Consent, confidentiality, and the Data Protection Act.
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Biomedical Research↗
Biomedical subjects
Simon Wessely
Publications and source records attributed to Simon Wessely.
The act of diagnosis: pros and cons of labelling chronic fatigue syndrome.
BACKGROUND: One of the many controversies surrounding chronic fatigue syndrome (CFS) is the possible impact of the diagnostic label: is it disabling or enabling? In this paper, we discuss the pros and cons of labelling CFS. METHOD: A narrative synthesis of the literature. RESULTS: Diagnosed CFS patients have a worse prognosis than fatigue syndrome patients without such a label. The ways in which CFS patients perceive themselves, label their symptoms and appraise stressors may perpetuate or exacerbate their symptoms, a process that involves psychological, psychosocial and cultural factors. Labels can also lead to conflicts with doctors who fear diagnosis might lead to worse outcomes. However, on the other hand, finding a label that fits one's condition can provide meaning, emotional relief and recognition, whilst the denial of the diagnosis of CFS in those who have already reached their own conclusion can be very counter productive. The act of diagnosis therefore seems to be a trade-off between empowerment, illness validation and group support, contrasted with the risk of diagnosis as self-fulfilling prophecy of non-recovery. CONCLUSIONS: The answer to the question of 'to label or not to label' may turn out to depend not on the label, but on what that label implies. It is acceptable and often beneficial to make diagnoses such as CFS, provided that this is the beginning, and not the end, of the therapeutic encounter.
Culture↗
The impact of a diagnosis of fibromyalgia on health care resource use by primary care patients in the UK: an observational study based on clinical practice.
OBJECTIVE: To investigate the impact of a diagnosis of fibromyalgia (FM) in clinical practice on health care resource use in the UK. METHODS: Rates of visits, prescriptions, referral, and diagnostic testing were estimated in patients who had been diagnosed as having FM between 1998 and March 2003 in UK primary care and compared with those in matched controls. Rates were calculated in 6-month intervals from 10 years before until 4 years after the FM diagnosis. RESULTS: Patients (2260) were newly diagnosed as having FM; 81.3% were women. Their mean age was 49 years. FM patients had considerably higher rates of visits, prescriptions, and testing from at least 10 years prior to diagnosis compared with controls. By the time of diagnosis, FM patients had 25 visits and 11 prescriptions per year compared with 12 visits and 4.5 prescriptions per year in controls. Visit rates were highest for depression, followed by fatigue, chest pain, headache, and sleep disturbance. Following diagnosis, visits for most symptoms and health care use markers declined, but within 2-3 years, most visits rose to levels at or higher than those at diagnosis. CONCLUSION: Primary care patients who had been diagnosed as having FM reported higher rates of illness and health care resource use for at least 10 years prior to their diagnosis, which suggests that illness behavior may play a role. Being diagnosed as having FM may help patients cope with some symptoms, but the diagnosis has a limited impact on health care resource use in the longer term, possibly because there is little effective treatment.
Adolescent↗
Diurnal excretion of urinary cortisol, cortisone, and cortisol metabolites in chronic fatigue syndrome.
OBJECTIVE: The aim of this study was to obtain comprehensive information on basal hypothalamic-pituitary-adrenal (HPA) axis activity in chronic fatigue syndrome (CFS) patients who were not affected by medication or comorbid psychiatric disorder likely to influence the HPA axis. METHOD: Steroid analysis of urine collections from 0600 to 2100 h at 3-h intervals in CFS patients and in controls. RESULTS: Urinary free cortisol and cortisone concentrations showed a significant normal diurnal rhythm, but levels were lower across the cycle in CFS. In contrast, while urinary cortisol metabolites also showed a normal diurnal rhythm, levels were not significantly different between the CFS and controls at any time. Derived metabolite ratios were similar in both groups. CONCLUSION: This study provides further evidence for reduced basal HPA axis function in patients with CFS, based on lower free cortisol and cortisone levels, but this is not corroborated by cortisol metabolite data. The difference between these measures cannot be explained by an altered timing of the diurnal rhythm.
