Prof Peter D White: Neurology and Psychiatry SpRs Teaching Weekend

Prof PD White: Neurology and Psychiatry SpRs Teaching Weekend

Shortlink for this posting: http://wp.me/p5foE-2p0

14 November 2009

THE BRITISH NEUROPSYCHIATRY ASSOCIATION

http://www.bnpa.org.uk

http://bnpa.org.uk/doc/HANDBOOK.pdf

Neurology and Psychiatry SpRs Teaching Weekend

12 to 14 December 2008 St Anne’s College – Oxford

THE ESSENTIALS OF NEUROPSYCHIATRY

Presentations:

[...]

09:50 Chronic fatigue syndrome: neurological, psychological or both?

Peter White, Professor of Psychological Medicine, Barts and the London Medical School

The extract I am appending is a summary of Professor Peter Denton White’s presentation (Page 46 of PDF) in which he talks about the taxonomy of CFS “being a mess”.

During his Royal Society of Medicine “CFS” Conference presentation, in April 2008, White had said, ominously:

“…So ICD-10 is not helpful and I would not suggest, as clinicians, you use ICD-10 criteria. They really need sorting out; and they will be in due course, God willing.”

See unofficial transcript of part of White’s RSM presentation, here, in which he presents his thoughts on current ICD taxonomy:

Prof Peter White discouraging RSM Conference from using ICD-10: http://tinyurl.com/PDW-RSM-ICD-10

In an April 2009 paper, co-authored by White, the authors propose a change to current ICD-10 codings:

http://www.ncbi.nlm.nih.gov/pubmed/19366500

Psychological Medicine Preprint “Risk markers for both chronic fatigue and irritable bowel syndromes: a prospective case-control study of primary care”

In the section “Implications for Further Research” the authors state that because the paper finds that:

“These data also suggest that fatigue syndromes are heterogeneous (Vollmer-Conna et al. 2006), and that CFS/ME and PVFS should be considered as separate conditions, with CFS/ME having more in common with IBS than PVFS does (Aggarwal et al. 2006). This requires revision of the ICD-10 taxonomy, which classifies PVFS with ME (WHO, 1992)”

 Presentation given at Neurology and Psychiatry SpRs Teaching Weekend

http://bnpa.org.uk/doc/HANDBOOK.pdf

[Extract]

Presentation:

Chronic fatigue syndrome: neurological, psychological or both?

Peter White, Professor of Psychological Medicine, Barts and the London Medical School

Epidemiology of fatigue and CFS

Fatigue is a common symptom in both the community and primary care. When asked, between 10 and 20 per cent of people in the community will report feeling abnormally tired at any one time.

At the same time, fatigue is continuously distributed within the community, with no point of rarity.

Therefore any cut-off is arbitrary and the prevalence will vary by how the question is asked, the symptom volunteered, and its context. Between 1.5 % and 6.5 % of European patients will consult their general practitioner with a primary complaint of fatigue every year, the incidence varying by age and population. Fatigue is more commonly reported and presented to general practitioners by women and the middle-aged, and is most closely associated with mood disorders and reported stress. It does not seem to vary by ethnicity in the UK, but there is an intriguing paradox in that it is reported more commonly by those in high income countries, yet is presented to medical care more often in low income countries.

Prolonged or chronic fatigue is significantly less common than the symptom of fatigue and it is only in the last 10 years that consensus has emerged about the existence of a chronic fatigue syndrome (CFS), also called myalgic encephalomyelitis (ME). CFS is now accepted as a valid diagnosis by medical authorities in the UK, in the United States of America, as well as internationally. About one third of patients presenting to their doctor with six months of fatigue will meet criteria for a chronic fatigue syndrome. The other two thirds have fatigue secondary to another condition, most commonly mood and primary sleep disorders. Its primary symptom is fatigue, both physical and mental, which particularly follows exertion. Other symptoms agreed in consensual guidelines include poor concentration and memory, sleep disturbance, headache, sore throat, tender lymph glands, muscle and joint pain.

There are several criterion based definitions of CFS. These definitions were derived by consensus and have not been supported by empirical studies, and continue to be refined. Their utility stems from providing reliable criteria for research studies, rather than clinical use. The prevalence of CFS is between 2.5 % and 0.4 % depending on the definition used and whether comorbid mood disorders are excluded (that is mood disorders that are not thought to be the primary diagnoses). It is most common in women, the middle-aged, and ethnic minorities (unlike fatigue) – at least in English speaking countries.

The diagnosis and classification of CFS

The clinical taxonomy for CFS is a mess. The ICD-10 classification defines CFS within both the neurology chapter and mental health chapters. Myalgic encephalomyelitis, the alternative name for CFS, is classified as a neurological disease (G93.3) (a.k.a. post-viral CFS), whereas neurasthenia (a.k.a. CFS not otherwise specified) is classified within mental health (F48).

[Ed: Note that White does not mention, here, that Chronic fatigue syndrome is listed in ICD-10: Volume 3, The Alphabetical Index* at G93.3, the same coding as for Benign myalgic encephalomyelitis, and for Postviral fatigue syndrome (ICD-10: Volume 1: The Tabular List).]

*ICD-10: Volume 3, The Alphabetical Index:
http://www.scribd.com/doc/7350978/ICD10-2006-Alphabetical-Index-Volume-3

[Back to PDW]

(Incidentally, this mess is not specific to CFS, since there are several conditions within the neurology chapter of ICD-10 that are also classified in the mental and behavioural disorders chapter. For instance, Alzheimer’s disease is classified within neurology, whereas dementia due to Alzheimer’s disease is classified under mental health. My personal view is that it is high time that all mental health disorders and neurological diseases affecting the brain were classified within the same chapter, simply called diseases/disorders of the brain and nervous system.)

[Ed: The WHO Department of Mental Health and Substance Abuse, which is overseeing the revision of Chapter V (Mental and Behavioural Disorders), is also managing the technical part of the revision of Chapter VI (Diseases of the Nervous System). According to Dr Geoffrey Reed, Senior Project Officer, WHO Department of Mental Health and Substance Abuse, Proposal forms for ICD Chapter V and Chapter VI are in preparation and expected to be released shortly.]

[Back to PDW]

There is also a current debate between “lumpers” and “splitters” about the nosology of “functional” somatic syndromes (symptom defined conditions), such as CFS, IBS and “fibromyalgia”. Some argue that the close associations between the syndromes (those with CFS are also more likely to have fibromyalgia and/or IBS) argues in favour of their being different manifestations of one over-arching functional somatic syndrome (the “lumpers”). Others argue that these syndromes are best understood by exploring their heterogeneity (the “splitters”). There is evidence to support both arguments, but two large and recent epidemiological studies suggest that chronic unexplained fatigue, for one, is both associated with and separate from other “functional” somatic syndromes. In particular, predisposing risk factors are shared whereas triggering factors are different.

CFS is not an easy diagnosis to make, since misdiagnosis is common in patients diagnosed as having CFS. A recent audit of my CFS clinic revealed that 4 out of 10 new patients (n = 250) assessed did not have CFS, and that was after a third of referrals had already been rejected as not being CFS.

The most common misdiagnoses were mood disorders, especially depressive disorders, and primary sleep disorders, particularly sleep apnoea. Other misdiagnoses included coeliac disease and autoimmune conditions. Alternative neurological diagnoses were made in 2%.

Aetiology and pathophysiology

The aetiology of CFS is unknown, but there is evidence that different risk markers are associated with predisposition, triggering, and maintenance of the illness. Predisposing risk markers include female sex, middle age, mood disorders (especially depressive disorders), other symptom defined syndromes, such as irritable bowel syndrome, and possibly either sedentary behaviour or excessive activity. As might be expected CFS patients are more likely to have attended their GP, than healthy matched controls, even up to 15 years before onset, but recent work shows that those with IBS (and no CFS) have the same tendency.

Triggering risk markers are less well established, but there is sufficient evidence to support certain infections as aetiological factors not only for fatigue but also CFS, with the best replicated evidence supporting a role for Epstein-Barr virus infection, which triggers CFS in 10% of those infected.

Maintaining or perpetuating risk markers are most important in determining treatment programmes, since reversing maintaining factors should lead to improvement. Reasonably well established factors include mood disorders, such as dysthymia, illness beliefs such as believing the whole condition is physical, pervasive inactivity, avoidant coping, membership of a patient support group, and being in receipt of or dispute about financial benefits.

Few pathophysiological findings in CFS have been replicated in independent studies. Those that have been include down-regulated hypothalamic pituitary-adrenal axis, physical deconditioning, and discrepant reports between perception of symptoms and disability and their objective tests.

The latter finding is now supported by functional brain scanning studies suggesting altered brain activity with specific tasks. The discrepancy between subjective states and objective tests has been found before in other symptom defined syndromes, such as “fibromyalgia”, and may be related to enhanced interoception (the perception of visceral phenomena), a concept first described by Charles Sherrington in 1904. One hypothesis currently being tested is that the common predisposition to “functional” somatic syndromes is caused by enhanced interoception.

Recent work suggests that these factors may be reversed by rehabilitation.

Prognosis

Without treatment the prognosis of CFS is poor with a systematic review of outcomes finding the median full recovery rate was 5 % (range 0-31%) and the median proportion of patients who improved of 39.5% (range 8-63%). Being younger, having less fatigue baseline, a sense of control over symptoms and not attributing illness to a physical cause were all associated with a better outcome. The prognosis is considerably better after treatment.

