MUS, PPS services and IAPT integration into NHS primary care - what's happening across the UK?

[trishrhymes]

AAaaaaaargh!

 

[Countrygirl]

More on Santhouse.

http://www.meactionuk.org.uk/reasons-for-patient-disenchantment.htm

Horace A Reid,
Ill-Health Retired
Co. Down

Santhouse et al. congratulate themselves that research done by their colleagues at King’s College has underpinned the principal recommendations in NICE Guideline CG53.[1] As he has stated, Santhouse was himself a member of that Guideline Development Group.

In fact the NICE GDG was frequently at odds with senior staff at King’s CFS Research and Treatment Unit. In 2007 NICE concluded that “Currently, the aetiology of CFS/ME remains unknown”; (Guideline CG53 p 69). But Professor Trudie Chalder, head of the King’s team of which Santhouse[2] is part, disagrees. She has stated unequivocally that CFS is a “classical psychosomatic disorder.”[3] Chalder is a registered nurse, specialising in CBT. In 2006 NICE emphatically refused to endorse any of the myriad theories that CFS/ME is a psychiatric entity.[4] But Professor Simon Wessely, Santhouse’s colleague at the King’s CFS unit, has long suggested the contrary. By resort to means of continual repetition, Wessely’s “functional somatic” hypothesis [5] has in many quarters acquired the status of scientific fact.

NICE was not persuaded by lengthy submissions from King’s [6] that depression is a predisposing factor for CFS/ME. The GDG dismissed this claim in two curt sentences; (CG53 p 155). But in this present BMJ editorial, Santhouse et al. try to resurrect their self-serving theory that CFS and depression are integral.[7] In a press release in 2008, Professor Chalder claimed a 25% complete cure rate for CFS patients at the unit where she and Santhouse work.[8] In 2006 and 2007 NICE carefully distanced itself from such optimistic promises. The GDG said rates of full recovery are actually as low as 5-10%, [CG53 p 71] and warned that raising false hopes among patients would lead to disappointment.[9]

In 2006 Chalder and others claimed that “Cognitive behavioural therapy and graded exercise therapy have been shown to be effective in restoring the ability to work in those who are currently absent from work.”[10] In 2007 NICE demurred: “There is a lack of studies in this area … More information is needed on functional outcomes such as return to work or education.” (CG53 p 61)

Santhouse et al. describe CBT and GET as “treatments” for CFS/ME. As defined by NICE they are much less than that. They are merely techniques to help patients cope with an intractable and so far untreatable condition. In the words of NICE: “The GDG did not regard CBT or other behavioural therapies as curative or directed at the underlying disease process, which remains unknown. Rather, such interventions can help some patients cope with the condition"; (CG53 p 252).

The authors seem to suggest that evidence for the efficacy of CBT/GET is “robust” for most of the patient spectrum. But Santhouse knows very well it is not robust. In a 2009 commentary on a Cochrane Review, he conceded that with only 40% of CFS patients benefiting from CBT/GET, the cumulative results “are more modest than its proponents would recognize.”[11] More damningly, he acknowledged the Cochrane finding[12] that the known and frequent adverse events associated with the GET/CBT combination, have never been scientifically evaluated. As Santhouse put it, “researchers have never really looked.”[11]

Santhouse et al. record that “often” there is “breakdown of trust between doctors and the patients and their families”. This is a shameful situation, but it was predictable. And eleven years ago it was predicted, by a leading American CFS researcher.[13] His warning came in response to Professor Wessely’s “functional somatic” hypothesis, then first published.[5]

The unattractive treatment philosophy currently obtaining at King’s deviates significantly from NICE guidance. Nevertheless it has been assiduously propagated, and has now been embraced across many parts of the UK. It is ironic that a number of valuable NICE recommendations remain unimplemented, while psychogenic theories proliferate. Nor is that any coincidence. It is easier, and cheaper, for doctors and social services to ignore and stigmatise severely-affected housebound patients like Lynn Gilderdale, than to provide the comprehensive range of home support services that NICE recommended. Such is the pervasive unwelcoming atmosphere in much of the NHS, that many thousands of ME patients have disconnected altogether from conventional medical care. Their fears of iatrogenic harm are well justified, given the hazardous, poorly-tested and unproven nature of the only “treatments” on offer.

