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Undiagnosed and comorbid disorders in patients with presumed chronic fatigue syndrome.

Bob

Senior Member
Messages
16,455
Location
England (south coast)
I thought this had been posted before, but I can't find it anywhere...


Undiagnosed and comorbid disorders in patients with presumed chronic fatigue syndrome.
Mariman A, Delesie L, Tobback E, Hanoulle I, Sermijn E, Vermeir P, Pevernagie D, Vogelaers D.
J Psychosom Res. 2013 Nov;75(5):491-6.
doi: 10.1016/j.jpsychores.2013.07.010.
Epub 2013 Aug 20.

Full paper:
http://www.sciencedirect.com/science/article/pii/S0022399913002766

If the above link takes you to the jpsychores website instead of the ScienceDirect website, then (to access the full paper) click on "Access this article on ScienceDirect" (top-right of the jpsychores webpage.)

Abstract only:
http://www.ncbi.nlm.nih.gov/pubmed/24182640
http://www.jpsychores.com/article/S0022-3999(13)00276-6/abstract


Abstract
OBJECTIVE:
To assess undiagnosed and comorbid disorders in patients referred to a tertiary care center with a presumed diagnosis of chronic fatigue syndrome (CFS).

METHODS:
Patients referred for chronic unexplained fatigue entered an integrated diagnostic pathway, including internal medicine assessment, psychodiagnostic screening, physiotherapeutic assessment and polysomnography+multiple sleep latency testing. Final diagnosis resulted from a multidisciplinary team discussion. Fukuda criteria were used for the diagnosis of CFS, DSM-IV-TR criteria for psychiatric disorders, ICSD-2 criteria for sleep disorders.

RESULTS:
Out of 377 patients referred, 279 (74.0%) were included in the study [84.9% female; mean age 38.8years (SD 10.3)]. A diagnosis of unequivocal CFS was made in 23.3%. In 21.1%, CFS was associated with a sleep disorder and/or psychiatric disorder, not invalidating the diagnosis of CFS. A predominant sleep disorder was found in 9.7%, 19.0% had a psychiatric disorder and 20.8% a combination of both. Only 2.2% was diagnosed with a classical internal disease. In the total sample, a sleep disorder was found in 49.8%, especially obstructive sleep apnea syndrome, followed by psychophysiologic insomnia and periodic limb movement disorder. A psychiatric disorder was diagnosed in 45.2%; mostly mood and anxiety disorder.

CONCLUSIONS:
A multidisciplinary approach to presumed CFS yields unequivocal CFS in only a minority of patients, and reveals a broad spectrum of exclusionary or comorbid conditions within the domains of sleep medicine and psychiatry. These findings favor a systematic diagnostic approach to CFS, suitable to identify a wide range of diagnostic categories that may be subject to dedicated care.
 
Last edited:

MeSci

ME/CFS since 1995; activity level 6?
Messages
8,231
Location
Cornwall, UK
I thought this had been posted before, but I can't find it anywhere...


Undiagnosed and comorbid disorders in patients with presumed chronic fatigue syndrome.
Mariman A, Delesie L, Tobback E, Hanoulle I, Sermijn E, Vermeir P, Pevernagie D, Vogelaers D.
J Psychosom Res. 2013 Nov;75(5):491-6.
doi: 10.1016/j.jpsychores.2013.07.010.
Epub 2013 Aug 20.

Full paper:
http://www.sciencedirect.com/science/article/pii/S0022399913002766
PDF:
http://ac.els-cdn.com/S002239991300...t=1383674193_092ca769adfca6d5b5d119bd946263d9
Abstract only:
http://www.ncbi.nlm.nih.gov/pubmed/24182640
http://www.jpsychores.com/article/S0022-3999(13)00276-6/abstract


Abstract
OBJECTIVE:
To assess undiagnosed and comorbid disorders in patients referred to a tertiary care center with a presumed diagnosis of chronic fatigue syndrome (CFS).

METHODS:
Patients referred for chronic unexplained fatigue entered an integrated diagnostic pathway, including internal medicine assessment, psychodiagnostic screening, physiotherapeutic assessment and polysomnography+multiple sleep latency testing. Final diagnosis resulted from a multidisciplinary team discussion. Fukuda criteria were used for the diagnosis of CFS, DSM-IV-TR criteria for psychiatric disorders, ICSD-2 criteria for sleep disorders.

RESULTS:
Out of 377 patients referred, 279 (74.0%) were included in the study [84.9% female; mean age 38.8years (SD 10.3)]. A diagnosis of unequivocal CFS was made in 23.3%. In 21.1%, CFS was associated with a sleep disorder and/or psychiatric disorder, not invalidating the diagnosis of CFS. A predominant sleep disorder was found in 9.7%, 19.0% had a psychiatric disorder and 20.8% a combination of both. Only 2.2% was diagnosed with a classical internal disease. In the total sample, a sleep disorder was found in 49.8%, especially obstructive sleep apnea syndrome, followed by psychophysiologic insomnia and periodic limb movement disorder. A psychiatric disorder was diagnosed in 45.2%; mostly mood and anxiety disorder.

