Webcast: (Medically Unexplained) Physical Symptoms: A Scientist Practitioner Approach June 8 Trudie Chalder

On a good cognitive day and in the right frame of mind I can defend myself very & argue my case very well in front of a doctor. That doesn't mean a damn though. One thing I have learned from my working life that is very transferable to being an ME patient -

You cannot change someone else's mind - they have to do that themselves. You can discuss and reason all day long but if they are not prepared to hear & actively engage with you, even if they pretend to listen, there is little you can do about it. It doesn't mean we shouldn't try and argue our case if we are able to, just that when if doesn't work the failure isn't necessarily ours.

A closed mind will deafen a person far more than blocked ears.

That does sound very uncomfortable though!

 

http://www.pulsetoday.co.uk/views/b...eres-what-i-want-you-to-know/20040354.article

Does anyone have access to this article?

 

The way I get access to Pulse articles is :

a) delete cookies for the site
b) then reload the page
c) Every time you change page you have to do this again, so I hardly ever read Pulse as a result because it's irritating.

I use Firefox. I just click on the padlock in the web address for the page. One of the options that comes up is "Clear cookies and site data". Go for that, then reload.

 

I do hope you pointed out that there have been exclusions added for PVFS, BME and CFS under ICD-11's BDD since January 17, 2020?


Re Chalder and her enthusiasm for DSM-5's Somatic symptom disorder:

The new IAPT Data Set v2.0 which had been scheduled for roll-out on April 01 was postponed to July 01, then to August 01, and yesterday (August 04), roll-out was postponed again to September 01.*


This is from the most recent version of spreadsheet document "IAPT v2.0 Terminology Mapping Guidance" (now designated as Version: 3.3), which was published on the IAPT Data Set v2.0 pages on July 17:


Spreadsheet: "IAPT v2.0 Terminology Mapping Guidance" Current Version: v3.3 Last Updated: 17 July 2020:

https://digital.nhs.uk/data-and-inf...to-the-iapt-data-set-v2.0---from-1-april-2020

https://digital.nhs.uk/binaries/con...apt_v2_terminology_mapping_guidance_v3.3.xlsx





I have been in contact with Elainer Wooler, Principal Terminology Specialist, Terminology and Classifications Delivery Service, NHS Digital, since February, and I am continuing to monitor the progress and outcome of Request #29847.

Extract from Request #29847:

Description of the addition or change

Sheree Hemingway and myself attended a call with the NHS England IAPT senior team on 11/11/19 regarding the mapping of a cohort of patients who require psychological therapy in relation to persistent physical symptoms. This cohort was previously categorised in IAPT as 'Medically unexplained symptoms - other' but this is no longer appropriate.

The IAPT National Clinical Advisor highlighted that Somatic Symptom Disorder (300.82* I think) in DSM-5 is the appropriate definition for this cohort. However, a SNOMED or ICD-10 code was required for the IAPT Data Set submission.
It was agreed that this DSM-5 code would be mapped to SNOMED as a new 'Somatic Symptom Disorder' concept if possible.
I am not sure how this would map up in the SNOMED hierarchy and would be grateful for your steer.​

*300.82 is a code from the U.S.'s ICD-9-CM which was retired in 2015 and replaced with ICD-10-CM. In ICD-10-CM, SSD is an inclusion under F45.1 Undifferentiated somatoform disorder.

This request was submitted on behalf of IAPT leads last November.

It requests the creation of a new Concept code for the term Somatic symptom disorder to be added to the April release of the SNOMED CT UK Edition, in order that a Concept code for SSD could be used to replace the terminology, "Medically unexplained symptoms - other" for the new Data Set v2.0 and in its associated documentation.

(There is no ICD-10 code for SSD but IAPT can make use of SNOMED CT Concept codes. There is currently no SSD in SNOMED CT, either in the International Edition of in any of the national extensions, including the U.S. Edition, so they have had to submit a formal request for consideration of a new code being created for SSD.)


On February 23, I submitted stakeholder feedback robustly opposing the addition of the SSD term to the SNOMED CT UK Edition or to the International Edition.

IAPT had originally urgently requested addition of a new Concept code for SSD to be added in time for the April 2020 release of the SNOMED CT UK Edition, as the original roll-out date for the new Data Set had been April 01.

Following my stakeholder submission, I was informed by Ms Wooler, on March 13, that they would not be adding Somatic symptom disorder to the April SNOMED CT release as there are still discussions taking place regarding this and that further research needed to take place with SNOMED International and probably discussion with the Royal College of Psychiatrists; that it may take some months to conclude the discussions but that she would keep me updated with any changes.