Comments in reference to Professor Wessely made by Professor Jason in 1999 could equally provide enlightenment for Santhouse et al. in 2010: “Biases toward psychiatric explanations for these syndromes have been filtered to the media … Perhaps the dissatisfaction with medical care that the authors cite as a common theme among patients with these syndromes, is the stigma they endure due to the trivialization ...”[13]

Horace Reid.

 

[lilpink]

I suspect the Women's Equality Party might be interested in the talk on 'Risk markers for developing Functional Somatic Syndromes'. Are we talking about 'dryness' again, do you reckon?

Very possibly. Might be worth you sending them a line?

 

[slysaint]

List of publications here is frightening:
https://www.national.slam.nhs.uk/about-us/our-experts/trudiechalder/

Chronic fatigue Service at the South London and Maudsley (SLAM)

Children:
Eligibility

• 
  
  
  • Adolescents (11 years), up to 18 years
  • Male or female
  • Long-lasting fatigue
  • Mild to profound disability
  • Disturbed sleep pattern
  • Associated anxiety and depression may be present

Outcomes
Expected outcomes may include:

• Resume daily activities
• Establish a sleep routine
• Reduced associated anxiety or depression

Our results

Adults:
Overview
We are an internationally recognised service providing assessment and evidence-based treatment for persistent physical symptoms (PPS). Our expertise includes chronic symptoms in long term conditions and medically unexplained symptoms. We treat a range of conditions including:

• Persistent physical symptoms
• Chronic fatigue syndrome
• Chronic physical symptoms and disability in long term conditions
• Fibromyalgia
• Irritable bowel syndrome
• Non-cardiac chest pain
• Dysfunctional breathing
• Chronic pain
  Eligibility
  • Age 18+ years
  • Male or female
  • Long lasting physical symptoms which have not responded to usual treatment (three months or more)
  • Long lasting physical or mental fatigue which has not responded to usual treatment (three months or more)
  • Profound disability where the physical symptoms are impacting on several areas of the person’s life
  • People who frequently attend the GP surgery and are not responding to usual reassurance and advice
  • People who have frequent hospital admissions for physical symptoms which are not responding to reassurance and advice
  • Disturbed sleep pattern, e.g. the person is sleeping during the day or unable to get to sleep at night and has not responded to the usual treatment

Our outcomes include:

• Resume daily activities
• Establish sleep routine
• Address associated anxiety or depression
• Challenge problematic beliefs which interfere with progress, which may relate to the rehabilitation programme, perfectionism or low self-esteem
• Lifestyle changes which may help to prevent relapse
• A graded return to work, addressing long-term sickness issues
• A discharge plan that incorporates agreement on how to maintain and build upon progress, work towards further targets and manage relapses, should they occur
  
  
  

 

[Yogi]

The Women's Equality Party has come out out against MUS as a mental health condition in their Manifesto that was launched on 12th May -

https://d3n8a8pro7vhmx.cloudfront.n...3495_Manifesto_2017_V4_Singles.pdf?1494600051

See Equal Health section pages 25 and 26 - "“Medically unexplained symptoms” or “MUS” should not be regarded as a mental health condition or problem"

That is really strange (in a good way) that a political party refers to MUS issues in its manifesto.

Why are the other parties so in bed with the MUS specialists.

 

[lilpink]

Why are the other parties so in bed with the MUS specialists.

Hard to know the answers but I'm sure we can guess. The WEP have no interest in power for its own sake, they just want to achieve what it says on their tin. An indication of this is how they have chosen to share their manifesto with the other main parties in the hopes those parties crib some of their policy ideas. What's the betting none of them are that interested in 'MUS' other than to embrace it with open arms?:

 

[Esther12]

Expected outcomes may include:

Expected outcomes may include:

? So is there evidence those outcomes are likely or not?

