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Undiagnosed and comorbid disorders in patients with presumed chronic fatigue syndrome.

Discussion in 'Latest ME/CFS Research' started by Bob, Nov 5, 2013.

  1. Bob

    Bob

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    I thought this had been posted before, but I can't find it anywhere...


    Undiagnosed and comorbid disorders in patients with presumed chronic fatigue syndrome.
    Mariman A, Delesie L, Tobback E, Hanoulle I, Sermijn E, Vermeir P, Pevernagie D, Vogelaers D.
    J Psychosom Res. 2013 Nov;75(5):491-6.
    doi: 10.1016/j.jpsychores.2013.07.010.
    Epub 2013 Aug 20.

    Full paper:
    http://www.sciencedirect.com/science/article/pii/S0022399913002766

    If the above link takes you to the jpsychores website instead of the ScienceDirect website, then (to access the full paper) click on "Access this article on ScienceDirect" (top-right of the jpsychores webpage.)

    Abstract only:
    http://www.ncbi.nlm.nih.gov/pubmed/24182640
    http://www.jpsychores.com/article/S0022-3999(13)00276-6/abstract


    Abstract
    OBJECTIVE:
    To assess undiagnosed and comorbid disorders in patients referred to a tertiary care center with a presumed diagnosis of chronic fatigue syndrome (CFS).

    METHODS:
    Patients referred for chronic unexplained fatigue entered an integrated diagnostic pathway, including internal medicine assessment, psychodiagnostic screening, physiotherapeutic assessment and polysomnography+multiple sleep latency testing. Final diagnosis resulted from a multidisciplinary team discussion. Fukuda criteria were used for the diagnosis of CFS, DSM-IV-TR criteria for psychiatric disorders, ICSD-2 criteria for sleep disorders.

    RESULTS:
    Out of 377 patients referred, 279 (74.0%) were included in the study [84.9% female; mean age 38.8years (SD 10.3)]. A diagnosis of unequivocal CFS was made in 23.3%. In 21.1%, CFS was associated with a sleep disorder and/or psychiatric disorder, not invalidating the diagnosis of CFS. A predominant sleep disorder was found in 9.7%, 19.0% had a psychiatric disorder and 20.8% a combination of both. Only 2.2% was diagnosed with a classical internal disease. In the total sample, a sleep disorder was found in 49.8%, especially obstructive sleep apnea syndrome, followed by psychophysiologic insomnia and periodic limb movement disorder. A psychiatric disorder was diagnosed in 45.2%; mostly mood and anxiety disorder.

    CONCLUSIONS:
    A multidisciplinary approach to presumed CFS yields unequivocal CFS in only a minority of patients, and reveals a broad spectrum of exclusionary or comorbid conditions within the domains of sleep medicine and psychiatry. These findings favor a systematic diagnostic approach to CFS, suitable to identify a wide range of diagnostic categories that may be subject to dedicated care.
    Last edited: Nov 5, 2013
  2. MeSci

    MeSci ME/CFS since 1995; activity level 6

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    Perhaps the main thing that this study illustrates is that the Fukuda criteria are crap, or that people are being misdiagnosed on a huge scale. It worries me though, as I can just see how it may be reported in the media and used in arguments to carry on pushing BS like CBT, GET and 'sleep hygiene'.

    I would have thought that a representative sample subjected to expert investigation would actually turn out to have a high incidence of physical disease.

    Only seeing the abstract leaves me with more questions than answers. I think the paper could do with thorough critical analysis. Thanks for posting it anyway.
    WillowJ, Valentijn and Bob like this.
  3. Bob

    Bob

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    The full paper is available at the moment, including a PDF version.

    I've edited my opening post because the main link sometimes redirects to a different website which only shows the abstract

    To view the full paper, use this link:
    http://www.sciencedirect.com/science/article/pii/S0022399913002766

    If this link takes you to the jpsychores website instead of the ScienceDirect website, then (to access the full paper) click on "Access this article on ScienceDirect" (top-right of the jpsychores webpage.)
    MeSci likes this.
  4. peggy-sue

    peggy-sue

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    I'm left wondering about folk like my friend, who suffered from "CFS" for 10 years before it was discovered he needed a pacemaker all along.

    He had heart failure. Not "CFS".
    Tito and Bob like this.
  5. Valentijn

    Valentijn Activity Level: 3

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    They are probably using inadequate methods to diagnose psychological disorders. I haven't read the full paper, but typically it involves questionnaires where physical symptoms are taken as proof of anxiety or depression.
  6. MeSci

    MeSci ME/CFS since 1995; activity level 6

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    Finally got it!

    Not time for thorough critical analysis, but I note the following statements:

    "In unequivocal CFS, no symptoms or signs of coexisting sleep or psychiatric disorders are observed."

    Is there really such a thing as 'unequivocal CFS', bearing in mind what a vague and probably heterogeneous 'syndrome' it is, especially when criteria such as Fukuda are used?

    The paper seems quite tautological in this respect: use vague case definitions and you get a mixed, confusing bunch of patients. Hardly surprising!

    I also find it surprising that they find it surprising that a lot of people with CFS have sleep problems, anxiety and mood problems. It's hardly a surprise to anyone familiar with Phoenix Rising, where we are way ahead of these guys with links and theories as to likely reasons for these 'co-morbidities'.

    The researchers also say that anxiety disorder excludes CFS. I disagree. I think that they can both have the same, physical cause. Many of us have found that a diet-and-supplement regime that improves our physical symptoms also reduces anxiety - the likely connection being gut flora.

    Too tired to read any more - may look again tomorrow.
    peggy-sue and Beyond like this.
  7. Simon

    Simon

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    Agree that's an odd way to define CFS, I don't think psychiatric disorders are exclusionary according to Fukuda, and maybe that explains the very low rate of 'unequivocal' CFS cases @23%.

    @Bob, thanks, and that linked article is now marked Open Access so should be no problem (though J Psychosomatic Research site still paywalled).

    They do use questionnaires, but where a pyschological disorder is suspected they referrred to a psychiatrist, so looks sound on that front.
  8. Bob

    Bob

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    All things considered, are you absolutely convinced about that, Simon? :)
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  9. aimossy

    aimossy Senior Member

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    seems waaaay to subjective.and not very rigorous to me.
    peggy-sue and Bob like this.
  10. IreneF

    IreneF Senior Member

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    I thought sleep disorders were common among us CSFers, and not necessarily exclusionary. Especially since "unexplained fatigue" is hardly diagnostic.
    JAH, peggy-sue, aimossy and 1 other person like this.

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