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Chemobrain (& CFS): critical review & causal hypothesis [=somatoform via biomed]

adreno

PR activist
Messages
4,841
It is probably far better established than the causal role of viruses in ME/CFS, yet I bet if posted up a new study that found a link between enterovirus or herpes viruses and ME/CFS, people here would not say "I reject the assertion that ME/CFS can be caused by viruses".
Completely unrelated in my view, but the main point is that studies must stand up to scrutiny. It's not enough to have something published, but the methodology and analysis must hold up. But I understand it can be difficult for people with no scientific background to evaluate research.
 

Hip

Senior Member
Messages
17,824
The problem with your statement is the sleight of hand involved. You've equated my brother's vasovagal syncope due to being upset just at the thought of blood with the reaction that I get when I've been standing in a queue for too long.

No, it is not me who has equated it. It appears to medically accepted that vasovagal syncope can have various different triggers.

Of course, if you can find some studies casting doubt over current medical understanding of the triggers of vasovagal syncope, I'd by more than happy to read them. But as far as I can see, there is no medical controversy here. So far, it's just the opinion a few people here current medical understanding on vasovagal syncope is wrong.
 

Large Donner

Senior Member
Messages
866
As I explained, I have come across this before in my reading about ME/CFS. Perhaps people need to do more background reading about ME/CFS.

Can you explain to me the mechanism that is at play when a healthy person gets a sudden shock, their heart rate rockets then stabilizes doesn't cause any other effects other than they maintain a standing position and don't feel dizzy. Secondly use the same example with a person with a heart condition or difficulty standing due to PoTS. Then explain why the first example is not considered psychosomatic. Psycho due to the emotional shock raised heart rate then corrected heart rate and somatic due to the mechanism that keeps their body upright?

Is this psychosomatic? According to your logic it should be, therefore according to your ongoing logic both examples would be psychosomatic and would have no differentiation medically, therefore disqualifying the very notion of the psychosomatic component being related to the person with ill health.

Both examples started with the same event followed a physical mechanism and ended in a different result.
 
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Scarecrow

Revolting Peasant
Messages
1,904
Location
Scotland
Of course, if you can find some studies casting doubt over current medical understanding of the triggers of vasovagal syncope,
I think you must have misunderstood my post if you think I'm disagreeing with you about triggers. Not all triggers are relevant to ME/CFS.
 

Large Donner

Senior Member
Messages
866
It's not a rational model. It creates complex relationships between multiple factors, when it can be explained in much simpler terms as a direct relationship between a biological cause and the symptoms. There's no need or basis for inserting an unproven intermediary in the form of psychosomatism.


Awww poor little scientists all they want is to tag along with a few little words like stress related and bla bla bla ........ component, so they can stay on the gravy train forever and you are taking this all away from them with common sense and logic. Even their peers dont do this to them.

Don't you get it they wanted to be real doctors but they just couldn't be bothered, you are so mean.

Are you one of those terrible ME militants?
 

Hip

Senior Member
Messages
17,824
They are definitely hypothesising that chemobrain is a somatoform disorder but they're using the term 'somatoform' in a way that I'm unfamiliar with; They say that the chemobrain patients are perceiving cognitive impairment, but because their perceived (subjective) cognitive impairment doesn't match what can be objectively measured in cognitive tests (i.e. cognitive tests are normal), it means that the symptoms are a false interpretation of reality (i.e. patients are perceiving impairment that doesn't exist), and so it is a somatoform disorder, despite other measurable biological abnormalities.

Technically the definition of somatoform does not automatically imply a psychological cause; it can be a physiological cause as well; though there is often an underlying assumption of a likely psychological cause, so to class a disease as somatoform tends to "tar" the disease as psychologically-caused.

But technically, somatoform is different to psychosomatic. Psychosomatic always means there is a psychological component to the symptoms (and always means the symptoms are objectively measurable); whereas somatoform can mean either a psychological or physiological cause to the symptoms (and always means the symptoms are not objectively measurable; they are only subjectively detected).



But to conclude that the cognitive impairment isn't real seems like quite a jump in reasoning to me, as there could be a number of reasons why subjective experience doesn't match objective tests (e.g. the tests could be inadequate or they could be measuring the wrong thing. They acknowledge that cognitive studies have been small and underpowered.)

