interest)
In the pre-publication comments for:
BMC Med. 2009 Oct 12;7(1):57.
An evaluation of exclusionary medical/psychiatric conditions in the
definition of chronic fatigue syndrome.
Jones JF, Lin JM, Maloney EM, Boneva RS, Nater UM, Unger ER, Reeves WC.
I found the following:
http://www.biomedcentral.com/imedia/1359091482294844_comment.pdf
Reviewer's comment:
In that same paragraph. Why would MMD with melancholic features be
exclusionary but non-melancholia would not?
CDC team's reply:
During the deliberations regarding the criteria for the definition of the
syndrome, there
was great concern raised by our UK and other European colleagues that MDD
with
melancholia overlapped too much with CFS and it would be difficult to
separate the 2
entities. They won the day regarding this point in the definition and MDD
with
melancholia is an exclusionary condition. This emphasizes the somewhat
arbitrary nature
of how exclusions are determined and applied.
=========
This seems to suggest that the CDC would like that MDDm (Major Depressive
Disorder with melancholic features) was not an exclusionary diagnosis for
CFS including in the research setting!
=========
A little background information:
The situation in 1994 and 2003:
"The 1994 case definition stated that any past or current diagnosis of major
depressive disorder with psychotic or melancholic features, anorexia
nervosa, or bulimia permanently excluded a subject from the classification
of CFS ... we now recommend that if these conditions have been resolved for
more than 5 years before the onset of the current chronically fatiguing
illness, they should not be considered exclusionary."
Reeves headed the 2003 group.
However when he wrote the 2005 paper they wrote:
"Following recommendations of the International CFS Study Group, only
current MDDm was considered exclusionary for CFS"
- which isn't a true reflection of the 2003 recommendations at all.
==========
One other issue on the CDC's Georgia CFS cohort which may or may not be of
interest to people:
http://www.biomedcentral.com/imedia/1359091482294844_comment.pdf
Reviewers' comment:
Why were other psychiatric illnesses evaluated by telephone, but not MDD? Is
Anxiety or Trauma included in the Other category or was it evaluated? Did
the
telephone interview query symptoms or diagnosed illness?
CDC team's reply:
The telephone interview was used to collect information only on conditions
that could be
reliably self-reported. Only the psychotic exclusionary psychiatric
illnesses fall into this
category. While the telephone interview did query symptoms and information
on current
depression, post trauma stress disorder, and anxiety, these data were used
only for
recruitment to the clinic. All clinic subjects were evaluated on the SCID
interview in the
clinic for a more rigorous diagnostic process."
The results for this can be seen in Table 3 of the main paper.
There were lots of people with medical conditions excluded at the telephone
interview stage but not that many with psychiatric conditions.
This leaves excluding some psychiatric conditions including current MDDm,
down to one SCID.
Given how poor some of the other criteria the CDC are using e.g. low score
on the Role Emotional subscale is sufficient to show impairment, low
activity to show fatigue, etc, this risks "false positive" CFS diagnoses, it
would seem.
Tom Kindlon
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