Treatment

The NICE guidelines, published in 2007, were based on an updated systematic review. The essence of specialist care is rehabilitation, provided on an individual basis with an appropriately qualified and trained therapist. The two approaches with the greatest evidence of efficacy are cognitive behaviour therapy (CBT) and graded exercise therapy (GET). Approximately 60% of patients report significant improvement with these approaches and about 25%report full recovery, which lasts. No pharmacological treatments are recommended (antidepressants are ineffective), but symptomatic pharmacotherapy for specific symptoms (such as pain) or comorbid conditions such as depressive illness) can be helpful complementary treatments.

These rehabilitation approaches have not received universal approval from patient charities, with concerns that patients may be harmed by exercise therapies or that CBT implying that the condition is psychological.

Is CFS neurological or psychological?

This is a nonsensical question when one considers the neuroscience of consciousness and recent advances in functional brain physiology. The philosopher, John Searle, stated the answer to this Cartesian dualism that still bedevils western medicine. “Conscious states are caused by neurophysiological mechanisms, and are realised in neurophysiological systems.” Therefore it is not possible to have a psychological process or event without a neurological mediating process. It is neither of the mind or body; it is both.

Fatigue secondary to neurological diseases

Fatigue is commonly associated with chronic medical disorders, but it should be differentiated from fatiguability. Fatiguability is the onset of a physical sensation of fatigue and weakness after exertion and is commonly reported with neurological diseases such as multiple sclerosis and myopathies.

Apart from measures of disease activity, other associations of secondary fatigue in general that have been repeatedly found include sleep disturbance, mood disorders, inactivity and physical deconditioning. Studies of fatigue associated with multiple sclerosis are instructive and exemplary. As in all studies of secondary fatigue, measures of the severity or pathophysiology of the disease itself are associated with fatigue. Some cytokines are associated, but others are not.

Associations vary depending on the fatigue measure, confirming the multidimensional nature of fatigue, but all measures are associated with depression. Objectively confirmed sleep disturbance is also associated with fatigue. Fatigue associated with MS therefore requires biopsychosocial management.

There have been a number of studies of various treatments aimed at reversing the associations of secondary fatigue in general, in the hope they would help fatigue directly, with variable results. As with CFS, the most consistent evidence of efficacy has been with graded exercise programmes and CBT.

Attarian HP, Brown KM, Duntley SP, et al. The relationship of sleep disturbances and fatigue in multiple sclerosis. Arch. Neurol. 61 (2004), 525-8.

Baker R, Shaw EJ. Diagnosis and management of chronic fatigue syndrome or myalgic encephalomyelitis (or encephalopathy): summary of NICE guidance. BMJ 2007 doi: 10.1136/bmj.39302.509005. AE

Chambers D, Bagnall A-M, Hempel S, Forbes C. Interventions for the treatment, management and rehabilitation of patients with chronic fatigue syndrome/myalgic encephalomyelitis: an updated systematic review. J R Soc Med 2006;99:506-20.

Cleare AJ. The neuroendocrinology of chronic fatigue syndrome. Endocr. Rev. 24 (2003), 236-52.

Flachenecker P, Bihler I, Weber F, et al., Cytokine mRNA expression in patients with multiple sclerosis and fatigue. Mult. Scler. 10 (2004), 165-9.

Fulcher KY, White PD. Strength and physiological response to exercise in patients with the chronic fatigue syndrome. J. Neurol. Neurosurg. Psychiatry 69 (2000), 302-7.

Joyce J, Hotopf M, Wessely S. The prognosis of chronic fatigue and chronic fatigue syndrome: a systematic review. Q. J. Med. 90 (1997), 223-33.

Kroencke DC, Lynch SG, Denney DR. Fatigue in multiple sclerosis: relationship to depression, disability, and disease pattern. Mult. Scler. 6 (2000), 131-6.

Lyall M, Peakman M, Wessely S. A systematic review and critical evaluation of the immunology of chronic fatigue syndrome. J. Psychosom. Res. 55 2003), 79-90.

National Institute for Health and Clinical Excellence. Clinical guideline CG53. Chronic fatigue syndrome/myalgic encephalomyelitis (or encephalopathy): diagnosis and management. London, NICE, 2007. http://guidance.nice.org.uk/CG53.

Reeves WC et al. Identification of ambiguities in the 1994 chronic fatigue syndrome research case definition and recommendations for resolution.BMC Health Serv Res 3 (2003), 25.

Romani A, Bergamaschi R, Candeloro E, et al., Fatigue inmultiple sclerosis: multidimensional assessment and response to symptomatic treatment. Mult. Scler. 10 (2004), 462-8.

M. C. Tartaglia, S. Narayanan, S. J. Francis, et al., The relationship between diffuse axonal damage and fatigue in multiple sclerosis. Arch. Neurol. 61 (2004), 201-7.

Wessely SC, Hotopf M, Sharpe M. Chronic Fatigue and its Syndromes (Oxford: Oxford University Press, 1998).

Wessely S, Nimnuan C, Sharpe M. Functional somatic syndromes: one or many? Lancet 354 (1999), 936-9.

Wessely S, White PD. In debate: there is only one functional somatic syndrome. Br. J. Psychiatry 185 (2004), 95-6.

White PD, Thomas JM, Kangro HO, et al., Predictions and associations of fatigue syndromes and mood disorders that occur after infectious mononucleosis. Lancet 358 (2001), 1946-54.

White PD, Sharpe MC, Chalder T, DeCesare JC, Walwyn R; on behalf of the PACE trial group. Protocol for the PACE trial: a randomised controlled trial of adaptive pacing, cognitive behaviour therapy, and graded exercise, as supplements to standardised specialist medical care versus standardised specialist medical care alone for patients with the chronic fatigue syndrome/myalgic encephalomyelitis or encephalopathy. BMC Neurol 2007;7:6.

[ Extract ends, doc: http://bnpa.org.uk/doc/HANDBOOK.pdf ]

For detailed information on the proposed structure of ICD-11, the Content Model and operation of iCAT, the collaborative authoring platform through which the WHO will be revising ICD-10, please scrutinise key documents on the ICD-11 Revision Google site:
https://sites.google.com/site/icd11revision/
https://sites.google.com/site/icd11revision/home/documents

For information around the DSM and ICD revision processes see DSM-V and ICD-11 Directory page: http://meagenda.wordpress.com/dsm-v-directory/

Suzy Chapman
http://meagenda.wordpress.com
http://twitter.com/MEagenda

Medically Unexplained Psychologising of ME (MUPs) by Peter Kemp

An essay by Peter Kemp orginally published on Co-Cure

WordPress Shortlink: http://wp.me/p5foE-2lq

 

Medically Unexplained Psychologising of ME (MUPs)

Permission to repost

10 October 2009

In this essay I will explore some psychic phenomena that might be relevant to psychologising of illness.

Generalisations cannot practically be made, MUPs is not just heterogeneous from a psychic viewpoint – it is likely to be individual. So I can only explore my impressions and I hope you will read my theories as falling somewhere between the Origin of Speciousness and A Tale of Two Settees.

Use of some terminology has been unavoidable but I include a few definitions and illustrations as ‘Asides’ that I hope will help make the essay accessible to PWME.

Peter Kemp

Acronyms:

PWME = Person (or People) With ME

MUPs = Medically Unexplained Psychologising of ME

 

Medically Unexplained Psychologising of ME (MUPs)

Aside 1

AN ILLUSTRATION OF ‘PROJECTION’

Jack thinks that it would be very bad to be envious; this might be something his parents taught him. He notices envy in other people and condemns them for being envious. The envy that he so often notices might be real or not, it does not matter because it is HIS envy he is seeing. He is Projecting his envy onto other people to try and hide and control it within himself.

WITHDRAWAL OF PROJECTION

Projection is an unconscious process, people are not aware when they are doing it, but if they can become aware of the true source of a problem there may be an opportunity for growth.

One day Jack says to Jill, ‘I think you are envious of Mary’s little lamb’; and Jill says, ‘actually, I love Mary so much I gave her that lamb. I think you are envious because I get on so well with Mary.’ Jack’s theories fall apart and his projection is laid bare. If he is honest and humble enough he can then discover his own envy and stop projecting it. It may help if Jill points out ‘what’s wrong with being envious anyhow? It is part of how I know what I like and what I want’.

Through this uncomfortable experience Jack stops projecting envy and finds that natural feelings of envy can help him to make decisions about what he wants in life.

———————————————

Projected Fear

PWME represent ‘ideal’ subjects for the projection of all sorts of fears, Fear of losing control, Fear of weakness, Fear of illness, Fear of physical inadequacy, and perhaps worst of all, Fear of fear. For some MUPs I suspect that subtler projections and issues arise, such as Fear of being wrong and Fear of being misunderstood. All these fears have their roots in the psyche and are most troublesome when their origins are unconscious and when strongly denied. This may result in odd behaviour that may nevertheless be easily justified, but the justifications do not reveal the true motives behind the behaviour, instead they contribute to their concealment.

To confront fear it must be acknowledged but if it originates from an intense inner conflict it might be that the ego is not ready to withstand it. In these circumstances an internal struggle is maintained to repress some aspects of a complex in order to protect the ego. Enacting these conflicts in the world is a common way of reinforcing defences and avoids addressing the conflict directly. Unfortunately, this never resolves the issue at its source and means that substitute conflicts must constantly be found. As such projecting Fear may be predisposing and initiating; and because projection is an avoidance strategy, it is likely to be a maintaining factor in MUPs.

Withdrawal of Projection

For some people in whom contact with PWME arouses issues with fear, the psyche may seize this as an opportunity for growth. If someone projects fear onto another they may sometimes be able to compare their projection with the actual person. If discrepancies are found then the projection might start to weaken, then the projector has an opportunity to challenge and eventually withdraw the projection.