I have not looked at the paper in detail, but would first question the level of ME/CFS severity of the patients tested. Mild ME/CFS patients I imagine are not going to be too bad cognitively; we know this anyway, because lots of mild ME/CFS patients work. Whereas moderate and severe patients I expect are going to have far greater levels of cognitive impairment.

The other thing is nature of the cognitive tests. What are the tests measuring? I personally find that simple low-level cognitive tasks that are not complex (ie, do not have many components) I perform OK at. So if these were the type of cognitive tests used, that could explain why why subjective experience doesn't match objective tests.

But high level tasks that (a) require a bird's eye mental overview of the situation in order perform, and (b) have many complex interrelating facets, I perform very badly on.

Case in point is writing computer software. This was my profession, and I could write complex software blindfolded and with my hands tied behind my back. But now with ME/CFS, writing software is beyond me.



They have chosen - without explaining why, as far as I can see - to categorise mecfs as a non-pathological biological process, as opposed to a pathological one.

That choice itself would seem to be a subjective one. Just as some argue that for example ADHD or Asperger's are within the bounds of normal human experience. That is an arbitrary setting of what is normal and what is abnormal.

Seems a rather foolish statement, though, given that there is a huge spectrum of severity of ME/CFS, as well as ADHD and autism spectrum disorders.

One could possibly argue that very mild ME/CFS, where people still go to work, is within the normal bounds of human experience (I wouldn't argue this myself, but I can follow the argument). However, when you have a severe ME/CFS patient who is mostly bedbound, and extremely cognitively challenged, under no stretch of the imagination can you consider that normal.
 

chipmunk1

Senior Member
Messages
765
But technically, somatoform is different to psychosomatic.

Somatoform means there is no physical cause for your symptoms which implies that it is mental.

No doctor telling you you have somatoform disorder believes that you are physically ill.

WebMD is pretty honest and blunt.

Somatoform disordersare mental illnesses that cause bodily symptoms, including pain. The symptoms can't be traced back to any physical cause. Andtheyarenottheresultofsubstanceabuseoranothermentalillness.

Treatment of Somatoform Disorders
Patients who experience unexplained physical symptoms often cling to the belief that their symptoms have an underlying physical cause, despite evidence to the contrary

http://www.webmd.com/mental-health/somatoform-disorders-symptoms-types-Treatment
 

Hip

Senior Member
Messages
17,824
As for your question on POTS, I don't follow what you are asking. But if you are asking whether POTS is psychosomatic, then the answer is no, is it not (as far as I am aware). Neither is orthostatic hypotension psychosomatic, which is the third type of orthostatic intolerance that ME/CFS patients can suffer from.
 
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Hip

Senior Member
Messages
17,824
Somatoform means there is no physical cause for your symptoms which implies that it is mental.

Somatoform relates to the experience of bodily symptoms or sensations, and somatoform means that there is no detectable physical cause in your body (like a lesion or inflammation) that could give rise or explain those symptoms. So for example, if you feel pain in your stomach, but there is no detectable abnormalities in the stomach, that can be classed as a somatoform symptom.

However, that does not exclude the possibility that something is physically amiss in your brain or the wiring of nervous system that creates the sensation of pain. So for example central sensitization could provide a physiological explanation for somatoform symptoms.
 

chipmunk1

Senior Member
Messages
765
However, that does not exclude the possibility that something is physically amiss in your brain or the wiring of nervous system that creates the sensation of pain. So for example central sensitization could provide a physiological explanation for somatoform symptoms.

If we look at this historically, very likely somatoform disorder is not a single disorder. It can be anything that medicine does not understand.

It does not tell us anything about the patient or the illness but something about the physician.
 

Bob

Senior Member
Messages
16,455
Location
England (south coast)
Most types of cognitive testing for ME patients has normal results, but researchers have now found that ME patients do have measurable differences in some specific cognitive tasks related to multi-tasking. (In simple tasks we have no measurable differences.)
Does anyone happen to have handy references for this research? Not sure if my records are systematic enough.
maybe you'll find something here? plenty of references to other studies:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3655280/
That's perfect! Thanks so much for that, mango :thumbsup:

I can't remember seeing that paper before, and it jogged my memory because it included the papers that I had been thinking of, as follows...

