Comorbidities of Patients with Functional Somatic Syndromes Before, During and After First Diagnosis, 2020, Donnachie et al

[Andy]

Full title: Comorbidities of Patients with Functional Somatic Syndromes Before, During and After First Diagnosis: A Population-based Study using Bavarian Routine Data

Functional somatic syndromes (FSS) are characterised by the presence of one or multiple chronic symptoms that cannot be attributed to a known somatic disease. They are thought to arise though a complex interaction of biological and psychosocial factors, but it is unclear whether they share a common aetiology. One hypothesis supported by recent studies is that the FSS are postinfectious disorders, as is widely recognised for a subset of patients with irritable bowel syndrome.

Our study used claims data submitted by office-based physicians to compare groups of patients with different FSS in the five years before and after the point of first diagnosis. Even five years prior to diagnosis, FSS patients consulted more frequently for a range of psychological and somatic conditions than did controls. Following diagnosis, consultation rates increased further and remained persistently high. Five years after diagnosis, between 34% (somatization disorder) and 66% (fibromyalgia) of patients were still being treated for the condition. Both prior gastrointestinal and upper-respiratory infection were associated with an increased risk of developing an FSS. We therefore recommend that patients at risk should be identified at an early stage and the underlying psychosocial and somatic issues addressed to prevent progression of the condition.

Open access, https://www.nature.com/articles/s41598-020-66685-4

 

[rvallee]

They are thought to arise though

Millions of lives are controlled by "it is thought to". Absurd.

FSS patients consulted more frequently for a range of psychological

That's quite ridiculous. The patients don't have a choice, they rarely pursue it, are simply told they must or even not given a choice. It's like prescribing placebos and then remarking that the patients frequently take placebos thus confirming a psychosomatic explanation. Come on that's completely circular!

We therefore recommend that patients at risk should be identified at an early stage and the underlying psychosocial and somatic issues addressed to prevent progression of the condition

Then maybe stop making stuff up and allow for medical care to build up services and expertise like the patient community has been begging for over decades? And drop the psychosocial nonsense, entirely superfluous.

 

[Snowdrop]

Lots to look at there. But all I'll say for now is that they did not pick up one co-morbidity post-diagnosis --- Medical post-traumatic syndrome.

I guess you just don't find what you're not looking for.

 

[rvallee]

Lots to look at there. But all I'll say for now is that they did not pick up one co-morbidity post-diagnosis --- Medical post-traumatic syndrome.

I guess you just don't find what you're not looking for.

The topic of medical gaslighting needs to become very prominent. I think it will in all the upheaval that COVID-19 will cause to the MUS/FND ideology. A new chapter in the book of medicine in its own right, close by to the new chapter on the germ theory of disease and how it's not a binary thing.

It's becoming impossible to ignore that it's very likely that the vast majority of chronic illnesses are caused by pathogens and the immune system's reaction. Which, to be fair, was always the damn obvious explanation. The problem is often presented as many disciplines blindly poking at an elephant and sensing different things. Turns out it germs may actually be the whole elephant in the room. COVID-19 basically has them all wrapped in at once, its presentation is basically a wild buffet of all the discriminated diseases and "medically unexplained" symptoms that medicine loves to hate.

It's a form of systemic injustice and the timing right now could not be any more ripe. As much as we see lots of it in the ME and chronic illness community, I see so much of it even in the "respectable" chronic illnesses, it's definitely not just us. It's rampant throughout all of medicine because of the belief in conversion disorder and poor assessment of evidence.

Freud is about to get his final judgment and it's a plain zero.

 

[Sean]

Even five years prior to diagnosis, FSS patients consulted more frequently for a range of psychological and somatic conditions than did controls. Following diagnosis, consultation rates increased further and remained persistently high.

What exactly is this demonstrating?

People who are sick are more likely to go to the profession supposed to deal with sick people?

Diagnosis takes too long?

FSS is irrelevant?

Both prior gastrointestinal and upper-respiratory infection were associated with an increased risk of developing an FSS.

But this did not trigger concerns about the FSS concept?

 

[Snow Leopard]

Since is study is medical record based, much of these findings reflect physician-biased patterns of diagnosis, rather than the symptoms themselves.

It should however be noted that the physician-recorded diagnoses analysed reflect an often selective and chaotic description of the complaints as perceived and reported by the patient 29. On the other hand, the patients’ selection of medical subspecialty to consult or, in some healthcare systems, the subspecialty referred to by the primary care physician for further diagnosis, may determine the final diagnosis (e.g. IBS if a gastroenterologist is consulted, or chronic pelvic pain syndrome if seen by a gynaecologist or urologist)5. The observed predominance of certain symptoms is the product of a complex decision-making process both on the part of the patient and of the physician30. As observed in the routinely collected data, these leading symptoms may be viewed as an inherent part of the disease experience but do not necessarily imply the presence of distinct diseases or phenotypes.

The use of routinely collected claims data may also be viewed as a limitation. Medical information is limited to the ICD-10 diagnoses recorded for the purposes of billing. These diagnoses are not generally audited and reflect to some extent the coding and clinical practices of the physicians. For example, we are unable to include patients whose diagnoses record only the symptoms experienced and not an underlying FSS. Additionally, we are unable to differentiate between a patient in remission and a patient who chooses no longer to consult for a persisting FSS.

The study could have been used to estimate incidence of diagnosis (vs age) and diagnosed prevalence for the primary conditions, but they chose not to...