The effect of comorbid medical and psychiatric diagnoses on chronic fatigue syndrome

Objective To assess the accuracy of diagnoses made by referrers to a chronic fatigue syndrome (CFS) service. Design Retrospective service evaluation surveys of both rejected referral letters and medical case-notes after full clinical assessment. Setting A specialist CFS clinic in London, UK. Participants In the first survey, we assessed rejected referral letters between March 2007 and September 2008. In the second survey, we ascertained the primary diagnosis made in case-notes of 250 consecutive new patients assessed between April 2007 and November 2008. Main outcome measures Reasons for rejection of referrals and primary diagnosis in those assessed. Results In the first survey, 154 out of 418 referrals (37%) were rejected. Of these, 77 out of the available 127 referrals (61%) had a likely alternative diagnosis. In the second survey of clinically assessed patients, 107 (43%) had alternative medical/psychiatric diagnoses, while 137 out of 250 (54%) patients received a diagnosis of CFS. The commonest alternative medical diagnoses of those assessed were sleep disorders and the commonest alternative psychiatric diagnosis was depressive illness. Altogether 184 of 377 (49%) patients had alternative diagnoses to CFS. Conclusions Half of all the referred patients to a specialist CFS clinic had alternative medical and psychiatric diagnoses. Specialist medical assessment for patients with unexplained, disabling, chronic fatigue needs to incorporate both medical and psychiatric assessments.

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Effect of psychiatric disorders on outcome of cognitive-behavioural therapy for chronic fatigue syndrome

The British Journal of Psychiatry ◽

10.1192/bjp.187.2.184 ◽

2005 ◽

Vol 187 (2) ◽

pp. 184-185 ◽

Cited By ~ 24

Author(s):

Judith Prins ◽

Gijs Bleijenberg ◽

Eufride Klein Rouweler ◽

Jos Van Der Meer

Keyword(s):

Chronic Fatigue Syndrome ◽

Psychiatric Disorders ◽

Cognitive Behavioural Therapy ◽

Chronic Fatigue ◽

Behavioural Therapy ◽

Psychiatric Diagnoses ◽

Psychiatric Interview ◽

Fatigue Syndrome ◽

Cognitive Behavioural ◽

The Impact

SummaryPsychiatric disorders have been associated with poor outcome in individuals with chronic fatigue syndrome (CFS). This study examines the impact of psychiatric disorders on outcome of cognitive-behavioural therapy (CBT). Psychiatric diagnoses were assessed with a structured psychiatric interview in a CBT trial of 270 people with CFS. Lifetime and current psychiatric disorders were found in 50 and 32% respectively. No significant differences in fatigue severity and functional impairment following treatment were found between participants with and without psychiatric diagnoses.

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Physicians' Diagnoses of Psychiatric Disorders for People with Chronic Fatigue Syndrome

The International Journal of Psychiatry in Medicine ◽

10.2190/pnf9-xfwj-da24-r3pu ◽

2002 ◽

Vol 32 (2) ◽

pp. 109-124 ◽

Cited By ~ 6

Author(s):

Susan R. Torres-Harding ◽

Leonard A. Jason ◽

Victoria Cane ◽

Adam Carrico ◽

Renee R. Taylor

Keyword(s):

