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

[Dx Revision Watch]

The timeline for the December 2016 Call for Bids for funding for delivery of integrated IAPT services is

18 January 2017 Submissions deadline for bidders
February 2017 Investment Decision taken by NHS England Investment Committee
March 2017 Notification of investment decisions


I'll go back to the NHS England site in a few months time and see whether there is any information on the locations of successful "Intervention 1" bidders for this new tranche of funding for delivering IAPT services, specifically where it has been obtained for

Long term conditions

Chronic Fatigue Syndrome (CFS)

and

Persistent distress in association with
medically unexplained symptoms that
cannot be classified as panic disorder,
health anxiety, IBS, CFS, or chronic pain


Transformation fund call to bid
https://www.england.nhs.uk/stps/tf-call-to-bid/

Improving access to psychological therapies (Integrated IAPT)
> Mental Health Call to Bid

https://www.england.nhs.uk/wp-content/uploads/2016/12/mental-health-call-to-bid.pdf

> Intervention 1 - Integrated IAPT

"Funding is for delivery of integrated IAPT services – to develop integrated services at scale (for instance teams of 10 therapists or more)."

"A significant aspect of the funding will be for expanding the IAPT workforce through new IAPT trainees or recruiting suitably qualified experienced therapists not already in IAPT. Training places will be subject to capacity at Universities, which we will work with Health Education England to secure."

"Because the academic year spans financial year the salary of trainees (and potentially their course costs) will also span the financial year. Areas will need to plan to locally fund trainees in 2018/19."

"We expect new Integrated IAPT services to start during the course of 2017/18 – the right time
will depend on the current local position and alignment with training courses."

 

[Squeezer]

This is far worse than the NICE guidelines.

I note for Chronic Fatigue Syndrome treatment is simply listed as Graded Exercise Therapy (GET) or CBT.

So no mention of the fact that NICE only considers these moderately helpful for mild to moderate sufferers and not helpful for severe sufferers.

No mention of medical symptomatic treatments for pain, sleep etc., and certainly no mention of the fact that NICE recognises ME as a neurological, not a psychiatric condition.

No mention of the weakness of the 'evidence' for these being any use at all, let alone potentially harmful.

Quotes from the NICE Guidelines: https://www.nice.org.uk/Guidance/cg53

'Is this guideline up to date?
In 2015 we were told about 3 US reports that indicated there are likely to be changes in diagnostic criteria that could have an impact on the guideline recommendations. We decided to start a check of whether the guideline needs updating, and plan to publish our decision in summer 2017. We have since been made aware of new information about the 2011 PACE trial, and we will also consider that in the check.'

'Many different potential aetiologies for CFS/ME – including neurological, endocrine, immunological, genetic, psychiatric and infectious – have been investigated, but the diverse nature of the symptoms can not yet be fully explained. The World Health Organization (WHO) classifies CFS/ME as a neurological illness (G93.3), and some members of the Guideline Development Group (GDG) felt that, until research further identifies its aetiology and pathogenesis, the guideline should recognise this classification. Others felt that to do so did not reflect the nature of the illness, and risked restricting research into the causes, mechanisms and future treatments for CFS/ME.'

'The recommendations in this guideline emphasise the importance of early symptom management, making an accurate diagnosis, ensuring that significant clinical features are investigated, and working in partnership with people with CFS/ME to manage the condition. Different combinations of approaches will be helpful for different people.'

'Treatment and care should take into account patients' individual needs and preferences.'

'People with CFS/ME should have the opportunity to make informed decisions about their care and treatment.'

'Cognitive behavioural therapy and/or graded exercise therapy should be offered to people with mild or moderate CFS/ME and provided to those who choose these approaches'

....................

Unfortunately I have cherry picked the relatively good bits from NICE, which overall is bad, since it is full of detail about how to do GET and CBT and recommends them even though the evidence when written was slight, and now, since the PACE fiasco, is non-existent.

I think the 'informed decisions' bit is vitally important because a truly informed decision would be based on the biomedical evidence, particularly the bits about faulty energy metabolism and the dangers of pushing into aerobic exercise, as well as the evidence that PACE and FINE showed GET and CBT don't work.

Anyone claiming to treat ME should therefore both know these facts, and give them to patients so they can make 'informed decisions'. To do otherwise is unethical, unprofessional and irresponsible. And it goes against the government's own guidelines that specify informed decisions.

