Letter to Editor-reply to"Neurology out-patients with symptoms unexplained by disease

[Dolphin]

Letter to the Editor

SIMON OVERTON
Psychological Medicine, Volume 40, Issue 01, January 2010, pp 172-173
doi:10.1017/S0033291709991413 (About doi), Published Online by Cambridge
University Press 08 Oct 2009

Reply to:
Sharpe, M, Stone, J, Hibberd, C, Warlow, C, Duncan, R, Coleman, R, Roberts,
R, Cull, R, Pelosi, A, Cavanagh, J, Matthews, K, Goldbeck, R, Smyth, R,
Walker, A, Walker, J, MacMahon, A, Murray, G, Carson, A (2009).
Neurology out-patients with symptoms unexplained by disease: illness
beliefs and financial benefits predict 1-year outcome

Can be read for free at:

html version:
http://bit.ly/8q7tVP i.e.
http://journals.cambridge.org/actio...8432&fulltextType=LT&fileId=S0033291709991413

pdf version:
http://bit.ly/6kIxKY i.e.
http://journals.cambridge.org/actio...40&jid=PSM&volumeId=40&issueId=01&aid=6778432

If those links I used don't work, follow the link on the home page for the
issue which is a free, open access issue:
http://bit.ly/61jsr1 i.e.
http://journals.cambridge.org/action/displayIssue?jid=PSM&volumeId=40&issueId=01&iid=6778188#

(The start is a little difficult to read but don't let that put you off. Well done to Simon. Tom)

 

[Nina]

Very good, especially the last sentence sums things up fairly well.

That whole approach makes 2 logical and, more importantly, ethical mistakes.

First, by ignoring substancial evidence that points strongly into the direction of organical involvement, simply for the reason that findings do not resolve the question of disease aetiology 100%.

And second, by postulating that a disabling disease should not be recognized as such just because it is allegedly caused by psychological problems, and therefore, as Simon so aptly puts it, denying the weakest members of society the most basical support.

I would suggest a study on the psychological health status of people who feel the urgent need to deny obviously sick patients help and to actually turn the fact that they are ill against them.

Coincidentally, I am currently working on an open letter to German authorities who still ask doctors to "not affirm CFS patients in their false illness beliefs" and of course promote CBT/GET and general "physical activation".

 

[Esther12]

Very good, especially the last sentence sums things up fairly well.

The first page of this is still available... but the last sentence is now hidden from us!

This, along with the paper it's responding too is now on my list of things to read when I've done everything else in the world.

From the abstract of the Sharpe paper, it looked like their findings weren't that overwhelming:

http://www.ncbi.nlm.nih.gov/pubmed/19627646

Poor outcome on the CGI ('unchanged', 'worse' or 'much worse') was reported by 482 (67%) out of 716 patients. The only strong independent baseline predictors were patients' beliefs [expectation of non-recovery (odds ratio [OR] 2.04, 95% confidence interval [CI] 1.40-2.96), non-attribution of symptoms to psychological factors (OR 2.22, 95% CI 1.51-3.26)] and the receipt of illness-related financial benefits (OR 2.30, 95% CI 1.37-3.86). Together, these factors predicted 13% of the variance in outcome.

Also, re the 'believing it's psychological improves outcome' finding... what does this really mean? What leads people to believe that their health problems are psychological in nature - could it be that those who do so are more likely to suffer from psychological problems? Are there confounding factors that would mean that those with some neurological symptoms who believe that their symptoms are psychologically based would be more likely to improve than those who do not? I think that there probably are. Also, as the only treatments available would be psychological, it seems unsurprising that those who think that psychological factors play a role in their ill health are more likely to improve - antibiotics were the only treatment available, I would expect that the belief that one was suffering from a bacterial infection would also correlate with increased chance of improvement - that would be no reason to try to encourage people to believe that their health problems were bacterial in nature, or to take a wider view of their problems and accept that bacterial infections are an important perpetuating factor.

Sorry... rambling again.

 

[Dolphin]

The first page of this is still available... but the last sentence is now hidden from us!

This, along with the paper it's responding too is now on my list of things to read when I've done everything else in the world.

This is all that's on page 2 (along with COI statement and references):

health-related benefits per se. Furthermore, by denigrating a patient’s own perceptions of their illness they deny the therapeutic partnership by which any disease may be overcome, irrespective of aetiology.

 

[Esther12]

Ta D. I thought that it sounded as if it were winding up just before I got cut off. Not sure I'm so keen on the last sentence personally.