 

[Dx Revision Watch]

http://forums.phoenixrising.me/inde...-2017-a-day-with-the-mupp-ets-and-more.51518/

Esther Crawley - 18th May 2017 - A day with the MUPP(ets) and more

 

[Skycloud]

Here's one to sign and share widely. Closes on the 26th. It would be good to show the WEP we appreciate the stance they have taken regarding 'MUS'. If you feel able to add a paragraph about the way the BPS school has affected you then please feel free.

http://www.groupcard.com/c/QACkpQAJPMw/Thank-You-Card-for-Women039s-Equality-Party

or tiny: https://tinyurl.com/ljurdhw

signed

 

[lilpink]

signed

Obliged

 

[Skycloud]

Obliged

also simultaneously bumped

 

[lilpink]

also simultaneously bumped

Cunning plan

 

[Dx Revision Watch]

http://www.psychosomatika-cls.cz/wp-content/uploads/2016/09/Newsletter_EAPM_December_2016.pdf

EAMP Newsletter 2016

4. Scientific initiatives:

EAPM supports European COST Action Initiative
Bernd Löwe

Bodily Distress Syndromes including Somatic Symptom Disorders, Somatoform Disorders, Somatization Disorders, Medically Unexplained Symptoms or Functional Disorders are serious, complex and common medical problems of unknown aetiology and pathogenesis. Low recognition rates and long durations of untreated illness contribute to severe impairments in quality of life and high rates of chronic courses. To date, there is no agreement on medical guidelines throughout Europe, in some countries there are no guidelines or specialized treatment options at all. Current treatment is primarily symptom-oriented and based on medication which proved to have a modest effect on the symptoms. The health care costs associated with Bodily Distress Syndromes are comparable to depressive and anxiety disorders.

Research efforts in the field of Bodily Distress Syndromes are currently fragmented and scattered across Europe. A common European research agenda and the inclusion of underrepresented European countries is urgently needed.

The EURONET-SOMA initiative – a nationally funded conference series on two occasions in 2016 initiated by Bernd Löwe and his team from Hamburg, Germany - was an important first step to bring together leading experts in the field to provide the necessary framework for a European network. An expert panel of 29 experienced researchers from 9 European countries (the Netherlands, Denmark, Sweden, Norway, Latvia, Belgium, United Kingdom, Germany, and Russia) presented their recent research projects and state-of-the-art clinical procedures. The EURONET-SOMA participants agreed to jointly apply for a COST Action.

The main aim of the proposed COST Action will be the establishment of a sustainable integrated network of researchers in Europe working in the field of Bodily Distress Syndromes. The network will tackle persisting research challenges arising from a lack of known aetiology and common understanding of Bodily Distress Syndromes, from deficits in diagnostic and treatment processes and high associated socio-economic costs. The network aims to foster a multidisciplinary and multinational pan-European network of research experts, clinicians, patients and policy makers. The EAPM strongly supports this initiative. Requests for further information may be directed to Isabel Winter, Administrator of the EAPM, contact@eapm.eu.com.

-----------------------------------

http://www.rug.nl/research/portal/activities/euronetsoma(e42b9a9c-15b7-4611-aaaf-3fda851bf93f).html

EURONET-SOMA
Conference participation › Participation in conference

Judith Rosmalen - Speaker, 3-Nov-2016

Update Summerschool and MOOC

• Interdisciplinary Centre Psychopathology and Emotion regulation (ICPE)

Conference Title EURONET-SOMA
Period 02/11/2016 → 04/11/2016
City Hamburg
Country Germany

---------------------------------

In Press

J Psychosom Res. 2017 Apr 7. pii: S0022-3999(17)30384-7. doi: 10.1016/j.jpsychores.2017.04.003. [Epub ahead of print]

https://www.researchgate.net/public..._report_of_the_EURONET-SOMA_conference_series

Weigel A1, Hüsing P1, Kohlmann S1, Lehmann M1, Shedden-Mora M1, Toussaint A1, Löwe B2; EURONET-SOMA Group.