On that basis, the whole 'Integrated IAPT' program is unethical and needs to be stopped.

Now what do I do?

The extracts you've taken TrishRhymes are excellent I would have several copies of them with me - and a reference to the full document - ready to hand over everytime I saw a health care professional. The BPS lobby seem to operate under the unprofessional and personal opinion that patients should do as they, the BPS lobby, dictates. Well they are wrong and the BPS lobby clearly seek to misinform patients across a whole spectrum of illnesses - not just ME - and it seems like they actually continue to try and get NICE and other guidance to conform to whatever format is in THEIR narrow and self-serving interests. In fact, the IAPT program seems like a concerted attempt to ignore or circumvent NICE and other guidance and simply impose whatever evangelical belief the BPS lobby choose to peddle.

 

[Dx Revision Watch]

From May 2016

East London NHS Foundation Trust

One day symposium

Somatic Symptom Disorder/ 'Medically Unexplained Symptoms' in Primary Care


Note: At 15.00 and again at 16.30, another term to add to the burgeoning list -

"Functional Distress Disorder".

Note also, that the criteria for DSM-5 SSD allows for application of the diagnosis to patients with symptoms associated with diagnosed general medical conditions and the so-called FSSs, if the clinician considers the degree of distress or preoccupation with the symptom or symptoms to be "excessive".

Flyer: PDF https://www.elft.nhs.uk/uploads/files/1/Events/2016/Programme for International symposium on SSDMUS.pdf

Some of the terms in use in the UK:

Somatoform disorders (coded in ICD-10 and SNOMED CT but not in DSM-5; retired for ICD-11 Beta draft)

Medically unexplained symptoms (MUS)
Medically unexplained physical symptoms (MUPS)

Persistent physical symptoms (PPS) (may include CFS, IBS, FM et al)

Functional symptoms
Functional disorders
Functional somatic symptoms and syndromes (FSS) (may include CFS, IBS, FM et al)

Functional Distress Disorder (a relatively new term with no known published criteria and not found elsewhere that I can find))

Bodily Distress Syndrome (Fink et al 2010; operationalized in Denmark in clinical and research settings)
Bodily distress disorder (also seen used interchangeably with BDS)

Bodily Stress Syndrome (proposed for ICD-11 Primary Care version but not approved; adaptation of BDS)

*Bodily distress disorder (proposed for ICD-11 Core edition and entered into the Beta draft)

*Somatic symptom disorder (DSM-5; criteria set is intellectual property of APA's publishing arm)
(also listed in ICD-11 Core edition Beta under Synonyms to proposed Bodily distress disorder)

*Diagnosis can be applied to patients with persistent, distressing symptoms associated with diagnosed general medical conditions if considered "excessive".

 

[slysaint]

Some of the terms in use in the UK:

Somatoform disorders (coded in ICD-10 and SNOMED CT but not in DSM-5; retired for ICD-11 Beta draft)

Medically unexplained symptoms (MUS)
Medically unexplained physical symptoms (MUPS)

Persistent physical symptoms (PPS) (may include CFS, IBS, FM et al)

Functional symptoms
Functional disorders
Functional somatic symptoms and syndromes (FSS) (may include CFS, IBS, FM et al)

Functional Distress Disorder (a relatively new term with no known published criteria)

Bodily Distress Syndrome (Fink et al 2010; operationalized in Denmark in clinical and research settings)
Bodily distress disorder (also seen used interchangeably with BDS)

Bodily Stress Syndrome (proposed for ICD-11 Primary Care version but not approved; adaptation of BDS)

*Bodily distress disorder (proposed for ICD-11 Core edition and entered into the Beta draft)

*Somatic symptom disorder (DSM-5; criteria set is intellectual property of APA's publishing arm)
(also listed in ICD-11 Core edition Beta under Synonyms to proposed Bodily distress disorder)

*Diagnosis can be applied to patients with persistent, distressing symptoms associated with diagnosed general medical conditions if considered "excessive".

Good grief
is this a private naming party or can anyone join in?

