Psychosomatic symptoms related to exacerbation of fatigue in patients with medically unexplained symptoms, 2022, Hashimoto et al.

[Dolphin]

Free full text:
https://onlinelibrary.wiley.com/doi/full/10.1002/jgf2.582

ORIGINAL ARTICLE
Open Access
Psychosomatic symptoms related to exacerbation of fatigue in patients with medically unexplained symptoms

Kazuaki Hashimoto MD, PhD,Takeaki Takeuchi MD, PhD,Maya Murasaki MD,Miki Hiiragi MD,Akiko Koyama MD,Yuzo Nakamura MD,Masahiro Hashizume MD, PhD
First published: 11 October 2022

https://doi.org/10.1002/jgf2.582



Abstract
Background
Medically unexplained symptoms (MUS) are common conditions that cause various somatic complaints and are often avoided in primary care. Fatigue frequently occurs in patients with MUS. However, the somatic and psychiatric symptoms associated with fatigue in patients with MUS are unknown. This study aimed to clarify the intensity of fatigue and the related somatic and psychiatric symptoms in patients with MUS.

Methods
A total of 120 patients with MUS aged 20–64 years who visited the Department of Psychosomatic Medicine, Toho University Medical Center Omori Hospital, between January and March 2021 were considered. The participants' medical conditions were assessed using the Chalder Fatigue Scale (CFS), Somatic Symptom Scale-8 (SSS-8), and Hospital Anxiety and Depression Scale (HADS). We estimated the relationship between CFS, SSS-8 and HADS by using Spearman's rank correlation. Additionally, linear multiple regression analysis with CFS as the objective variable was used to identify symptoms related to fatigue.

Results
Fatigue was significantly associated with all symptoms observed (p < 0.01). Linear multiple regression analysis revealed that “dizziness,” “headache,” and “Sleep medication” were extracted as relevant somatic symptoms (p < 0.05), independent of anxiety and depression, which were already known to be associated with fatigue in MUS.

Conclusion
The intensity of anxiety, depression, headache, and dizziness were all associated with the intensity of fatigue in MUS patients. On the contrary, sleeping medication was associated with lower levels of fatigue in MUS.

 

[Sean]

Medically unexplained symptoms (MUS) are common conditions that cause various somatic complaints

Seems circular.

 

[SNT Gatchaman]

However, medical personnel often avoid MUS because it is difficult to explain the mechanism of these symptoms occurring in patients through clinical examinations and tests. Then, about 20%–25% of MUS patients develop chronic symptoms, making treatment even more difficult.

We are ignorant and we don't like it, so we try to avoid these patients. Also we don't try to appropriately research and treat these patients. Many patients don't spontaneously recover. We find that it's hard to treat patients when we don't treat them.

Fatigue is also a common symptom in healthy individuals and is a nonspecific and subjective symptom. Therefore, medical personnel often underestimate fatigue. However, fatigue has been reported that the economic burden and social loss caused by fatigue are significant.

(I'll let the poorly constructed last sentence pass.) What we as healthy doctors understand by the term fatigue is perfectly normal and seen in healthy people leading normal healthy lives. Also, fatigue leads to significant economic burden and social loss, but is totally-the-same-thing because it has the same name.

Furthermore, chronic fatigue syndrome, also treated as one of the MUS, significantly reduces the quality of life and functioning of patients and their families due to its severity. Therefore, addressing fatigue before it becomes chronic might be important. Unfortunately, research on early detection or intervention for fatigue is scarce.

"Significantly reduces quality of life and functioning" so prevention "might be important". OK I'd prefer something a little stronger but fine, scientific papers shouldn't overstate a position.

However, a previous randomized controlled trial study demonstrated that early intervention with psychoeducation for infectious mononucleosis was preventive for fatigue in primary care.

Whoops, you've overstated the position.

There are no clear diagnostic criteria for MUS. Nevertheless, patients in this study were defined as those with somatic complaints examined by multiple physicians who concluded that organic dysfunctions could not adequately explain their symptoms or pathology, citing previous studies.

We have have no idea what is causing the symptoms so we've decided it's in their heads. Also, we've all published some papers saying this, therefore that's what it is. We're sticking with it.

MUS is a complex condition associated with multiple somatic and psychiatric symptoms. Depression and anxiety are associated with MUS, and these psychiatric states are also associated with fatigue.

