Tag: psychiatric diagnoses

Correlates of long-COVID-19: the role of demographics, chronic illness, and psychiatric diagnosis in an urban sample

Abstract:

Long-COVID-19 symptoms are an emerging public health issue. This study sought to investigate demographics, chronic illness, and probable psychiatric diagnoses as correlates for long-COVID-19 in an urban adult sample. Self-report Qualtrics surveys were sent to students across City University of New York (CUNY) campuses in New York City in Winter 2021-2022. Binary logistic regressions were used to assess the relation of a range of factors with endorsement of long-COVID-19. Results demonstrated that Latinx participants endorsed higher odds of long-COVID-19, as compared to non-Latinx white participants.

Participants who endorsed having a prior chronic illness and those who met the cut-off for probable psychiatric diagnoses all endorsed higher odds of long-COVID-19. Long-COVID-19 may be more likely among specific subpopulations and among persons with other ongoing physical and mental illness.

Source: Schulder T, Rudenstine S, Ettman CK, Galea S. Correlates of long-COVID-19: the role of demographics, chronic illness, and psychiatric diagnosis in an urban sample. Psychol Health Med. 2023 Feb 8:1-13. doi: 10.1080/13548506.2023.2177684. Epub ahead of print. PMID: 36752386. https://pubmed.ncbi.nlm.nih.gov/36752386/

The Effect of Comorbid Medical and Psychiatric Diagnoses on Chronic Fatigue Syndrome

Abstract:

OBJECTIVE: To determine if presence of co-existing medically unexplained syndromes or psychiatric diagnoses affect symptom frequency, severity or activity impairment in Chronic Fatigue Syndrome.

PATIENTS: Sequential Chronic Fatigue Syndrome patients presenting in one clinical practice.

DESIGN: Participants underwent a psychiatric diagnostic interview and were evaluated for fibromyalgia, irritable bowel syndrome and/or multiple chemical sensitivity.

RESULTS: Current and lifetime psychiatric diagnosis was common (68%) increasing mental fatigue/health but not other illness variables and not with diagnosis of other medically unexplained syndromes. 81% of patients had at least one of these conditions with about a third having all three co-existing syndromes. Psychiatric diagnosis was not associated with their diagnosis. Increasing the number of these unexplained conditions was associated with increasing impairment in physical function, pain and rates of being unable to work.

CONCLUSIONS: Patients with Chronic Fatigue Syndrome should be evaluated for current psychiatric conditions because of their impact on patient quality of life, but they do not act as a symptom multiplier for the illness. Other co-existing medically unexplained syndromes are more common than psychiatric co-morbidities in patients presenting for evaluation of medically unexplained fatigue and are also more associated with increased disability and the number and severity of symptoms.

Key Messages: When physicians see patients with medically unexplained fatigue, they often infer that this illness is due to an underlying psychiatric problem. This paper shows that the presence of co-existing psychiatric diagnoses does not impact on any aspect of the phenomenology of medically unexplained fatigue also known as chronic fatigue syndrome. Therefore, psychiatric status is not an important causal contributor to CFS. In contrast, the presence of other medically unexplained syndromes [irritable bowel syndrome; fibromyalgia and/or multiple chemical sensitivity] do impact on the illness such that the more of these that co-exist the more health-related burdens the patient has.

Source: Natelson BH, Lin JS, Lange G, Khan S, Stegner A, Unger ER. The Effect of Comorbid Medical and Psychiatric Diagnoses on Chronic Fatigue Syndrome. Ann Med. 2019 Oct 23:1-18. doi: 10.1080/07853890.2019.1683601. [Epub ahead of print] https://www.ncbi.nlm.nih.gov/pubmed/31642345

Modern-Day Relics of Psychiatry

Abstract:

Constantly shifting cultural views influence public perceptions of psychiatric diagnoses, sometimes accommodated by changes in diagnostic terminology. Evolving scientific knowledge of the era is at times used to justify and support mental illnesses. Too often, however, remasked nomenclatures fail to alter social stigma, in part because political arguments are used. Scientific validations of variant behaviors as symptoms with a pathologic status are unfortunately overshadowed.

Examples of cultural bias effects on recurring diagnostic challenges illustrate a need for scientific validation. Renaming fails to improve stigma or diagnostic clarity. For example, neurasthenia, or nervous exhaustion, was attributed to fast-paced urban life through the late 1970s. Its symptoms are now largely, to no real advantage, retitled as chronic fatigue syndrome. Diagnoses like “hysteria” have evolved into histrionic personality disorder and somatoform spectrum disorders, although less as a result of demonic possession or a “wandering uterus.” Decriminalized and depathologized homosexuality remains a political football, where religious “sin” conceptualizations have not been displaced by studies documenting healthy adjustments among groups with diverse sexual orientations and preferences.