 

[Dx Revision Watch]

https://keats.kcl.ac.uk/pluginfile.php/1208848/mod_folder/content/0/Popular%20term.pdf

The most popular terms for medically unexplained symptoms: The views of CFS patients

Federica Picariello a,b, Sheila Ali b, Rona Moss-Morris a, Trudie Chalder c,⁎
a King's College London, United Kingdom
b South London and Maudsley NHS Foundation Trust, United Kingdom
c King's College London, United Kingdom

Table 2
Cumulative score for each term.

Term Sum

Persistent Physical Symptoms 94
Complex Physical Symptoms 76
Medically Unexplained Physical Symptoms 52
Medically Unexplained Symptoms 41
Functional Somatic Syndrome 41
Bodily Distress Disorder 33
Functional Syndrome 29
Functional Symptoms 26
Other 26
Somatoform Disorder 24
Bodily Distress Syndrome 21
No preference 14

 

[Dx Revision Watch]

Notice for the one day symposium I posted above:

http://www.rcpsych.ac.uk/pdf/Liaison Psychiatry Faculty Newsletter Spring 2016.pdf

Faculty of Liaison Psychiatry Newsletter 16 March 2016

‘Somatic Symptom Disorder / ‘Medically Unexplained Symptoms’ in Primary Care’

A one day state of the art symposium for primary and secondary health care
professionals.

Friday 6 May 2016 St Bartholomew’s Hospital, London.

Funded by the Health Foundation, free to attend, CDP certificate and lunch provided.
Patients with SSD/MUS pose significant challenges to primary care practitioners. They
often have unmet health needs as a result of incorrect diagnosis and because it is difficult
to engage these patients in holistic care. Consequently treatment is often ineffective
despite frequent presentation at primary and secondary care services, resulting in high
cost pressures to the health economy. Existing models have not met the complex needs
necessary to achieve positive health outcomes for this group.

Kevin Mullins, Head of Mental Health NHS England and National Director IAPT Programme Long-Term-Conditions, will talk about the National Mental Health Integrated Care Strategy and Professor Rona Moss-Morris, Professor of Health Psychology at King’s College London who is also National Advisor on MUS – IAPT, will present findings from the DoH/IAPT national pathfinder project.

There will be keynote addresses by international experts (Professor Peter Henningsen,
Professor Claas Lahmann and Professor Gabriel Ivbijaro) as well as an introduction to
research into an innovative care pathway conducted in East-London. Finally, Dr Phillip
Moore - Chair Mental Health Commissioners Network, will talk about the treatment of
patients with functional distress disorder in Primary Care from a General Practitioners
and Commissioners perspective.

For further information and to book your place please email: MUS@elft.nhs.uk
More details about the conference can be found on this link
https://www.elft.nhs.uk/Events/Medically-Unexplained-Symptoms-Conference-

 

[TiredSam]

The most popular terms for medically unexplained symptoms: The views of CFS patients

Federica Picariello a,b, Sheila Ali b, Rona Moss-Morris a, Trudie Chalder c,⁎

FFS

 

[Cheshire]

https://keats.kcl.ac.uk/pluginfile.php/1208848/mod_folder/content/0/Popular%20term.pdf

The most popular terms for medically unexplained symptoms: The views of CFS patients

Federica Picariello a,b, Sheila Ali b, Rona Moss-Morris a, Trudie Chalder c,⁎
a King's College London, United Kingdom
b South London and Maudsley NHS Foundation Trust, United Kingdom
c King's College London, United Kingdom

Table 2
Cumulative score for each term.

Term Sum

Persistent Physical Symptoms 94
Complex Physical Symptoms 76
Medically Unexplained Physical Symptoms 52
Medically Unexplained Symptoms 41
Functional Somatic Syndrome 41
Bodily Distress Disorder 33
Functional Syndrome 29
Functional Symptoms 26
Other 26
Somatoform Disorder 24
Bodily Distress Syndrome 21
No preference 14

Where on earth did they get their "cfs" patients? In every survey done by Leonard Jason, the prefered term is ME.

 

[Dx Revision Watch]

Where on earth did they get their "cfs" patients? In every survey done by Leonard Jason, the prefered term is ME.

"Participants were asked to indicate their three most preferred terms
out of a list of commonly used terms and to provide any extra comments."

"A recent population study looked at the nomenclature preferences of
698 healthy adults. They found that the term “Persistent Physical Symptoms”
was the top preference, followed by “Functional Symptoms” [17].