For example; a person fearful of losing control might project this onto a PWME; if they then realize that the PWME is actually coping well (with what for many people is a terrifying aspect of disability), the projector may think something like; ‘I thought he was weak, but I could not cope so well with such a loss of control’. This represents a stage of withdrawal of a projection as the projector has discovered that the source of the fear is within himself. Such situations might be considered MUPs based on transient / opportunistic factors; and is I suspect, a very common occurrence. Some MUPs might be able to relate to this if they find they vacillate between impatience and respect towards a PWME. This could be a sign that projections are weakening and the source of fear might be discoverable.

Correspondence between Stephen Ralph and Dr Charles Shepherd

Correspondence between Stephen Ralph and Dr Charles Shepherd

WordPress Shortlink: http://wp.me/p5foE-2jm

The opinion piece below, which includes extracts from recent correspondence with Dr Charles Shepherd is authored and published by Stephen Ralph; the views and opinions expressed are the views and opinions of Mr Ralph and any comments or queries resulting out of this opinion piece should be addressed to Mr Ralph and not to ME agenda.

Stephen Ralph maintains a website at  www.meactionuk.org.uk 

Dr Charles Shepherd is an Honorary Medical Advisor and a Trustee/Director of the ME Association http://www.meassociation.org.uk/

A copy of the statement which Stephen Ralph quotes from is here:

 XMRV and ME/CFS: WHAT DO WE KNOW SO FAR? AND WHAT DON’T WE KNOW? (VERSION 3) (04.11.09)  http://wp.me/p5foE-2kq

—————–

By Stephen Ralph  ME Action UK

Permission to Repost

06 November 2009

Like many of you, I was alarmed when I read the recent MEA XMRV Statement No.3 particularly because of one telling sentence.

I decided to ask Dr Shepherd a series of questions and although I had several answers, I had no answer at all to one important question that I asked several times.

I asked Dr Shepherd about this statement.

“Demonstrating a link between a retrovirus and ME/CFS does not, by itself, resolve the physical vs psychological debate.

Research studies have demonstrated links between retroviruses and diseases as diverse as autoimmune disorders (which could be relevant to ME/CFS), immunodeficiency diseases, multiple sclerosis, tumours, anaemias and even schizophrenia.”

In reply I got the following from Dr Shepherd.

“I don’t think this comment will have any effect whatsoever on psychiatry.

Psychiatrists already know that viruses and psychiatric illness can sometimes be linked.

I put this info into version 3 because some people are wrongly assuming that having a viral link in an illness means that it must be physical rather than psychological. And that the physical vs psychological battle in ME/CFS is now almost over. I only wish…..

Retroviruses may be involved in schizophrenia and it is being said the up to 40% of people with autism have XMRV.”

I then asked Dr Shepherd what he would do if he found he was XMRV negative and how this might impact on his judgment.

In reply I had the following from Dr Shepherd…

“I don’t know my XMRV status. I obviously could have access to XMRV testing facilities. But as knowing my XMRV result isn’t going to affect either my diagnosis of ME or the management of my illness at this stage I don’t see any point in being tested.”

Lastly, I asked Dr Shepherd if he did or did not support the views of Professors Simon Wessely, Michael Sharpe and Peter White.

I asked this question twice for the sake of clarification.

Dr Shepherd has decided not to answer that question.

I asked the question because on numerous occasions the MEA have released hedge betting, sitting-on-the-fence statements or cheek turning Statements that effectively support the agenda of Somatoform Psychiatry or completely ignore the agenda of Somatoform Psychiatry.

The statement regarding XMRV not ending the debate on mental v physical is for my eyes indicating that yet again the MEA and Dr Shepherd are entertaining the possibility that Wessely White and Sharpe are right.

Dr Shepherd – you should be actively ending the involvement of Professors Wessely, White and Sharpe and you should be representing the total “State of Science” from across the Atlantic as is the case with the ESME – see their website for example…

http://esme-eu.com/news/category7.html

…instead of selectively picking what you want to feed your members and back peddling on the profound implications of XMRV and what was said at the CFSAC last week.

As we all know, the liaison faction of psychiatry firmly and militantly assert that CFS is a functional psychosomatic syndrome and that ME does not exist at all.

We know that the likes of Wessely, White and Sharpe are trying to get CFS into the next edition of the DSM – DSM-V and reclassified in ICD-11.

Both Action for ME and the ME Association are doing nothing to stop this agenda.

I asked Dr Shepherd some time ago if he or the MEA were going to do anything about the CSSID DSM-V ICD-11 agenda and Dr Shepherd said he was too busy and it wasn’t on his list of things to do.

In my view, the ME Association is not a lot more than the Public Relations arm of Action for ME.

Yes they seem approachable and yes they seem to press all the buttons that please some of their members.

But as soon as you ask anything considered “controversial” or important – then Dr Shepherd and/or the MEA goes silent and refuses to answer the question as is the case by default with Action for ME.

It seems to me that here in the UK and for many years, the ME population are being held hostage by the mental health movement who seem to have castrated both Action for ME and the ME Association who between them dominate the arena yet lay silent and do nothing to counter the mental health agenda…

So it seems to me that neither charity actually give a damn about the concerns of the ME community unless those views accord with their agenda that they will not discuss when challenged in ANY detail.

They say the devil is in the detail but we do not know what the detail is because when we ask we get nothing back.

Under these circumstances we need those over in the USA and those in the UK with Independence of mind and purposes such as ME Research UK, the 25% ME Group and Invest in ME – to come to the rescue of the UK ME patient population.

If people are not happy with this e-mail I have written and you think I am being unfair then you should ask Dr Shepherd and the MEA yourselves and get the answers he would not give to me or the many others who have asked similar questions over the years that never get answered.

Why does the MEA turn the other cheek and choose not to robustly challenge the views of Professor Wessely and his colleagues and instead state that “they already know” so that these individuals are therefore beyond challenging…

How exactly does liaison psychiatry “already know” that retro-viruses cause mental illness and does the MEA believe that XMRV potentially causes functional mental illness in people with ME? If not then why stay silent – creating a space for the opposition to occupy.

Why does the MEA put out neutered statements that reflect the views of liaison psychiatry instead of using all the evidence available to robustly and technically challenge those views?

Why is the ME Association calling for the use of the CDC Fukuda Criteria in UK XMRV research when the Fukuda criteria has been and is still being exploited by Wessely et al due to its well known ability to produce a heterogeneous patient group and therefore research results that are by default inconclusive and “mixed” and challengeable by those with a mental health agenda?

Why does the ME Association not firmly call for the use the Canadian criteria or use both Fukuda and the Canadian criteria in parallel research to make the research outcomes more meaningful and less open to exploitative deconstruction when the ME Association at one time adopted the Canadian Criteria by a democratic vote and then quietly swept that democratic vote under their carpet?

This is all about accountability. We should be given full answers to all of the above questions.

What is wrong in asking?  Why does that make us bad?

Yours sincerely,

Stephen Ralph

www.meactionuk.org.uk

Action for M.E. and Facebook; CISSD Final Report finally published

Action for M.E. and Facebook; CISSD Final Report finally published

WordPress Shortlink: http://wp.me/p5foE-2gi

Action for M.E. maintains a Facebook site at: http://www.facebook.com/actionforme

Over the past few weeks, questions and criticism around Action for M.E.’s governance, the way in which it relates to its membership, its policies and operation and its relationship with government have been raised by various users on its Facebook “Wall”.

Action for M.E. has chosen not to respond to these questions individually, on the Wall, itself, but by issuing a set of responses in a PDF document. The first document was this one: Facebook responses 20.10.09

A second, updated, set of responses was issued yesterday. It’s not clear whether these responses have been compiled by Action for M.E.’s new Policy Manager or by another member of staff, as the document is unsigned, but it’s interesting to see how the organisation has fielded these questions and concerns.

[To clarify - none of the questions for which responses were provided had been raised by me. I prefer to liaise directly with organisations for information, documents or for policy and position statements or, where applicable, obtain information via the Freedom of Information Act.]

Action for M.E. is becoming rather discomforted that its Facebook site is being used by some as a vehicle for raising political issues but you cannot take the politics out of ME. Users are already asking how the organisation intends to define “political”.

Those of us who were members, in 2003, of the joint charities’ message board “MEssage-UK” will recall how rapidly first Action for M.E., then AYME pulled out of this venture when faced with too many awkward questions; how the message board was then set for pre-moderation by the ME Association; how the moderator, Tony Britton, vetoed posts of a “political nature” without ever setting out how he was going to define what came under the heading of “political” and what did not; how the archives were sifted through for “contentious” messages by senior ME Association staff and then quietly excised without the authors being informed; how the board was closed down suddenly just days before the critical December 03 AGM in which Dr Shepherd was standing as a candidate in the Trustee elections…

When will our patient organisations learn that if they are going to place themselves on public platforms they first need to develop policies for the fielding of questions?

This latest set of responses can be opened in PDF format here:

PDF file: ONGOING FB Q and A document. 29.10.09

Answers to questions raised on the Action for M.E. facebook page, October 2009. Updated

or from Action for M.E’s website, here: http://tinyurl.com/ongoingFB-responses291009

—————-

One of the responses is for a question raised (note, not by me) around the CISSD Project, for which Action for M.E. had acted as principal administrators throughout the project’s life (2003 to 2007).

In response to this question, on Page 23:

Question: “What was your involvement in the CISSD project Conceptual Issues in Somatoform and Similar Disorders for which you received a grant of 67k and why was this project kept so secretive from your members? Only information about it was released when freedom of information act requests were made that pushed you in to a corner where you had to confirm you were involved in it. Was this CISSD project set up with the purpose as suggested by other sources with the intent to look at changing the ME/CFS ICD-10 coding* to that of a Somatoform disorder?”

Action for M.E prefaces its reply with, “As a charity, Action for M.E. is not obliged to answer questions under the Freedom of Information Act but provides information of its free will, as resources allow.”

