CLD vs Organically Unexplained Symptoms Article

Topics with information and discussion about published studies related to Lyme disease and other tick-borne diseases.
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RitaA
Posts: 2768
Joined: Thu 1 Jul 2010 8:33

CLD vs Organically Unexplained Symptoms Article

Post by RitaA » Wed 2 Jan 2013 2:29

This article is almost guaranteed to generate a lot of comments/discussion in Lymeland during the coming days and weeks. My thanks to the blogger "Relative Risk" for providing a synopsis since many of us only have access to the article's abstract.

http://relative-risk.blogspot.com/2013/ ... s-ous.html
01 JANUARY 2013

CLD vs. OUS

Csallner G, Hofmann H, Hausteiner-Wiehle C. Patients with "Organically Unexplained Symptoms" Presenting to a Borreliosis Clinic: Clinical and Psychobehavioral Characteristics and Quality of Life. Psychosomatics. 2012 Dec 27.

Symptoms can persist for weeks to months after treatment, but there is no evidence for ongoing infection with Borrelia burgdorferi in patients with prolonged subjective symptoms after adequate antibiotic therapy Nevertheless, there is an increasing number of patients who claim to suffer from “Chronic Lyme Disease.” Despite nonspecific physical findings, negative laboratory testing, or adequate treatment, these patients attribute bodily symptoms to a persistent spirochetal infection, and often continue to take antibiotics for months or years. Due to this confusion, Lyme borreliosis tends to be overdiagnosed and overtreated; it is associated with “inappropriate use of health services, avoidable treatment-related illness, and substantial disability and distress”. It has been repeatedly suggested that “Chronic Lyme Disease” is just another unwarranted label for “organically unexplained symptoms” (OUS), “functional” or “somatoform” syndromes, comparable to several medicohistoric (e.g., “chronic brucellosis”) or “modern” phenomena (e.g., “fibromyalgia syndrome,” or “chronic fatigue syndrome”).

In the present study, we aimed to explore the prevalence of OUS among patients presenting to a University borreliosis clinic, and to describe their clinical and psychobehavioral characteristics as well as their health-related quality of life. A total of 162 patients met the inclusion criteria. Thirty-two patients refused to participate in the study (reasons not documented), resulting in a participation rate of 80%. Five patients were excluded because of incomplete assessment of organic symptom explicability. Therefore, complete data sets were available from 125 patients….

This study explored the prevalence and characteristics of patients with OUS presenting to a University borreliosis clinic. The prevalence of patients whose symptoms were rated as “organically unexplained” was about 30%, consistent with the literature on “medically unexplained symptoms” in various clinical settings; 30–32 with 60%, a comparable study conducted in a borreliosis clinic found an even higher rate.

Looking at more detailed illness-related cognitions, emotions, and behaviors, patients with OUS reported many more illness consequences and negative emotional illness representations (including frustration and worry), they felt less reassured in the medical context, more dissatisfied with medical care, and more convinced of having a serious illness.

The fact that our patients with OUS reported a decreased mental and physical health-related quality of life is consistent with findings in other studies.

In our study, there was a substantial number of patients with “organically unexplained symptoms” inaccurately ascribed to Lyme disease. These patients revealed a reduced quality of life and, if asked for them, many clinical and psychobehavioral characteristics that were different compared with patients with “organically explained symptoms” and that can indicate significant somatic and mental distress. An early focus on all of the patients’ bodily and mental symptoms, as well as on subjective illness perceptions and illness consequences, may contribute to an earlier identification of OUS and allow for a more specific, interdisciplinary treatment and identification of individual needs of action.
Switching countries/continents for a moment ...

The Complex Chronic Medicine clinic (that is expected to open soon in Vancouver) appears to be adopting an interdisciplinary approach if the following recruitment ad is any indication. The fact that it was posted under the Department of Psychiatry did not escape my notice, and some patients may avoid attending the clinic for this reason alone:

http://psychiatry.ubc.ca/2012/11/13/phy ... -medicine/
November 13, 2012

Physicians – Complex Chronic Medicine
Here's a snippet that suggests/confirms an interdisciplinary approach will be be adopted in Vancouver:

