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Sharpe: Somatic symptom count scores do not identify patients with symptoms unexplained by disease:

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13,774
http://www.ncbi.nlm.nih.gov/pubmed/24935983

Somatic symptom count scores do not identify patients with symptoms unexplained by disease: a prospective cohort study of neurology outpatients.
Carson AJ1, Stone J2, Hansen CH3, Duncan R4, Cavanagh J5, Matthews K6, Murray G7, Sharpe M8.
Author information
Abstract

OBJECTIVE:
Somatic symptoms unexplained by disease are common in all medical settings. The process of identifying such patients requires a clinical assessment often supported by clinical tests. Such assessments are time-consuming and expensive. Consequently the observation that such patients tend to report a greater number of symptom has led to the use of self-rated somatic symptom counts as a simpler and cheaper diagnostic aid and proxy measure for epidemiological surveys. However, despite their increasing popularity there is little evidence to support their validity.

METHODS:
We tested the score on a commonly used self-rated symptom questionnaire- the Patient Health Questionnaire (PHQ 15) (plus enhanced iterations including an additional 10 items on specific neurological symptoms and an additional 5 items on mental state) for diagnostic sensitivity and specificity against a medical assessment (with 18 months follow-up) in a prospective cohort study of 3781 newly attending patients at neurology clinics in Scotland, UK.

RESULTS:
We found 1144/3781 new outpatients had symptoms that were unexplained by disease. The patients with symptoms unexplained by disease reported higher symptoms count scores (PHQ 15: 5.6 (95% CI 5.4 to 5.8) vs 4.2 (4.1 to 4.4) p<0.0001). However, the PHQ15 performed little better than chance in its ability to identify patients with symptoms unexplained by disease. The findings with the enhanced scales were similar.

CONCLUSIONS:
Self-rated symptom count scores should not be used to identify patients with symptoms unexplained by disease.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Maybe a worthwhile reference for someone? I've not read the whole thing.

The way some tried to argue that a high symptom count was good evidence of MUS/hysteria/functional symptoms/whatever always seemed silly to me.
 
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Sharpe's listed dead last, so probably had very little involvement or control over the contents. But it's nice that his name is on it, as he shouldn't have an excuse to play stupid now.
 

Sasha

Fine, thank you
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Location
UK
Sharpe's listed dead last, so probably had very little involvement or control over the contents. But it's nice that his name is on it, as he shouldn't have an excuse to play stupid now.

Weirdly, in medical papers, the first author listed is the main author and the next most important author is often listed last.
 

Bob

Senior Member
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16,455
Location
England (south coast)
I think the order of names can vary. I've occasionally seen senior researchers listed last, but more often I think I've seen minor players and external consultants listed last.
 

alex3619

Senior Member
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Location
Logan, Queensland, Australia
In this context its about neurology patients ... and we do not yet understand the brain. The most likely explanation is the simple one: there is lots of stuff we still don't know, and so all that can be said about the symptoms is that the cause is unknown and is worthy of further study.

From the abstract (I have not read the full paper) the conclusion appears fine taken in isolation:

CONCLUSIONS:
Self-rated symptom count scores should not be used to identify patients with symptoms unexplained by disease.
 

Bob

Senior Member
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Location
England (south coast)
I've only read the abstract, but I wonder if my interpretation is correct that neurologists use the PHQ15 as a short-cut to assessing their patients to decide if they have medically unexplained symptoms (i.e. to decide whether to dismiss their patients as 'somatisers'), and now they've discovered that the PHQ15 is useless. If so, it all seems rather corrupt.
 

Min

Guest
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UK
Must admit I had hoped that Sharpe, who called us " the undeserving sick of our society and our health service.” had retired.
 

Bob

Senior Member
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16,455
Location
England (south coast)
The way some tried to argue that a high symptom count was good evidence of MUS/hysteria/functional symptoms/whatever always seemed silly to me.
It's been proposed that the ICC selects a higher rate of non-ME patients (i can't remember if it was suggested that it selects somatising patient or patients with other psychological disorders) because of its requirement for a higher number of symptoms. (Was it Lenny Jason who proposed this?) I've never understood that argument, or how he came to that conclusion. I wonder if the assertion is based on one of these somatic symptom questionnaires like the PHQ15? I'll make a point of looking out for that if I come across Jason's research again. (Caveat: my memory about this is so vague that I might have it all wrong.)
 

worldbackwards

Senior Member
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2,051
Must admit I had hoped that Sharpe, who called us " the undeserving sick of our society and our health service.” had retired.
He'll live forever. When the holocaust comes, it'll be him, Wessely and some cockroaches left standing.
 
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15,786
It's been proposed that the ICC selects a higher rate of non-ME patients (i can't remember if it was suggested that it selects somatising patient or patients with other psychological disorders) because of its requirement for a higher number of symptoms. (Was it Lenny Jason who proposed this?) I've never understood that argument, or how he came to that conclusion.
I'm pretty sure he said that the ICC selects for more patients who also fulfill criteria for somatization disorders or similar. My conclusion (not his) was that the problem is obviously with the diagnostic criteria for somatization disorders :p
 

Min

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Esther, Sharpe said this of ME/ CFS patients in 1999:

“Those who cannot be fitted into a scheme of objective bodily illness yet refuse to be placed into and accept the stigma of mental illness remain the undeserving sick of our society and our health service


How have these doctors, who harm us so badly, got away for all these years with ignoring the fact that our illness is classified as neurological? It is monstrous.
 

Scarecrow

Revolting Peasant
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Location
Scotland
Re the Sharpe quotation, here's the horse's mouth, so to speak. To be fair to Sharpe, the very blunt sentence has to be read in context. He did NOT suggest that PWCFS are 'the undeserving sick'.

The history of CFS has its roots clearly in the last
century. The issues surrounding it are shared with a
number of other poorly understood or 'medically
unexplained' illnesses.

Despite the age and size of this problem it seems that
we have made little progress in achieving an
understanding that permits effective treatment to be
offered to and accepted by those affected.

Those who cannot be fit into a scheme of objective
bodily illness yet refuse to be placed into and accept
the stigma of mental illness remain to paraphrase
Bernard Shaw the undeserving sick of our society and
our health-service.


However things are changing. Neuroscience is breaking
down the barrier between mind and brain. Doctor patient
relationships are changing to give more credence to the
patient's subjective experience. The collaborative
integrative approach of good CBT provides one model of
how we could proceed.

Perhaps we will do better in the next century. I hope
so.

http://www.meactionuk.org.uk/ME_-_What_do_we_Know_-_October_1999_-_310805.pdf

Of course his basic stance is nonsense but if you're going to accuse him, accuse him for the right thing.

p.s. The title of the lecture 'ME - What do we Know?' was pretty amusing. Not much, in his case.

 
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Scarecrow

Revolting Peasant
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Scotland

This is how I interpreted what he meant, again from his own words:

Michael’s comment he posted here to my reproducing this text was:

A very well constructed website. And I agree that patients with CFS and related condition suffer as the undeserving sick of modern society. But if you read Pygmalion by Bernard Shaw you will understand that that is a criticism of social morals and conventions – not a literal statement!
MS
 

Simon

Senior Member
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Location
Monmouth, UK
The Study said:
Somatic symptoms unexplained by disease
They mean 'unexplained by known/identified disease' ie it should actually be a "we can't find a disease to account for the symptoms" diagnosis, not a "there is no disease" diagnosis. That's a pretty important distiction, one you'd hope the researchers would have been able to make for themselves.