Diagnosis of psychiatric disorder in clinical evaluation of chronic fatigue syndrome

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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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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Psychiatric diagnosis and chronic fatigue syndrome: Controversies and conflicts

Journal of Mental Health ◽

10.1080/09638230500136621 ◽

2005 ◽

Vol 14 (3) ◽

pp. 269-276 ◽

Cited By ~ 8

Author(s):

Michael Sharpe

Keyword(s):

Chronic Fatigue Syndrome ◽

Psychiatric Diagnosis ◽

Chronic Fatigue ◽

Fatigue Syndrome

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Alternative Diagnoses to Chronic Fatigue Syndrome in Referrals to a Specialist Service: Service Evaluation Survey

JRSM Short Reports ◽

10.1258/shorts.2011.011127 ◽

2012 ◽

Vol 3 (1) ◽

pp. 1-5 ◽

Cited By ~ 19

Author(s):

Anoop Devasahayam ◽

Tara Lawn ◽

Maurice Murphy ◽

Peter D White

Keyword(s):

Chronic Fatigue Syndrome ◽

Chronic Fatigue ◽

Service Evaluation ◽

Depressive Illness ◽

Primary Diagnosis ◽

Psychiatric Diagnoses ◽

Specialist Service ◽

Medical Diagnoses ◽

Fatigue Syndrome ◽

Referral Letters

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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Predictors of response to treatment for chronic fatigue syndrome

The British Journal of Psychiatry ◽

10.1192/bjp.181.3.248 ◽

2002 ◽

Vol 181 (3) ◽

pp. 248-252 ◽

Cited By ~ 53

Author(s):

Richard P. Bentall ◽

Pauline Powell ◽

Fred J. Nye ◽

Richard H. T. Edwards

Keyword(s):

Chronic Fatigue Syndrome ◽

Psychological Treatment ◽

Controlled Trial ◽

Depression Scale ◽

Chronic Fatigue ◽

Response To Treatment ◽

Poor Outcome ◽

Fatigue Syndrome ◽

Predictors Of Response ◽

Randomised Controlled

BackgroundControlled trials have shown that psychological interventions designed to encourage graded exercise can facilitate recovery from chronic fatigue syndrome.AimsTo identify predictors of response to psychological treatment for chronic fatigue syndrome.MethodOf 114 patients assigned to equally effective treatment conditions in a randomised, controlled trial, 95 completed follow-up assessments. Relationships between variables measured prior to randomisation and changes in physical functioning and subjective handicap at 1 year were evaluated by multiple regression.ResultsPoor outcome was predicted by membership of a self-help group, being in receipt of sickness benefit at the start of treatment, and dysphoria as measured by the Hospital Anxiety and Depression scale. Severity of symptoms and duration of illness were not predictors of response.ConclusionsPoor outcome in the psychological treatment of chronic fatigue syndrome is predicted by variables that indicate resistance to accepting the therapeutic rationale, poor motivation to treatment adherence or secondary gains from illness.

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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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Clinical Update: Chronic Fatigue Syndrome

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2002.janfeb02 ◽

2002 ◽

Vol 7 (1) ◽

pp. 6-9

Author(s):

Leon H. Ensalada ◽

Christopher R. Brigham

Keyword(s):

Chronic Fatigue Syndrome ◽

Rating Scale ◽

Specific Treatment ◽

Depression Scale ◽

Chronic Fatigue ◽

Multiple Chemical Sensitivity ◽

Physical Symptoms ◽

Convincing Evidence ◽

Illness Behavior ◽

Fatigue Syndrome

Abstract Chronic fatigue syndrome (CFS) is a term applied to individuals who report severe chronic fatigue out of proportion to their efforts, but the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fourth and Fifth Editions, are clear that no ratable impairment is linked to CFS. Chronic fatigue is not synonymous with CFS; only a small fraction of persons who present with chronic fatigue symptoms meet the criteria for CFS; and CFS, like fibromyalgia and multiple chemical sensitivity, is poorly understood. CFS may be associated with disability but primarily is based on psychological rather than physical symptoms. No tests confirm the diagnosis of CFS, and routine laboratory testing is reserved for excluding other medical conditions. CFS is an illness without a disease and often is characterized by illness behavior expressed as somatization. To date, no convincing evidence supports the notion that CFS is an infectious, neuroendocrine, or immunologic disorder. Thus, sophisticated behavioral assessment is critical and may include a fatigue rating scale, a depression scale, and psychological and personality inventories. No specific treatment has been recommended for CFS treatment, but cognitive and behavioral interventions may be useful to address psychological symptoms; medication is reserved for specific symptoms indicative of depression or anxiety.

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