Chronic Fatigue and Neurasthenia

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Thursday, October 8. 2015

Chronic Fatigue and Neurasthenia

In the borderlands of physiologic abnormalities, changes happen all the time. For example, yesterday's perversion is today's celebrated "difference," while yesterday's lazy kid now has an internet addiction disorder.

Common sense people take it all with some humor and many grains of salt.

By borderlands, I mean the areas in which there are only subjective, untestable, vague complaints. Of course, that applies to many disorders in the Psychiatric domain.

One of my favorite bugaboos is Multiple Chemical Sensitivity. I am told that one can obtain lifetime disability for this impossible disease which is, in fact, either fictitious in some cases and "hysteria" in others.

Another is "Chronic Lyme Disease," and another is Chronic Fatigue Syndrome. It used to be called Neurasthenia. Freud thought, at first, that it was caused by the chemistry of sexual deprivation. Every patient I have seen referred to me with this trashcan diagnosis has had a mood disorder and/or a personality disorder. No, one of them had an undiagnosed schizophrenia.

Nevertheless, the squeaky wheels get the grease: The Tragic Neglect of Chronic Fatigue Syndrome.

Posted by Dr. Joy Bliss in Psychology, and Dr. Bliss at 14:45 | Comments (13) | Trackbacks (0)

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You know, a lot of the same things used to be said about TB in the 19th century, before the causative pathogen was identified. Then doctors changed their tune real quick.

Just because it is currently a 'trash can' diagnosis doesn't mean that chronic fatigue syndrome isn't real:

https://www.washingtonpost.com/national/health-science/with-his-son-terribly-ill-a-top-scientist-takes-on-chronic-fatigue-syndrome/2015/10/05/c5d6189c-4041-11e5-8d45-d815146f81fa_story.html

We as a species are still at the very, very beginning of medical knowledge. More has been learned about medicine since the end of WWII than in the previous 200,000 years of human history. Most MDs are acutely aware of the thin scrim of knowledge they have that is spread over a vast ocean of ignorance. Oftentimes it is the most senior people who are the most willing to admit that they don't have a specific diagnosis.

Someday, when the cause(s) of CFS have been identified and the course of the disease is better understood...this post could be a bit embarrassing for you.

#1 JM01 on 2015-10-08 16:08 (Reply)

Unfortunately, the unexplained illnesses in medicine are labeled psychological by default until science catches up. I'm old enough to remember when autism was thought to be caused by distant parenting or "refrigerator moms", ulcers were though to be caused by stress, and MS was referred to as "hysterical paralysis". Today, because of science, patients have viable treatments and are no longer blamed for their symptoms.

#2 JM01 on 2015-10-08 16:38 (Reply)

All true.

We shall see. All I can go by is the evidence at hand. Otherwise, it's just speculation. Guess what? There are still hysterical seizures, as neurologists know well.

There are more things in heaven and earth, Horatio,
Than are dreamt of in your philosophy.

#2.1 Dr B on 2015-10-08 17:32 (Reply)

chronic fatigue syndrome is the perfect "illness". No visable symptoms it is totally whatever the patient says it is. It garners benefits and is an excuse for everything from not working to not maintaining relationships. It is the perfect malingering disease for anyone who doesn't want to do something. At the risk of attracting slings and arrows I will suggest that 90% of those with this "illness" are middle age overweight and unattractive women seeking attention. A very convenient "illness" indeed.

#3 GoneWithTheWind on 2015-10-08 18:26 (Reply)

"Chronic Lyme Disease" Big joke, right.
There was time Lyme Disease was another 'imaginary' disease until it wasn't.

I'm retired, widowed and living alone. Just who am I trying to impress or fool? At least my primary care doc believes something odd is going on since the last two times I tested positive for Lyme there was no rash and didn't find any ticks.
Of course the 'Specialist' toes the company line, CLD isn't possible, it's in my head. The drugs they prescribed are infallible. Case closed.

The chronic pain, joints and muscle; please don't waste our time.

Witch doctors would be a step up.

#4 John the River (Link) on 2015-10-08 19:19 (Reply)

I spent about one half of my litigation career fighting functional medical issues, like multiple chemical sensitivities. My favorite was a physician/med school professor at Oregon Health and Sciences University who would diagnose nearly anyone with porphyria.