A European research network to improve diagnosis, treatment and care for patients with persistent somatic symptoms: Work report of the EURONET-SOMA conference series

(...)

"...Practitioners in psychosomatic medicine are faced with the new diagnosis of “Somatic Symptom Disorder” in DSM-5 [8] and the suggested “Bodily Distress Disorder” in ICD-11 [9,10] which both no longer exclude the existence of underlying medical conditions."

"EURONET-SOMA successfully brought leading European experts in the field of persistent somatic symptoms together."

"Suggestions to face this challenge included to synthesize current conceptual models, definitions and etiology models and to develop recommendations for further interdisciplinary and multi-method research. Furthermore, there was consent between the EURONET-SOMA experts about the urgent need for a common and interdisciplinary agreement on the diagnostic classification for persistent somatic symptoms. This includes a consent on practical, valid, and comparable measures to assess persistent somatic symptom diagnosis and severity across European countries as well as recommendations for core outcome domains for clinical trials on persistent somatic symptoms. From a treatment perspective prevention programs, personalized and targeted treatment programs as well as online and public health interventions are promising approaches but still in their infancies. It is a challenge to identify key risk and protective factors for the development and chronic manifestation of somatic symptoms as well as barriers to early treatment."

"We believe that EURONETSOMA was an important first step and has the potential to further contribute to a common understanding of the terminology, conceptualization and management of persistent somatic symptoms as well as to obtain a fundamental etiological knowledge about the issue to increase the effectiveness of preventive approaches and early treatment interventions. In the long run, we hope to transfer knowledge regarding persistent somatic symptoms between different medical disciplines and clinical psychology as well as from research into clinical practice and make diagnostic procedures, treatment solutions and outcomes comparable across Europe. Thereby, we hope to prevent patients from iatrogenic harm due to unnecessary examinations and provide them with appropriate health care."

(...)

Participants of the EURONET-SOMA Group in alphabetical order:

Gunta Ancane, Marie Bendix, Manfred Beutel, Chris Burton, Francis Creed, Paul Enck, Per Fink, Lisbeth Frostholm, Harald Gündel, Peter Henningsen, Paul Hüsing, Chris Kenedi, Ksenya Khohlova, Maria Kleinstäuber, Sebastian Kohlmann, Willem J. Kop, Claas Lahmann, Marco Lehmann, Bernd Löwe, Ulrik Malt, Krzysztof Małyszczak, Alexandra Martin, Nadine Pohontsch, Winfried Rief, Judith Rosmalen, Joanna Rymaszewska, Heribert Sattel, Andreas Schröder

 

[Dx Revision Watch]

An award for Per Fink from the EAMP ( European Association of Psychosomatic Medicine ) whose official journal is the Journal of Psychosomatic Research - a subscription rag for publishing its cronies' papers.


EAPM Life Time Awards 2017

http://www.eapm2017.com/index.php/awards

Alison Creed Award

The Award in memory of Alison Creed for life time achievement in the field of Psychosomatic Medicine/ Consultation Liaison Psychiatry.
Awarded to: Prof. Per Fink, Aarhus

 

[Dx Revision Watch]

From this year's EAMP 2017 Conference, Barcelona, programme:

June 28th – 1st July 2017

EAPM 2017

http://www.eapm2017.com/index.php/programme

or

PDF: http://www.eapm2017.com/images/site/SCHEDULE.pdf

Selected presentations:

Epidemiology of Functional Somatic Syndromes
JGM Rosmalen T Jørgensen

Explanatory models and current understanding of functional somatic syndromes - recent developments
Andreas Schröder Omer Van den Bergh

