The Elephant in the Room Series Two: MUPSS Project: Sykes, Psychiatry and Psychosomatics conferences

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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 Two:

The MUPSS Project: Sykes, Psychiatry and Psychosomatics conferences

15 April 2009

On 12 April, I reported on recent information gathered around the international CISSD (Conceptual Issues in Somatoform and Similar Disorders) Project which includes the response from the Institute of Psychiatry to a request for information under the Freedom of Information Act. See:  http://tinyurl.com/CISSDProjectMUPSSProject

I also reported on a new project currently being undertaken by Dr Richard Sykes, PhD, former Director of Westcare UK. In February, Dr Sykes had told me that he was continuing to work on the subject of “symptoms and syndromes that are commonly regarded as unexplained”.

The Institute of Psychiatry’s response disclosed that Dr Sykes’ “Honorary Membership” of the WHO Collaborating Centre ceased in 2007 and that he is now attached to the WHO Collaborating Centre as a “Visiting Research Associate”. Since 2008, Dr Sykes has been engaged on the “London Medically Unexplained Physical Symptoms and Syndromes (MUPSS) Project” for which he receives a research award of £27,000 per year from the Institute of Psychiatry. The award for the “MUPSS Project” commenced in 2008 and is intended to cover all research and associated expenses e.g. travel, attendance at conferences. It is funded by a grant from the Hugh and Ruby Sykes Charitable Trust. No other information was included about the “MUPSS Project” and there is no information available on the WHO Collaborating Centre’s website.

So the aims and objectives of the “MUPSS Project” remain to be established, as does the nature and extent of the WHO Collaboration Centre’s involvement in it. It is not yet known whether a Work Group has been convened (as in the case of the CISSD Project) or whether this Project is being undertaken solely by Dr Sykes. 

It is not known how the Project is being carried out or who the stakeholders are, but is understood that a paper or papers may result out of the Project, which is said by Dr Sykes to have relevance to “all conditions characterised by medically unexplained symptoms, not just CFS/ME”.  So very little is known at the moment other than that this Project relates to what Dr Sykes perceives as “medically unexplained symptoms (MUS)” and that he includes within this category, “CFS/ME”.

In 2006 and 2007, with a clutch of papers resulting out of the CISSD Project Workshops already published in the Journal of Psychosomatic Research, Dr Sykes disseminated the Project’s findings on the psychiatric and psychosomatic conference circuit, chairing plenary sessions on classificatory issues around the so-called “Somatoform Disorders” and presenting on “Emerging proposals from the CISSD Project”. In 2007, his presentation at the Melvin Ramsay Society meeting was titled: “Conceptual issues in the classification of ME/CFS”. Dr Sykes uses the terms “chronic fatigue syndrome”, CFS, “CFS/ME” and “ME/CFS” interchangeably and under the umbrella of the so-called “functional somatic syndromes”.

In 2008, Dr Sykes was listed as a participant in the following conferences:

“Advances in Liaison Psychiatry and Psychosomatics in Europe Conference”

Zaragoza, Spain – June 25-28th, 2008

Several areas of psychiatric and psychosomatic research were presented at this conference including sessions on “Medically Unexplained Syndromes (MUS)” and “Somatoform” related topics. You will recognise the names of Professors Michael Sharpe, Francis Creed and several others who had been members of the CISSD Project Work Group. Professors Sharpe and Creed are also members of the DSM Revision “Somatic Distress Disorders” Work Group. The full conference programme can be read here:

Congress programme: http://www.eaclpp.org/zaragoza/scientific_program.html

Preliminary programme PDF:

http://www.eaclpp.org/zaragoza/texts/Preliminary%20Programme%20Zaragoza%202008_1.pdf  

Dr Sykes was listed as Chair/Discussant for the following session:

SIMULTANEOUS WORKSHOPS ECPR / EACLPP

“SOMATOFORM DISORDERS AND THE SIREN “PSYCHOGENIC INFERENCE”. HIDDEN PERILS
AND SAFE ESCAPE ROUTES” 
Chair/Discussant: Sykes RD (United Kingdom)

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A couple of months earlier, in April 2008, Dr Sykes had also been listed as a Poster at:

