ME/CFS Clinical Guidelines for Psychiatrists (E. Stein)

Although not new, this publication from 2005 is new to me. The complete title is:

"Assessment and Treatment of Patients with ME/CFS: Clinical Guidelines for Psychiatrists"

Nothing to fear here . . . it was written by a Canadian psychiatrist (Eleanor Stein) who has both personal and clinical experience with ME/CFS, FM and MCS (Multiple Chemical Sensitivities). It has been translated into Norwegian (@Kalliope , @MountainMonkey ), German (@Joh , @TiredSam ) and Italian -- all versions available in PDF at the following link:

http://eleanorsteinmd.ca/publications/

The criticisms of CBT and GET are more nuanced than they likely would be if the publication were written now. Nevertheless, problems including lack of proof of efficacy and weak selection criteria for study participants are discussed.

From the Table of Content:

"3. ME/CFS is NOT a Psychiatric Disorder
3.1 Rates of Psychiatric Disorder in CFS Are Similar to Rates in Other Chronic Medical Conditions
3.2 Rates of Personality Disorder in ME/CFS Are Not Elevated
3.3 Genetics of Depression and ME/CFS Are Independent
3.4 Physiological Measures Between ME/CFS and Depression Differ
3.5 Illness Severity and Not Psychological Factors Predict Outcome"

A few of my favourite segments:

"Despite the preponderance of research to the contrary, a group of primarily British psychiatrists continue to publish that ME/CFS is caused and exacerbated by faulty self perception and avoidance behavior. The faulty beliefs are described as: ”the belief that one has a serious disease; the expectation that one's condition is likely to worsen; the "sick role," including the effects of litigation and compensation; and the alarming portrayal of the condition as catastrophic and disabling” (Barsky & Borus, 1999). It should be noted that neither this paper written by Barsky nor any of the others with similar views are evidence based, they are the personal opinions of the authors."

"If ME/CFS were a psychiatric disorder, one would expect psychological symptoms to predict outcome. However this is not the case. Studies consistently show that symptom severity at onset and whether one meets full criteria for CFS predict prognosis in ME/CFS (Darbishire et al, 2005) but psychological symptoms and cognitive beliefs do not"

"As the following data show, psychiatric disorder in ME/CFS is most often secondary to the loss of health, lifestyle, social role and financial means as well as the social stigma of having a serious disabling but poorly understood illness."

 

Something for the archives @Cheshire or @Woolie ?

 

Yes! I'll leave this one for @Cheshire, as it falls within some of the topics she has been working on.

 

That is excellent.

 

Thanks for tagging me @MsUnderstood! I've ordered stuff from Eleanor Stein before after I saw a video about her great work but can't remember what it was exactly, I think a self-help pacing program. Great to know that German material is available! My head is spinning from reading the new German ME guideline, but will check it out in the next days, thanks!

 

Thank you @MsUnderstood

 

Eleanor Stein’s Clinical Guidelines for Psychiatrists is excellent. It’s a shame it’s not more widely known and utilised. I emailed her late last year, to ask her if she had any plans to update it, so it could incorporate some of the more recent evidence. Sadly, she doesn’t.