Identifying and Treating Common Psychiatric Conditions Comorbid with Myalgic Encephalomyelitis and/or Fibromyalgia

I recommend you read the four-page professional psychiatric journal article "Identifying and Treating Common Psychiatric Conditions Comorbid with Myalgic Encephalomyelitis and/or Fibromyalgia" which appeared in Psychiatric Times on January 18, 2013 (29. 1) There is much focus and commotion/debate with the DSM-5 having come out recently which serves to remind all people with CFS (ME)/FM/MCS/etc. of the importance of knowing the information that pertains to YOU, so that you and your providers do not get led astray from the path to well-being. Lumigrate serves to light that path through providing a good complement of information for YOU, whether that be a patient/consumer or a provider.

Dr. Eleanor Stein of the Univ. of Calgary describes the differences between ME, fibromyalgia (FM) and known psychiatric conditions in this recent article written for Psychiatric Times:http://www.psychiatrictimes.com/print/article/10168/2123915 [1] (free registration required to view the article)

//www.psychiatrictimes.com/print/article/10168/2123915 (free registration required to view the article)

[2]

The article is written by Eleanor Stein, MD, pictured above (thank you to CFIDS Association's Facebook share of this, which made me aware and allows me to Share easily here, hopefully encouraging action/reading of the entire article. She is Clinical Assistant Professor in the department of psychiatry at the University of Calgary, Calgary, Alberta, and a psychiatrist in private practice dedicated to the treatment of myalgic encephalomyelitis/chronic fatigue syndrome, fibromyalgia, and multiple chemical sensitivity. There is a simple registration process which entails no financial cost to view the entire article.

I not only suggest you go and read, I suggest you PRINT it. Study it, and keep a copy of it in your records that go with you to medical appointments, so that you can offer it to your providers, who likely would appreciate such a find falling into their hands and make a copy for themselves. Or, you can simply print this topic which has the information on how to access it, and summary information in order to encourage going to the article. And certainly, study it as much as possible. Important to note: it does refer to fish oil near the end, which is, in my mind, a very good thing! I attended a CME (continuing medical education) about mood disorders in primary care and there was nothing about fish oil presented.

Naturally, I asked, and the presenter, a psychiatry professor of similar position to Dr Stein but from Denver, Colorado not Calgary, Canada, was familiar with the studies about it but said that it was unfounded, and talked about how much fish you'd have to eat to get that amount of fish oil. I was disappointed, as my learning/research over the years as well as my fibromyalgia/CFS-knowlegeable physicians in some cases, since as far back as 1997 have encouraged me about not only eating certain types of fish, but taking fish oil.

I would have liked to have all the ears in the room I was in that day hearing that fish oil and nutrition is part of mental and physical well-being. So we can hope that THIS information reaches them and others, eh? (Canadian tease/reference -- eh?) Live and Learn. Learn and Live Better! ~~ Mardy

(I have added formatting and breaks to what I copied and pasted here from the journal to make it easier for tired brains of the professionals or consumers reading, but the following summary is word for word as provided.)

"This article reviews the diagnostic criteria for both myalgic encephalomyelitis (ME) (ie, chronic fatigue syndrome) and fibromyalgia (FM) and describes how to differentiate them from depressive and anxiety disorders, the psychiatric conditions with which they are most often confused. The patients in the following Case Vignettes have ME and/or FM; not all have a psychiatric condition.

Despite thousands of peer-reviewed papers documenting their unique characteristics and pathophysiology, ME and FM continue to be mistaken for psychiatric conditions. This is problematic because it can delay accurate diagnosis and appropriate treatment, often for years. Although they have some symptoms in common (eg, fatigue, cognitive problems, unrefreshing sleep), ME and FM differ from each other and from all known psychiatric conditions. Diagnostic clarity depends on knowledge of the diagnostic criteria for each condition and identifying the pathognomonic, non-overlapping symptoms.

Diagnostic criteria for myalgic encephalomyelitis

The Canadian Consensus Criteria are used for diagnosis of ME. These criteria require the concurrent presence of disabling fatigue, postexertional malaise, unrefreshing sleep, muscle or joint pain, mood or cognitive symptoms, and at least 2 of the following: autonomic, neuroendocrine, or immune symptoms (Table 1).¹

Postexertional malaise (immediate or delayed), the pathognomonic symptom of ME, is unusual in any psychiatric condition: most psychiatric patients feel better rather than worse after mental or physical exertion. Pain is not a core symptom of any common psychiatric condition but is reported to be elevated in major depression.²

Autonomic, neuroendocrine, and immune symptoms are not common in any psychiatric condition.

What new information does this article provide?

■ Myalgic encephalomyelitis (ME) and fibromyalgia (FM) are complex biomedical conditions. Because psychiatric conditions are commonly comorbid, they should be looked for in patients with ME and FM.

What are the implications for psychiatric practice?

■ Consider the diagnoses of ME and FM in “psychiatric” patients with a disproportionate number of physical symptoms, especially in those who are not responding as expected to psychiatric interventions.

Diagnostic criteria for fibromyalgia

New criteria for diagnosing FM were published in 2010.³ These criteria eliminate the previously required need for tender points on physical examination and add the criteria of fatigue, unrefreshing sleep, cognitive symptoms, and a long list of somatic symptoms (none of which are specific to FM) to the pathognomonic symptom of widespread pain (Table 2).

Since fatigue, unrefreshing sleep, and cognitive symptoms are common to many psychiatric conditions, these new criteria do not aid in the differentiation between FM and a psychiatric diagnosis.

A careful review of the entire constellation of symptoms is needed to identify whether the psychological or physical symptoms predominate. In patients with aching, tiring pain all over as the primary presenting symptom in combination with several other somatic symptoms, FM should be considered." (PLEASE USE LINK, ABOVE AND GO OUT TO READ / STUDY/ PRINT / SHARE the entire article..........)

CFIDS' Facebook link: www.facebook.com/CFIDSAssn [3], or find them at www.cfids.org [4]. Thanks again!

Comments from their FB share included these pertinent comments from people who have Liked/Joined their page:

"An earlier, more detailed document by Dr. Stein, "Assessment and Treatment of Patients with ME/CFS: Clinical Guidelines for Psychiatrists" (2005) sacfs.asn.au/download/guidelines_psychiatrists.pdf [5] "

(note, 2005 will not have the new way of diagnosing which is specifically discussed in this 2013 paper, so you'd not want to provide someone with only the 2005 document.)

"Audio presentation is at mefmaction site."

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Live and Learn. Learn and Live Better! is my motto. I'm Mardy Ross, and I founded Lumigrate in 2008 after a career as an occupational therapist with a background in health education and environmental research program administration. Today I function as the desk clerk for short questions people have, as well as 'concierge' services offered for those who want a thorough exploration of their health history and direction to resources likely to progress their health according to their goals. Contact Us comes to me, so please do if you have questions or comments. Lumigrate is "Lighting the Path to Health and Well-Being" for increasing numbers of people. Follow us on social networking sites such as: Twitter: http://twitter.com/lumigrate [6] and Facebook. (There is my personal page and several Lumigrate pages. For those interested in "groovy" local education and networking for those uniquely talented LumiGRATE experts located in my own back yard, "LumiGRATE Groove of the Grand Valley" is a Facebook page to join. (Many who have joined are beyond our area but like to see the Groovy information! We not only have FUN, we are learning about other providers we can be referring patients to and 'wearing a groove' to each other's doors -- or websites/home offices!) By covering some of the things we do, including case examples, it reinforces the concepts at Lumigrate.com as well as making YOU feel that you're part of a community. Which you ARE at Lumigrate!