Trudie Chalder, BPS and MUS proponent - presentations, interviews and news

Nightsong said:
Yes, important to realise that this is not just a random video, but is part of Health Education England's e-learning for NHS clinicians.

I asked someone with access to this to find out if there were any other Long COVID or ME/CFS related courses; as shown by the screenshots below, there are courses on fatigue in Long COVID, the setting up of post-COVID rehabilitation clinics, a course on "persistent physical symptoms", and a course on managing ME in adolescents (by a nurse at Great Ormond Street).

Someone with good reason to take these courses really needs to review all of this content with a critical eye and ensure that HEE receives complaints where, as in the Chalder video, bogus, fraudulent or insulting claims are made.
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I see the course on setting up a multidisciplinary team features a specific doctor who is now, as of September, "the NHS’s first ever National Specialty Adviser for Long Covid – a role created to help the NHS meet the new demand for ongoing care from people suffering long term physical and psychological after-effects from the virus."

This doctor is exceptionally keen to address the potential self reinforcing loop triggered by infection, which may mainly consist of poor sleep/apnoea, anxiety and worse symptoms. Certainly a figure to watch for emerging developments.

PS. dry tone intended

EDIT: removed the name because a public post and not sure I would like this coming up in a search

EDIT V2: reference for the above quote https://www.newcastle-hospitals.nhs...t-national-speciality-advisor-for-long-covid/
 
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Haveyoutriedyoga said:
I see the course on setting up a multidisciplinary team features a specific doctor who is now, as of September, "the NHS’s first ever National Specialty Adviser for Long Covid – a role created to help the NHS meet the new demand for ongoing care from people suffering long term physical and psychological after-effects from the virus."
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I see that the director is based at UCL. We may have to keep our eyes on this. We are seeing some strange links. Bannerjee, who wrote this apparent allusion to Wessely, https://doi.org/10.1136/bmj.n2736 seemingly unwittingly,( but who knows?) is at the institution. Tim Kendall the NHS England and NHS Improvement-X24 clinical director of Mental Health is also a visiting Professor.
 
Nightsong said:
Yes, important to realise that this is not just a random video, but is part of Health Education England's e-learning for NHS clinicians.

I asked someone with access to this to find out if there were any other Long COVID or ME/CFS related courses; as shown by the screenshots below, there are courses on fatigue in Long COVID, the setting up of post-COVID rehabilitation clinics, a course on "persistent physical symptoms", and a course on managing ME in adolescents (by a nurse at Great Ormond Street).

Someone with good reason to take these courses really needs to review all of this content with a critical eye and ensure that HEE receives complaints where, as in the Chalder video, bogus, fraudulent or insulting claims are made.
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I've got an excuse to do covid related courses and webinars, I've started going through and already found and reported a ref to the 2007 ME guidance and 'graded exercise'
 
Webinar Dec 2021
How to Approach Long COVID: Research Update and Practical Applications
Presented by Professor Trudie Chalder

"...We have developed an approach which is based on the idea that after the initial illness has subsided physical and psychological processes contribute to ongoing symptoms, distress and disability. By targeting these processes and regulating sleep, rest and activity, as well as reducing distress it is possible that symptoms will reduce and quality of life will improve. This workshop will emphasise the importance of a formulation driven approach."

more at
BPS attempts at psychologizing Long Covid
 
Hutan said:
after the initial illness has subsided physical and psychological processes contribute to ongoing symptoms, distress and disability.
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I absolutely detest that word "distress".

In a post by @JemPD she said :

JemPD said:
Yes, i know people dont like malaise & i agree to a point because of the connotations with swooning victorian ladies.
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and I completely understand what she was getting at with the comment about swooning Victorian ladies. I think the connotations may be similar with "distress".

I think the connotations of "distress" are equally insulting and dismissive in a medical context, suggesting that people who are distressed are weak and need to stiffen their spines and their upper lips. I personally associate distress with babies and toddlers crying or people crying at funerals. I don't associate it with people being ill. Does anyone with a broken leg, appendicitis or flu ever get described as "distressed"?

[Actually, I can imagine someone not getting a diagnosis for appendicitis might get distressed if they were turned away by a doctor with no diagnosis or with a referral to a CBT therapist.]
 
Hutan said:
We have developed an approach which is based on the idea that after the initial illness has subsided physical and psychological processes contribute to ongoing symptoms, distress and disability. By targeting these processes and regulating sleep, rest and activity, as well as reducing distress it is possible that symptoms will reduce and quality of life will improve. This workshop will emphasise the importance of a formulation driven approach."
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Idea. An approach based on an idea.
 