Chronic Fatigue Syndrome ◽

Psychiatric Disorder ◽

Psychiatric Disorders ◽

Psychiatric Illness ◽

Chronic Fatigue ◽

Self Report ◽

Control Group ◽

Psychiatric Diagnoses ◽

Psychiatric Interview ◽

Fatigue Syndrome

Objective: To examine rates of psychiatric diagnoses given by patients' primary or regular physicians to persons with chronic fatigue syndrome (CFS), persons with psychiatrically explained fatigue, and a control group. Physicians' psychiatric diagnosis and participants' self-reported psychiatric diagnoses were compared to lifetime psychiatric diagnoses as measured by a structured psychiatric interview. Method: Participants were recruited as part of a community-based epidemiology study of chronic fatigue syndrome. Medical records of 23 persons with chronic fatigue syndrome, 25 persons with psychiatrically explained chronic fatigue, and 19 persons without chronic fatigue (controls) were examined to determine whether their physician had given a diagnosis of mood, anxiety, somatoform, or psychotic disorder. Lifetime psychiatric status was measured using the Structured Clinical Interview for the DSM-IV (SCID). Participants' self reports of specific psychiatric disorders were assessed as part of a detailed medical questionnaire. Results: Physicians' diagnosis of a psychiatric illness when at least one psychiatric disorder was present ranged from 40 percent in the psychiatrically explained group, 50 percent in the control group, and 64.3 percent in the CFS group. Participants in the psychiatrically explained group were more accurate than physicians in reporting the presence of a psychiatric disorder, and in accurately reporting the presence of a mood or anxiety disorder. Conclusions: The present investigation found underrecognition of psychiatric illness by physicians, with relatively little misdiagnosis of psychiatric illness. Physicians had particular difficulty assessing psychiatric disorder in those patients whose chronic fatigue was fully explained by a psychiatric disorder. Results emphasized the importance of using participant self report as a screening for psychiatric disorder.

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Chronic Fatigue Syndrome in Canadian Adults: Profiling Demographic and Socioeconomic Factors, Mental Health Diagnoses and Conditions, and Life Experiences

10.21203/rs.3.rs-408624/v1 ◽

2021 ◽

Author(s):

Alysha Renouf ◽

Ken Fowler ◽

Stacey Wareham-Fowler

Keyword(s):

Mental Health ◽

Chronic Fatigue Syndrome ◽

Substance Dependence ◽

Life Experience ◽

Treatment Options ◽

Chronic Fatigue ◽

Canadian Community Health Survey ◽

Psychiatric Diagnoses ◽

Fatigue Syndrome ◽

Statistics Canada

Abstract Background: Chronic fatigue syndrome (CFS) is a debilitating condition characterized by a complex assortment of biological, psychological, and functional issues. In the literature, while a debate persists in terms of CFS etiology and treatment options, very rudimentary queries also linger in terms of associated CFS demographic and socioeconomic characteristics, comorbid psychiatric diagnoses, and potentially deleterious life challenges and experiences which, if more definitively clarified, may help elucidate illness origin and management. Methods: Using data extracted from the Canadian Community Health Survey – Mental Health (CCHS-MH) (Statistics Canada, 2013) for adults aged 20 to 64 years of age, the current study developed a descriptive statistical profile of demographic, socioeconomic, psychiatric, and life experience characteristics of Canadians reporting a diagnosis of CFS. Further, a series of two-factor Chi Square tests were carried out to determine whether featured variables were significantly more likely for CFS sufferers as compared to adult Canadians without a CFS diagnosis. Results: It was observed that those reporting a CFS diagnosis were significantly more likely to be female, between the ages of 45-64, divorced or separated, living alone, unemployed or unable to work, and of relatively low personal income. CFS sufferers were also more likely to have comorbid psychiatric diagnoses including lifetime and 12-month Major Depressive Disorder (MDD), Generalized Anxiety Disorder (GAD), and substance dependence, as well as self-reported posttraumatic stress disorder (PTSD), attention deficit hyperactivity disorder (ADHD), sleeping troubles, and reported histories of childhood physical and sexual maltreatment. Conclusions: A very compelling demographic, socioeconomic, psychiatric, and life history profile of CFS sufferers emerged in this study, corroborating many findings in the literature. Since this study involved a national assessment CFS across Canada, it may afford some lucidity and insight in terms of etiological implications, and hence more precision in diagnosis, and potentially innovative treatment options. Future topics of inquiry, and potential limitations are also considered.

