Concerns about IOM diagnostic criteria including those with mental illnesses?

[ahimsa]

I'm no expert so maybe this is a dumb question. Please bear with me.

In a nutshell, the new IOM diagnostic criteria says (my wording)

Must have these 3 symptoms:
* impaired day-to-day function, new or definite onset, etc.
* worsening of symptoms after physical or mental exertion (PEM)
* unrefreshing sleep

Plus one of the following 2 symptoms:
* cognitive impairment
* orthostatic intolerance (e.g., POTS or NMH)

For those who are worried that the new diagnostic criteria will include too many patients with a primarily psychiatric illness, are there are lot of mental illnesses that would overlap with these criteria?

E.g., do a lot of folks with depression also have Orthostatic Intolerance? Or PEM?

Please don't take this as an argument. I honestly do not know the answer. I'm trying to understand. Thanks!

(an image of the detailed diagnostic criteria is attached)

 

[Hope123]

No, most people with ONLY depression, in my experience and reading, do not have orthostatic intolerance and PEM. However, having depression does not mean you can't be affected or that you are protected from getting OI and SEID.
The topic you refer do is also addressed in another one of the threads, if I can find it.

 

[Hope123]

This was addressed in one of the other threads:
http://forums.phoenixrising.me/inde...mary-psychiatric-disorders.35517/#post-557500

 

[ahimsa]

However, having depression does not mean you can't be affected or that you are protected from getting OI and SEID.

Thanks. Yes, it makes sense that people can have more than one thing at a time (co-morbid).

What I was asking is this - why is there a concern that these IOM diagnostic criteria will pull in a lot of folks with primarily mental illness?

At least, I think I read that concern on one or more of the threads about not liking the IOM criteria. Was I mistaken?

 

[ahimsa]

This was addressed in one of the other threads:
http://forums.phoenixrising.me/index.php?threads/iom’s-redefinition-of-me-invites-over-diagnosis-and-risks-inclusion-of-primary-psychiatric-disorders.35517/#post-557500

Thanks for the link! It may take me a while to read it but I appreciate it.

(in fact, it looks like I've already read it, and even liked it, LOL!)

 

[ahimsa]

I have now looked back and found some of the threads with these concerns. And I finally clicked on the link to the blog (I had not clicked through the first time) and tried to read it.

But I confess that the arguments confused me. I just don't get how this set of criteria will specifically pull in folks who do not have some form of ME/SEID. While it is true that they may have this version of ME/SEID plus other things, I don't see how having co-morbid depression, or any other mental illness, will be a problem for clinical diagnosis.

What am I missing?

 

[Hope123]

Thanks. Yes, it makes sense that people can have more than one thing at a time (co-morbid).

What I was asking is this - why is there a concern that these IOM diagnostic criteria will pull in a lot of folks with primarily mental illness?

At least, I think I read that concern on one or more of the threads about not liking the IOM criteria. Was I mistaken?

With all due respect, I think that concerns comes from people who are not familiar with clinical diagnosis or research. The IOM criteria are clinical criteria meant to identify as many people as possible that might be affected by SEID so that they can get appropriate care. You don't want to leave a lot of people out in the cold.

For research, researchers should decide what their study criteria are on a study-by-study basis depending on their interests. The whole concept of coming up with a "clinical" case definition vs. a "research case definition" for this disease makes no sense. In most of medicine, the two are the one and the same, with researchers then deciding which, if any subgroups, they want to address. So, for example, all patients with irritable bowel syndrome are identified by what is known as Rome criteria but a researcher may decide instead to focus in their study on IBS-D, those with diarrhea predominant symptoms instead of constipation (IBS-C). That's perfectly within their right but then their results will only apply to IBS-D, not IBS-C.

Similarly for research studies on SEID, the researchers can decide if they want SEID+depression subjects or SEID minus depression subjects. Or they can have both and then in the analysis, compare the two different groups.

 

[slayadragon]

I think the concern is that some physicians are not going to evaluate whether patients have PEM rigorously enough, and thus will diagnose people who don't actually have PEM as having it and therefore as having "this disease" (whatever the name ends up being.

Certainly that is possible. But it's my feeling that the way to correct that would not be to prohibit people with psych conditions from being diagnosed with the disease, but rather to be sure that physicians know how to evaluate the existence of PEM.

 

[Hope123]

I think the concern is that some physicians are not going to evaluate whether patients have PEM rigorously enough, and thus will diagnose people who don't actually have PEM as having it and therefore as having "this disease" (whatever the name ends up being.

Certainly that is possible. But it's my feeling that the way to correct that would not be to prohibit people with psych conditions from being diagnosed with the disease, but rather to be sure that physicians know how to evaluate the existence of PEM.

Yes, I agree with your second paragraph about education but the same doctors that diagnose illness merely by a name or symptom without really understanding what it is are just bad doctors all around, not just when it concerns this disease. Physicians are like anyone else -- there's the average, the stars, and the ones who are so ignorant that they don't even know what they don't know. (Dunning-Kruger effect)

http://www.gq-magazine.co.uk/comment/articles/2014-01/10/stupidity-for-dummies

 

[ahimsa]

@slayadragon , thanks for your explanation. At least I can understand that concern (as opposed to being completely confused). I thought the concern was specifically about psychiatric patients being pulled in by the criteria.

Maybe this specific concern (patient does not really have PEM) will be addressed when there is a list of testing that's recommended? Or interview questions when taking a medical history? (as you can see, I don't know much about this...)

I also agree with what @Hope123 said. All you can do is provide some good information and then try to train doctors well. There will always be incompetent or sloppy doctors.