Date sent:      	Sun, 4 Nov 2001 

Yet another WHO code mistake

Article:

General Hospital Psychiatry Volume 23, Issue 5, Pages 254-260
September-October 2001

Hiroko Akagi(a), Ivana Klimes(b) and Christopher Bass(c)

URL: http://www.sciencedirect.com/science/journal/01638343


Cognitive behavioral therapy for chronic fatigue syndrome in a general
hospital - feasible and effective

*****Section 2.1 gives the criteria for the selection of patients:

2.1. PATIENTS

Patients selected for follow-up were: all patients referred to the
Department
of Psychological Medicine (DPM) between 1991 and 1997, aged between 16 and
65 at presentation, satisfied diagnostic criteria for CFS [3]/neurasthenia
(F48.0, [15]) and offered CBT. When indicated, additional treatment for
coexisting psychiatric disorders was also provided. The patients were
identified from the departmental database and Fatigue clinic diaries.

*****Footnotes:

3. M.C. Sharpe, L.C. Archard, J.E. Banatvala et al., A report - chronic
fatigue syndrome: guidelines for research. J R Soc Med 84 (1991), pp.
118-121.

15. ICD-10. The ICD-10 classification of mental, and behavioral disorders.
Geneva, World Health Organization, 1992.


***** Thoughts:

One might easily infer from the above that CFS and neurasthenia are the
same.  However they are not.  The WHO ICD-10, 1992 codes CFS to G93.3 (a
neurological code) and neurasthenia to F48.0 (a psychiatric code).

As we are all aware there is an attempt, on the part of some psychiatrists
to say that CFS is a psychiatric disorder. These psychiatrists are ignoring
the large body of evidence that those who suffer from CFS have physiological
disorders. This article, gives clear evidence of the bias of these
psychiatrists - to the point of their toying with the World Health
Organization Codes.

On the one hand this is the clearest statment that the Sharpe Definition for
CFS (1991) is actually a definition for psychiatric illness & not really
CFS. I submit that this is a dirty little secret finally made public by both
the footnote & description above: "CFS/neurasthenia".

That CFS is equated by some to neurasthenia is not new, it has happened in
the Kings College WHO Collaborating Centre, about which there has been
considerable mention on this list. Connie Nelson's post to CO-CURE of 11/2 &
11/3 give an excellent description of the Troubles at Kings College. It is
clear from her post of 11/3 that the World Health Organization does not
agree with the Collaborating Centre's fiddling with the codes:

"   The information posted on the website in question has recently been
modified
       on the basis of advice provided by the Classification, Assessment,
Surveys
      and Terminology Team here at WHO Headquarters.

     You will see that there is now a clear distinction between chronic
fatigue,
     fatigue syndrome and neurasthenia on the one hand and chronic fatigue
     syndrome and ME on the other.   "


*****Suggestions:

We submit that just as the Kings College Collaborating Centre has been
corrected by the WHO, that a correction to this article must be made. It is
very disappointing that such a mistake could occur in a peer reviewed
journal article.

To be perfectly honest I do not know what the best recourse is. These three
suggestions come to mind :



1. To alert the authors of this paper of their mistake:
    Corresponding author. Tel.: +44-1865-220379; fax: +44-1865-220 373;
email: Christopher.bass@oxmhc_tr.anglox.nhs.uk

2. To alert the journal of the mistake:
http://www.elsevier.com/locate/genhospsych

3. To alert the WHO of the continuing problems with psychiatrists
incorrectly using their codes:
Fax to Geneva: att'n Dr. Gro Bruntland
                     Director General
                     World Health Organization
                     20 Avenue Appia
                     1211 Geneva, 27, Switzerland

I mention the latter to help build the case that these little mistakes in
using the WHO code are not perhaps entirely accidental.


***** Other suggestions:

If anyone has any other suggestions as to what to do with this emerging
pattern, please do let me know. We could always lobby to change the name of
the 1991 Oxford CFS Criteria to the Oxford Neurasthenia Criteria ;-)

Jean Harrison

With thanks to Pamela Wong and Connie Nelson


--
 323.9 is fine! For those in the US diagnosed with CFS ask you doctor and
see if you can be rediagnosed with ME. ICD-9CM Code 323.9