Each of these remains severely socially stigmatized. The pseudoscience of “drapetomania,” once used to rationalize and pathologize a slave’s freedom, is perceived now as psychiatric incarcerations of mentally healthy individuals, more commonly in totalitarian regimes-a politicization of stigma. Research reviews and funding efforts need to emphasize a sound basis for individuals caught in perpetuated diagnostic challenges, not remedied by simple shifts in nomenclature.

Source: Tripathi S, Messias E, Spollen J, Salomon RM. Modern-Day Relics of Psychiatry. J Nerv Ment Dis. 2019 Sep;207(9):701-704. doi: 10.1097/NMD.0000000000001059. https://www.ncbi.nlm.nih.gov/pubmed/31464983

Psychiatric misdiagnoses in patients with chronic fatigue syndrome

Abstract:

OBJECTIVES: The aim of this study was to examine the accuracy of doctors at diagnosing co-morbid psychiatric disorders in patients with chronic fatigue syndrome (CFS).

DESIGN: Case series comparing clinical diagnoses with a standardized structured psychiatric interview.

SETTING: Secondary care specialist chronic fatigue syndrome clinic.

PARTICIPANTS: One hundred and thirty-five participants of a randomized controlled trial of non-pharmacological treatments at one centre in the PACE trial.

MAIN OUTCOME MEASURES: Current psychiatric diagnoses made by CFS specialist doctors, compared with current psychiatric diagnoses made independently using a structured psychiatric interview.

RESULTS: Clinicians identified 59 (44%, 95% CI 39-56%) of patients as suffering from a co-morbid psychiatric disorder compared to 76 (56%, CI 53-69%) by structured interview. Depressive and anxiety disorders were most common. Clinicians were twice as likely to miss diagnoses (30 patients, 22%) than misdiagnose them (13, 10%). Psychiatrists were less likely to miss diagnoses than other clinicians, but were as likely to misdiagnose them.

CONCLUSIONS: Doctors assessing patients in a chronic fatigue syndrome clinic miss psychiatric diagnoses more often than misdiagnosing them. Missed diagnoses are common. CFS clinic doctors should be trained to diagnose psychiatric disorders.

 

Source: Lawn T, Kumar P, Knight B, Sharpe M, White PD. Psychiatric misdiagnoses in patients with chronic fatigue syndrome. JRSM Short Rep. 2010 Sep 6;1(4):28. doi: 10.1258/shorts.2010.010042. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2984352/ (Full article)

 

The management of children with chronic fatigue syndrome-like illness in primary care: a cross-sectional study

Abstract:

BACKGROUND: Most studies on children with chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME) have been undertaken in tertiary care and little is known about their management in primary care.

AIM: To describe the characteristics of patients aged 5-19 years with CFS-like illness in primary care and to examine how GPs investigate and manage patients.

DESIGN OF STUDY: Descriptive retrospective questionnaire study.

SETTING: Sixty-two UK GP practices in the MRC General Practice Research Framework (GPRF).

METHOD: One hundred and twenty-two practices were approached; 62 identified 116 patients consulting a GP with severe fatigue lasting over 3 months. Practice nurses and GPs completed questionnaires from medical notes and patients completed postal questionnaires.

RESULTS: Ninety-four patients were considered by a clinical panel, blind to diagnosis, to meet the Oxford CFS criteria with a fatigue duration of 3 months. Seventy-three per cent were girls, 94% white, mean age was 12.9 years and median illness duration 3.3 years. GPs had principal responsibility for 62%. A diagnosis of CFS/ME was made in 55%, 30% of these within 6 months. Fifty per cent had a moderate illness severity. Paediatric referrals were made in 82% and psychiatric referrals in 46% (median time of 2 and 13 months respectively). Advice given included setting activity goals, pacing, rest and graded exercise.

CONCLUSIONS: Patient characteristics are comparable to those reported in tertiary care, although fewer are severe cases. GPs have responsibility for the majority of patients, are diagnosing CFS/ME within a short time and applying a range of referral and advice strategies.

 

Source: Saidi G, Haines L. The management of children with chronic fatigue syndrome-like illness in primary care: a cross-sectional study. Br J Gen Pract. 2006 Jan;56(522):43-7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1821410/ (Full article)