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Diagnosis of psychiatric disorder in clinical evaluation of chronic fatigue syndrome

Journal of the Royal Society of Medicine ◽

10.1177/014107680009300608 ◽

2000 ◽

Vol 93 (6) ◽

pp. 310-312 ◽

Cited By ~ 23

Author(s):

Alicia Deale ◽

Simon Wessely

Keyword(s):

Chronic Fatigue Syndrome ◽

Psychiatric Disorder ◽

Clinical Evaluation ◽

Psychiatric Diagnosis ◽

Depression Scale ◽

Chronic Fatigue ◽

Psychiatric Diagnoses ◽

Fatigue Syndrome ◽

Standardized Interview ◽

Brief Screening

Summary The overlap of symptoms in chronic fatigue syndrome (CFS) and psychiatric disorders such as depression can complicate diagnosis. Patients often complain that they are wrongly given a psychiatric label. We compared psychiatric diagnoses made by general practitioners and hospital doctors with diagnoses established according to research diagnostic criteria. 68 CFS patients referred to a hospital fatigue clinic were assessed, and psychiatric diagnoses were established by use of a standardized interview schedule designed to provide current and lifetime diagnoses. These were compared with psychiatric diagnoses previously given to patients. Of the 31 patients who had previously received a psychiatric diagnosis 21 (68%) had been misdiagnosed: in most cases there was no evidence of any past or current psychiatric disorder. Of the 37 patients who had not previously received a psychiatric diagnosis 13 (35%) had a treatable psychiatric disorder in addition to CFS. These findings highlight the difficulties of routine clinical evaluation of psychiatric disorder in CFS patients. We advise doctors to focus on subtle features that discriminate between disorders and to use a brief screening instrument such as the Hospital Anxiety and Depression Scale.

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Long- and short-term blood pressure andRR-interval variability and psychosomatic distress in chronic fatigue syndrome: authors’ reply 1

Clinical Science ◽

10.1042/cs19990155 ◽

1999 ◽

Vol 97 (3) ◽

pp. 319 ◽

Cited By ~ 1

Author(s):

D.A. DUPREZ ◽

M.L. DE BUYZERE ◽

B. DRIEGHE ◽

F. VANHAVERBEKE ◽

Y. TAES ◽

...

Keyword(s):

Blood Pressure ◽

Chronic Fatigue Syndrome ◽

Chronic Fatigue ◽

Short Term ◽

Fatigue Syndrome

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Diagnostic Concordance Between Categorical and Dimensional Instruments to Assess Personality Disorder in Chronic Fatigue Syndrome

European Journal of Psychological Assessment ◽

10.1027/1015-5759/a000281 ◽

2017 ◽

Vol 33 (3) ◽

pp. 158-165

Author(s):

Natalia Calvo ◽

Naia Sáez-Francàs ◽

Sergi Valero ◽

Jesús Castro-Marrero ◽

José Alegre Martín ◽

...

Keyword(s):

Personality Disorder ◽

Chronic Fatigue Syndrome ◽

Personality Assessment ◽

Chronic Fatigue ◽

Specific Pattern ◽

Harm Avoidance ◽

Assessment Instrument ◽

Compulsive Disorder ◽

Fatigue Syndrome ◽

Self Transcendence

Abstract. The study examines the relationship between a categorical and a dimensional personality assessment instrument in patients with Chronic Fatigue Syndrome (CFS). A total of 162 CFS patients were included in the study (91.4% women; mean age 47.5 years). All subjects completed the Spanish versions of the Personality Diagnostic Questionnaire-4+ (PDQ-4+) and the Temperament and Character Inventory-Revised (TCI-R). Results: 78 (48.1%) of the patients presented a Personality Disorder (PD), the most frequent being Cluster C, specifically Obsessive-compulsive disorder, followed by Avoidant disorder. PDs showed a specific pattern of correlation with temperament scales. All PD clusters correlated positively with Harm Avoidance and Self-Transcendence, and negatively with Reward Dependence, Self-Directedness, and Cooperativeness. In a logistic regression analysis, Self-Directedness and Cooperativeness predicted PD presence. The findings are consistent with previous studies in non-CFS samples and suggest that the combination of the Temperament and Character dimensions (low Self-Directedness and Cooperativeness and high Harm Avoidance and Self-Transcendence) correlates with PD severity, and that Self-Directedness and Cooperativeness are associated with PD presence in CFS patients. The integration of these two perspectives expands the current comprehension of personality pathology in CFS patients.

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