The 12th Invest in ME Research Conference June, 2017, Part 2
MEMum presents the second article in a series of three about the recent 12th Invest In ME International Conference (IIMEC12) in London.
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The presence of co-morbid mental health problems in a cohort of adolescents with CFS

Discussion in 'Latest ME/CFS Research' started by hixxy, Nov 4, 2017.

  1. hixxy

    hixxy Senior Member

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    Clin Child Psychol Psychiatry. 2017 Oct 1:1359104517736357. doi: 10.1177/1359104517736357. [Epub ahead of print]

    The presence of co-morbid mental health problems in a cohort of adolescents with chronic fatigue syndrome.

    Loades ME, Rimes KA, Ali S, Lievesley K, Chalder T.

    Abstract

    OBJECTIVE:
    To report on the prevalence of mental health disorders in adolescents with chronic fatigue syndrome (CFS) and to compare the diagnoses identified by a brief clinician-administered psychiatric interview with self-report screening questionnaires.

    DESIGN:
    Cross-sectional study.

    SETTING:
    Consecutive attenders to specialist CFS clinics in the United Kingdom.

    PATIENTS:
    N = 52 adolescents, age 12-18 years with CFS.

    MEASURES:
    Self-report questionnaires and a brief structured psychiatric diagnostic interview, administered by a researcher.

    RESULTS:
    On the psychiatric interview, 34.6% met a diagnosis of major depressive disorder and 28.8% had an anxiety disorder. Of these, 15% had co-morbid anxiety and depression. Those with a depression diagnosis reported significantly greater interference on the school and social adjustment scale. They also scored significantly higher on trait anxiety, but not on state anxiety. There were no differences between those who had an anxiety disorder and those who did not on fatigue, disability or depressive symptoms. Children's Depression Inventory (CDI) score was associated with a depression diagnosis on the psychiatric interview. However, neither the state nor the trait subscale of the State-Trait Anxiety Inventory (STAI) was associated with an anxiety diagnosis.

    CONCLUSION:
    Clinicians should assess for the presence of anxiety and depressive disorders in adolescents with CFS using a validated psychiatric interview. Treatment should be flexible enough to accommodate fatigue, depression and anxiety. Transdiagnostic approaches may suit this purpose. Goals should include pleasurable activities particularly for those who are depressed.

    KEYWORDS:
    CFS/ME; Chronic fatigue syndrome; MINI-KID; adolescents; anxiety; depression

    https://www.ncbi.nlm.nih.gov/pubmed/29096528
    http://journals.sagepub.com/doi/10.1177/1359104517736357
     
    Last edited: Nov 4, 2017
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  2. duncan

    duncan Senior Member

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    :meh:

    Trudie. :bang-head:
     
  3. ebethc

    ebethc Senior Member

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    OBJECTIVE:
    To report on the prevalence of mental health disorders in adolescents with chronic fatigue syndrome (CFS) and to compare the diagnoses identified by a brief clinician-administered psychiatric interview with self-report screening questionnaires.

    ==

    I swear, UK psychologists are on a mission to make ppl believe that CFS is a mental illness.....

    It's highly likely that ANYONE w a chronic illness doesn't have to manage co-morbid mental health disorders PLUS there's no way to distinguish if the depression is "co-morbid" w being an adolescent (hormonal changes, bullying, social pressure, divorced parents/family situation, etc.) OR it could be that an individual has mental health issues separate from adolescence OR it's co-morbid w a separate health issue OR it is indeed co-morbid w CFS ... Teenagers are not likely to give accurate "self-reporting" because they likely can't distinguish these differences.... Shame on the "adults" for not helping - and possibly harming - these kids.

    Quacks.
     
    Last edited: Nov 4, 2017
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  4. Hip

    Hip Senior Member

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    PR's own poll found the rate of depression in ME/CFS was 37.6%, which is similar to the 34.6% figure found in this study.
     
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  5. duncan

    duncan Senior Member

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    @Hip, what a load of crap.
     
  6. ebethc

    ebethc Senior Member

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    Core question: is depression a primary or secondary issue in CFS?

    Why important?: drives tx plan, funding, general understanding of the illness

    results of some quick googling... Much more

    e.g. What's the rate in any chronic illness?
    "Researchers found that patients with an autoimmune disease were 45 percent more likely to have a mood disorder, while any history of infection increased the risk of a mood disorder by 62 percent. About one-third of people diagnosed with a mood disorder had been hospitalized in the past for a serious infection. "
    https://www.healthline.com/health-n...-tied-to-autoimmune-diseases-infection-061213

    50% of MS patients vs 20% of gen'l population will become depressed
    https://mymsaa.org/PDFs/MSAA.Depression.0507.pdf

    45% higher rate of depression & anxiety women w lupus (one man in study, so leaving his results out)
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678948/



    --
    I also think the points made in this letter are excellent, and add good context to these types of discussions.... The field of psychology could use a lot more scientific rigor... It's surprising that insurance cos. pay them at all, considering the lack of objective evidence... but why should they expected to do more when they get paid for doing less??

    (now former) NIMH Director Dr Thomas Insell
    "Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment."

    https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2013/transforming-diagnosis.shtml
     
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  7. Hip

    Hip Senior Member

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    What specifically are you saying is a load of crap?