Mangement of functional/somatoform disorders
Christopher Burton

From Joint Hypermobility to Neuroconnective Phenotype: New Psychosomatic paradigm
Antonio Bulbena

PROACTIVE C-L PSYCHIATRY: EVIDENCE FOR A NEW MODEL
Michael Sharpe

Treatment of functional somatic syndromes: new trials, and potentially negative treatment effects
Andreas Schröder

Somatic symptom disorders and related disorders: a new DSM-5 category. Clinical characteristics
and priorities for a research agenda.
Christina Van der Feltz- Cornelis

Persistent Somatic Symptoms – Current Concepts & Recommendations from the EURONETSOMA group *
Sebastian Kohlmann, Bernd Löwe

* See my post #573 above

 

[Countrygirl]

[QUOTE="Dx Revision Watch, post: 851793,

Alison Creed Award

The Award in memory of Alison Creed for life time achievement in the field of Psychosomatic Medicine/ Consultation Liaison Psychiatry.
Awarded to: Prof. Per Fink, Aarhus[/QUOTE]



Per Fink.......................the doctor who poisoned Karina by overdosing her on antipsychotics for ME symptoms.

Shameful!

As they say, the devil certainly looks after his own.

 

[Countrygirl]

Joint hypermobility/EDS is psychosomatic?

Really?

 

[slysaint]

Joint hypermobility/EDS is psychosomatic?

Really?

Someone should tell the NHS

Ehlers-Danlos syndromes (EDS) are a group of rare inherited conditions that affect connective tissue.

Connective tissues provide support in skin, tendons, ligaments, blood vessels, internal organs and bones.
The different types of EDS are caused by faults in certain genes that make connective tissue weaker. Depending on the type of EDS, the faulty gene may have been inherited from one parent, or both parents.
Sometimes the faulty gene isn't inherited, but occurs in the person for the first time.

 

[dangermouse]

Joint hypermobility/EDS is psychosomatic?

Really?

Well, I'm not surprised but still left feeling speechless. The BPS are taking over everything it would seem.

 

[Dx Revision Watch]

Here is more from the presenter et al:

https://www.intechopen.com/books/a-...chosomatics-the-new-neuroconnective-phenotype

Chapter 8

Joint Hypermobility, Anxiety, and Psychosomatics — The New Neuroconnective Phenotype

By Guillem Pailhez, Juan Castaño, Silvia Rosado, Maria Del Mar Ballester, Cristina Vendrell, Núria Mallorquí-Bagué, Carolina Baeza- Velasco and Antonio Bulbena
DOI: 10.5772/60607

Abstract: In this chapter, after summarizing the concept and diagnosis of the Joint Hypermobility (Hyperlaxity), we review case control studies in two directions: Anxiety in Joint Hypermobility and Joint Hypermobility in Anxiety disorders, studies in nonclinical samples, review papers, and one incidence study. Collected evidence tends to confirm the strength of the association described two and a half decades ago. Common mechanisms involved include genetics, autonomic nervous system dysfunctions, and interoceptive and exteroceptive processes. Considering clinical and nonclinical data, pathophysiological mechanisms, and present nosological status, we suggest a new Neuroconnective phenotype in which together around a common core Anxiety-Collagen hyperlaxity, it includes five dimensions: behavioral, psychopathology, somatic symptoms, somatosensory symptoms, and somatic illnesses. Somatic illnesses include irritable bowel, dysfunctional esophagus, multiple chemical sensitivity, dizziness or unsteadiness (central vestibular pattern), chronic fatigue, fibromyalgia, glossodynia, vulvodynia, hypothyroidism, asthma, migraine, temporomandibular dysfunction, and intolerances or food and drug hypersensitivity. It is envisaged that new descriptions of anxiety disorders and also of some psychosomatic conditions will emerge and different nosological approaches will be required.

Keywords: Anxiety disorders, joint hypermobility, hyperlaxity, psychosomatic medicine, phobic disorders

Full chapter is Open Access and there is also aPDF.