illness in the new ICC criteria compared to other definitions have
been raised. Below is a compilation for comparison.
It should probably be noted that causes of symptoms of mental illness
have been customarily classified as "organic" or "functional". Organic
disorders were those held to be caused by physical illness affecting
the brain (that is, psychiatric disorders secondary to other
conditions), while functional disorders were considered to be
disorders of the functioning of the mind in the absence of physical
disorders (that is, primary psychological or psychiatric disorders).
Some of the authors of the so-called Oxford criteria hold that ME and
CFS are functional (Lancet. 1999 Sep 11;354(9182):936-9.) whereas the
authors of the so-called Canadian and ICC definitions specifically
exclude functional or primary disorders.
1988- =93Holmes Definition=94 -
Chronic Fatigue Syndrome: A Working Case Definition
Exclusions...Other clinical conditions that may produce similar
symptoms must be excluded by thorough evaluation, based on history,
physical examination, and appropriate laboratory findings. These
conditions include ...chronic psychiatric disease, either newly
diagnosed or by history (such as endogenous depression; hysterical
personality disorder; anxiety neurosis; schizophrenia; or chronic use
of major tranquilizers, lithium, or antidepressive medications)...
drug dependency or abuse (such as alcohol, controlled prescription
drugs, or illicit drugs).
1991 =96 =93Oxford Definition=94
A report - chronic fatigue syndrome: guidelines for research
Exclusions - Certain patients should be excluded from the definition.
They include: Patients with a current diagnosis of schizophrenia,
manic depressive illness, substance abuse, eating disorder or proven
organic brain disease. Other psychiatric disorders (including
depressive illness, anxiety disorders, and hyperventilation syndrome)
are not necessarily reasons for exclusion.
Mood disturbance
(i) The term mood disturbance has been used to include depression,
loss of interest and loss of pleasure (anhedonia), anxiety, emotional
lability and irritability.
(ii) These phenomena should be distinguished from each other.
(iii) To be regarded as a symptom the mood disturbance should be
(a) complained of;
(b) should represent a significant change from a previous state; and
(c) should be relatively persistent or recurrent.
Judgements (sic) of the appropriateness of mood disturbance are
unreliable and should be avoided.
(iv) The symptom should be described as follows:
(a) type: depressed mood, anhedonia, anxious mood, emotional lability,
irritability;
(b) severity: standard scales are available to assess the severity of
depressed mood and anxiety. In addition it should be determined
whether the patient's disorder is sufficient to meet operational
diagnostic criteria for major depressive disorder, generalized anxiety
disorder or panic disorder according to a recognized psychiatric
classification, e.g. the current edition of the Diagnostic and
Statistical Manual of the American Psychiatric Association,
DSM-III-R'7;
(c) duration and frequency of the mood disturbance should be reported.
Report of a consensus meeting held at Green College, Oxford 23 March 1990
1994 =93Fukuda=94 definition
The Chronic Fatigue Syndrome: A Comprehensive Approach to Its
Definition and Study
The following conditions exclude a patient from the diagnosis of
unexplained chronic fatigue....
Any past or current diagnosis of a major depressive disorder with
psychotic or melancholic features; bipolar affective disorders;
schizophrenia of any subtype; delusional disorders of any subtype;
dementias of any subtype; anorexia nervosa; or bulimia nervosa.
4. Alcohol or other substance abuse within 2 years before the onset of
the chronic fatigue and at any time afterward.
The following conditions do not exclude a patient from the diagnosis
of unexplained chronic fatigue.
1. Any condition defined primarily by symptoms that cannot be
confirmed by diagnostic laboratory tests, including fibromyalgia,
anxiety disorders, somatoform disorders, nonpsychotic or
nonmelancholic depression, neurasthenia, and multiple chemical
sensitivity disorder.
2. Clarification of the relation between the chronic fatigue syndrome
and the neuropsychiatric syndromes is particularly important. The
latter disorders are potentially the most important source of
confounding in studies of chronic fatigue syndrome. Somatoform
disorders, anxiety disorders, major depression, and other
symptomatically defined syndromes can manifest severe fatigue and
several somatic and psychological symptoms and are diagnosed more
frequently in populations affected by chronic fatigue (11-13) and the
chronic fatigue syndrome (14, 15) than in the general population.
3. The extent to which the features of the chronic fatigue syndrome
are generic features of chronic fatigue and de-conditioning due to
physical inactivity common to a diverse group of illnesses (16, 17)
must also be established.
(Papers cited: 11. Manu P, Matthews DA, Lane TJ. The mental health of
patients with a chief complaint of chronic fatigue. A prospective
evaluation and follow-up. Arch Intern Med. 1988;148:2213-7.
12. Manu P, Matthews DA, Lane TJ. Panic disorder among patients with
chronic fatigue. South Med J 1991;84:451-6.
13. Manu P, Lane TJ, Matthews DA. Somatization disorder in patients
with chronic fatigue. Psychosomatics. 1989;30:388-95.
14. Kruesi MJ, Dale J, Straus SE. Psychiatric diagnoses in patients
who have chronic fatigue syndrome. J Clin Psychiatry. 1989;50:53-6.
15. Wessely S, Powell R. Fatigue syndromes: a comparison of chronic
postviral fatigue with neuromuscular and affective disorders. J Neurol
Neurosurg Psychiatry. 1989;52:940-8.
16. Swartz MN. The chronic fatigue syndrome=97one entity or many? N Engl
J Med. 1988;319:1726-8.
17. Pawlikowska T, Chalder T, Hirsch SR, Wallace P, Wright DJ, Wessely
SC. Population based study of fatigue and psychological distress. BMJ.
1994;308:763-6.)
2003 =93International=94 criteria
Identification of ambiguities in the 1994 chronic fatigue syndrome
research case definition and recommendations for resolution
Exclusions: Permanent psychiatric exclusions include lifetime
diagnoses of bipolar affective disorders, schizophrenia of any
subtype, delusional disorders of any subtype, dementias of any
subtype, organic brain disorders, and alcohol or substance abuse
within 2 years before onset of the fatiguing illness.
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.
Because these illnesses may resolve with little or no likelihood of
recurrence and only active disease or disease requiring prophylactic
medication would contribute to confusion with evaluation of CFS
symptoms, 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.
International CFS Study Group
2003 Myalgic Encephalomyelitis / Chronic Fatigue Syndrome: Clinical
Working Case Definition, Diagnostic and Treatment Protocols
Exclusions:
Exclude active disease processes that explain most of the major
symptoms of fatigue, sleep disturbance, pain, and cognitive
dysfunction.... primary psychiatric disorders and substance abuse.
2005 =93Reeves definition=94
Chronic Fatigue Syndrome =96 A clinically empirical approach to its
definition and study
...Following recommendations of the International CFS Study Group,
only current MDDm was considered exclusionary for CFS.
2011 =93ICC=94 criteria (specifically ME not CFS)
Myalgic Encephalomyelitis: International Consensus Criteria
Exclusions: As in all diagnoses, exclusion of alternate explanatory
diagnoses is achieved by the patient=92s history, physical examination,
and laboratory/biomarker testing as indicated. It is possible to have
more than one disease but it is important that each one is identified
and treated. Primary psychiatric disorders, somatoform disorder and
substance abuse are excluded. Paediatric: =91primary=92 school phobia.
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