The 16th AEP European Congress of Psychiatry: “Pathways to Integrative Care” France, Nice, April 5 – 9, 2008   http://www.kenes.com/aep2008/

“The AEP 2008 European Congress of Psychiatry is organized by the Association of European Psychiatrists (AEP), the largest international association of psychiatrists in Europe with a membership base from more than 63 countries. AEP NICE 2008 brings together a blend of psychiatrists from all specialties with lectures and symposia focusing on different psychiatry and neuropsychiatry fields”

This AEP Congress was sponsored by Astra-Zeneca, Bristol-Myers Squibb, Otsuka, JPharmaceuticals, Pfizer, Eli Lilly and Janssen-CILAG.

Dr Sykes’ Poster session at the AEP European Congress of Psychiatry was listed under:

Poster Session III: Diagnoses And Classification

“Somatoform disorders and the siren “psychogenic inference”: seductive charms, hidden perils and a safe escape route”

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In the Co-Cure commentary on the “CDC Stakeholders’ Meeting on CFS Strategic Research Plan”, published 15 April and archived at: http://listserv.nodak.edu/cgi-bin/wa.exe?A2=ind0904c&L=co-cure&T=0&F=&S=&P=59, Dr Mary Schweitzer sets out, succinctly, her concerns over the CDC’s use of the term “medically unexplained syndromes”, over the broadening of definitions and the implications for insurance claimants.

Also see posting: CDC Stakeholders’ Meeting on CFS Strategic Research Plan and e-Petition

The recommendations and proposals of the CISSD Project have informed the APA’s DSM revision process, the development process towards ICD-11 and the “Harmonization” between DSM-V and ICD-11 Chapter on Mental and behavioural disorders. According to Dr Sykes, “Somatoform Disorders are a category of Mental Disorders, used mainly by psychiatrists, that are characterized by medically unexplained physical symptoms.”

Does the “Medically Unexplained Physical Symptoms and Syndromes (MUPSS) Project” also intend to feed into these processes and specifically the potential revision of classifications around the so-called “Somatoform Disorders” and the “Functional somatic syndromes” into which are shovelled CFS, ME, FM, IBS, CS, CI, TMI, SBS and GWS?

While the ME Association are putting together their report on the CISSD Project will they also establish the nature and purpose of Dr Sykes’ latest Project and its relevance for their members, who are also going to find the use of the term “medically unexplained symptoms” disturbing. Did Dr Sykes consult with ME patient organisations before obtaining funding for this Project through the Institute of Psychiatry? The language he uses around the illness and his abstruse and esoteric presentation titles suggest that he is becoming disturbingly out of touch with the stakeholder patient group in whose name and in whose interests and for whose benefit this new Project purports to have been initiated.

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Selected sessions from the MUS and somatoform topic areas (which included sessions on adolescents with chronic fatigue syndrome) from the

“Advances in Liaison Psychiatry and Psychosomatics in Europe Conference”

Zaragoza, Spain – June 25-28th, 2008

http://www.eaclpp.org/zaragoza/scientific_program.html

PLENARY SESSION EACLPP/ECPR

HOW DO WE EVALUATE PATIENT OUTCOME IN STUDIES OF FUNCTIONAL SOMATIC SYMPTOMS AND DISORDERS?

Chair/Discussant: Rosendal M (Denmark)

– Sharpe M, Butcher I, Carson A, Walker J, Cavanagh J, Williams C (Scotland-UK). The self rated clinical global impression (CGI) – its use in a trial of CBT self help in patients attending neurology clinics with MUS

– Christensen KS, Bech P, Fink P (Denmark). Responsiveness of screening questionnaires for mental disorders in primary care

– Creed F (United Kingdom). Abdominal pain, health status or healthcare costs – which outcome is relevant to a psychological treatment trial for irritable bowel syndrome patients?

– Frostholm L (Denmark). Is the common-sense model of illness useful as an outcome measure in patients with functional somatic symptoms and disorders in primary care?

