C F S  - Information International
 

For the representatives of Psychiatry, the medical speciality possibly coming to be responsible for the health, treatment and clinical research on the patients in the diagnosis group presently known as Chronic Fatigue Syndrome, CFS, please address the following questions:

1. Do you believe that all current "medically unexplained" diseases are of a psychiatric nature?

   Do you also believe that all diseases that are "medically unexplained" should be evaluated and treated by psychiatrists?

2. Do you find the term "medically unexplained" to be synonymous with the diagnosis "somatization disorder"?

   If not, what is the difference?

3. If you consider CFS as diagnosed by the revised CDC definition (Fukuda et al.) to be a "somatization disorder", what positive evidence or indications do you have for this?

   Please comment on whether the exact premises for the DSM-IV category are fulfilled in this syndrome.

   Also please define "functional somatization" and explain why this term has replaced "somatization disorder" in some of your scientific papers?

4. If you believe CFS by nature should belong among the psychiatric disease categories, please comment on which among the established diseases you find most fitting for CFS:  Somatization disorder or Depression (or both)?

   Alternatively, do you think there should be a new and different category, so CFS can have it's "own" category?

5. Do you believe that patients with documented physical or laboratory abnormalities such as POTS, HPA axis disturbances or abnormal blood immunology parameters should be excluded from the CFS definition?

6. You have repeatedly spoken and written on the benefits of graded exercise for CFS patients. What is your comment on the work of Dr. Natelson and the New Jersey CFS research group?

   This group finds physical strain to compromise the cognitive abilities with CFS patients (LaManca et al. 1998), what is your explanation for this discrepancy?

7. What is your comment on the work by Dr. Lenny Jason of Chicago and his team? Do you respect the results of his work on the importance of the CFS name? This group has repeatedly argued against including CFS in the psychiatric diagnosis category. How, in your opinion, can you and this group hold such opposite views on the nature of CFS?

8. You have in your scientific publications recognized the existence of two different CFS definitions, the CDC definition and the Oxford definition. Please reveal your present opinion on the difference, if any, between these two definitions.

9. You have often claimed Cognitive Behavioral Therapy, CBT, to be the best treatment for CFS. How come, as was most recently summarized in BMJ, Jan 2000 (Reid et al.), CBT has only been proven to work for CFS with the use of the Oxford definition and only with English patient populations?

10. Why does Cognitive Behavioral Therapy, CBT, work equally well - or better - with a number of established somatic diseases than for CFS?

    How long does the effect of CBT last?  If you do not know, what is your estimate?

11. Dr. Wessely has written (Lancet, Sep 1999): "there is empirical evidence of a link between functional somatic syndromes and altered functioning of the central nervous system". Would you care to elaborate on this and explain what this link is?

12. Has the brain biochemical-biophysical nature of fatigue been defined so precisely that one can find scientific arguments for psychiatric treatment being the most correct treatment of CFS? If so, please provide the reference to this.

Mette Marie Andersen, M.D. (Denmark)