These porphyria cases resulted in about a decade of litigation across myriad cases, where the professor appeared as the plaintiff's/claimant's expert witness. I used experts from the US, Canada, and GB. As I recall I was successful in each of these cases and the professor was finally called to task by the university.

The damage that man did to his patients is depressing. Even after we would win a case some patients were unable to accept that they did not have this rare and very special disease. Often their lives were destroyed.

I smell the same true believer mentality in some of the comments.

Mark Sherman

#5 Maddog on 2015-10-08 21:33 (Reply)

Well, the National Academy of Medicine disagrees with your assessment. But they actually reviewed the literature. Have you?

http://jama.jamanetwork.com/article.aspx?articleid=2118591

How many mood disorders are currently undergoing research demonstrating the efficacy of a drug like Rituximab?

https://www.newscientist.com/article/mg22730284-000-antibody-wipeout-relieves-symptoms-of-chronic-fatigue-syndrome/

We try to understand, in spite of how we're treated, that the biases of medical professionals are what they are. Unwillingness to pay much attention to current thinking on this condition--which used to be called Myalgic Encephalomyelitis (what Melvin Ramsay witnessed at Royal Free in 1955 was not Beard's construct)--doesn't seem like too much to ask. Not if people are going to write the same old tired crap about malingering and 'hysteria.'

Here's the full report. It contradicts most, if not all, of what you've written about this. Is it too much to ask that you take a look at it? This disease is not fictitious, not a mood disorder, not psychiatric, and horribly debilitating and disabling.

If you don't want to look at it, perhaps you could explain why someone like me would be more interested in doing absolutely nothing so I can collect 1/6th of what I once earned and live in borderline poverty. Why someone should think it's a mood disorder when a patient presents with profound immunological dysfunction, abnormal result on tilt table test, low circulating blood volume, low Natural Killer cell count and function, Neurally Mediated Hypotension, and abnormal response on 2-day CPET testing (unless you think these things can be faked, in which case there's nothing more to discuss, is there).

https://iom.nationalacademies.org/~/media/Files/Report%20Files/2015/MECFS/MECFS_ReportBrief.pdf

#6 Not this again on 2015-10-08 21:41 (Reply)

I have a rare autoimmune disease called CIDP (google it, if your are curious). After several years of misery, including times when I could not stand unaided, let along walk, I am now in remission. I can walk more-or-less normally, and do most normal daily tasks. However, I get very fatigued with even slight exertion. At a recent conference for people with CIDP, a speaker asked the audience how many had problems with fatigue. I estimate that three-quarters raised their hands.

CIDP is so rare that many doctors are unaware of it. My GP tells me that I am educating him. I have come to realize that many cases go undiagnosed, sometimes for years.

I suspect that many cases of chronic fatigue are actually due to some other undiagnosed syndrome like this.

#7 Bill Henstock on 2015-10-08 23:17 (Reply)

My favorite is Electromagnetic Hypersensitivity.

It should be simple to construct a test to check if a person is really sensitive to wifi and other electromagnetic radiation.

The test should be mandatory for anyone claiming to have these kinds of illnesses.

#8 EarlW on 2015-10-09 03:20 (Reply)

A Stanford Med study shows MRI evidence of abnormalities in CFS/SEID patients' brains:

http://med.stanford.edu/news/all-news/2014/10/study-finds-brain-abnormalities-in-chronic-fatigue-patients.html

Please read if you value factual information.

#9 CA researcher on 2015-10-09 13:02 (Reply)

[/url] http://med.stanford.edu/news/all-news/2014/10/study-finds-brain-abnormalities-in-chronic-fatigue-patients.html

I hope this is now a link.

#9.1 CA researcher on 2015-10-09 13:08 (Reply)

What is a mood disorder or a personality disorder?

#10 annieoakley on 2015-10-09 13:17 (Reply)

tIvuGTUrZAMsFpUApi 7019

#11 EWMCuerlsiaHCNc (Link) on 2015-10-11 20:57 (Reply)

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Thursday, October 8. 2015

Chronic Fatigue and Neurasthenia