Date sent:      	Tue, 25 Dec 2001 

Source: http://www.ahmf.org/01stein.html

Abstracts Sydney Conf. (18/35) = Dr Eleanor Stein
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How to differentiate CFS from psychiatric disorder

Eleanor Stein MD FRCP(C)

Psychiatrist, The Burke Institute
Suite G100 Holy Cross Centre
2210 - 2nd St. SW
Calgary, Alberta
T2S 3C3
Canada
Ph (403) 685-4861
FAX (403) 215-7659
email: cdnpsych@telusplanet.net


A recent publication in the Australian Medical Journal concluded
that 6/10 patients presenting to general practitioners have a
mental illness (somatization disorder) based on questionnaire
self report data of physical symptoms. These somatic symptoms
are assumed to be without physical cause though this hypothesis
is never tested or validated. It is a mistake to use screening
instruments such as the Beck Depression Inventory, the General
Health Questionnaire or the SPHERE to diagnose mental illness
in persons with undiagnosed somatic complaints including those
with CFS because of the unstated, unproven and incorrect
assumption that the somatic complaints are of psychological
origin.


This paper specifies the clinical differences between CFS and
the two most common psychiatric disorders: anxiety and
depression. A clinical psychiatric diagnosis rests upon the
patient demonstrating the core psychiatric manifestations of
depression (eg. anhedonia) or anxiety (eg. unrealistic fear)
whereas a diagnosis of CFS requires the presence of 4 or 8
physical symptoms (eg. pain, sore throat) in addition to fatigue.
A referenced handout summarizing the research literature
differentiating between CFS and depression will be
presented.


Depressive and anxious reactions to having a serious, chronic,
unpredictable disorder lacking social legitimacy are common
among CFS patients. A comorbid psychiatric diagnosis should
only be considered if the psychiatric symptoms predated the
onset of CFS, if the symptoms are generalized beyond health
and quality of life issues affected by CFS or if the symptoms are
so severe that they prevent a patient from participating in
treatment. Management of the common psychological reactions
to CFS and of comorbid psychiatric diagnoses will be
discussed.