Adult↗
Is the increased reporting of symptomatic ill health in Gulf War veterans related to how one asks the question?
BACKGROUND: Following the 1991 Gulf War (GW) there was much controversy surrounding service-related health effects. Evidence from the Vietnam experience suggested that self-reported ill health following that conflict might be related to how service during the conflict is framed. The aim of this article is to determine if a GW health effect persisted when the same questions were asked in a "non-GW" context. METHOD: Prevalence of physical and psychological health problems were ascertained in a study assessing health screening from a random sample of UK Armed Forces. Record linkage between the screening survey and service history was conducted to obtain information on participation in the GW. RESULTS: Differences in health outcomes were found between the GW and the non-GW groups. This difference existed for symptomatic measures (OR=1.84, 95% CI, 1.17-2.91) rather than psychological or behavioral measures. No differences were found in psychological measures such as PTSD or behavioral measures such as alcohol consumption. Those deployed to the GW had a poorer self-perception of health (OR=1.47, 95% CI 1.02-2.11). CONCLUSIONS: Even in the absence of framing, a Gulf-related ill health effect was found.
Attitude to Health↗
Terrorism and dispelling the myth of a panic prone public.
Governments and commentators perceive the public to be prone to panic in response to terrorist attacks--conventional or involving chemical, biological or radiological weapons. Evidence from five such incidents suggests that the public is not prone to panic, although people can change their behaviours and attitudes to reduce the risk of themselves being exposed to a terrorist incident. Behavioural responses may be divided into acts of omission, such as not making unnecessary journeys, and acts of commission, such as taking prophylactic medication despite the inherent risk of side effects. Evidence suggests that the public are aware of these differences, and tend to adopt responses proportionate to the risk. Drawing upon the literature in the social and natural sciences, our discussion encompasses differing risk perceptions of terrorist threats and consequences of attacks. How do fear and anxiety interact with behavioural responses to amplify or attenuate perceptions that can be modified through risk communication undertaken by authorities?
Fear↗
Chronic fatigue syndrome: an update focusing on phenomenology and pathophysiology.
PURPOSE OF REVIEW: Chronic fatigue syndrome is a controversial condition especially concerning its clinical definition and aetiopathogenesis. Most recent research progress has been made in phenomenology and pathophysiology and we focused our review on these two areas. RECENT FINDINGS: The phenomenology research supports the notion of a discrete fatigue syndrome which can be distinguished from depression and anxiety. The current case definition, however, may need an improvement based on empirical data. Recent advances in understanding the pathophysiology of chronic fatigue syndrome continue to demonstrate the involvement of the central nervous system. Hyperserotonergic state and hypoactivity of the hypothalamic-pituitary-adrenal axis constitute other findings, but the question of whether these alterations are a cause or consequence of chronic fatigue syndrome still remains unanswered. Immune system involvement in the pathogenesis seems certain but the findings on the specific mechanisms are still inconsistent. Genetic studies provide some evidence of the syndrome being a partly genetic condition, but environmental effects seem to be still predominant and identification of specific genes is still at a very early stage. SUMMARY: The recent findings suggest that further research is needed in improving the current case definition; investigating overlaps and boundaries among various functional somatic syndromes; answering the question of whether the pathophysiologic findings are a cause or consequence; and elucidating the involvement of the central nervous system, immune system and genetic factors.
Brain↗
Uptake of screening for breast cancer in patients with mental health problems.