I should like to clarify that the Freedom of Information requests submitted by me in relation to the CISSD Project had been submitted to the Institute of Psychiatry. Information resulting out of these requests under the FOIA is available here: http://meagenda.wordpress.com/dsm-v-directory/information-obtained-under-foi-act/

One of my requests to the Institute of Psychiatry had been for a copy of the December 2007 “CISSD Final Report” from Dr Richard Sykes to Action for M.E. I had suggested to the Institute of Psychiatry’s Legal Compliance Office that the report ought to be provided with a erratum note, by Dr Sykes, addressing a number of errors he had made in the document that had come to light in June 09, when an unauthorised copy of the text had been placed in the public domain.

Unfortunately, what the Institute of Psychiatry were provided with by Dr Sykes, in order to fulfil the request, is evidently an earlier draft of the December 2007 text. It is missing the Contents page, and there are other disparities between the text that I was provided with and the Final version. No erratum note had been attached, either.

However, as part of its response to the Facebook question, Action for M.E. has now elected to publish two files. The first is a copy of the December 2007 CISSD “Final Report” to Action for M.E., the second, a copy of the “Co-ordinator’s Report”, with a covering letter and summary.

Action for M.E. has finally put these documents in the public domain!

Open PDF files here:

CISSD project report 1

The CISSD Project and CFS/ME Report on the CISSD Project for Action for ME 

Conceptual Issues in Somatoform and Similar Disorders

Report to be read in conjunction with Co-ordinator’s Final Report

Richard Sykes December 2007

CISSD project report 2

Covering letter

The CISSD Project 2003-2007

(Conceptual Issues in Somatoform and Similar Disorders)

Summary

FINAL REPORT OF CO-ORDINATOR   Richard Sykes PhD, CQSW

or from Action for M.E’s website, here:

http://www.afme.org.uk/res/img/resources/CISSD%20project%20report%201.pdf
http://www.afme.org.uk/res/img/resources/CISSD%20project%20report%202.pdf

 

In August, Action for M.E. had published an article titled “Classification conundrum” on pages 16 and 17 of Issue 69 of its membership magazine, InterAction.

You can read a copy of the article here, in an ME agenda posting dated 25 August 2009:

“Action for M.E. stuffs the elephant back into the cupboard”

Note that although the Project had been initiated by Dr Richard Sykes, Dr Sykes does not appear to have contributed to this article – basically an apologia piece authored by Dr Derek Pheby.

In fact, Dr Sykes and his role as instigator and co-ordinator of the Project is not mentioned in the article at all. Nor is the Project’s source of funding – the charitable Trust run by Dr Sykes’ brother, Sir Hugh Sykes, a non-executive director of A4e, the largest European provider of Welfare to Work programmes. 

The December 2007 “Final Report” document has historical significance.  It also contains material (including an entire Appendix) which was omitted from the “CISSD Summary Report” that the ME Association published in June, this year, having negotiated with Dr Sykes for an article. (But having trumped Action for M.E., the MEA has made no comment whatsoever on the implications of the CISSD Project nor provided its membership with an analysis of the various papers and documents that came out of it.  Nor has the MEA made any comment or published any information on the progress of the ICD-10 and DSM revision processes for which the CISSD Project was initiated and has fed into.)

The document sets out Dr Sykes’ views, opinions and perceptions (and misperceptions) that had not previously been publicly available. It would have been appropriate for Action for M.E. to have negotiated with Dr Sykes for this document to have been published in 2007.  Instead, it kept the lid on this project –  a project that had been chaired by Professors Michael Sharpe and Kurt Kroenke and had involved many influential, international researchers and clinicians from the field of liaison psychiatry and psychosomatics – several of whom are now directly involved in the revision of the American Psychiatric Association’s DSM-IV.

In August, I called publicly on Action for M.E. to publish a copy of the CISSD “Final Report” on its website and to preface it with an erratum note addressing both the errors of coding within “Appendix B” of the document and also Dr Sykes’ misconception that “Chronic fatigue syndrome” does not appear in ICD-10.

Chronic fatigue syndrome is listed in the International Statistical Classification of Diseases and Related Health Problems: 10th Revision Version for 2006, Volume 3, the Alphabetical Index (ICD-10 Volume 3).

For the entry in question, see page 528, top right hand column:

http://www.scribd.com/doc/7350978/ICD10-2006-Alphabetical-Index-Volume-3

Since no erratum note has been published with these documents please be aware that where Dr Sykes has written “G33.3″ and “G33.4″ on Pages 12 and 13 of document:

http://www.afme.org.uk/res/img/resources/CISSD%20project%20report%201.pdf

this should read “G93.3″ and “G93.4″.

Why has Action for M.E. published these documents without negotiating with Dr Sykes for an Erratum?

Why did Action for M.E. not publish these documents in August to accompany the article in InterAction?

 

*There is no coding for “ME/CFS” in ICD-10. 
Postviral fatigue syndrome is classified in Chapter VI of ICD-10 Volume 1: The Tabular List at G93.3.
(Benign) myalgic encephalomyelitis is classified in Chapter VI of ICD-10 Volume 1: The Tabular List at G93.3.
Chronic fatigue syndrome is listed in ICD-10 Volume 3: The Alphabetical Index under G93.3.

—————–

Text version of December 2007 CISSD “Final Report” here: CISSD Final Report to AfME 2007

Text version of December 2007 CISSD “Co-ordinator’s Report” here: CISSD PROJECT Coordinators Final Report

June 2009 Summary Report on CISSD as published by the ME Association

The Editorial: The proposed diagnosis of somatic symptom disorders in DSM-V to replace somatoform disorders in DSM-IV – a preliminary report by DSM-V Work Group members, Joel Dimsdale and Francis Creed was published in the June issue of the Journal of Psychosomatic Research:

Free access to both text and PDF versions of this Editorial at: http://www.jpsychores.com/article/S0022-3999(09)00088-9/fulltext

For detailed information on the proposed structure of ICD-11, the Content Model and operation of iCAT, the collaborative authoring platform through which the WHO will be revising ICD-10, please scrutinise key documents on the ICD-11 Revision Google site:

https://sites.google.com/site/icd11revision/
https://sites.google.com/site/icd11revision/home/documents

For information around the DSM and ICD revision processes see DSM-V and ICD-11 Directory page: http://meagenda.wordpress.com/dsm-v-directory/

Journal of Psychosomatic Research: In Press: Is there a better term than “Medically unexplained symptoms”?

Image | belgianchocolate | Creative Commons

Keywords

APA    DSM    DSM-IV    DSM-V    WHO    ICD    ICD-10    ICD-11    American Psychiatric Association    Diagnostic and Statistical Manual of Mental Disorders    World Health Organization    Classifications    DSM Revision Process    DSM-V Task Force    DSM-V Somatic Distress Disorders Work Group    Somatic Symptom Disorders Work Group    DSM-ICD Harmonization Coordination Group    International Advisory Group    Revision of ICD Mental and Behavioural Disorders    Global Scientific Partnership Coordination Group    ICD Update and Revision Platform    WHO Collaborating Centre    CISSD Project    MUPSS Project    Somatoform    Somatisation    Somatization    Functional Somatic Syndromes    FSS    MUS    Myalgic encephalomyelitis    ME    Chronic fatigue syndrome    CFS    Fibromyalgia    FM    IBS    CS    CI    GWS

The Elephant in the Room Series Three:

Journal of Psychosomatic Research In Press: Is there a better term than “Medically unexplained symptoms”?

WordPress Shortlink for this posting: http://wp.me/p5foE-2d6

24 October 2009

 

An In Press version of the Editorial: Is there a better term than “Medically unexplained symptoms”?, to be published in a forthcoming issue of the Journal of Psychosomatic Research, is already available online (purchase required). The Editorial needs to be read in conjunction with a white paper from:

The European Association for Consultation-Liaison Psychiatry and Psychosomatics (EACLPP) http://www.eaclpp.org/

A white paper of the EACLPP Medically Unexplained Symptoms study group

Patients with medically unexplained symptoms and somatisation – a challenge for European health care systems  (Gillian.D.Dunkerley@manchester.ac.uk )

The White Paper can be downloaded from the EACLPP site here: http://www.eaclpp.org/working_groups.html

The document is approx 76 pages long, including tables and charts.  I had considerable difficulty opening this document, in May, due to a corrupted table and I note that the file on the EACLPP site is still glitchy. A copy of the document was therefore obtained directly from the EACLPP and can be opened by clicking the link below.  Note that there may have been revisions to the document as supplied on 19 May, but it will serve as reference for those who might also experience difficulties opening the file from the EACLPP website. If you would like a copy of the file sent to you as a Word.doc, email ME agenda with “EACLPP MUS DOC” in the subject line and I will forward a copy [600 KB].  The tables and charts are slow to load.

Draft – prepared by: Peter Henningsen and Francis Creed January 2009

EACLPP Working group on MUS version 16 Jan 2009

The current issue of the Journal of Psychosomatic Research is Volume 67, Issue 5, Pages A1-A4, 367-466 (November 2009)  http://www.sciencedirect.com/science/journal/00223999

Journal of Psychosomatic Research

In Press

Editorial
Is there a better term than “Medically unexplained symptoms”?

Abstract: http://tinyurl.com/jpsychoresMUS

doi:10.1016/j.jpsychores.2009.09.004

References and further reading may be available for this article. To view references and further reading you must purchase this article.

Editorial

Francis Creed a, Elspeth Guthrie a, Per Fink b, Peter Henningsen c, Winfried Rief d, Michael Sharpe e and Peter White f

a University of Manchester, Manchester, UK 
b University Hospital Aarhus, Denmark
c Technical University, Munich Germany
d University of Marburg, Germany
e University of Edinburgh, UK
f Queen Mary University of London, UK

Received 24 August 2009; revised 24 August 2009; accepted 7 September 2009. Available online 17 October 2009.

