Medically unexplained syndromes: irritable bowel syndrome, fibromyalgia and chronic fatigue (2018) Luty

Source: BJPsych Advances

Preprint

Date: June 6, 2018

URL:
https://www.cambridge.org/core/jour...onic-fatigue/056188C35015F793F283E6F385386289

Medically unexplained syndromes: irritable bowel syndrome, fibromyalgia and chronic fatigue
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Jason Luty

- Liaison Psychiatry, Farm Lodge, C/O Bradgate Unit, Glenfield Hospital, Groby Road, Leicester LE3 9EJ, UK. Email: jason.luty@yahoo.co.uk

Abstract

This is a review of three of the more common medically unexplained syndromes that present for treatment to liaison psychiatry services in general medical hospitals: chronic fatigue syndrome, fibromyalgia and irritable bowel syndrome. The three are interrelated, extremely
disabling and comorbid mood disorders are frequent. In general, treatment, whether psychological or medical, has very modest impact. The disputed classification of medically unexplained syndromes is also reviewed. There is a clear gulf between the views and experiences of patients with these syndromes and the medical establishment. In this article I summarise give the evidence for pharmacological, psychosocial and 'alternative' or 'complementary' interventions for a range of disorders, about which there is some dispute. I leave it to the reader to decide which interventions hold the most promise.

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(c) 2018 The Royal College of Psychiatrists
(c) 2018 Cambridge University Press

 

Some editing wouldn’t have gone astray Jason Luty.

 

Typo in the abstract is not good is it?!

 

Or this:
Psychosomatic comorbidities such as migraine, gastrointestinal disorders, and chronic fatigue syndrome are common in patients with OD.

in: https://www.jpsychores.com/article/S0022-3999(18)30376-3/fulltext

 

Interesting review of Jason Luty! It seems he's left the Bradgate Unit now.

 

It ends with

It also acknowledges the poor long term followup results in PACE, and reports the recovery outcomes from the PACE reanalysis. Unfortunately it doesn't make clear that this was the analysis as originally planned or that there were no statistically significant differences between groups.

Anyway, the PACE criticism is slowly getting into the literature.

 

where is the actual review part of this paper.

 

https://sci-hub.tw/https://doi.org/10.1192/bja.2017.34

 

This looks like a muddled review by a junior doctor who has not himself quite worked out what he wants to say. It mentions some of the issues patients have with treatments but makes no constructive analysis. The account of PACE is still woefully inaccurate.

This reminds me that maybe ME advocacy should be deliberately targeting very young professionals and students in medicine and allied professions (therapists). These are the people who may still have an open mind about what they should be doing. Judging by this they may see some of both sides and be uncertain. They need to hear loud and clear that the studies of treatments are simply not informative because they are too badly designed.

 

What seems odd is that he has picked up from the PACE follow up that there was no long term benefit yet that is not how the paper he quotes presents it at all. And he seems oblivious to the much more obvious problems with the original PACE results - not just the re-analysis but the uselessness of the trial design.

Perhaps this was all he felt he could say without losing his job. Maybe he overdid it as it is!

 

Re the PACE, and other trials using the Oxford criteria: 6 months of medically unexplained fatigue; do we know much about these study subjects? Other than that 13 percent in the PACE trial were actually quite healthy.

Of course we can assume there were several people with depression. How about
IBS, and whatever else the GET/CBT band calls unexplained? It would be interesting to know what "diagnoses"the subjects have.

It seems circular and confusing; for example, depression can cause fatigue, depression is a medical diagnosis, and yet it's also medically unexplained chronic fatigue. So on the one hand a person can be diagnosed with depression, but also labeled as having a mystery condition causing fatigue. Egad!

And, what about misdiagnosis? The arrogance of medicine to categorize people with medically unexplained chronic fatigue, while dismissing important signs and symptoms. For example someone diagnosed with CFS, who actually had a life threatening ilness they died from.