Wednesday, December 30, 2009

"Functional" or "psychosomatic" symptoms

 
One of the major difficulties that repeatedly muddies both the bio and
psychosocial research are unsubstantiated claims by biopsychosocial
ideological adherents that common symptoms of an infectious process are
depression instead. At this time there is no objective means of proving this
opinion.

The failure to acknowledge the substantial body of biomedical research
objectively showing an infectious process in well-defined patient groups
with CFS and/or Myalgic Encephalomyleitis  (ICD-10 G93.3) doesn't change the
factual evidence. It may however mislead other researchers or clinicians who
may not have the time or inclination to review the actual biomedical
literature or dismiss it because it does not fit with their preconceived and
unproven opinion. The history of medicine is full of theories that medical
technological advances render amusing or irrelevant at best.

It should be noted that feelings of worthlessness or excessive or
inappropriate guilt and loss of interest or pleasure are not generally
present in CFS and/or ME patients although required for a diagnoses of major
depressive disorder. As CFS expert and psychologist Dr. Leonard Jason has
noted repeatedly, CFS patients are full of plans for such a time when their
symptoms abate.
Common sense tells us that sadness or depression related to
loss of health is a normal part of the disease experience not proof that no
disease process exists. Also, loss of energy and exercise intolerance are
not remotely related and are only confused when doctors (and psychiatrists
are MDs) substitute their personal opinion for the actual experience of the
patient.
It should also be noted that the DSM requires that any symptoms
that can be attributed to a medical disease cannot be used to make a
diagnosis of  a major depressive episode or psychosomatic disorder for that
matter. Refusal to believe an explanation that would diminish the
researchers standing as an "expert" is not the same thing as unexplained.

Although psychology and psychiatry have the potential to have much to offer
patients with organic diseases in the way of adjunctive therapies,
unfortunately at this point in time the DSM remains a manual of  opinion and
association.

It should also be noted that the names of the person or persons who wrote
this letter were not made publicly available. Whether it indicates that they
are unwilling to take full public responsibility for their opinion is
speculative.


Neuro Endocrinol
Lett.<javascript:AL_get(this,%20'jour',%20'Neuro%20Endocrinol%20Lett.');>2009
Nov 25;30(5). [Epub ahead of print]
"Functional" or "psychosomatic" symptoms, e.g. a flu-like malaise, aches and
pain and fatigue, are major features of major and in particular of
melancholic depression: time to amend the diagnostic criteria for major
depression and.

[No authors listed]

FULL TITLE: "Functional" or "psychosomatic" symptoms, e.g. a flu-like
malaise, aches and pain and fatigue, are major features of major and in
particular of melancholic depression: time to amend the diagnostic criteria
for major depression and the rating scales that measure severity of illness.


BACKGROUND: Major depression is characterized by multifarious symptoms and
symptoms clusters, such as the melancholic and anxiety symptom clusters.
There is a strong comorbidity and a biological similarity between major
depression and myalgic encephalomyelitis / chronic fatigue syndrome
(ME/CFS).
 
AIM: The aim of the present study was to examine "psychosomatic"
symptoms reminiscent of ME/CFS in major depression. Toward this end, we
examined the 12-item Fibromyalgia and Chronic Fatigue Syndrome Rating (FF)
Scale and the Hamilton Depression Rating Scale (HDRS) in 103 major depressed
patients by means of multivariate pattern recognition methods.

RESULTS: Our findings support the existence of two factors, i.e. a fatigue
and somatic (F& S) factor, i.e aches and pain, muscular tension,
fatigue, concentration difficulties, failing memory, irritability, irritable
bowel, headache, and a subjective experience of infection; and a depression
factor, i.e. sadness, irritability, sleep disorders, autonomic symptoms, and
a subjective experience of infection. Cluster analysis performed on the 12
FF items found two different clusters, which were separated by highly
significant differences in the F& S items, the most significant being a
subjective experience of infection, aches and pain, muscular tension,
fatigue, concentration difficulties and failing memory. Multivariate
analyses showed that the differences between both clusters were
quantitatively, and not qualitatively, and reflected the severity of the
F& S dimension. There was a strong association between the F& S
symptoms and melancholia and chronic depression. Treatment resistant
depression was characterized by higher scores on the depression factor
score. There was a strong correlation between the HDRS score and the FF
items, fatigue, a subjective experience of infection, and sadness.

CONCLUSIONS: Our findings show that F& S symptoms are a major feature of
depression and largely predict severity of illness, and chronic and
melancholic depression. It is concluded that the diagnostic criteria of
depression and melancholia and rating scales to measure severity of illness
should be modified to include the F& S symptom profile.

PMID: 20035251 [PubMed - as supplied by publisher]

* * *
"loss of energy and exercise intolerance are not remotely related and are only confused when doctors (and psychiatrists are MDs) substitute their personal opinion for the actual experience of the patient."
 
My medical records are full of statements where the doctor wrote down what he wanted me to say to support his preferred diagnosis rather than what I actually told him.
 
 

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