Re- Peter White et al (2010) Psychiatric misdiagnoses in patients with CFS


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Here is David Sampson's comment on the recent Peter White et al paper entitled "Psychiatric misdiagnoses in patients with chronic fatigue syndrome" published in the JRSM Short Reports:

Re- Peter White et al (2010) Psychiatric misdiagnoses in patients with
chronic fatigue syndrome :Tara Lawn1 ? Praveen Kumar1 ? Bernice Knight2 ?
Michael Sharpe3 ? Peter D White4 on behalf of the PACE trial management
group (listed in protocol reference). J R Soc Med Sh Rep 2010;1:28. DOI

In this paper Professor White notes the high prevalence of co-morbid
psychiatric illness in a cohort of CFS sufferers (56%) defined using the Oxford
CFS Criteria and their under-diagnosis by clinicians in a secondary care
specialist Chronic Fatigue Syndrome clinic.

The main question concerns the validity of employing the Oxford CFS
criteria in this study. Rates of co-morbid psychiatric illness in ME/CFS patients
are known to be affected by diagnostic criteria which clearly influence
patient selection (Jason, 2004).

In assessing the validity of the Oxford CFS criteria it is interesting
that Professor White himself noted in his original Lancet paper (White, 2001)
examining various CFS criteria that: "both mood disorder at 2 months and
emotional personality (neuroticism) predicted Oxford-defined CFS...These
predictions of CFS were related more to having a co-morbid mood disorder than
to having CFS itself".

What is of critical importance is the fact that the strongest determinant
of an "Oxford defined CFS" are mood disorder and premorbid psychiatric
disorder/GP attendance in year before onset- all of which are predictors of
mood disorder/psychiatric illness quite independently of a fatigue syndrome
( see Sampson, 2010).

If such Oxford defined patients are ME/CFS patients who happen to have
developed depression/psychiatric illness subsequently to CFS itself then
premorbid psychiatric history would not be such a potent predictor- however it

This demonstrates yet again that not only do such broad criteria fail to
exclude patients with primary psychiatric diagnosis in the absence of
physical symptoms (Stein 2005, Jason 1997, Sampson 2010) but that these criteria
may be better at selecting such patients than ME/CFS patients per se.

If both ME/CFS and mood disorder/psychiatric illness were synonymous this
would not matter- however they are not. The genetics of ME/CFS,
hypothalamic-pituitary-adrenal axis function, quantitive EEG and brain blood flow on
SPECT all differentiate between CFS and mood disorder/depression (Stein,

This suggests that at very best the Oxford CFS criteria are ambiguous and
at worst misleading and tautological in conception.

In fact as long ago as 2001 Professor White noted in his study examining
various ME/CFS criteria "These data support the difference in nosology and
aetiology between acute and chronic fatigue syndromes (of relatively short
duration) and mood disorders. They also suggests that the Oxford and CDC
criteria for CFS should be used with caution or only with stratification by
mood disorder in aetiological studies".

David Sampson BSC(Hons),MSc,MBPsychS


Jason L. et al. (2004) Comparing the Fukuda et al Criteria and the
Canadian Case definition for Chronic Fatigue Syndrome. Journal of Chronic Fatigue
Syndrome ,12, 37-52.

White P. et al. (2001); Lancet, Vol. 358, N.9297; pp 1946-1953 Predictions
and associations of fatigue syndromes and mood disorders that occur after
infectious mononucleosis.

Sampson D.P. (2010) Close Analysis of a Large Published Trial Into
Fatigue Syndromes and Mood Disorders That Occur After Documented Viral Infection.
Bulletin of the IACFS/ME, Vol 18,Issue 2, Summer 2010.

Stein E (2005). Chronic Fatigue Syndrome: Assessment and Treatment of
Patients with ME/CFS: Clinical Guidelines for Psychiatrists.

Jason L. (1997). Politics, Science, and the Emergence of a New Disease:
The Case of Chronic Fatigue Syndrome, American Psychologist; Vol. 52, No. 9,