The Effect of Comorbid Medical and Psychiatric Diagnoses on Chronic Fatigue Syndrome, 2019, Natelson et al

[Andy]

Abstract
Objective: To determine if presence of co-existing medically unexplained syndromes or psychiatric diagnoses affect symptom frequency, severity or activity impairment in Chronic Fatigue Syndrome.

Patients: Sequential Chronic Fatigue Syndrome patients presenting in one clinical practice.

Design: Participants underwent a psychiatric diagnostic interview and were evaluated for fibromyalgia, irritable bowel syndrome and/or multiple chemical sensitivity.

Results: Current and lifetime psychiatric diagnosis was common (68%) increasing mental fatigue/health but not other illness variables and not with diagnosis of other medically unexplained syndromes. 81% of patients had at least one of these conditions with about a third having all three co-existing syndromes. Psychiatric diagnosis was not associated with their diagnosis. Increasing the number of these unexplained conditions was associated with increasing impairment in physical function, pain and rates of being unable to work.

Conclusions: Patients with Chronic Fatigue Syndrome should be evaluated for current psychiatric conditions because of their impact on patient quality of life, but they do not act as a symptom multiplier for the illness. Other co-existing medically unexplained syndromes are more common than psychiatric co-morbidities in patients presenting for evaluation of medically unexplained fatigue and are also more associated with increased disability and the number and severity of symptoms.

• Key Messages
• When physicians see patients with medically unexplained fatigue, they often infer that this illness is due to an underlying psychiatric problem.
  
  
• This paper shows that the presence of co-existing psychiatric diagnoses does not impact on any aspect of the phenomenology of medically unexplained fatigue also known as chronic fatigue syndrome. Therefore, psychiatric status is not an important causal contributor to CFS.
  
  
• In contrast, the presence of other medically unexplained syndromes [irritable bowel syndrome; fibromyalgia and/or multiple chemical sensitivity] do impact on the illness such that the more of these that co-exist the more health-related burdens the patient has.
  

Paywall, https://www.tandfonline.com/doi/full/10.1080/07853890.2019.1683601
Scihub, sci-hub.se/10.1080/07853890.2019.1683601

 

[rvallee]

Psychiatric diagnosis was not associated with their diagnosis.

All things we already knew but worth putting it to rest.

I would very much like this to be followed by investigation of psychiatric misdiagnosis, which is the obvious reason for so much misleading co-morbidity. This would be very revealing. The vast majority of so-called psychiatric comorbidities here are simply errors, confusing superficial similarities and mostly based on a misrepresentation of the symptoms, especially a separate notion of "psychiatric mental fatigue", whatever that is, rather than the normal consequence of physiological exhaustion that no one should be confused about as nearly every human on Earth has experienced it.

Elizabeth Unger is a co-author. Hopefully this has some impact with the CDC burying the failed psychiatric model for good.

 

[duncan]

Elizabeth Unger is a co-author. Hopefully this has some impact with the CDC burying the failed psychiatric model for good.

 

[Hoopoe]

We found that CFS patients with or without current or past psychiatric diagnoses were comparable in regards to measures of their illness (activity, pain, fatigue) as assessed with standardized questionnaires (MFI-20, SF-36, PROMIS Pain, CDC-SI).

This is the important part.

The data shows that current or past psychiatric illness may be associated with worse illness measures but the effect is too small to survive correction for multiple comparisons.

This suggest that viewing CFS as manifestation of depression/anxiety is largely incorrect. It's a separate problem that needs its own treatment.

 

[Mithriel]

fibromyalgia, irritable bowel syndrome and/or multiple chemical sensitivity.

These are just as likely to be symptoms of ME rather than comorbidities. The association of fibromyalgia with ME only started after the invention of CFS. The myalgia which was often severe was not considered by the US doctors who saw fatigue as the main symptom so people were told they had fibro as well. It became very mixed up and has gotten worse since the definition of fibro has been loosened.

It is, of course, possible to have fibromyalgia or irritible bowel syndrome alongside ME but the important point is whether the symptoms used to diagnose them are caused by fibro causes or ME causes, if you see what I mean.

I may have stomach pains but it is has implications if it is helicobacter or an ME imbalance causing it.

I just don't think that enough people know how complex ME is as a disease.

 

[Peter T]

These are just as likely to be symptoms of ME rather than comorbidities. The association of fibromyalgia with ME only started after the invention of CFS. The myalgia which was often severe was not considered by the US doctors who saw fatigue as the main symptom so people were told they had fibro as well. It became very mixed up and has gotten worse since the definition of fibro has been loosened.

It is, of course, possible to have fibromyalgia or irritible bowel syndrome alongside ME but the important point is whether the symptoms used to diagnose them are caused by fibro causes or ME causes, if you see what I mean.

I may have stomach pains but it is has implications if it is helicobacter or an ME imbalance causing it.

I just don't think that enough people know how complex ME is as a disease.

From a subjective point of view I agree that it is very difficult to distinguish between what is a symptom of ME and what is a cooccurring condition.

For example my current IBS began at the same time as my ME and varies in direct conjunct with it, so it seems reasonable for me to regard it as a symptom of my ME. It could be a separate condition directly triggered by my ME, but it then would seem to make little sense to distinguish the two. Similarly my sensitivity to noise and light and my costochondritis postdate the onset of my ME and vary in direct proportion to it.

In contrast my gluten intolerance, although not identified until after the onset of my ME, may have predated the ME, further it is triggered by what I eat and varies only with the amount of gluten eaten, it is totally independent of the current severity of my ME. In this situation! though there seems to be a higher incidence of gluten intolerance in people with ME than in the general population, I would be happy to regard it as behaving as though it was a distinct cooccurring condition.

 

[Grigor]

68% seems a little high?!?

 

[Snow Leopard]

68% seems a little high?!?

This is a tertiary care study, not a community based study. Tertiary care studies have strong selection biases. Secondly, having a psychiatric diagnosis currently or in the past reflects biases in diagnosis. For example, if there is a trend in this area for CFS patients to be diagnosed with depression first, that would be reflected in the results.

Also:

Patients had been ill an average of 13.4 years.

 

[rvallee]

68% seems a little high?!?

It's just association anyway and generally not much more sophisticated than "Do you have anxiety? Yes? Diagnosis of anxiety it is."

I don't know if it's on my file, but a few years back my GP handed me a reference to psychotherapy for affective disorder. I didn't know whether to laugh or cry but I was too exhausted from the trip there to react more than blank disbelief. That's generally how most of those are made. Zero reliability and this is the reason I have little doubt the "crisis" of mental health is mostly those mistakes being overblown.

It actually mostly highlights how common those errors are and how unreliable those "associations" are. The BPS literature is almost entirely built on pointing at their own mistakes as evidence that they are right. It's all a house of cards and this here is yet more evidence of this.

 

[janice]

I'd forgotten I'd already seen this
However it gave me a good boost (again) to see even more good quality evidence undermining the old delusional ideas of poorly informed psychiatrists.

 

[Mij]

For example my current IBS began at the same time as my ME and varies in direct conjunct with it, so it seems reasonable for me to regard it as a symptom of my ME. It could be a separate condition directly triggered by my ME, but it then would seem to make little sense to distinguish the two.

I may have stomach pains but it is has implications if it is helicobacter or an ME imbalance causing it.

It appears that h pylori became active (?) at the same time during my sudden ME viral onset. The infection symptoms manifested for 5 years and got worse until I was finally tested and properly treated.

I read somewhere years ago that ME doctors have found this infection to be an issue with many ME pts?