Article Outline

Introduction

“Medically unexplained symptoms” – one advantage, but many reasons to discontinue use of the term

Criteria to judge the value of alternative terms for “medically unexplained symptoms”

Terms suggested as alternatives for “medically unexplained symptoms”

Implications for treatment

Implications for DSM-V and ICD-11

Conclusion

References

Note:

Francis Creed is Co-Editor of the Journal of Psychosomatic Research.

Francis Creed, Per Fink, Peter Henningsen and Winfried Rief were all members of the international CISSD Project, (Principal Administrators: Action for M.E.; Co-ordinator: Dr Richard Sykes. Dr Sykes is now engaged in the “London MUPSS Project” in association with the Institute of Psychiatry).

Michael Sharpe was UK Chair for the CISSD Project.

Michael Sharpe and Francis Creed have been members of the APA’s DSM-V Somatic Distress Disorders Work Group since 2007.

Francis Creed (UK), Peter Henningsen (Germany) and Per Fink (Denmark) are the co-ordinators of European EACLPP MUS Work Group.

Francis Creed and Peter Henningsen were the authors of “A white paper of the EACLPP Medically Unexplained Symptoms study group – Patients with medically unexplained symptoms and somatisation – a challenge for European health care systems”, January 2009.

Draft white paper here: http://www.eaclpp.org/working_groups.html

Per Fink is a member of the Danish Working Group on Chronic Fatigue Syndrome, established in August 2008 and expected to complete its work in spring 2009.

 

An Editorial: The proposed diagnosis of somatic symptom disorders in DSM-V to replace somatoform disorders in DSM-IV – a preliminary report by DSM-V Work Group members, Joel Dimsdale and Francis Creed on behalf of the DSM-V Workgroup on Somatic Symptom Disorders was published in the June 2009 issue of the Journal of Psychosomatic Research.

Full text of the June 2009 DSM-V SSD Work Group preliminary report can be accessed here:

http://www.jpsychores.com/article/S0022-3999(09)00088-9/fulltext

See section: Psychological factor affecting general medical condition 

“…The conceptual framework that we propose will allow a diagnosis of somatic symptom disorder in addition to a general medical condition, whether the latter is a well-recognized organic disease or a functional somatic syndrome such as irritable bowel syndrome or chronic fatigue syndrome…”

No updates or reports have been published on the APA’s website by DSM-V Task Force or Work Groups since brief reports issued in April 2009. DSM-V is anticipated to be finalised in May 2012 with field trials expected to start this October. No detailed Timeline for DSM-V is available.

Previous DSM Task Force chairs, Robert L Spitzer and Allen Frances, have been two of the most vocal critics of the current Task Force’s oversight of the revision process. Read their joint letter to the APA Board of Trustees here:  Letter to APA Board of Trustees July 09. In Dr Frances Responds to Dr Carpenter: A Sharp Difference of Opinion, Psychiatric Times, 9 July, Frances called for the posting of all the suggested wordings for DSM-V criteria sets well before considering field trials.

 

Javier Escobar, co-author of the Special Report: Unexplained Physical Symptoms: What’s a Psychiatrist to Do? Psychiatric Times, Aug 2008, was also a member of the Work Group for the “Conceptual Issues in Somatoform and Similar Disorders (CISSD) Project.

Javier Escobar is a member of the DSM-V Task Force, serves as a Task Force liaison to the Somatic Symptom Disorders Work Group and said to work closely with this work group.

http://www.psychiatrictimes.com/display/article/10168/1171223

01 August 2008
Psychiatric Times. Vol. 25 No. 9
Special Report

PSYCHIATRY AND MEDICAL ILLNESS
Unexplained Physical Symptoms What’s a Psychiatrist to Do?

Humberto Marin, MD and Javier I. Escobar, MD

According to Escobar and Marin:

“The list of somatoform disorders kept expanding with the addition of vague categories, such as “undifferentiated somatoform disorder” or “somatoform disorder NOS [not otherwise specified],” which, unfortunately, are the most common diagnoses within the somatoform genre. These terms failed to transcend specialty boundaries. Perhaps as a corollary of turf issues, general medicine and medical specialties started carving these syndromes with their own tools. The resulting list of “medicalized,” specialty-driven labels that continues to expand includes fibromyalgia, chronic fatigue syndome, multiple chemical sensitivity, and many others (Table 1).

Table 1

Functional somatic syndromes

Irritable bowel syndrome
Chronic fatigue syndrome
Fibromyalgia
Multiple chemical sensitivity
Nonspecific chest pain
Premenstrual disorder
Non-ulcer dyspepsia
Repetitive strain injury
Tension headache
Temporomandibular joint disorder
Atypical facial pain
Hyperventilation syndrome
Globus syndrome
Sick building syndrome
Chronic pelvic pain
Chronic whiplash syndrome
Chronic Lyme disease
Silicone breast implant effects
Candidiasis hypersensivity
Food allergy
Gulf War syndrome
Mitral valve prolapse
Hypoglycemia
Chronic low back pain
Dizziness
Interstitial cystitis
Tinnitus
Pseudoseizures
Insomnia
Systemic yeast infection
Total allergy syndrome”

These labels fall under the general category of functional somatic syndromes and seem more acceptable to patients because they may be perceived as less stigmatizing than psychiatric ones. However, using DSM criteria, virtually all these functional syndromes would fall into the somatoform disorders category given their phenomenology, unknown physical causes, absence of reliable markers, and the frequent coexistence of somatic and psychiatric symptoms.”

DSM-V and ICD-11 have committed as far as possible “to facilitate the achievement of the highest possible extent of uniformity and harmonization between ICD-11 mental and behavioural disorders and DSM-V disorders and their diagnostic criteria” with the objective that “the WHO and APA should make all attempts to ensure that in their core versions, the category names, glossary descriptions and criteria are identical for ICD and DSM.”

The International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders most recent meeting took place on 28 – 29 September. It is anticipated that a Summary Report of the meeting will be available in late November/December.

For detailed information on the proposed structure of ICD-11, the Content Model and operation of iCAT, the collaborative authoring platform through which the WHO will be revising ICD-10, please scrutinise key documents on the ICD-11 Revision Google site:

https://sites.google.com/site/icd11revision/
https://sites.google.com/site/icd11revision/home/documents

For information around the DSM and ICD revision processes see DSM-V and ICD-11 Directory page: http://meagenda.wordpress.com/dsm-v-directory/

ICD Revision Advisory Groups: Mental and Behavioural Disorders and TAG Neurology

Information on the new International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders and the Topic Advisory Group (TAG) for Neurology

WordPress Shortlink for this posting: http://wp.me/p5foE-25M

The text below has been compiled using information provided by the Senior Project Officer, Department of Mental Health and Substance Abuse, WHO, Geneva, and is published with permission. The text may be reposted provided it is published unedited, in full and http://meagenda.wordpress.com is credited as the source.  

The International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders was constituted by the WHO for a period of two years (2007 – 2008) with the primary task of advising the WHO on all steps leading to the revision of the mental and behavioural disorders classification in ICD-10, in line with the overall ICD revision process.

The initial period of operation has now expired and the group has been reconstituted and reappointed for the next two year period. The appointment of the Harmonization Group and other working groups reporting to the Advisory Group has also now expired, and new working groups will be appointed based on the current needs of the revision.

The Advisory Group is co-ordinated by Senior Project Officer, Dr Geoffrey M Reed, PhD, who is seconded to the Department of Mental Health and Substance Abuse, WHO, Geneva, through the IUPsyS (International Union for Psychological Science). The Department of Mental Health and Substance Abuse will also be managing the technical part of the revision of Diseases of the Nervous System (currently Chapter VI), as it is doing for Chapter V.

The new Advisory Group expands and makes some changes to its composition in order to obtain better geographical representation and also based on the nature of the tasks of the next period of the revision process.

The members of the new International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders are:

Steven Hyman (Chair), Harvard University, Cambridge, Massachusetts, USA
José Luís Ayuso-Mateos, Universidad Autónoma de Madrid, Madrid, Spain
Alan Flisher, University of Cape Town, Rondebosch, South Africa
Wolfgang Gaebel, Heinrich-Heine University, Düsseldorf, Germany
Oye Gureje, University College Hospital, Ibadan, Nigeria
Assen Jablensky, University of Western Australia, Crawley, Australia
Brigitte Khoury, American University of Beirut Medical Center, Beirut, Lebanon
Anne Lovell, Institute National de la Santé et de la Recherche Médicale, Paris, France
Maria Elena Medina-Mora, Instituto Nacional de Psiquiatria Ramon de la Fuente, México, D.F., Mexico.
Afarin Rahimi, Tehran University of Medical Sciences, Tehran, Iran
Norman Sartorius, Geneva, Switzerland
Pratap Sharan, All India Institute of Medical Sciences, New Delhi, India
Pichet Udomratn, Prince Songkha University, Hat Yai, Thailand
Xiao Zeping, Shanghai Mental Health Center, Shanghai, China

The professional and scientific organisations that have been asked to appoint representatives to the International Advisory Group for Mental and Behavioural Disorders, and the names of their representatives, are:

International Association of Child and Adolescent Psychiatry and Allied Professions (IACAPAP):
Per-anders Rydelius, Karolinska Institutet, Stockholm, Sweden

International Council of Nurses (ICN):
Tesfamicael Ghebrehiwet, International Council of Nurses, Geneva, Switzerland

International Federation of Social Workers (IFSW):
Dr Sabine Bährer- Kohler, Psychiatric University Clinic, Basel, Switzerland

International Union of Psychological Science (IUPsyS):
Ann D. Watts, Entabeni Hospital, Durban, South Africa

World Organization of National Colleges, Academies, and Academic Associations of General Practitioners/Family Physicians (WONCA):
Michael Klinkman, University of Michigan, Ann Arbor, Michigan, USA

World Psychiatric Association (WPA):
Mario Maj, University of Naples, Naples, Italy

All of these organisations were also represented on the previous Advisory Group with the exception of IACAPAP.