"The aim of the current study was to find out which umbrella term patients
with chronic fatigue syndrome (CFS) preferred, that could be
used to describe not only their condition, but also illnesses such as IBS
and non-cardiac chest pain. This study was intended to build on
Marks and Hunter's study [17] using a population of patients with CFS
in secondary care."

"Method
Design and procedure
This study employed a cross-sectional mixed methods design. Participants
were recruited using convenience sampling. Surveys were
placed in the waiting room of an outpatient unit for CFS. Participants
completed the survey while waiting for their appointment.

Participants
Participants were recruited from the Chronic Fatigue Syndrome Unit
at the South London and Maudsley (SLaM) NHS Trust. This exploration
of patients' views was considered an audit and approved by the South
London and Maudsley NHS Foundation Trust and Psychological
Medicine Clinical Academic Group."

 

[Squeezer]

Good grief
is this a private naming party or can anyone join in?

*Diagnosis can be applied to patients with persistent, distressing symptoms associated with diagnosed general medical conditions if considered "excessive".

Says who? Who exactly (name required) of the person that wrote this and the basic on which this faceless person has effectively dictated such a blanket assertion in respect of patients they have never met? This is like rabble rousing at arms length and advocating someone else to do their dirty work. It is also negligent in respect of ANY meaningful accountability to the author.

"Distressing" to whom? The so-called medical professional who simply doesn't like being challenged by a patient who is entitled to have fully informed consent at all times?

"Excessive" in whom's opinion? The same author who, from a distance, is attempting to orchestrate a blanket approach to individual patients about who they know ZERO.

 

[Dx Revision Watch]

https://keats.kcl.ac.uk/pluginfile.php/1208848/mod_folder/content/0/Popular%20term.pdf

"Materials
Patients were asked to rank their top three preferred terms to
describe conditions that are characterised by a variety of physical symptoms.
Patients were asked: “If you had a physical symptom such as fatigue
or pain that persisted and was found by doctors not to be caused by a particular
disease, which of the following umbrella terms would you prefer
most?”.

The terms included in this survey were:

1) Complex Physical Symptoms, 2) Functional Symptoms, 3) Functional Somatic Syndrome,
4) Functional Syndrome, 5) Bodily Distress Disorder, 6) Bodily Distress
Syndrome, 7) Medically Unexplained Symptoms, 8) Medically Unexplained
Physical Symptoms, 9) Persistent Physical Symptoms, 10)
Somatoform Disorder, 11) No preference/don't know, and 12) Other.
Participants were given space to add any further comments at the end
of the first page. Participants were also asked to provide demographic
information"

 

[Dx Revision Watch]

*Diagnosis can be applied to patients with persistent, distressing symptoms associated with diagnosed general medical conditions if considered "excessive".

Says who? Who exactly (name required) of the person that wrote this and the basic on which this faceless person has effectively dictated such a blanket assertion in respect of patients they have never met? This is like rabble rousing at arms length and advocating someone else to do their dirty work. It is also negligent in respect of ANY meaningful accountability to the author.

This concept forms part of the American Psychiatric Association's DSM-5 definition and criteria for Somatic symptom disorder which were developed between 2009-2012.

The criteria were developed by the SSD Work Group, chaired by Prof Joel E Dimsdale. (An international work group which included UK's Michael Sharpe and Francis Creed.)

The DSM-5 published in 2013 and the definition, characteristics and criteria for SSD have been extensively discussed on these forums and written about elsewhere since 2010, when the first draft of DSM-5 was released for the first of three public review and comment periods.

So a diagnosis of SSD can be applied in some patients with, for example, diagnosed cancer, cardiovascular disease, diabetes etc. and also in some patients with CFS, IBS, FM.

This concept also forms part of the definition for ICD-11 Core edition's proposals for "Bodily distress disorder" which is similarly conceptualized to DSM-5's SSD.

ICD-11 Beta draft: "Bodily distress disorder is characterized by the presence of bodily symptoms that are distressing to the individual and excessive attention directed toward the symptoms, which may be manifest by repeated contact with health care providers. If a medical condition is causing or contributing to the symptoms, the degree of attention is clearly excessive in relation to its nature and progression..."
http://apps.who.int/classifications/icd11/browse/f/en#/http://id.who.int/icd/entity/767044268​

The concept does not form part of the criteria for Fink et al (2010) Bodily Distress Syndrome, where, if the symptoms are better explained by another disease, this cannot be labelled BDS.