CONCLUSIONS:
A multidisciplinary approach to presumed CFS yields unequivocal CFS in only a minority of patients, and reveals a broad spectrum of exclusionary or comorbid conditions within the domains of sleep medicine and psychiatry. These findings favor a systematic diagnostic approach to CFS, suitable to identify a wide range of diagnostic categories that may be subject to dedicated care.

Perhaps the main thing that this study illustrates is that the Fukuda criteria are crap, or that people are being misdiagnosed on a huge scale. It worries me though, as I can just see how it may be reported in the media and used in arguments to carry on pushing BS like CBT, GET and 'sleep hygiene'.

I would have thought that a representative sample subjected to expert investigation would actually turn out to have a high incidence of physical disease.

Only seeing the abstract leaves me with more questions than answers. I think the paper could do with thorough critical analysis. Thanks for posting it anyway.
 

Bob

Senior Member
Messages
16,455
Location
England (south coast)
Only seeing the abstract leaves me with more questions than answers.
The full paper is available at the moment, including a PDF version.

I've edited my opening post because the main link sometimes redirects to a different website which only shows the abstract

To view the full paper, use this link:
http://www.sciencedirect.com/science/article/pii/S0022399913002766

If this link takes you to the jpsychores website instead of the ScienceDirect website, then (to access the full paper) click on "Access this article on ScienceDirect" (top-right of the jpsychores webpage.)
 

peggy-sue

Senior Member
Messages
2,623
Location
Scotland
I'm left wondering about folk like my friend, who suffered from "CFS" for 10 years before it was discovered he needed a pacemaker all along.

He had heart failure. Not "CFS".
 
Messages
15,786
Perhaps the main thing that this study illustrates is that the Fukuda criteria are crap, or that people are being misdiagnosed on a huge scale. It worries me though, as I can just see how it may be reported in the media and used in arguments to carry on pushing BS like CBT, GET and 'sleep hygiene'.

I would have thought that a representative sample subjected to expert investigation would actually turn out to have a high incidence of physical disease.

Only seeing the abstract leaves me with more questions than answers. I think the paper could do with thorough critical analysis. Thanks for posting it anyway.
They are probably using inadequate methods to diagnose psychological disorders. I haven't read the full paper, but typically it involves questionnaires where physical symptoms are taken as proof of anxiety or depression.
 

MeSci

ME/CFS since 1995; activity level 6?
Messages
8,231
Location
Cornwall, UK
The full paper is available at the moment, including a PDF version.

I've edited my opening post because the main link sometimes redirects to a different website which only shows the abstract

To view the full paper, use this link:
http://www.sciencedirect.com/science/article/pii/S0022399913002766

If this link takes you to the jpsychores website instead of the ScienceDirect website, then (to access the full paper) click on "Access this article on ScienceDirect" (top-right of the jpsychores webpage.)

Finally got it!

Not time for thorough critical analysis, but I note the following statements:

"In unequivocal CFS, no symptoms or signs of coexisting sleep or psychiatric disorders are observed."

Is there really such a thing as 'unequivocal CFS', bearing in mind what a vague and probably heterogeneous 'syndrome' it is, especially when criteria such as Fukuda are used?

The paper seems quite tautological in this respect: use vague case definitions and you get a mixed, confusing bunch of patients. Hardly surprising!

I also find it surprising that they find it surprising that a lot of people with CFS have sleep problems, anxiety and mood problems. It's hardly a surprise to anyone familiar with Phoenix Rising, where we are way ahead of these guys with links and theories as to likely reasons for these 'co-morbidities'.

The researchers also say that anxiety disorder excludes CFS. I disagree. I think that they can both have the same, physical cause. Many of us have found that a diet-and-supplement regime that improves our physical symptoms also reduces anxiety - the likely connection being gut flora.

Too tired to read any more - may look again tomorrow.
 

Simon

Senior Member
Messages
3,789
Location
Monmouth, UK
Not time for thorough critical analysis, but I note the following statements:

"In unequivocal CFS, no symptoms or signs of coexisting sleep or psychiatric disorders are observed."

Is there really such a thing as 'unequivocal CFS', bearing in mind what a vague and probably heterogeneous 'syndrome' it is, especially when criteria such as Fukuda are used?
...

The researchers also say that anxiety disorder excludes CFS. I disagree. I think that they can both have the same, physical cause...
Agree that's an odd way to define CFS, I don't think psychiatric disorders are exclusionary according to Fukuda, and maybe that explains the very low rate of 'unequivocal' CFS cases @23%.

@Bob, thanks, and that linked article is now marked Open Access so should be no problem (though J Psychosomatic Research site still paywalled).

They are probably using inadequate methods to diagnose psychological disorders. I haven't read the full paper, but typically it involves questionnaires where physical symptoms are taken as proof of anxiety or depression.
They do use questionnaires, but where a pyschological disorder is suspected they referrred to a psychiatrist, so looks sound on that front.