Arnie Pye said:
I absolutely detest that word "distress".
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Yes, agree. It is used with negative (belittling, infantilising, misogynistic) connotations exactly as you describe. As we all know, anyone suffering these symptoms would be distressed, by their very nature and degree. It is remarkable how people learn to suppress and hide this from doctors and society at large. Probably something everyone reading this thread understands intimately.

Arnie Pye said:
Does anyone with a broken leg, appendicitis or flu ever get described as "distressed"?
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Actually yes. It's a common term for describing a medical presentation that is clearly due to physical pathology. Its most common use case is "respiratory distress", which would be further delineated in terms of respiratory rate and effort/work of breathing, along with pulse rate and oxygen saturation.
 
podcast interview
The Journal of Rheumatology's Editor-in-Chief Earl Silverman discusses this month's selection of articles that are most relevant to the clinical rheumatologist. Included is an excerpt from this month’s Editor’s Picks spotlight interview with authors Yasaman Emad, Nicola Dalbeth, John Weinman, Trudie Chalder and Keith J. Petrie about their article "Why Do Patients With Gout Not Take Allopurinol?" -doi.org/10.3899/jrheum.210950
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Why Do Patients With Gout Not Take Allopurinol?
Abstract
Objective. The objectives of this study were to examine the reasons patients give for nonadherence to allopurinol and to examine differences in intentional nonadherence for patients who did and did not achieve serum urate (SU) levels at treatment target.

Methods. Sixty-nine men with gout attending rheumatology clinics, all prescribed allopurinol for ≥ 6 months, completed the Intentional Non-Adherence Scale (INAS). Differences in the types of intentional nonadherence were analyzed between those who did and did not achieve SU at treatment target (< 0.36 mmol/L, 6 mg/dL).

Results. The most frequently endorsed reasons for not taking their urate-lowering therapies (ULT) were because participants wanted to lead a normal life (23%) or think of themselves as a healthy person again (20%). Patients also reported not taking allopurinol as a way of testing if they really needed it (22%). Participants with SU above target endorsed significantly more INAS items as reasons for not taking their medication, had more medicine-related concerns, and were more likely to give Testing treatment as a reason for nonadherence. Participants who were younger, single, and non–New Zealand European also endorsed more reasons for not taking their allopurinol.

Conclusion. The major reasons behind the patient’s decision not to take allopurinol relate to the desire to lead a normal life and the strategy of testing the treatment to see if they could reduce the dose without getting symptoms. These results provide some potentially modifiable targets for adherence interventions and some recommendations to clinicians about how to reframe ULT for patients in order to improve adherence.
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https://www.jrheum.org/content/49/6/622

(haven't listened to it; curious about TCs involvement)
 
Why Do Patients With Gout Not Take Allopurinol?

Sixty-nine men with gout attending rheumatology clinics, ...
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I don't know if gout affects men more than women, or if gender is at all relevant. But I bet if they had done a study using female subjects they would have studied anxiety and depression as reasons for non-adherence.
 
Arnie Pye said:
on't know if gout affects men more than women
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Spontaneous gout is much more common in men, and even more so in Maori men. Old ladies get gout if put on diuretics.

I don't quite get what the Intentional Non-Adherence Scale is supposed to do and wonder if it was modelled on the Chalder Fatigue Scale. The results suggest that, as one might expect, there is nothing to 'scale'. What matter are the answers to specific questions on their own.

And if you ask specific questions you will get answers that fit those questions (so we are taught not to ask such leading questions in medicine). I wonder if the questions include: 'Can't be bothered'. 'Sod that.' 'Too sozzled to care, frankly.'
 
Sly Saint said:
podcast interview


Why Do Patients With Gout Not Take Allopurinol?

https://www.jrheum.org/content/49/6/622

(haven't listened to it; curious about TCs involvement)

"These results provide some potentially modifiable targets for adherence interventions and some recommendations to clinicians about how to reframe ULT for patients in order to improve adherence."
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I don't fully get why the research is needed. I can imagine who the individuals are (almost imagine the types of interactions going on at an appointment), and noone is being told anything new

More to the point given that taking allopurinol or not and getting agonising pain is instrumental conditioning in itself - a couple of bouts of gout following forgetting or deciding not to take it will quash any boundary-testing in the dumbest of creatures surely - and there is nothing stronger than that in the world of psychological techniques, so why would you claim/think 'interventions' would better that?

*EDIT: the only exception being in capability issues such as dementia etc - so why Chalder would be involved and solutions wouldn't be based on electronic memory aids involving product designers instead I don't know

If the symptoms were different, less direct, more of a problem for others than pain to themselves I might understand, but it is as direct as it comes to Pavlov/Skinner surely?

Is it the type of condition that early adherence makes a difference to long-term outcome - I'm unaware whether gout is the sort of thing that costs huge amounts to treat or becomes irreversibly worse etc?
 
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