http://psychiatry.ubc.ca/files/2012/11/ ... dicine.pdf
Candidates will be registered with or eligible for registration with the College of Physicians and
Surgeons of British Columbia or the College of Naturopathic Medicine of British Columbia. They
will have specialty training in one or more of the following areas: Internal Medicine,
Rheumatology, Infectious Diseases, Physiatry, Neurology, Psychiatry, Anesthesiology, Pediatrics
and its relevant subspecialties, Naturopathic Medicine, or Family Medicine with subspecialty
interest/training in complex chronic medicine. The ideal candidate will also have or be eligible for
a faculty appointment at the University of British Columbia or equivalent.
Here's a link to the German published article's abstract:

http://www.sciencedirect.com/science/ar ... 8212001624
Psychosomatics

Available online 27 December 2012

In Press, Corrected Proof — Note to users

Original Research Reports

Patients with “Organically Unexplained Symptoms” Presenting to a Borreliosis Clinic: Clinical and Psychobehavioral Characteristics and Quality of Life

Gisela Csallner, M.D. a, b,
Heidelore Hofmann, M.D. a,
Constanze Hausteiner-Wiehle, M.D. b, ,

a Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technische Universität München (TUM), Germany
b Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Technische Universität München (TUM), Germany

http://dx.doi.org/10.1016/j.psym.2012.08.012, How to Cite or Link Using DOI

Objective

This study explores the prevalence of patients with “organically unexplained symptoms” presenting to a Lyme borreliosis clinic and describes their clinical and psychobehavioral characteristics as well as health-related quality of life.

Methods

Study instruments consisted of a set of self-rating questionnaires and a organicity rating of presenting symptoms by an acknowledged expert. Participants included 125 patients presenting with symptoms attributed to borreliosis. Clinical and psychobehavioral characteristics as well as health-related quality of life for patients whose symptoms were rated as “organically unexplained” were compared with those of patients whose symptoms were rated as “organically explained.”

Results

Symptoms of 37 (30%) patients were rated as “organically unexplained” (ORG−) and symptoms of 88 (70%) patients were rated as “organically explained” (ORG+). ORG− differed from ORG+ in various clinical and psychobehavioral characteristics and in health-related quality of life. For example, ORG− reported a higher number of symptoms, more illness consequences and negative emotional illness representations, and felt less reassured in the medical context, more dissatisfied with medical care, and more convinced of having a serious illness.

Conclusions

Our results suggest that patients with “organically unexplained symptoms” inadequately attributed to Lyme borreliosis reveal many clinical and psychobehavioral characteristics that indicate significant somatic and mental distress. An early focus on all of the patients' mental and bodily symptoms, as well as on subjective illness perceptions and consequences allows for a more specific plan.
I strongly suspect this abstract has been posted before now here on LNE, but I was unable to find it. Maybe I just didn't try hard enough, so please do post a link to the original thread if you happen to come across it.

Thanks. :)

duncan
Posts: 1370
Joined: Wed 5 Sep 2012 18:48

Re: CLD vs Organically Unexplained Symptoms Article

Post by duncan » Wed 2 Jan 2013 12:06

Oh, please let them say False Illness Beliefs...Please...

Damn. Can't seem to find it.

Otherwise, a brilliant parody, IMO.

NellyP
Posts: 43
Joined: Mon 29 Oct 2007 18:22

Re: CLD vs Organically Unexplained Symptoms Article

Post by NellyP » Wed 2 Jan 2013 19:27

01 JANUARY 2013
Nice way to start the new year !!!

Didn't they mean for it to come out on April 1st 2013 ?

Nelly (Paris-France)

X-member
Posts: 5978
Joined: Mon 30 Jul 2007 18:18

Re: CLD vs Organically Unexplained Symptoms Article

Post by X-member » Wed 2 Jan 2013 20:27

From the post above:
Didn't they mean for it to come out on April 1st 2013 ?
:D :D

X-member
Posts: 5978
Joined: Mon 30 Jul 2007 18:18

Re: CLD vs Organically Unexplained Symptoms Article

Post by X-member » Thu 3 Jan 2013 15:04

From the first post:
A total of 162 patients met the inclusion criteria. Thirty-two patients refused to participate in the study (reasons not documented)...
What was the inclusion criteria? Was it: "No signs of an uncured, active Lyme INFECTION"?

duncan
Posts: 1370
Joined: Wed 5 Sep 2012 18:48

Re: CLD vs Organically Unexplained Symptoms Article

Post by duncan » Fri 4 Jan 2013 12:09

I was curious about the inclusion criteria as well, but after reading the very first sentence of the article, I found myself wondering if it would even matter.

I'd also be interested in knowing if the German Borreliosis Society were considering a response.

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