The first meeting of the reconstituted Advisory Group took place on 28 – 29 September 2009, in Geneva. There have been no other meetings since the December 2008 meeting of the former group. It is anticipated that a Summary Report of the meeting held last month, 28 – 29 September will be available within two months.

The report of the meeting held on 1 – 2 December 2008 can be read here: http://www.who.int/mental_health/evidence/icd_advisory_group_december_08_summary.pdf

—————–

Topic Advisory Group for Neurology

Lead WHO Secretariat for TAG Neurology is Dr Tarun Dua, Management of Mental and Brain Disorders, Department of Mental Health and Substance Abuse, WHO. Email: duat@who.int.

Dr Dua, a neurologist, co-ordinated the Atlas Multiple Sclerosis Resources in the World 2008, a collaboration between the World Health Organization and the Multiple Sclerosis International Federation and was a co-author of the World Health Organization publication, Neurological Disorders: Public Health Challenges, 2006 or download by chapters in PDF format at: http://www.who.int/mental_health/neurology/neurodiso/en/index.html

The members of the Topic Advisory Group (TAG) for Neurology are:

Raad Shakir (Chair), Imperial College London, London, UK
Donna Bergen, Rush University Medical Center, Chicago, Illinois, USA
Pierre Bill, Inkosi Ambert Luthuli Central Hospital, Durban, South Africa
Mandaville Gourie-Devi, Institute of Human Behaviour and Allied Sciences, New Delhi, India
Mitsuru Kawamua, School of Medicine, Showa University, Tokyo, Japan
Marco Medina, National Autonomos University of Honduras, Tegucigalpa, Honduras
Mohamad Mikati, American University of Beirut Medical Center, Beirut, Lebanon

The professional and scientific organisations that have been asked to appoint representatives to the Topic Advisory Group for Neurology, and the names of their representatives, are:

Alzheimer’s Disease International:
Murat Emre, Istanbul Faculty of Medicine, Istanbul, Turkey

International Brain Research Organization:
Krister Kristensson, Karolinska Institutet, Stockholm, Sweden

International Child Neurology Association
Marc Patterson, Mayo Clinic, Rochester, Minnesota, USA

International Headache Society:
Jes Olesen, University of Copenhagen, Copenhagen, Denmark

International League Against Epilepsy:
Ettore Beghi, Istituto “Mario Negri”, Milan, Italy

International Neuropsychological Society:
Andreas Monsch, University Hospital Basel, Basel, Switzerland

Movement Disorders Society:
Kapil D Sethi, Medical College of Georgia, Augusta, Georgia, USA

Multiple Sclerosis International Federation:
Alan J. Thompson, Director, National Hospital for Neurology & Neurosurgery, London, UK

World Federation of Neurosurgical Societies:
Marc Levivier, Centre Romand de Neurochirurgie, Lausanne, Switzerland

World Federation of Neurology:
Johan Aarli, University of Bergen, Bergen, Norway

World Stroke Organization:
Bo Norrving, Lund University, Lund, Sweden

1 October 2009

—————————–

Daily iCAMP YouTubes on the WHOICD11 Channel: http://www.youtube.com/user/WHOICD11

Transcripts of YouTube narrations on the ICD11 blog: http://whoicd11.blogspot.com/

For further information on the proposed structure of ICD-11, the Content Model and iCAT, the collaborative authoring platform the WHO will be using to revise ICD-10:

https://sites.google.com/site/icd11revision/
https://sites.google.com/site/icd11revision/home/documents

Agenda for the 22 September – 2 October iCAMP Alpha Draft Training Meeting [MS Word]

Content Model Style Guide document [MS Word]

Morbidity Reference Group Discussion papers:
        ICD-11 rules, conventions and structure [MS Word]
        Revision topics for topic advisory groups [MS Word]

Content Model Blank document [Excel]

Content Model Myocardial infarction example document [Excel]

Content Model Hypertension Category example document [Excel]

ICD 11 Alpha Draft presentation by Dr B. Ustun [MS pptx slides]

Start-Up List presentation by Dr R. Jakob [MS pptx slides]

Myocardial infarction Content Model presentation [MS ppt slides]

[Note that some of these documents are "works in progress" and subject to ongoing review and revision.]

The Elephant in the Room Series Three: Who’s watching the WHO?

Image | belgianchocolate | Creative Commons

Keywords

APA    DSM    DSM-IV    DSM-V    WHO    ICD    ICD-10    ICD-11    American Psychiatric Association    Diagnostic and Statistical Manual of Mental Disorders    World Health Organization    Classifications    DSM Revision Process    DSM-V Task Force    DSM-V Somatic Distress Disorders Work Group    Somatic Symptom Disorders Work Group    DSM-ICD Harmonization Coordination Group    International Advisory Group    Revision of ICD Mental and Behavioural Disorders    Global Scientific Partnership Coordination Group    ICD Update and Revision Platform    WHO Collaborating Centre    CISSD Project    MUPSS Project    Somatoform    Somatisation    Somatization    Functional Somatic Syndromes    FSS    MUS    Myalgic encephalomyelitis    ME    Chronic fatigue syndrome    CFS    Fibromyalgia    FM    IBS    CS    CI    GWS

The Elephant in the Room Series Three:

Who’s watching the WHO?

WordPress Shortlink for this posting: http://wp.me/p5foE-25h

30 September 2009

It’s now Week Two of the Geneva iCAMP Meeting to test iCAT – the multi-layered, wiki-like collaborative authoring platform that the WHO will be using to revise ICD-10. Are you watching the video reports?

The most important difference between ICD-10 and ICD-11 will be the Content Model:

“Population of the Content Model and the subsequent review process will serve as the foundation for the creation of the ICD-11. The Content Model identifies the basic characteristics needed to define any ICD category through use of multiple parameters (e.g. Body Systems, Body Parts, Signs and Symptoms, Diagnostic Findings, Causal Agents, Mechanisms, Temporal Patterns, Severity, Functional Impact, Treatment interventions, Diagnostic Rules).”

For the next edition of ICD, we’re unlikely to be looking at just a couple of lines in Chapter VI*, or whatever…

Daily iCAMP YouTubes are being posted on the WHOICD11 Channel. They’re all less than five minutes long and you can watch Days 1 to 6 here: http://www.youtube.com/user/WHOICD11 or on ME agenda here and here

For those with connections too slow for YouTube, transcripts of the narrations that intersperse the footage are being posted on the ICD11 blog, here: http://whoicd11.blogspot.com/

There are three more YouTube reports to come before iCAMP disperses.

The videos will give a feel for the potential extent of the Content Model and how the iCAT platform is intended to function as a multi-user, web-based authoring and review tool, through which alpha and beta drafts will be developed.

But for better understanding of the proposed structure of ICD-11 and the potential implications for the population of content, you really need to go here:

https://sites.google.com/site/icd11revision/
https://sites.google.com/site/icd11revision/home/documents

Here you will find:

Minutes of the 3 – 7 August 2009 iCAMP Meeting, Geneva [MS Word]

Provisional List of Participants for 22 September – 2 October 2009 iCAMP Meeting [MS Word]

Participants’ CVs [MS Word]

Agenda for the 22 September – 2 October iCAMP Alpha Draft Training Meeting [MS Word]

Content Model Style Guide document [MS Word]

Morbidity Reference Group Discussion papers:
ICD-11 rules, conventions and structure [MS Word]
Revision topics for topic advisory groups [MS Word]

ICD11 Model Representation Comparison document [MHTML]

Content Model Blank document [Excel]

Content Model Myocardial infarction example document [Excel]

Content Model Urticaria example document [Excel]

Content Model Hypertension Category example document [Excel]

ICD 11 Alpha Draft presentation by Dr B. Ustun [MS pptx slides]

Start-Up List presentation by Dr R. Jakob [MS pptx slides]

iCAT Tool presentation by T. Tudorache [MS ppt slides]

Myocardial infarction Content Model presentation [MS ppt slides]

Workflow document [pdf]

and ancillary material.

[Note that some of these documents are "works in progress" and subject to ongoing review and revision, so you will need to monitor the site from time to time for revised and updated versions, which is why I've not given the file paths.]

[Note also, that those with Office 2003 installed may not be able to open the slides of two presentations produced using the more recent PowerPoint file format "pptx" and will need to download the free MS Office 2007 PowerPoint Viewer (pptx viewer) or in my case, in order to view the Robert Jakob Start-Up List presentation, the MS Office Compatibility Pack for Word, Excel, and PowerPoint 2007 File Formats.]

The ICD-11 alpha draft is planned for May 2010, the beta draft for May 2011 and the final draft expected to be submitted to WHA by 2014, for implementation in 2015.

The additional dimension of the concurrent DSM-V development process towards its own alpha draft, the ICD-DSM commitment to congruency and “harmonization” between the two systems and the involvement of DSM Task Force members in the Advisory Group for Mental and Behavioural Disorders needs to be borne in mind. The APA plans to publish DSM-V in May 2012, several years ahead of ICD-11.

We don’t have an ETA, yet, for the launch of iCAT.