A study that confirms specific types of cognitive deficits in ME patients:
Togo F, Lange G, Natelson BH, Quigley KS.
Attention network test: Assessment of cognitive function in chronic fatigue syndrome.
J Neuropsychol. 2015;9:1-9.
http://www.ncbi.nlm.nih.gov/pubmed/24112872

Meta analysis (2010) of cognitive deficits in ME patients:
Cockshell SJ, Mathias JL.
Cognitive functioning in chronic fatigue syndrome: a meta-analysis.
Psychol Med 2010;40:1253-67.
http://www.ncbi.nlm.nih.gov/pubmed/20047703

Also:
Cockshell SJ, Mathias JL.
Cognitive deficits in chronic fatigue syndrome and their relationship to psychological status, symptomatology, and everyday functioning.
Neuropsychology. 2013;27:230-42.
http://www.ncbi.nlm.nih.gov/pubmed/23527651
 
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Hip

Senior Member
Messages
17,824
It does not tell us anything about the patient or the illness

I tend to agree, if it is assumed that the cause of the somatoform symptoms is psychological (which it unfortunately often is). That's usually an excuse for lots of psychobabble, abandonment of biomedical research, and doctors dismissing patients.

However, if we assume that somatoform symptoms have a physiological cause in the nervous system (such as central sensitization, or autoantibodies disrupting neuronal receptors), then that paints a different picture — and a different avenue for research.

The third option is that those symptom which are currently classified as somatoform will turn out to have a real physical cause in the body, such as low level chronic intracellular infection in the tissues.


I don't like the use of the term somatoform, though, because it often connotes an "all in the mind" psychological cause to the symptoms.



It should be pointed out that the purely mental symptoms of ME/CFS, the symptoms that have no bodily component, cannot be classed as somatoform, because somatoform only refers to symptoms or sensations that come from the body (or at least appear to come from the body).

So, for example, purely mental symptoms such as brain fog, short-term memory problems, emotional lability, emotional sensitivity cannot be classed as somatoform, by the definition of somatoform.
 
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Hip

Senior Member
Messages
17,824
Yeah, or just because the evidence in favor of the psychosomatic model of disease is crap.

But I am in agreement with that. I have not seen much evidence for any disease being fully psychosomatic (ie, the entire physical disease being due to psychological / stress causes). Except perhaps the shell shock illness that occurred during WW1, which could be fully psychosomatic (although other theories state that the shock waves from exploding shells could have damaged the nervous system, leading to the involuntary physical shaking of shell shock).

However, it should not be denied that some diseases can have a psychosomatic component. Conditions like eczema, psoriasis, blood pressure, and heart disease are aggravated by stress.

And any man that has failed to perform on the night, so to speak, in terms of anxiety-induced erectile dysfunction, knows full well how stress can affect bodily function. Of course I am not admitting to that aliment!
 
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lansbergen

Senior Member
Messages
2,512
So, for example, purely mental symptoms such as brain fog, short-term memory problems, emotional lability, emotional sensitivity cannot be classed as somatoform, by the definition of somatoform.

So you decided short-term memory problems is mental. Well I see it as a brain problem.
 

Hip

Senior Member
Messages
17,824
Then again: What is mental? Definition please.

We are not going around and around that same roundabout again are we? Even when we have these mind / brain conversations, and explanations are discussed, people keep coming back to the same topic again, and nothing is established.
 
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Large Donner

Senior Member
Messages
866
Then again: What is mental? Definition please.

You wont get one, (a scientific definition of mental) especially as related to the theory of an existence of something described as psychosomatic. Nor will you get a photograph of the mind or a report of an autopsy on the mind or even an artist impression, I've asked before.

But if you want the brain in the above formats I can show you them all day long.

There is such a claim of the mind though, no doubt there's even a "razor sharp" definition of one, apparently that's good enough. Especially if you find a link to someone else saying it, then by default it is proof of a mind body connection.
 
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