Nielk
Senior Member
- Messages
- 6,970
This is probably a simplistic question but, why do they think that one million previously sane, active, happy people would all of a sudden choose a life of misery, isolation and disgrace?
Welcome to Phoenix Rising!
Created in 2008, Phoenix Rising is the largest and oldest forum dedicated to furthering the understanding of and finding treatments for complex chronic illnesses such as chronic fatigue syndrome (ME/CFS), fibromyalgia (FM), long COVID, postural orthostatic tachycardia syndrome (POTS), mast cell activation syndrome (MCAS), and allied diseases.
To become a member, simply click the Register button at the top right.
To my mind, Dr. Jason's work is sometimes lacking in professional propriety. I'm not sure how you can claim to have revised the work of others, as he claims to have done in “The development of a revised Canadian myalgic encephalomyelitis-chronic fatigue syndrome case definition.” At best, you can propose your own modified version.Jason has published an enormous amount of work, and I think it might be necessary to read some of it to find out where he is coming from....
Anyway, I think that Jason is a top quality researcher, and this is simply part of his rigorous research.
So comorbit depression and anxiety mean almost nothing in the big picture, though hard on patients, but any claim to somatization needs to be questioned. Does Lenny say anything about psychogenic illness in the paper, does anyone know?
"Katon and Russo (1992) have argued that a requirement of more symptoms to meet criteria could inadvertently select for individuals with psychiatric problems. Similarly, Kroenke (2003) found similar results examining 15 variables within a fatigued sample. Upon examination of 13 of these 15 variables in the sample, we found that a greater number of symptoms was associated with increased psychiatric comorbidity. In addition, those who met the ME-ICC classification had significantly more Kroenke symptoms than those that met the Fukuda CFS criteria. Thus while the ME-ICC criteria are an improvement over the vague and minimal guidelines of Fukuda and colleagues (1994), it is possible that the ME-ICC criteria select for individuals with increased psychiatric symptoms and functional impairment."
"Based on the present analyses, the ME-ICC criteria appear to select a more functionally impaired and symptomatic group of individuals, with regards to both mental and physical health, when compared to a group who only meet the Fukuda criteria. However, the present study had a number of limitations. The questions used to tap the domains of the ME-ICC were not specifically designed for this purpose, and thus some symptoms were not ideally operationalized."
I'm not sure either how you maintain your role as objective arbitror, validating definitions, while at the same time promoting your own competing measures. At what point does conflict of interest become an issue?
Unfortunately the results of the SCID are pretty meaningless until he reveals how he treated symptoms like inability to read, watch TV, or socialize, as well as insomnia, hypersomnia, mild or severe cognitive problems, feeling weak, and being totally drained after minimal physical activity. The DSM-IV specifically lists these as indicating depression when the patient is to shy to acknowledge feeling depressed. And with the SCID it's very much up to the researcher/psychiatrist to decide whether or not to attribute them to a biological disease and therefore not interpret them as indicating depression.He simply reports the finding that a proportion of patients had comorbid psychiatric illness, based on the SCID. (Using the various SF-36 subscale scores, there was no increase in any psychiatric presentation, but there was when using the SCID.)
Yes, and why would people who can't obtain a diagnosis have formed false illness-beliefs about having ME?This is probably a simplistic question but, why do they think that one million previously sane, active, happy people would all of a sudden choose a life of misery, isolation and disgrace?
In the current study, the ME-ICC case definition criteria identified a subset of patients with more functional impairments and physical, mental and cognitive problems than the larger group of patients meeting the Fukuda et al. (1994) criteria. In addition, higher rates of psychiatric co-morbidity were found in the ME-ICC condition, a finding that might have been influenced by requiring a higher number of symptoms to meet the ME-ICC case definition.
I've read the paper, and as far as my memory serves me, there is absolutely no mention of anything like 'psychosomatic' or 'somatization' etc, or anything else along those lines. He simply reports the finding that a proportion of patients had comorbid psychiatric illness, based on the SCID. (Using the various SF-36 subscale scores, there was no increase in any psychiatric presentation, but there was when using the SCID.) Jason doesn't infer anything from the results.
It's a fairly short paper, and I've selected a couple of paragraphs that I think are the most significant from the conclusion (I'm not sure how much I can legally post, so I might delete some of this later):
See pages 9 – 10 of the CCC Guidelines for “Differences Between ME/CFS and Psychiatric Disorders,” including “Depression” and “Somatoform Disorder.”As others have said, we would expect more severe patients to have more psychological issues, which might allow a comorbid psychiatric diagnosis.
One thing that always concerns me though is if symptoms of ME are similar to symptoms of depression, how do they distinguish them?
According to the list of exclusions, nobody diagnosed with a primary psychiatric disorder should have been given an ME-ICC diagnosis.In the current study, the ME-ICC case definition criteria identified a subset of patients with more functional impairments and physical, mental and cognitive problems than the larger group of patients meeting the Fukuda et al. (1994) criteria. In addition, higher rates of psychiatric co-morbidity were found in the ME-ICC condition, a finding that might have been influenced by requiring a higher number of symptoms to meet the ME-ICC case definition.JasonBrown et al used the SCID (Structured Clinical Interview for DSM-IV) to establish Axis I psychiatric diagnoses. It appears that the SCID was administered before the medical assessment.
One thing that always concerns me though is if symptoms of ME are similar to symptoms of depression, how do they distinguish them? I suspect many of the instruments they are using should be called blunt instruments.