How about the somatic symptoms the patients describe are commonly associated with these other symptoms — which you have labelled as anxiety and depression, but are probably largely dysautonomia and neuroinflammation?

The relationship between depression and fatigue may be influenced by subjective factors such as happiness [...]

What does this mean? Depression is a mood disorder principally characterised by anhedonia — a pathological inability to be happy. But if only the patient were more happy, they wouldn't be so unhappy? Or fatigued?

[...] and by brain inflammation associated with the activation of the immune response.

OMG! Science? ... hurrah! Quick — keep going with that ...

Functional dizziness may be associated with the dysfunction occurring in the anterior cingulate cortex, hippocampus, and insula, which are associated with mood disorders.

Oh never mind — "functional dizziness" — exacerbated by upright posture.

Any possible relationship to the robustly demonstrated pathological reduction in cerebral blood flow on standing, present in nearly all patients with this condition?

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Whenever I read "MUS" I now translate to "MFP" - Medically Failed Patients.

 

[Peter T]

Bad brain fog this morning, but aren’t the authors just saying the worse someone is the worse they are?

 

[Sean]

Whenever I read "MUS" I now translate to "MFP" - Medically Failed Patients.

 

[Milo]

Who would like to visit the department of psychosomatic medicine, raise you hand? ... Anyone?

 

[Sly Saint]

Medically unexplained symptoms (MUS) are common conditions that cause various somatic complaints

this is one description of MUS. IE a group of conditions; meaning diagnosed illnesses eg ibs,cfs etc.

the other interpretation however is more in line with the name; medically unexplained symptoms; namely the actual symptoms, which are primarily fatigue and pain.

the latter allows them to include an almost infinite number of conditions to the 'list' eg MS

see: https://www.s4me.info/threads/uk-im...blogs-and-discussion.14318/page-6#post-424909

you also need to question why they call them 'medically unexplained' when they are invariably symptoms included in the diagnostic criteria for the conditions.

 

[Trish]

but is totally-the-same-thing because it has the same name.

We have have no idea what is causing the symptoms so we've decided it's in their heads. Also, we've all published some papers saying this, therefore that's what it is. We're sticking with it.

Thanks SNTG, I enjoyed your witty translations of the authors' nonsense. They really haven't a clue.

 

[rvallee]

This thing where "a primary symptom" or a "differentiating symptom" has to be found seems to have completely warped medicine's ability to move ahead from acute card and onto chronic care. Common symptoms of illness are common in people who are ill. This is obviously consistent with illness.

It's really growing on me that it's the differential diagnosis approach that is failing here. It works when there are clear differences between diseases and unique symptoms. It obviously completely fails when that's not the case. It's often not the case. This is really a problem here of a model of reality being upheld above reality itself. This approach does not work when there are no clear differences, it just leads to silly nonsense like this.

However, medical personnel often avoid MUS because it is difficult to explain the mechanism of these symptoms occurring in patients through clinical examinations and tests. Then, about 20%–25% of MUS patients develop chronic symptoms, making treatment even more difficult.

It's generally difficult to get better at something without ever trying. It's often impossible when it's something especially difficult. Decades of continuing not to try, especially pushing the same mindless nonsense in circles, will also not make it any easier at figuring this out, one might even say that it's a failure of choice. It's me, I'm saying that, this failure is entirely a choice, complete dereliction of duty. Revolting stuff.

Not to speak of how medicine has, somehow, decided to make the two most common symptoms to be the defining symptoms of mental illness. That's as embarrassing a disaster as it gets. Frankly it's become as bad as "The card says Moops". What the hell is "the card says Moops", you might ask?

It's insisting that something that is clearly mislabeled has to be right, even though it's clearly wrong. The card has a typo, the answer is obviously wrong, but the model says otherwise, and the card/model is everything, a decision process based on nothing but winning an argument. That's following the rules the wrong way for the wrong reasons.

"It's Moors. That's a misprint".
"That's not Moops, you jerk"
"I'm sorry, the card says Moops"

 

[RedFox]

Are there any data on what percentage of people labeled as having MUS eventually get a medical diagnosis?

I imagine my own journey with ME. For almost 4 years, I had no medical explanation for my symptoms. Them BAM! ME diagnosis.