“The starting point for the ICD-11 alpha draft will be the “Start-Up List” of categories which has been drafted by WHO/HQ to initiate the editing process. This list includes all the proposals received to revise the existing ICD as well as the input from ICD national modifications. During alpha drafting, detailed structured definitions will be added to these ICD categories according to a common model…”    Agenda, ICD-11 Alpha Draft Training Meeting

It’s not yet known whether other proposals that have relevance to the ME community have already been submitted for review, over and above those proposals evident from the ICD Update and Revision Platform; or what input coming from ICD national modifications, WHO affiliates or other sources may have significance for us. That is, we do not know what will be the starting point for the reviewing of those sections relevant to our patient community.

“The ICD-11 will be a collaboratively authored project, and many people will be submitting proposals for content, much like wikipedia. Unlike Wiki, however, the ICD will be peer reviewed with the TAGs serving as the editorial boards. The Managing Editor for each TAG…will collect, synthesize, and present the information for each proposal, and they are responsible for ensuring that the correct team of reviewers is selected…”

“The beauty of a collaborative authoring tool like the iCAT is that it allows the creation of the ICD-11 to draw on the expertise of anyone at anytime, anywhere in the world. After a proposal is created, the Managing Editor will serve as “postmaster”, ensuring that each proposal is complete and correctly formatted, as well as thoroughly supported, before forwarding the content proposal on to the specifically chosen team of independent peer reviewers. It is also the job of the Managing Editor to filter out or address those proposals which do not fulfill the necessary criteria.

“Those content proposals which receive the appropriate percentage of approvals by the peer reviewers will be passed along to the Topic Advisory Group for further review. The TAG is responsible for further evaluation of the content proposal and the supporting information provided. Each content proposal which reaches this stage may also require the review of other, parallel, TAGs, if the content of the proposal overlaps between multiple TAG areas. Each proposal which meets the exacting requirements of the TAG or TAGs will be passed along for further evaluation by the Revision Steering Group…”

The Summary of the December 2008 Meeting of the International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders reported that the Advisory Group for the Revision of Diseases of the Nervous System (that is TAG Neurology and Chapter VI) had been approved and its members appointed and that the WHO Department of Mental Health and Substance Abuse would be managing the technical part of the revision of Chapter VI, as it is doing for Chapter V.

The 5th Meeting of the now reconstituted Advisory Group for the Revision of Mental and Behavioural Disorders was scheduled to take place this week, on 28 – 29 September.

Following this meeting, I hope to be in a position to provide information about the appropriate channels of communication with TAG Neurology and TAG Mental Health, the process through which stakeholders will be able to submit proposals and what will be required of them.

In the meantime, I recommend familiarising yourselves with the documentation and processes evolving at:
https://sites.google.com/site/icd11revision/home/documents

There’s a lot of material here, but we need to be informing ourselves around these processes, now.

*According to a discussion paper on ICD-11 rules, conventions and structure, it is proposed that Arabic should replace roman numerals throughout the classification (eg chapter numbering), except where they are the standard for a disease concept.  So for ICD-11, we might anticipate Chapter 5, Chapter 6 etc. rather than Chapter V, Chapter VI.

Suzy Chapman
30 September 2009

ICD-11 iCAMP on YouTube: Week Two

ICD-11 iCAMP on YouTube: Week Two

Week Two of the Geneva iCamp Meeting to test the iCAT collaborative authoring tool that the WHO will be using to revise ICD-10.

iCamp YouTube videos at:  WHO ICD11 Channel

Follow WHO ICD-11 on Twitter: http://twitter.com/WHOICD11

Follow WHO ICD-11 on Blogspot: http://whoicd11.blogspot.com

Follow WHO ICD-11 on Facebook: http://www.facebook.com/ICD11

ICD-11 Revision on Google Sites: https://sites.google.com/site/icd11revision

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YouTubes Days 1, 2, 3 and 4 can also be viewed at: http://wp.me/p5foE-23l

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WHO ICD Revision: iCAMP daily YouTubes:

Day 5 | 28 September 2009 |  4.28 mins

Fifth day of the World Health Organization’s International Classification of Diseases (ICD) Revision iCamp Meeting. This meeting will discuss the Collaborative Authoring Tool (iCAT) that will be used to revise the ICD towards its 11th Edition.

 
Day 6 | 29 September 2009 | 4.16 mins

Sixth day of the World Health Organization’s International Classification of Diseases (ICD) Revision iCamp Meeting. This meeting will discuss the Collaborative Authoring Tool (iCAT) that will be used to revise the ICD towards its 11th Edition.

 

Day 7 | 30 September 2009 | 3.47 mins

Seventh day of the World Health Organization’s International Classification of Diseases (ICD) Revision iCamp Meeting. This meeting will discuss the Collaborative Authoring Tool (iCAT) that will be used to revise the ICD towards its 11th Edition.

Day 8 | 01 October 2009 | 2.44 mins

Eighth day of the World Health Organization’s International Classification of Diseases (ICD) Revision iCamp Meeting. This meeting will discuss the Collaborative Authoring Tool (iCAT) that will be used to revise the ICD towards its 11th Edition.

Day 9 | 02 October 2009 | 5.50 mins

Ninth and final day of the World Health Organization’s International Classification of Diseases (ICD) Revision iCamp Meeting. This meeting will discuss the Collaborative Authoring Tool (iCAT) that will be used to revise the ICD towards its 11th Edition.

YouTubes Days 1, 2, 3 and 4: http://wp.me/p5foE-23l

ICD-11 iCAMP on YouTube

ICD-11 iCAMP on YouTube (Days 1, 2, 3and 4 now available below)

22 September saw the start of the Geneva iCamp Meeting to test the iCAT collaborative authoring tool that the WHO will be using to revise ICD-10. Follow WHOICD11 on Twitter: http://twitter.com/WHOICD11

According to ICD Revision on Facebook

i-CAMP

The training meeting for the ICD-11 alpha draft will test the collaborative authoring tool (iCAT) and further develop the joint authoring tools and procedures. Aims of the iCAMP: Shared Learning Process: – Learn the tooling environment – Learn …how to populate the content model and make structural changes – Learn the overall workflows for the revision process – Revise the overall tooling and organization of alpha-drafting Simulating the “Managing Editor” tasks for alpha-drafting – Managing the input from different sources into the ICD categories – Identifying the reviewers – Managing Workflows Observing the interactions amongst the participants to develop ideas for social networking for the ICD-11 Beta Drafting Phase.

The starting point for the ICD-11 alpha draft will be the “Start-Up List” of categories which has been drafted by WHO/HQ to initiate the editing process. This list includes all the proposals received to revise the existing ICD-10 as well as the input from ICD national modifications. During alpha drafting, detailed structured definitions will be added to these ICD categories according to a common model. In the iCAMP, participants will review the proposed classification structure, and start filling in the content model: i.e. they will define the diseases according to a common template which identifies the parameters and corresponding values for each of these parameters. Discussions will clarify and improve the content model, value sets, workflows and the overall revision process. During this structured exercise, the iCAT will be pilot tested mainly by the TAG Managing Editors and classification experts.

TAG Managing Editors will assume three different roles: (a) proposal generator, (b) reviewer, and (c) managing editor. Thus, they will be learning-by-doing the details of different contributor roles and testing whether the collaborative platform is fit for the intended purposes of the revision process. Classification Experts will examine the start up list for its completeness, accuracy, conformance with national adaptations and specialty adaptations as well as its relevance for intended use cases. They will also start working on the compilation of the coding rules and instructions (Volume II) and index (Volume III). Informatics experts will assist in tooling and workflows to ensure effective interactions between the proposal generators, managing editors and Topic Advisory Groups as well as other experts. They will also work on the multilingual aspects of the tooling and the products.

ICD Revision is posting iCamp YouTube videos on WHO ICD11 Channel

 

WHO ICD Revision: iCAMP Day 1

Day 1 | 22 September 2009 | 5.23 mins

“First day of the World Health Organization’s International Classification of Diseases (ICD) Revision iCamp Meeting. This meeting will discuss the Collaborative Authoring Tool (iCAT) that will be used to revise the ICD towards its 11th Edition.”

 
WHO ICD Revision: iCAMP Day 2

Day 2 | 23 September 2009 | 4.39 mins

“Second day of the World Health Organization’s International Classification of Diseases (ICD) Revision iCamp Meeting. This meeting will discuss the Collaborative Authoring Tool (iCAT) that will be used to revise the ICD towards its 11th Edition.”

 
WHO ICD Revision: iCAMP Day 3

Day 3 | 24 September 2009 | 3.46 mins

“Third day of the World Health Organization’s International Classification of Diseases (ICD) Revision iCamp Meeting. This meeting will discuss the Collaborative Authoring Tool (iCAT) that will be used to revise the ICD towards its 11th Edition.”

 
WHO ICD Revision: iCAMP Day 4

Day 4 | 25 September 2009 | 3.57 mins

“Fourth day of the World Health Organization’s International Classification of Diseases (ICD) Revision iCamp Meeting. This meeting will discuss the Collaborative Authoring Tool (iCAT) that will be used to revise the ICD towards its 11th Edition.”