Criteria comparison chart: S Chapman, Dx Revision Watch


The concept of persistent, distressing symptoms associated with diagnosed general medical conditions where the patient's psychobehavioural response to their symptoms is considered "excessive" was also included in the definition and criteria for DSM-IV's "Undifferentiated somatoform disorder" (F45.1 in ICD-10).

For DSM-5, all the Somatoform disorders categories in the previous edition of DSM (DSM-IV) were replaced with a single, new disorder term and construct - Somatic symptom disorder.


For further reading on DSM-5's SSD:

Mislabeling Medical Illness As Mental Disorder Allen Frances (with Suzy Chapman), Psychology Today, DSM 5 in Distress, December 8, 2012

Bad News: DSM 5 Refuses to Correct Somatic Symptom Disorder Allen Frances (with Suzy Chapman), Psychology Today, DSM 5 in Distress, January 16, 2013

Why Did DSM 5 Botch Somatic Symptom Disorder? Allen Frances (with Suzy Chapman), Psychology Today, Saving Normal, February 6, 2013

New Psych Disorder Could Mislabel Sick as Mentally Ill Susan Donaldson James, ABC News, February 27, 2013

Feature: Has the manual gone mental? Michael Gross, Current Biology, Volume 23, Issue 8, R295-R298, 22 April 2013 doi:10.1016/j.cub.2013.04.009

Comment submitted to ICD-11 TAG Mental Health, May 2015 re: Bodily distress disorder Suzy Chapman, May 2, 2015

The new somatic symptom disorder in DSM-5 risks mislabeling many people as mentally ill Allen Frances, BMJ 2013;346:f1580 BMJ Press Release

Somatic Symptom Disorder could capture millions more under mental health diagnosis Suzy Chapman, Dx Revision Watch, May 26, 2012

Submission to DSM-5 SSD Work Group on third draft Suzy Chapman, Dx Revision Watch, June 2012


Journal publications

Allen Frances¹, Suzy Chapman². DSM-5 somatic symptom disorder mislabels medical illness as mental disorder. 1 Department of Psychiatry, Duke University 2 DxRevisionWatch.com
Aust N Z J Psychiatry. 2013 May;47(5):483-4. doi: 10.1177/0004867413484525 http://www.ncbi.nlm.nih.gov/pubmed/23653063

In collaboration with Professor Allen Frances, chair of DSM-IV task force:

Frances A. DSM-5 Somatic Symptom Disorder. J Nerv Ment Dis. 2013 Jun;201(6):530-1. doi: 10.1097/NMD.0b013e318294827c http://www.ncbi.nlm.nih.gov/pubmed/23719325

Frances A. The new somatic symptom disorder in DSM-5 risks mislabeling many people as mentally ill. BMJ. 2013 Mar 18;346:f1580. doi: 10.1136/bmj.f1580 http://www.ncbi.nlm.nih.gov/pubmed/23511949

 

[Molly98]

Well, I have only just caught up on this.
What a load of utter bollocks, but very scary bollocks this is.

If I am going to be labelled as having a mental Health condition I am damn well choosing with one and I go all out for Oppositional Defiant disorder. none of this lame MUS FS PPS shit for me.

I am oppositional and defiant to any health professional or psychobabbler who thinks they have the right to label me, or attempts to treat me with their voodoo.

And I though psychotherapist were suppose to be caring, empathic and good listeners, it seems to me that most of them involved with this have a massive blind spot to the abusive side of their personality where they completely FAIL with a big fat F to listen to what the client is saying and take a truly condescending, paternalistic approach which totally belittles and disrespects the clients true experience, it is so patronising.
They do not recognise the autonomy of the patient.

Their failure to acknowledge the physical basis of our symptoms and put it all down to psychosomatic is abusive as they are using their position of power to enforce their subjective opinion over the client against the client's will and label the client against their will.

Quite Frankly calling the condition I suffer with ( ME) as a psychosomatic or functional condition is abusive and offensive to me, particularly because of how badly we have been treated and how much we have suffered as a community at the hands of psychobabblers.