Cort Johnson says:
April 30, 2013 at 12:02 pm
Lenny Jason sent an email stating that he’s following the discussion and that he’s “benefited from the excellent discussion and consideration of important issues.” and he added some clarifications. It also appears that an updated study soon in a appear in the IACFS/ME Fatigue journal may have not found increased mental issues in patients that meet the CCC criteria.
This just makes me glad that we have someone like Lenny who is addressing these issues in an organized manner:
For those that want my take on the issue of whether those with CFS can be differentiated from those with Major Depressive Disorder, I had worked on that issue an number of years ago with a graduate student, and our article that was published indicated that it was possible with the right symptoms and scoring to differentiate these conditions with 100% accuracy.
The article has this reference and the abstract is below:
Hawk, C., Jason, L.A., & Torres-Harding, S. (2006). Differential diagnosis of chronic fatigue syndrome and major depressive disorder. International Journal of Behavioral Medicine, 13, 244-251. PMID: 17078775
The goal of the present study was to identify variables that successfully differentiated patients with chronic fatigue syndrome (CFS), major depressive disorder (MDD) and controls. Fifteen participants were recruited for each of these three groups, and discriminant function analyses were conducted. Using symptom occurrence and severity data from the Fukuda and colleagues (1994) definitional criteria, the best predictors were post-exertional malaise, unrefreshing sleep, and impaired memory and concentration. Symptom occurrence variables only correctly classified 84.4% of cases, whereas when using symptom severity ratings, 91.1% were correctly classified. Finally, when using percent of time fatigue was reported, post-exertional malaise severity, unrefreshing sleep severity, confusion / disorientation severity, shortness of breath severity, and self-reproach to predict group membership, 100% were classified correctly.
I also have a paper that will appear very soon in the new Fatigue journal, and the reference and abstract are below, and this might also be of interest to your readers:
Jason, L.A., Brown, A., Evans, M., & Sunnquist, M. (in press). Contrasting Chronic Fatigue Syndrome versus Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Fatigue: Biomedicine, Health & Behavior
Abstract
Background: Much debate is transpiring regarding whether chronic fatigue syndrome (CFS) and myalgic encephalomyelitis (ME) are different illnesses. Methods: This article used data from three distinct samples to compare patients who met criteria for the myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) Canadian clinical case definition [1] to those who met the Fukuda et al. CFS case definition.[2] Purpose: Several prior studies that compared the Fukuda et al. CFS criteria to the Canadian criteria found that the Canadian criteria identified patients with more functional impairments and physical, mental, and cognitive problems than those who met Fukuda et al. criteria.[3,4] These samples were located in the Chicago metropolitan area, so the results could not be generalized to other locations. In addition, past studies used a symptom questionnaire that was not specifically developed to tap the Canadian criteria. The present study corrected these problems. Results: Findings indicated that fewer individuals met the Canadian criteria than the Fukuda et al. criteria, and those who met the Canadian criteria evidenced more severe symptoms and physical functioning impairment. Conclusions: Future research should continue to compare existing case definitions and determine which criteria best select for this illness.
Regards,
Lenny
biophile said:Brown et al used the SCID (Structured Clinical Interview for DSM-IV) to establish Axis I psychiatric diagnoses. It appears that the SCID was administered before the medical assessment. The authors note the potential problem of wrongly assigning medical symptoms to psychiatric categories in the assessment of symptoms which overlap between CFS and psychiatric disorders, state that the SCID helpfully allows for clinical judgement in the assignment of symptoms, and cite a psycho-diagnostic study (Taylor & Jason, 1998) which validated the use of the SCID in a sample of patients with CFS. I am not sure if the SCID is good enough (especially if done before a ME or CFS diagnosis), but for its potential faults, the SCID is still better than some other methods. The rates of psychiatric comorbidity were 27% for Fukuda defined CFS and 61.5% for ICC defined ME, and the difference was highly statistically significant (p=0.001). There are no details about which psychiatric diagnoses were made in either group, which is unfortunate.
Ember said:According to the list of exclusions, nobody diagnosed with a primary psychiatric disorder should have been given an ME-ICC diagnosis.
According to the list of exclusions, nobody diagnosed with a primary psychiatric disorder should have been given an ME-ICC diagnosis.
Leaving aside how reliably in such circumstances a distinction can be made between primary and secondary depression, that exclusion opens the door to psychs being able to avoid ever having to deal with the possibility of a primary ME (or CFS) diagnosis by simply diagnosing primary depression (or whatever) in the first place.
I don't see why primary depression and ME (or CFS) are mutually exclusive, nor why one should take causal precedent over the other, in the regular clinical setting. (The exclusion requirement is not a problem in a research setting where it is important to get a 'clean' sample, with minimal co-morbidities.)
I think in both cases (research and clinical diagnosis), psychiatric assessment needs to be done with an open mind. If the patient doesn't 'fess up to being depressed, it's very presumptuous to then use physical and cognitive symptoms to assume depression and shut the door on other possibilities.A psychiatric assessment does need to be done before a ME diagnosis can be made. I just wonder how the research team, after acknowledging the problem of wrongly assigning medical symptoms to psychiatric categories, can best make such decisions if the psychiatric interview is done first without any knowledge about the patient's medical status.
This particular paper is quite a small exploratory study, and all he seems to be saying is that ICC patients have a higher incidence of comorbid psychiatric issues than Fukuda patients.