1. Click here Guest, to read the 'News In Brief' from w/c 10th Dec.
    Dismiss Notice

Medically unexplained syndromes: irritable bowel syndrome, fibromyalgia and chronic fatigue (2018) Luty

Discussion in 'PsychoSocial ME/CFS Research' started by MeSci, Jun 12, 2018.

  1. MeSci

    MeSci Senior Member (Voting Rights)

    Messages:
    1,187
    Likes Received:
    7,533
    Location:
    Cornwall, UK
    Source: BJPsych Advances

    Preprint

    Date: June 6, 2018

    URL:
    https://www.cambridge.org/core/jour...onic-fatigue/056188C35015F793F283E6F385386289

    Medically unexplained syndromes: irritable bowel syndrome, fibromyalgia and chronic fatigue
    ----------------------------------------------------------
    Jason Luty

    - Liaison Psychiatry, Farm Lodge, C/O Bradgate Unit, Glenfield Hospital, Groby Road, Leicester LE3 9EJ, UK. Email: jason.luty@yahoo.co.uk

    Abstract

    This is a review of three of the more common medically unexplained syndromes that present for treatment to liaison psychiatry services in general medical hospitals: chronic fatigue syndrome, fibromyalgia and irritable bowel syndrome. The three are interrelated, extremely
    disabling and comorbid mood disorders are frequent. In general, treatment, whether psychological or medical, has very modest impact. The disputed classification of medically unexplained syndromes is also reviewed. There is a clear gulf between the views and experiences of patients with these syndromes and the medical establishment. In this article I summarise give the evidence for pharmacological, psychosocial and 'alternative' or 'complementary' interventions for a range of disorders, about which there is some dispute. I leave it to the reader to decide which interventions hold the most promise.

    --------
    (c) 2018 The Royal College of Psychiatrists
    (c) 2018 Cambridge University Press
     
    andypants, Inara, Joh and 2 others like this.
  2. Lidia

    Lidia Established Member (Voting Rights)

    Messages:
    76
    Likes Received:
    536
    Some editing wouldn’t have gone astray Jason Luty.
     
  3. Tia

    Tia Established Member (Voting Rights)

    Messages:
    91
    Likes Received:
    811
    Typo in the abstract is not good is it?!
     
  4. cyclamen

    cyclamen Established Member (Voting Rights)

    Messages:
    50
    Likes Received:
    189
    andypants, adambeyoncelowe and Inara like this.
  5. ladycatlover

    ladycatlover Senior Member (Voting Rights)

    Messages:
    555
    Likes Received:
    3,878
    Location:
    Liverpool, UK
    adambeyoncelowe and Hutan like this.
  6. strategist

    strategist Senior Member (Voting Rights)

    Messages:
    1,029
    Likes Received:
    10,400
    It ends with
    It also acknowledges the poor long term followup results in PACE, and reports the recovery outcomes from the PACE reanalysis. Unfortunately it doesn't make clear that this was the analysis as originally planned or that there were no statistically significant differences between groups.

    Anyway, the PACE criticism is slowly getting into the literature.
     
    Last edited: Jun 12, 2018
    andypants, MEMarge, Atle and 17 others like this.
  7. alktipping

    alktipping Senior Member (Voting Rights)

    Messages:
    218
    Likes Received:
    1,105
    where is the actual review part of this paper.
     
    andypants and Trish like this.
  8. Trish

    Trish Moderator Staff Member

    Messages:
    8,749
    Likes Received:
    48,341
    Location:
    UK
    Thanks @strategist - do you have a link so we can read the full article?
     
    alktipping likes this.
  9. strategist

    strategist Senior Member (Voting Rights)

    Messages:
    1,029
    Likes Received:
    10,400
    Inara, alktipping and adambeyoncelowe like this.
  10. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

    Messages:
    2,799
    Likes Received:
    30,811
    This looks like a muddled review by a junior doctor who has not himself quite worked out what he wants to say. It mentions some of the issues patients have with treatments but makes no constructive analysis. The account of PACE is still woefully inaccurate.

    This reminds me that maybe ME advocacy should be deliberately targeting very young professionals and students in medicine and allied professions (therapists). These are the people who may still have an open mind about what they should be doing. Judging by this they may see some of both sides and be uncertain. They need to hear loud and clear that the studies of treatments are simply not informative because they are too badly designed.
     
    andypants, MEMarge, Skycloud and 11 others like this.
  11. Trish

    Trish Moderator Staff Member

    Messages:
    8,749
    Likes Received:
    48,341
    Location:
    UK
    I think the conclusion is interesting:
    Edit: I mean in the sense that he does at least question the psychological approach.
     
    MEMarge, Inara, alktipping and 5 others like this.
  12. NelliePledge

    NelliePledge Senior Member (Voting Rights)

    Messages:
    1,877
    Likes Received:
    13,534
    Location:
    UK East Midlands
    Interesting clearly he didn’t give this person a feeling of being empathised with. Maybe if you have doubts about what you’re having to say to people that makes it harder to show empathy because you have to make yourself more of a robot to do it. My IAPT CBT person was quite robotic and I put it down to the process rather than her personally. I did get the feeling she was not comfortable being a sausage machine operator.
     
    MEMarge and alktipping like this.
  13. NelliePledge

    NelliePledge Senior Member (Voting Rights)

    Messages:
    1,877
    Likes Received:
    13,534
    Location:
    UK East Midlands
    I see his email is a yahoo rather than an NHS address. Maybe he is contactable on that still and would be interested in joining S4ME???
     
    MEMarge, Inara and alktipping like this.
  14. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

    Messages:
    2,799
    Likes Received:
    30,811
    What seems odd is that he has picked up from the PACE follow up that there was no long term benefit yet that is not how the paper he quotes presents it at all. And he seems oblivious to the much more obvious problems with the original PACE results - not just the re-analysis but the uselessness of the trial design.

    Perhaps this was all he felt he could say without losing his job. Maybe he overdid it as it is!
     
  15. Trish

    Trish Moderator Staff Member

    Messages:
    8,749
    Likes Received:
    48,341
    Location:
    UK
    I think he has done a very superficial overview - he keeps referring to 'chronic fatigue' instead of CFS, quotes whole chunks of the NICE guidelines, doesn't refer at all to the methodological flaws in PACE, and only seems aware of Oxford and Fukuda criteria ...
     
  16. DokaGirl

    DokaGirl Senior Member (Voting Rights)

    Messages:
    304
    Likes Received:
    1,695
    Re the PACE, and other trials using the Oxford criteria: 6 months of medically unexplained fatigue; do we know much about these study subjects? Other than that 13 percent in the PACE trial were actually quite healthy.

    Of course we can assume there were several people with depression. How about
    IBS, and whatever else the GET/CBT band calls unexplained? It would be interesting to know what "diagnoses"the subjects have.

    It seems circular and confusing; for example, depression can cause fatigue, depression is a medical diagnosis, and yet it's also medically unexplained chronic fatigue. So on the one hand a person can be diagnosed with depression, but also labeled as having a mystery condition causing fatigue. Egad!

    And, what about misdiagnosis? The arrogance of medicine to categorize people with medically unexplained chronic fatigue, while dismissing important signs and symptoms. For example someone diagnosed with CFS, who actually had a life threatening ilness they died from.
     
    adambeyoncelowe likes this.

Share This Page