precipitated my ME/CFS.
     
    Last edited: Aug 3, 2015
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  18. Dolphin

    Dolphin Senior Member

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