– Fritzsche K, Schweickhardt A (Germany). Measuring emotional distress: response shift in relation to intervention

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SIMULTANEOUS SESSIONS EACLPP/ECPR

FUNCTIONAL SYMPTOMS AND BODILY DISTRESS: BIOLOGICAL PATHWAYS

Chair/Discussant: Rosmalen J (the Netherlands)

– Fink P (Denmark). Bodily distress syndrome or disorder. An empirically based new diagnostic construct for somatisation and related disorders

– Rosmalen J (the Netherlands). Validation of bodily distress disorder in a general population sample

– Tak LM, Bakker SJL, Rosmalen JGM (the Netherlands). Dysfunction of the hypothalamic-pituitary-adrenal axis and somatization: A longitudinal cohort study

– Kuzminskyte R (Denmark). Impaired Pain Processing in Multiple Functional Somatic Symptoms

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UNDERSTANDING SOMATISATION THROUGH CROSS-CULTURAL LIAISON PSYCHIATRY

Chair/Discussant: Berardi D, Rigatelli M (Italy)

– Collazzos (Spain). Cross-cultural CL Psychiatry and somatisation

– Tarricone I, Morri M, Poggi F, Braca M, Pedrini E, Pompei G, Castellani A, Berardi D (Italy). Somatisation among migrants at the Bologna Transcultural Psychiatric Service in Bologna

– Özkan S (Turkey). Somatisation and Illness perception in different cultures

– Ferrari S (Italy). Prevalence and risk factors of somatic distress: the Modena study

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MEDICALLY UNEXPLAINED SYMPTOMS – A FIELD FOR QUALITATIVE RESEARCH?

Chair/Discussant: Risør MB (Denmark)

– Risør MB (Denmark). The healing processes of persons with medically unexplained symptoms – exploring qualitative approaches

– Dowrick C, Salmon P (UK). Expanding horizons: improving qualitative investigation of MUS in primary care

– Peters S, Graham CC, Dowrick C (UK). Psychological treatments for Medically Unexplained Symptoms (MUS) delivered by health professionals: Using qualitative methodologies to understand the story behind the numbers

– Hansen HS (Denmark). Classification of medically unexplained symptoms in primary care

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SIMULTANEOUS WORKSHOPS ECPR / EACLPP

SOMATOFORM DISORDERS AND THE SIREN “PSYCHOGENIC INFERENCE”. HIDDEN PERILS AND SAFE ESCAPE ROUTES

Chair/Discussant: Sykes RD (United Kingdom)

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THEMATIC ORAL SESSIONS

CHILD AND ADOLESCENT C-L AND PSYCHOSOMATICS

Chair/Discussant: Hindley P (United Kingdom)

– Vanderfaeillie J, Dick H, Willems D, Lampo A, Vandenplas Y (Belgium). Somatic symptoms in children: perception and recognition by the parents

– Janssens KAM, Oldehinkel AJ, Rosmalen JGM (the Netherlands). Parental overprotection predicts the development of functional somatic symptoms in early adolescents

– Van Cauwelaert K, Vanderfaeillie J, Lampo A, Vancoppenolle A, Meysmans M (Belgium). Evaluation of the relationship between cardiovascular exercise capacity, physical self–esteem and self reported fatigue in children with chronic fatigue

– Dick H, Vanderfaeillie J, Marchand J, Lampo A (Belgium). Psychiatric disorders and specific personality aspects in adolescents with chronic fatigue syndrome and implications towards treatment.

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SIMULTANEOUS SESSIONS ECPR

TREATMENT OF FUNCTIONAL SOMATIC SYMPTOMS

Chair/Discussant: Fink P (Denmark), Rief W (Germany)

– Fink P (Denmark). Unmet need of care for the somatising and mentally ill patients in Primary Care

– Rief W (Germany). Who seeks help because of bodily symptoms?

– Henningsen P (Germany). Management of functional somatic syndromes

– Sharpe M, Butcher I, Carson A, Walker J, Cavanagh J, Williams C (Scotland-UK). A randomised controlled trial of a guided self-help intervention for patients with medically unexplained neurological symptoms

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Previous reports in this series are archived at:  http://tinyurl.com/dsm-vdirectory

DSM-V and ICD-11 Directory can be downloaded in Word format here:  DSM-V and ICD-11 Directory

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Compiled by Suzy Chapman
15 April 2009

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