I do not think that a powerful group who has caused great harm, suffering and discrimination to a marginalised vulnerable group should have any right what so ever in determining and labelling that group and certainly not in treatment. I don't know if there is anywhere else in Western society that this is still considered acceptable anymore.

How is it right that those who have caused us harm in the first place continue to choose how to define us and how to treat us and that definition is used in a derogatory way, to treat us as less than, and less deserving as those that have the label of a 'real' physical health condition, as if we are some inferior species and labelling us in this way leads to further discrimination, ridicule and unfair treatment.

These Therapists have been brainwashed and then want to inflict their brainwashing on us. They are utterly blind to their own prejudices and faulty beliefs. it wouldn't be so bad if the faulty beliefs were about them but they are not they are about us and then they are given free reign to try out their little experiments


I think we have to take a stand against this, in a collective organised way

A standard letter that all of us should give to GP's etc if this approach is recommended would be a start, as would reaching out to fibromyalgia suffers who look like they are going to be treated in the same way, the more of us there are the harder to ignore.

Rant over

 

[Dx Revision Watch]

@Squeezer

Drafts of DSM-5 were released for three public review and comment periods in 2010, 2011 and 2012. I campaigned heavily during those years to encourage professional and lay stakeholders and patient organizations in the US, UK and internationally to submit comments in the three public review exercises.

Copies of submissions are archived on my site here:

https://dxrevisionwatch.com/dsm-5-drafts/dsm-5-ssd-submissions-2010/
https://dxrevisionwatch.com/dsm-5-drafts/dsm-5-ssd-submissions-2011/
https://dxrevisionwatch.com/dsm-5-drafts/dsm-5-ssd-submissions-2012/

There was also a fair bit of media coverage around the drafts of DSM-5 and around the SSD proposals.

In the US, SSD has been added to their version of ICD-10 (known as ICD-10-CM) as an inclusion term under F45.1 Undifferentiated somatoform disorder, and this was also objected to during comment periods.

There is no SSD term within ICD-10. But DSM-5 is used to some extent in the UK by liaison psychiatrists, psychologists and allied professionals.

 

[slysaint]

So many ways to say " we don't know what's wrong with you (but we'll give it a name to show we do)"

 

[slysaint]

Where on earth did they get their "cfs" patients? In every survey done by Leonard Jason, the prefered term is ME.

ME probably wasn't an option............typical pre selected questions

 

[Dx Revision Watch]

ME probably wasn't an option............typical pre selected questions

The study group was asked for preferred umbrella term for a range of illness groups (the so-called FSSs).

The researchers weren't seeking the preferred term for ME, CFS.


https://keats.kcl.ac.uk/pluginfile.php/1208848/mod_folder/content/0/Popular%20term.pdf

"Participants were asked to indicate their three most preferred terms
out of a list of commonly used terms and to provide any extra comments."

"A recent population study looked at the nomenclature preferences of
698 healthy adults. They found that the term “Persistent Physical Symptoms”
was the top preference, followed by “Functional Symptoms” [17].

"The aim of the current study was to find out which umbrella term patients
with chronic fatigue syndrome (CFS) preferred, that could be
used to describe not only their condition, but also illnesses such as IBS
and non-cardiac chest pain. This study was intended to build on
Marks and Hunter's study [17] using a population of patients with CFS
in secondary care."

"Patients were asked to rank their top three preferred terms to
describe conditions that are characterised by a variety of physical symptoms.
Patients were asked: “If you had a physical symptom such as fatigue
or pain that persisted and was found by doctors not to be caused by a particular
disease, which of the following umbrella terms would you prefer
most?”.

The terms included in this survey were:

1) Complex Physical Symptoms,
2) Functional Symptoms,
3) Functional Somatic Syndrome,
4) Functional Syndrome,
5) Bodily Distress Disorder, 6) Bodily Distress Syndrome,
7) Medically Unexplained Symptoms,
8) Medically Unexplained
Physical Symptoms,
9) Persistent Physical Symptoms,
10) Somatoform Disorder,
11) No preference/don't know, and
12) Other.

