New Oxford Textbook of Psychiatry, 2012 and 2020 editions - Sharpe et al on CFS

New Oxford Textbook of Psychiatry

Second edition published 2012
https://academic.oup.com/book/24770

Chapter 5.2.7 Chronic Fatigue Syndrome
by Michael Sharpe and Simon Wessely
https://doi.org/10.1093/med/9780199696758.003.0133

Abstract (paragraph breaks added)

Chronic fatigue syndrome is a controversial condition, conflicts about which have frequently burst out of the medical literature into the popular media. Whilst these controversies may initially seem to be of limited interest to those who do not routinely treat such patients, they also exemplify important current issues in medicine. These issues include the nature of symptom-defined illness; patient power versus medical authority; and the uncomfortable but important issues of psychological iatrogenesis. The subject is therefore of relevance to all doctors.

Fatigue is a subjective feeling of weariness, lack of energy, and exhaustion. Approximately 20 per cent of the general population report significant and persistent fatigue, although relatively few of these people regard themselves as ill and only a small minority seek a medical opinion. Even so, fatigue is a common clinical presentation in primary care. When fatigue becomes chronic and associated with disability it is regarded as an illness.

Such a syndrome has been recognized at least since the latter half of the last century. Whilst during the Victorian era patients who went to see doctors with this illness often received a diagnosis of neurasthenia, a condition ascribed to the effect of the stresses of modern life on the human nervous system the popularity of this diagnosis waned and by the mid-twentieth century it was rarely diagnosed (although the diagnosis subsequently became popular in the Far East—see Chapter 5.2.1).

Although it is possible that the prevalence of chronic fatigue had waned in the population, it is more likely that patients who presented in this way were being given alternative diagnoses. These were mainly the new psychiatric syndromes of depression and anxiety, but also other labels indicating more direct physical explanations, such as chronic brucellosis, spontaneous hypoglycaemia, and latterly chronic Epstein–Barr virus infection. As well as these sporadic cases of fatiguing illness, epidemics of similar illnesses have been occasionally reported.

One which occurred among staff at the Royal Free Hospital, London in 1955 gave rise to the term myalgic encephalomyelitis (ME), although it should be emphasized that the nature and symptoms of that outbreak are dissimilar to the majority of those now presenting to general practitioners under the same label.

A group of virologists and immunologists proposed the term chronic fatigue syndrome in the late 1980s. This new and aetiologically neutral term was chosen because it was increasingly recognized that many cases of fatigue were often not readily explained either by medical conditions such as Epstein–Barr virus infection or by obvious depression and anxiety disorders. Chronic fatigue syndrome has remained the most commonly used term by researchers.

The issue of the name is still not completely resolved however: Neurasthenia remains in the ICD-10 psychiatric classification as a fatigue syndrome unexplained by depressive or anxiety disorder, whilst the equivalent in DSM-IV is undifferentiated somatoform disorder. Myalgic encephalomyelitis or (encephalopathy) is in the neurological section of ICD-10 and is used by some to imply that the illness is neurological as opposed to a psychiatric one.

Unfortunately the case descriptions under these different labels make it clear that they all reflect similar symptomatic presentations, adding to confusion. Official UK documents have increasingly adopted the uneasy and probably ultimately unsatisfactory compromise term CFS/ME. In this chapter, we will use the simple term chronic fatigue syndrome (CFS).

 

The 2012 Edition chapter on CFS is in a large section headed Psychiatry in Medicine, with chapters including somatoform, MUS, somatisation, conversion disorder, hypochondriasis, factitious disorder and malingering, neuresthenia etc.
https://academic.oup.com/book/24770

 

The 2020 edition seems to have shrunk that section
https://academic.oup.com/book/35444

It's now headed
Somatic symptoms and related disorders
with chapter headings:

129 Deconstructing dualism: The interface between physical and mental illness
by Michael Sharpe and Jane Walker

Abstract
Illness is conventionally categorized into two main types: ‘medical’ or ‘psychiatric’. This dichotomization is such an accepted feature of current medical practice that we take it for granted. But is it really the best way to think about and manage illness? In order to answer these questions, the chapter reviews what is meant by ‘medical’ and ‘psychiatric’ illness and considers the assumptions underpinning this division. The chapter then outlines alternative and more unified conceptualizations of illness, as well as the development of integrated models of clinical care.

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130 Neural mechanisms in chronic pain relevant for psychiatric interventions
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131 Treatment of fibromyalgia (chronic widespread pain) and chronic fatigue syndrome
by Jonathan Price
[Note: Jonathan Price is one of the authors of the 2019 Exercise therapy for CFS Cochrane review, and all previous versions of that review. He is a colleague of Michael Sharpe at Oxford University].
Abstract

Fibromyalgia (FM), one of the chronic widespread pain syndromes, and chronic fatigue syndrome (CFS) are important and common conditions. They are considered together here because they are commonly comorbid and because of their similarities—they are long-term conditions with a relatively poor prognosis; central nervous system mechanisms and deconditioning play an important role in aetiology; graded exercise and psychological treatments have an important role in management; and comorbid mental disorders are common and have an adverse impact on important outcomes, including disability and chronicity. The prevalence of FM is rising, while that of CFS is declining. There is increased acceptance of the pivotal role of central nervous system factors in FM, while in CFS, the positions of different aetiological ‘movements’ appear bitterly entrenched. The main focus of this chapter is on FM and, in particular, key aspects of aetiology and treatment, especially those relating to the central nervous system.
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132 Factitious disorder and malingering
Abstract
Factitious disorder and malingering are two forms of abnormal illness behaviour in which mental or somatic symptoms are deliberately fabricated or grossly exaggerated or otherwise grossly misrepresented. They are forms of other-deceit, with the person in question assumed to be fully aware of this deceit. The central distinguishing feature of both is that factitious disorder is commonly thought to be motivated by internal incentives (primary gain: medical treatment, assuming the sick role), while malingering is directed towards an external goal (secondary gain, for example monetary compensation, sick leave). The utility of distinguishing between the two forms of feigning has long been questioned. Similarly, it must be questioned why factitious disorder is apprehended as a mental disorder in its own right. Neither the Diagnostic and Statistical Manual of Mental Disorders (DSM) nor the International Classification of Diseases (ICD) contains useful diagnostic guidelines for reliably diagnosing feigned illness presentations; in particular, several decades of malingering research and conceptual developments have found no repercussion there.

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133 Functional neurological symptom disorder (conversion disorder)
by Jon Stone and Michael Sharpe
Abstract
Conversion disorder (now also called functional neurological symptom disorder) describes symptoms (of motor and sensory dysfunction such as limb weakness, tremor, visual loss, with or without ‘blackouts’), which can be positively identified as being inconsistent with neurological disease. The disorder is common in neurological services and frequently seen by psychiatrists working in such settings. It is often associated with chronic severe disability. The diagnosis previously hinged on the neurologist’s demonstration of the lack of disease and the psychiatrist’s hypothesis of a ‘conversion’ of stress into a physical symptom. It is now based on positive findings on neurological assessment supplemented by a psychiatric assessment to confirm the diagnosis. Comorbid anxiety and depression disorders are common. Treatment is multi-disciplinary. Explanation of the condition to the patient is a crucial initial step supplemented, where necessary, by psychological treatment (especially for dissociative or non-epileptic attacks) and physiotherapy for functional motor symptoms. The prognosis without treatment is poor once the disability is established.

 

How to disappear an inconvenient disease.

(I actually doubt that decline is true.)