Somatic symptom disorder in patients with post-COVID-19 neurological symptoms: a preliminary report from the somatic study, 2022, Kachaner et al

Andy

Andy

Retired committee member
Full title: Somatic symptom disorder in patients with post-COVID-19 neurological symptoms: a preliminary report from the somatic study (Somatic Symptom Disorder Triggered by COVID-19)

Abstract

Objectives
To assess the diagnosis of somatic symptom disorder (SSD) in patients with unexplained neurological symptoms occurring after SARS-CoV-2 infection, also referred to as long COVID.

Design
Single-centre observational study.

Participants
Adult patients experiencing unexplained long-lasting neurological symptoms after mild COVID. Of the 58 consecutive patients referred in our centre, 50 were included.

Intervention
Patients were contacted for a standardised psychometric evaluation by phone, followed by a self-survey.

Main outcome
Positive diagnosis of SSD according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5).

Results
Although the patients did not meet the DSM-5 criteria for a functional neurological symptom disorder specifically, SSD diagnosis based on DSM-5 criteria was positive in 32 (64%) patients. In the remaining 18 patients, SSD was considered possible given the high score on diagnostic scales. Physical examination were normal for all. Brain MRI showed unspecific minor white matter hyperintensities in 8/46 patients. Neuropsychological assessment showed exclusively mild impairment of attention in 14 out of 15 tested patients, in discrepancy with their major subjective complaint. Forty-five (90%) patients met criteria for Chronic Fatigue Syndrome. Seventeen (32%) patients were screened positive for mood-anxiety disorders, 19 (38%) had a history of prior SSD and 27 (54%) reported past trauma. Additional self-survey highlighted post-traumatic stress disorder in 12/43 (28%), high levels of alexithymia traits and perfectionism. Long-lasting symptoms had a major impact with a high rate of insomnia (29/43, 67%), psychiatric follow-up (28/50, 56%) and work or pay loss (25/50, 50%).

Conclusion A majority of patients with unexplained long-lasting neurological symptoms after mild COVID met diagnostic criteria for SSD and may require specific management.

Open access, https://jnnp.bmj.com/content/early/2022/08/25/jnnp-2021-327899
 
The whole SSD diagnosis is based on behaviors, thoughts and feelings "appearing disproportionate" to the symptoms patients experience.

With Long Covid, where so much is poorly understood, that judgement is nearly impossible to make and an SSD diagnosis probably says more about the doctor than the patient.
 
This is the same crew that brought us the belief in having Covid yields Long Covid debacle earlier. I hope this doesn’t garner a significant amount of media attention and promotion, but I fear it may. There is just no escaping this stuff.

I also love how they bill this finding as somehow portending well for stemming the tide of disability associated with Long Covid. As if diverting these patients to CBT programs is really going to solve something in a material way. It would save an awful lot of money though if that’s what the goal is!
 
SSD is such a load of pseudoscientific twaddle that even some psychiatrists have a problem with this concocted category of (alleged) psychiatric illness:

Somatic symptom disorder has been a controversial diagnosis, since it was historically based primarily on negative criteria; that is, the absence of a medical explanation for the presenting physical complaints. Consequently, any person with a poorly understood illness can potentially fulfill the criteria for this psychiatric diagnosis, even if they exhibit no psychiatric symptoms in the conventional sense.

In the opinion of Allen Frances, chair of the DSM-IV task force, the DSM-5's somatic symptom disorder brings with it a risk of mislabeling a sizable proportion of the population as mentally ill.

Millions of people could be mislabeled, with the burden falling disproportionately on women, because they are more likely to be casually dismissed as 'catastrophizers' when presenting with physical symptoms.
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I have recently discovered that a quack psychiatrist I was forced to see by my (now former) workplace diagnosed me with SSD.

The basis for this diagnosis: I reported that I suffered from insomnia.

According to him, it was "impossible" for someone with ME/CFS to have insomnia because "everyone knows that people with CFS are always tired and sleep all the time".

Unfortunately this diagnosis has remained in my personnel file even though I have been diagnosed with ME/CFS by two specialist physicians.

Sadly, this quack has since retired so I am unable to report him to medical regulators.
 
Last edited:
Andy said:
"Additional psychometric evaluation
Forty-five (90%) patients fulfilled the criteria for CFS according to the SOFA scale."

Screening for prolonged fatigue syndromes: validation of the SOFA scale, 2000, Lloyd et al

Paywall, https://link.springer.com/article/10.1007/s001270050266
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Sci-Hub Screening for prolonged fatigue syndromes: validation of the SOFA scale and Prevalence of chronic fatigue syndrome in an Australian population years 2000 and 1990 respectively, nice to see the psychs using up to date research.
 
ME/CFS Skeptic said:
These seem to be the ten questions of the scale:
View attachment 18056

Take from this study: (PDF) Validation of the Korean Version of Schedule of Fatigue and Anergia: General Physician Questionnaire (researchgate.net)
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Those are basically the common symptoms of illness. This is completely unserious. Literally everyone who is currently ill fits those criteria. And basically the symptoms found in Long Covid and almost all acute infectious illnesses.

Chronic illness is fake because the symptoms, literally the common symptoms of illness, are vague and the cause isn't understood. This is real, though? What a scam.
 
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