Participants were given space to add any further comments at the end
of the first page. Participants were also asked to provide demographic
information"

 

[trishrhymes]

It gets worse and worse. They are re-inventing neurasthenia:

Just found this when I searched for neurasthenia:

**************************************************************************************************
'Neurasthenia is characterized by general lassitude, irritability, lack of concentration, worry, and hypochondria. The term was introduced into psychiatry in 1869 by G. M. Beard, an American neurologist. Neurasthenia covers a wide spectrum of symptoms, including painful sensations or numbness in parts of the body, chronic fatigue, anxiety, and fainting. Some medical historians believe that neurasthenia may actually be the same as the modern day disorder of chronic fatigue syndrome.

Also known as: Primary Neurasthenia, Cardiac Neurosis, Chronic Asthenia, Da Costa's Syndrome, Effort Syndrome, Functional Cardiovascular Disease, Soldier's Heart and Subacute Asthenia.

Diagnostic criteria for neurasthenia include:

Persistent and distressing symptoms of exhaustion after minor mental or physical effort including general feeling of malaise, combined with a mixed state of excitement and depression.

Accompanied by one or more of these symptoms: muscular aches and pains, dizziness, tension headache, sleep disturbance, inability to relax and irritability.

Inability to recover through rest, relaxation or enjoyment.

Disturbed and restless, unrefreshing sleep, often troubled with dreams.

Duration of over three months.

Does not occur in the presence of organic mental disorders, affective disorder, panic or generalized anxiety disorder.'

http://www.psychnet-uk.com/x_new_site/DSM_IV/neurasthenia.html

****************************************************************************************************

I'm surprised that wasn't on the list. Didn't they try to get ME put under this heading with the WHO a few years ago? I bet they'll try again.

This does not bode well for the NICE guideline rewrite.

Love the rant @Molly98

And thanks again @Dx Revision Watch for all your hard work.

Maybe it's time for us to try to do a letter writing campaign to all GP commissioning groups and GP practices in the country to try to stop them commissioning this garbage.

@charles shepherd can the MEA do anything about this?

 

[Dx Revision Watch]

Like handing them a shovel and asking them to dig their own grave.

 

[Dx Revision Watch]

It gets worse and worse. They are re-inventing neurasthenia:

Just found this when I searched for neurasthenia:

**************************************************************************************************
'Neurasthenia is characterized by general lassitude, irritability, lack of concentration, worry, and hypochondria. The term was introduced into psychiatry in 1869 by G. M. Beard, an American neurologist. Neurasthenia covers a wide spectrum of symptoms, including painful sensations or numbness in parts of the body, chronic fatigue, anxiety, and fainting. Some medical historians believe that neurasthenia may actually be the same as the modern day disorder of chronic fatigue syndrome.

Also known as: Primary Neurasthenia, Cardiac Neurosis, Chronic Asthenia, Da Costa's Syndrome, Effort Syndrome, Functional Cardiovascular Disease, Soldier's Heart and Subacute Asthenia.

Diagnostic criteria for neurasthenia include:

Persistent and distressing symptoms of exhaustion after minor mental or physical effort including general feeling of malaise, combined with a mixed state of excitement and depression.

Accompanied by one or more of these symptoms: muscular aches and pains, dizziness, tension headache, sleep disturbance, inability to relax and irritability.

Inability to recover through rest, relaxation or enjoyment.

Disturbed and restless, unrefreshing sleep, often troubled with dreams.

Duration of over three months.

Does not occur in the presence of organic mental disorders, affective disorder, panic or generalized anxiety disorder.'

http://www.psychnet-uk.com/x_new_site/DSM_IV/neurasthenia.html

****************************************************************************************************

I'm surprised that wasn't on the list. Didn't they try to get ME put under this heading with the WHO a few years ago? I bet they'll try again.

This does not bode well for the NICE guideline rewrite.

Love the rant @Molly98

And thanks again @Dx Revision Watch for all your hard work.

Maybe it's time for us to try to do a letter writing campaign to all GP commissioning groups and GP practices in the country to try to stop them commissioning this garbage.

@charles shepherd can the MEA do anything about this?

Neurasthenia is being retired for ICD-11 (it is subsumed into Bodily distress disorder).

It is unlikely that any changes to ICD-10 would be approved by WHO.

The erroneous listing of ME under F48.0 was not in the WHO's ICD-10. It was a UK adaptation of WHO material for a UK Primary Care publication - not the official ICD-10, which cannot be changed without WHO sanction.