IAPT are evidently still hoping to obtain approval of this request in time for implementation in the October SNOMED CT UK Edition release. I am intending to contact Ms Wooler, later this week, for an update on the status of Request #29847.


* Edited to insert IAPT notice re potential further postponement:

https://digital.nhs.uk/data-and-inf...ransition-to-iapt-v2.0-and-sdcs-cloud-delayed

Transition to IAPT v2.0 and SDCS Cloud delayed

Due to the rapidly changing situation with Covid-19, NHS England have advised that we postpone the transition from IAPT v1.5 to IAPT v2.0 until 1 September 2020. This will also delay migration from Bureau Service Portal (Open Exeter) to SDCS Cloud.

IAPT providers should, where possible, continue to submit April-July data using the IAPT v1.5 standard to the Bureau Service Portal.

As most providers have now moved to home working and access to IT systems is less convenient, we believe this is the appropriate action to help reduce the burden on the NHS and IAPT providers.

The further postponement will provisionally be for one month and IAPT v2.0 will now launch from 1 August 2020. The first submissions to SDCS Cloud will take place from 1 September. We will review the situation regularly and communicate any further changes. Any decision to extend further will be made at least two weeks prior to the new go live date.

​

Edited to correct a typo: In ICD-10-CM, Somatic symptom disorder was added as an inclusion under F45.1 Undifferentiated somatoform disorder, not under "F45.9". I've amended this.

 

She went on to report that she had experienced weeks of "myalgia and fatigue".

But she rallied enough to post a good deal of anti mask wearing stuff on Twitter (along with her friend Claire Fox) but for some reason has removed many of those anti mask wearing posts.

 

Thanks so much for sharing this. I'm away for a couple of weeks but I hope to be less headachy on my return to pen my concerns to IAPT directly. My concerns have been raised with Directors of NHS primary care.

Also, have paper being submitted too. Fingers crossed about that.

Joan Crawford
Counselling Psychologist

 

This morning, I have written again to:

Elaine Wooler (Principal Terminology Specialist, Terminology and Classifications Delivery Service, NHS Digital);
CC: Lynn Bracewell (Head, Terminology and Classifications Development, NHS Digital);
CC: Sheree Hemingway (Advanced Terminology Specialist, NHS Digital)

I have asked for an update on the status of Request #29847 in the context of our previous communications concerning IAPT's request for creation of a new Concept code for "Somatic symptom disorder" to be added to the SNOMED CT UK Edition.

I have also asked whether this request has been referred on to SNOMED International for further discussion, as per our earlier communications.

I will update when I have received a response.

 

Ms Wooler replied yesterday to say that NHS Digital did refer this request on to the SNOMED International terminology team; that discussions have not yet concluded but she will ask SNOMED International for an update on the status of this request.

If consideration were being given to potentially adding Somatic symptom disorder to the International Edition, either as a new SNOMED CT Concept code or under Synonyms to an existing Concept code, the next release of the International Edition isn't scheduled until January 2021, as the July 31 update has only just been released.

Whereas, IAPT want a code available by October for inclusion in the September roll-out of its Data Set v2.0.

 

https://www.symmetrycbt.co.uk/news/persistent-medically-unexplained-physical-symptoms

(note the Aviva [insurance co] logo on the site)

 

After reading my alerts on various threads I wasn't sure where to put this particular thought so I'm parking it here though I think it may apply to other discussions here.

I occurs to me that with the "new" bPs model that includes an over simple and perfunctory nod to biology in the form of 'neural rewiring' that this might establish their point of view NOT in neurology per se as one might think but in eastern mysticism (or perhaps attempting to combine the two).

Decades ago when eastern mysticism crossed over so to speak and made it's debut in the west there where many tales of incredible feats of control over biological functions. They even made their way into popular culture through tv episodes. And so the fascination began and the west tried to understand things from a science perspective.

The thing about those stories and today's CBT 'cognitive training / neural rewiring' is that ALL of the stories of those amazing feats of biological control came from people who had lived very specific lives apart from regular society. Their everyday lives were dedicated to this training. No trips to the mall with friends, no outside hobbies, no any of the usual things others might have done.

So, in other words this neural retraining was the discipline of a life time. The idea of a few sessions of CBT would not have achieved anything at all.

Maybe this is way off the mark in terms of what is going on but I'll just put it out there for consideration. Is this new iteration of CBT (changing cognitions / behaviour through brain remodelling) based in neuroscience or eastern mysticism?

Edit for spelling

 

It sounds to me to be based more on something from MKUltra.

 

I have no idea what MKUltra is.

 

It was the cold war covert brainwashing programme. Millions of dollars were expended in finding ways to alter perceptions and behaviours.

 

I see. Well psychology has gone there and done that too.