Week Two videos at: ICD-11 iCAMP on YouTube: Week Two

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Related material:

June 2009 PowerPoint presentation

Robert Jakob, Medical Officer, Classifications and Terminologies, WHO Geneva
Slides only, no audio [PDF format 1.3 MB]: Overview of ICD Revision towards ICD-11, includes Timelines for overall revision process and Alpha Draft Calendar; illustrates sample textual definition

April 2008 PowerPoint presentation

Christopher Chute, MD, Mayo Clinic bioinformatics specialist and ICD Revision Steering Group Chair
Audio and slides [31 mins plus question session]: ICD-11 Revision Update, Overview for the NCBO (National Center for Biomedical Ontology) of development process towards ICD-11 using wiki-like collaborative authoring tools (iCAT)

http://www.who.int/mental_health/evidence/icd_advisory_group_december_08_summary.pdf

Summary Report: 4th Meeting of the International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders (1-2 December 2008)

Reference to Psychological Medicine manuscripts in Summary of 4th meeting of Advisory Group for Revision of ICD-10 Chapter V

Image | belgianchocolate | Creative Commons

Keywords

APA    DSM    DSM-IV    DSM-V    WHO    ICD    ICD-10    ICD-11    American Psychiatric Association    Diagnostic and Statistical Manual of Mental Disorders    World Health Organization    Classifications    DSM Revision Process    DSM-V Task Force    DSM-V Somatic Distress Disorders Work Group    Somatic Symptom Disorders Work Group    DSM-ICD Harmonization Coordination Group    International Advisory Group    Revision of ICD Mental and Behavioural Disorders    Global Scientific Partnership Coordination Group    ICD Update and Revision Platform    WHO Collaborating Centre    CISSD Project    MUPSS Project    Somatoform    Somatisation    Somatization    Functional Somatic Syndromes    FSS    MUS    Myalgic encephalomyelitis    ME    Chronic fatigue syndrome    CFS    Fibromyalgia    FM    IBS    CS    CI    GWS

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The Elephant in the Room Series Three:

Reference to Psychological Medicine manuscripts in the Summary of the 4th meeting of the Advisory Group for Revision of ICD-10 Chapter V (Mental and Behavioural Disorders)

WordPress shortlink for this posting:  http://wp.me/p5foE-22o

On 18 September, I posted a copy of the Summary Report of the 4th Meeting of the International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders held on 1-2 December 2008, which has only just been published by the WHO.

When reading the Advisory Group’s latest report, bear in mind that it is a summary of a meeting held nine months ago. It has not yet been established when the Advisory Group anticipates publishing a summary of its next meeting which is scheduled for the end of this month (28-29 September).

Since the December 2008 meeting took place, the DSM-V “Somatic Symptom Disorders” Work Group has published an Editorial: The proposed diagnosis of somatic symptom disorders in DSM-V to replace somatoform disorders in DSM-IV – a preliminary report by DSM-V Work Group members, Joel Dimsdale (Chair) and Francis Creed. The report, published in the June 2009 issue of the Journal of Psychosomatic Research, expands on proposals in the very brief DSM-V Work Group update, published on the APA’s website, in April.

Page 1 of the Summary of the 4th Meeting of the International Advisory Group reports:

“2. Update on proposal for large groupings of mental and behavioural disorders: Overview of Psychological Medicine articles

Presenter: Dr. David Goldberg

“Dr. Goldberg described key changes and additional specifications in the proposal for large groupings of mental disorders discussed at the AG meeting in March, 2008. Manuscripts based on this proposal are now in press in Psychological Medicine. The current version of the proposals includes five clusters of disorders. Each of these clusters meets some, though not all, of the validation criteria as modified from Robins and Guze by Hyman and colleagues. Similarities within the proposed clusters make it reasonable to view the different disorders within the cluster as variations on a single theme rather than separate and ‘comorbid’ disorders. The AG emphasized that decisions about an overarching architecture of categories will need to be made within the next year, keeping in mind WHO’s emphasis on clinical utility in a broad range of settings and countries…”

and goes on to discuss the relevance of large groupings to ICD revision and the testing of clinical utility in various contexts.

The “Cluster” manuscripts referred to as “in Press in Psychological Medicine” are listed on the APA’s recently published webpage:

“Peer-Reviewed Publications from DSM-V Development”

http://www.psychiatry.org/MainMenu/Research/DSMIV/DSMV/DSMRevisionActivities/DSMV-Publications.aspx

“As part of the efforts to make information about DSM-V development as widely disseminated as possible, the American Psychiatric Institute for Research and Education is maintaining an ongoing list of peer-reviewed journal publications arising from the DSM-V planning conference series (2002-08) and from DSM-V Task Force and Work Group discussions (e.g., empirical literature reviews, secondary data analyses). This list will be continually updated.”

[...]

“119. Andrews G, Goldberg DP, Krueger RF, Carpenter Jr WT, Hyman SE, Sachdev P & Pine DS. Exploring the Feasibility of a Meta-Structure for DSM-V and ICD-11: Could It Improve Utility and Validity? Psychological Medicine; in press.

120. Sachdev P, Andrews G, Hobbs MJ, Sunderland M & Anderson TM. Neurocognitive Disorders: Cluster 1 of the Proposed Meta-Structure for DSM-V and ICD-11. Psychological Medicine; in press.

121. Andrews G, Pine DS, Hobbs MJ, Anderson TM & Sunderland M. Neurodevelopmental Disorders: Cluster 2 of the Proposed Meta-Structure for DSM- V and ICD-11. Psychological Medicine; in press.

122. Carpenter Jr WT, Bustillo JR, Thaker GK, van Os J, Krueger RF & Green MJ. Psychoses: Cluster 3 of the Proposed Meta-Structure for DSM-V and ICD-11. Psychological Medicine; in press.

123. Goldberg DP, Krueger RF, Andrews G & Hobbs MJ. Emotional Disorders: Cluster 4 of the Proposed Meta Structure for DSM-V and ICD-11. Psychological Medicine; in press.

124. Krueger RF & South SC. Externalizing Disorders: Cluster 5 of the Proposed Meta-Structure for DSM-V and ICD 11. Psychological Medicine; in press.

125. Goldberg DP, Andrews G & Hobbs MJ. Where Should Bipolar Appear in the Meta-Structure? Psychological Medicine; in press.”

Gavin Andrews, MD, is a member of the DSM-V Anxiety, Obsessive-Compulsive Spectrum, Posttraumatic, and Dissociative Disorders Work Group.

Sir David Goldberg, MD, is a member of the DSM-V Mood Disorders Work Group

Robert Krueger, PhD, is a member of the DSM-V Personality and Personality Disorders Work Group

William T Carpenter, Jr., MD, chairs the DSM-V Psychotic Disorders Work Group and is a member of the DSM-V Task Force

Steven E Hyman, MD, is a member of the DSM-V Task Force and chairs the International Advisory Group for the Revision of ICD Mental and Behavioural Disorders

Perminder Sachdev MD, PhD, FRAZCP, is a member of the DSM-V Neurocognitive Disorders Work Group

Daniel S. Pine, MD, chairs the DSM-V Disorders in Childhood and Adolescence Work Group and is a member of the DSM-V Task Force

Juan R. Bustillo, MD, is a member of the DSM-V Psychotic Disorders Work Group

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The June 2009 Journal of Psychosomatic Research Editorial: The proposed diagnosis of somatic symptom disorders in DSM-V to replace somatoform disorders in DSM-IV – a preliminary report by Joel Dimsdale and Francis Creed was published as free access.

It is not yet known which issue of Psychological Medicine these manuscripts are to be published in or whether they will be freely available to non subscribers to the journal.

Given that the DSM-V Task Force insists that its oversight of the DSM revision is a transparent process, one assumes that these manuscripts are going to be made freely accessible to all stakeholders irrespective of whether the proposals contained within them still stand or are now superseded by alternative proposals.

See also: Summary Report of 3rd Meeting International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders 11 – 12 March 2008, Geneva

See also: Pages 3 and 4 Diagnostic Issues Symposium programme

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Psychological Medicine is published by Cambridge Journals

http://journals.cambridge.org/action/displayJournal?jid=PSM

The Editors of Psychological Medicine are:

Kenneth S. Kendler
Psychiatric Genetics Research Program
Dept of Psychiatry
P O Box 980710
Richmond, VA 23298-0710 USA

and

Robin M. Murray
Institute of Psychiatry
de Crespigny Park
Denmark Hill
London SE5 8AF

The Editorial Board for Psychological Medicine includes:

Sir David Goldberg*
Institute of Psychiatry, London, UK

Professor Matthew Hotopf
Institute of Psychiatry, UK

Dr James Levenson*
Virginia Commonwealth University, USA

and

Professor S. C. Wessely
King’s College London, UK

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*Dr James Levenson, MD, is a member of the DSM-V Somatic Symptoms Disorders Work Group and had been a member of the CISSD Project.

*Professor Sir David Goldberg, MD, Professor (Emeritus) Institute of Psychiatry, has been a member of the International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders and is a member of the APA’s DSM-V Work Group for Mood Disorders.

Professor Goldberg was a member of the UK National Editorial Team and UK National Consensus Group for the WHO “Diagnostic and Management Guidelines for Mental Disorders in Primary Care: ICD-10 Chapter V Primary Care Version”.

For archived correspondence between Connie Nelson, the WHO, Geneva, and the WHO Collaborating Centre, Institute of Psychiatry, from 2001, concerning the issue of the WHO Collaborating Centre’s flexible use of terminology around chronic fatigue, fatigue syndrome and neurasthenia, and chronic fatigue syndrome and ME see:

http://www.meactionuk.org.uk/whomisc.htm

I will update when these manuscripts have been published.

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On the DSM-V Peer-Reviewed Publications from DSM-V Development page under “Somatoform Disorders” is listed the paper: 

88. Kanaan RAA, Lepine JP, & Wessely SC. The association or otherwise of the functional somatic syndromes. Psychosomatic Medicine, 2007; 69:855-859.

This paper can be accessed via Google Books “Preview”, published as Chapter 2 of:

“Somatic Presentations of Mental Disorders: Refining the Research Agenda for DSM-V”

Monograph published by the American Psychiatric Association, in 2009, summarising the proceedings of the September 2006 APA/WHO Beijing Symposium: Somatic presentations of mental disorders

See Chapter 2: Pages 9-18   http://tinyurl.com/somaticpresentationsDSM-V

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For latest “Elephant in the Room” series report (compiled before the release of the Advisory Group’s 4th meeting Summary Report)

see: DSM, ICD: transparency and timelines 03 September 2009.