    If you are one of the ME/CFS patients who suffers from depression, it's a further burden and misery for you. I know, because I am one of those patients who gets hit with depression, and mine is hard to treat.
     
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  8. Hip

    Hip Senior Member

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    I think it would be considered a secondary condition, ie, a comorbid condition to ME/CFS. It's not surprising to see depression in ME/CFS, given that depression is also common in other neurological or autoimmune conditions, as you have pointed out above.
     
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  9. duncan

    duncan Senior Member

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    @Hip,
    At the very least, how do they define CFS? Clearly they r buying into the CDC nonsense that it is excess fatigue.
     
    Last edited: Nov 5, 2017
  10. ebethc

    ebethc Senior Member

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    EXACTLY.

    It's a crucial distinction that's not noted in the study at all, which helps conflate the issues and perpetuate the crawley type nonsense. NOT good for us, IMO... Impacts funding (e.g., why look for biomarkers when it's all in yer head!), etc. ...

    BTW - the study was done by either psychologists or psychiatrists, who are not science motivated - hence my inclusion of the excellent NIMH letter.
     
  11. duncan

    duncan Senior Member

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    We need to be offended by these types of question.
     
    Last edited: Nov 5, 2017
  12. Hip

    Hip Senior Member

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    The distinction is clearly made by the word "co-morbid" in paper title, which the dictionary defines as "relating to or denoting a medical condition that co-occurs with another." The study of disease comorbidities (observing which comorbid illnesses are statistically more common in a given disease) is an important part of medical science. Thus the authors are clearly saying that major depression and anxiety are separate medical conditions that are found in ME/CFS.

    I see nothing wrong with studies like this, provided that the authors don't start suggesting that psychogenic factors are the cause of ME/CFS. Provided that ME/CFS is viewed as an organic disease, there is nothing wrong with examining the incidence of comorbidities such as depression. These type of studies on depression incidence are performed on other illnesses as well.
     
    Last edited: Nov 5, 2017
  13. alex3619

    alex3619 Senior Member

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    How do you validate such a psych interview with ME or even CFS? Until we have diagnostic markers for both depression and ME then we have no validated methods. Anxiety in an ME patient might be fully justified, it depends on the details.
     
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  14. duncan

    duncan Senior Member

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    You are so weird. lol

    Other disputed illnesses? Please put commentary in context.
     
  15. alex3619

    alex3619 Senior Member

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    Many of the symptoms found in depression are shared in ME. There are some very clear differences though. For a start, depressed patients are likely to have a normal repeat CPET. Or spectral coherence EEG results. ME patients are also likely to want to do lots of things, they just can't.
     
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  16. Hip

    Hip Senior Member

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    OK, so I found 583 studies on PubMed on depression in Parkinson's disease (see the PubMed search here), but only 88 on depression in ME/CFS (see the PubMed search here).

    So as usual, other illnesses are far better researched that ME/CFS. But the point I am making is that is quite normal to conduct studies on mental health comorbidities in physical diseases.
     
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  17. duncan

    duncan Senior Member

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    Do you wish to wager on what my response relative to their - those, er, studies - meaning is?
     
  18. alex3619

    alex3619 Senior Member

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    It is not in dispute that some ME patients have depression, anxiety, or both. What is doubtful is that any findings of depression or anxiety in ME patients are provable. They are inferred, often using observations that are normal in ME, and due to other factors like pain and exhaustion. False inference is probably common. Similar issues probably arise in many other conditions in which depression or anxiety appear to be comorbid disorders.

    So ME that is diagnosed as comorbid with either anxiety or depression may often be problematic. We do need research looking into this, but having biomarkers and understanding ME pathophysiology is essential so that ME directly induced issues are not conflated with either depression or anxiety. Its the same for depression and anxiety.

    However it cannot be dismissed that both depression and anxiety might emerge separately from ME, nor that the issues faced by many patients with ME might lead to either depression or anxiety. We are almost certainly not immune to either.

    The point remains though that all three diagnoses are difficult to scientifically diagnose, and use problematic methods. Subgroups definitely exist in all three that are easier to diagnose, and pathophysiology is actively being researched in anxiety and depression, but still massively under-researched in ME.

    I am not going to even bother discussing idiopathic chronic fatigue, including the Oxford criteria. Hopefully these patients were diagnosed with CFS via NICE guidelines, though that is problematic in itself.
     
  19. ebethc

    ebethc Senior Member

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    I don't see them as parallel (and I don't doubt that others have different experiences at all)..... For me, there's a hierarchy: CFS = Primary and Anxiety = Secondary... I went down a long road treating the secondary illness and the drugs made me worse (eg gut dysbiosis) and did not help at all.. Talk therapy did nothing.. meditation did nothing CFS-wise (although I think it can be helpful in general).
     
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  20. duncan

    duncan Senior Member

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    This effort is about fatigue. It is NOT about the symptom cluster that helps define ME/CFS. We need to stated this unequivacably- and we need to ensure we don't let these individuals slide in their bloated and self-serving definitions.
     
    Last edited: Nov 5, 2017
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