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Re- Peter White et al (2010) Psychiatric misdiagnoses in patients with CFS

Discussion in 'Latest ME/CFS Research' started by Daisymay, Sep 27, 2010.

  1. Daisymay

    Daisymay Senior Member

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    May be reposted.


    Here is David Sampson's comment on the recent Peter White et al paper entitled "Psychiatric misdiagnoses in patients with chronic fatigue syndrome" published in the JRSM Short Reports:



    Re- Peter White et al (2010) Psychiatric misdiagnoses in patients with
    chronic fatigue syndrome :Tara Lawn1 ? Praveen Kumar1 ? Bernice Knight2 ?
    Michael Sharpe3 ? Peter D White4 on behalf of the PACE trial management
    group (listed in protocol reference). J R Soc Med Sh Rep 2010;1:28. DOI
    10.1258/shorts.2010.010042

    http://shortreports.rsmjournals.com/content/1/4/28.full


    In this paper Professor White notes the high prevalence of co-morbid
    psychiatric illness in a cohort of CFS sufferers (56%) defined using the Oxford
    CFS Criteria and their under-diagnosis by clinicians in a secondary care
    specialist Chronic Fatigue Syndrome clinic.

    The main question concerns the validity of employing the Oxford CFS
    criteria in this study. Rates of co-morbid psychiatric illness in ME/CFS patients
    are known to be affected by diagnostic criteria which clearly influence
    patient selection (Jason, 2004).

    In assessing the validity of the Oxford CFS criteria it is interesting
    that Professor White himself noted in his original Lancet paper (White, 2001)
    examining various CFS criteria that: "both mood disorder at 2 months and
    emotional personality (neuroticism) predicted Oxford-defined CFS...These
    predictions of CFS were related more to having a co-morbid mood disorder than
    to having CFS itself".

    What is of critical importance is the fact that the strongest determinant
    of an "Oxford defined CFS" are mood disorder and premorbid psychiatric
    disorder/GP attendance in year before onset- all of which are predictors of
    mood disorder/psychiatric illness quite independently of a fatigue syndrome
    ( see Sampson, 2010).

    If such Oxford defined patients are ME/CFS patients who happen to have
    developed depression/psychiatric illness subsequently to CFS itself then
    premorbid psychiatric history would not be such a potent predictor- however it
    is.

    This demonstrates yet again that not only do such broad criteria fail to
    exclude patients with primary psychiatric diagnosis in the absence of
    physical symptoms (Stein 2005, Jason 1997, Sampson 2010) but that these criteria
    may be better at selecting such patients than ME/CFS patients per se.

    If both ME/CFS and mood disorder/psychiatric illness were synonymous this
    would not matter- however they are not. The genetics of ME/CFS,
    hypothalamic-pituitary-adrenal axis function, quantitive EEG and brain blood flow on
    SPECT all differentiate between CFS and mood disorder/depression (Stein,
    2005).

    This suggests that at very best the Oxford CFS criteria are ambiguous and
    at worst misleading and tautological in conception.

    In fact as long ago as 2001 Professor White noted in his study examining
    various ME/CFS criteria "These data support the difference in nosology and
    aetiology between acute and chronic fatigue syndromes (of relatively short
    duration) and mood disorders. They also suggests that the Oxford and CDC
    criteria for CFS should be used with caution or only with stratification by
    mood disorder in aetiological studies".

    David Sampson BSC(Hons),MSc,MBPsychS


    References

    Jason L. et al. (2004) Comparing the Fukuda et al Criteria and the
    Canadian Case definition for Chronic Fatigue Syndrome. Journal of Chronic Fatigue
    Syndrome ,12, 37-52.

    White P. et al. (2001); Lancet, Vol. 358, N.9297; pp 1946-1953 Predictions
    and associations of fatigue syndromes and mood disorders that occur after
    infectious mononucleosis.

    Sampson D.P. (2010) Close Analysis of a Large Published Trial Into
    Fatigue Syndromes and Mood Disorders That Occur After Documented Viral Infection.
    Bulletin of the IACFS/ME, Vol 18,Issue 2, Summer 2010.

    Stein E (2005). Chronic Fatigue Syndrome: Assessment and Treatment of
    Patients with ME/CFS: Clinical Guidelines for Psychiatrists.

    Jason L. (1997). Politics, Science, and the Emergence of a New Disease:
    The Case of Chronic Fatigue Syndrome, American Psychologist; Vol. 52, No. 9,
    973-983.
  2. Dolphin

    Dolphin Senior Member

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  3. Daisymay

    Daisymay Senior Member

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    Dolphin, I've posted this to the other link, sorry, don't know how to lock the thread.

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