OBJECTIVES: Mental illness is associated with physical illness and mortality from a variety of causes including cancer. There is little information on screening attendance among the mentally ill population. An audit was conducted of a breast screening service in inner London to determine uptake rates in women with mental illness. DESIGN: Cross sectional data linkage study of the local screening register and patients of the local psychiatric units. Screening uptake rates in all patients, those with a history of multiple detention in hospital, and those with psychosis were compared with the local reference population. SETTING: Women in three inner London boroughs. PARTICIPANTS: Screening records for 933 psychiatric patients and 44 195 women without mental health problems aged 50 to 64 years. MAIN RESULTS: Overall, psychiatric patients were as likely as the reference group to attend breast screening. Patients with a history of multiple detention were significantly less likely to attend (OR = 0.40, 0.29 to 0.55; p<0.001), as were patients with a diagnosis of psychosis (OR = 0.33, 0.18 to 0.61; p<0.01). Increasing age, a history of detention in hospital, and social deprivation remained independent predictors for non-attendance. CONCLUSION: Women with severe mental health problems may be less likely to attend national screening programmes such as breast screening, and action should be taken to overcome the barriers to attendance.
Breast Neoplasms↗
A systematic review of treatments for electromagnetic hypersensitivity.
BACKGROUND: Electromagnetic hypersensitivity (EHS) is a poorly understood condition in which patients report symptoms following perceived exposure to weak electromagnetic fields (EMFs) such as those produced by mobile phones or visual display units. Little is known about the aetiology of the condition although experimental data suggest that EMFs are an unlikely causal agent. In this systematic review we assessed the efficacy of any treatment for people reporting EHS. METHODS: Twelve literature databases were examined to identify relevant studies. We also hand-searched conference proceedings and examined the reference sections of reviews and other papers. Only clinical trials that compared the efficacy of a potential treatment for EHS against a control condition were included in the review. RESULTS: Nine controlled clinical trials were identified, examining the effects of cognitive behavioural therapy (4 studies), visual display unit screen filters (2 studies), 'shielding' EMF emitters (1 study), supplementary antioxidant therapy (1 study) and acupuncture (1 study). The quality of these studies was limited. Nevertheless, their results suggest that cognitive behavioural therapy is more effective than providing no treatment. None of the other therapies have had their efficacy adequately demonstrated. CONCLUSIONS: The evidence base concerning treatment options for EHS is limited and more research is needed before any definitive clinical recommendations can be made. However, the best evidence currently available suggests that cognitive behavioural therapy is effective for patients who report being hypersensitive to weak EMFs.
Acupuncture Therapy↗
The life and death of Private Harry Farr.
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Combat Disorders↗
Painful symptoms in depression: under-recognised and under-treated?
Current diagnostic systems maintain an artificial division between 'physical'and 'psychological'disorders. This is exemplified by the way in which pain symptoms are dealt with in the context of depressive illness. The consequences of this are discussed, and ways to enhance the clinical care of patients with depression and pain are suggested.
Depressive Disorder↗
The meaning of self-perception of health in the UK armed forces.
OBJECTIVES: We assessed the characteristics of self-perception of health (SPH) in relation to psychological distress and physical symptoms, and willingness of servicemen to see their Medical Officer (MO) by their SPH rating. DESIGN: We randomly selected 4,500 servicemen to receive either a full or an abridged screening questionnaire. MEASURES: The full questionnaire included 6 items from the short-form 36 and the question on SPH, the General Health Questionnaire-12, the post-traumatic stress disorder checklist and 15 symptoms. The abridged questionnaire included a subset of items from the full questionnaire. All 'screen-positive' and a random 'screen-negative' sample were invited to see an MO. RESULTS: 67.1% out of 4,500 servicemen completed the questionnaires. SPH was strongly associated with a summary short form-36 (SF-36) measure. There was a strong association between SPH and all assessment scales regardless of length of the questionnaires (p<.001). Even among those with very good or excellent SPH, high scores denoting psychological distress were prevalent (8.1%). Good SPH provided the largest variations in symptoms and scores. Servicemen with a poor/fair SPH were no more likely to accept a visit to the MO than the rest. CONCLUSIONS: SPH is an excellent question for surveillance because it is highly associated with psychological health but, at an individual level, it may convey different meanings depending on the person's individual interpretation of the term health. Symptomatic social avoidance may be high among servicemen who have a poor/fair SPH and methods, such as buddy support, may be helpful in decreasing isolation among those who may need professional support.
Adult↗
Serving in Bosnia made me appreciate living in Bristol: stressful experiences, attitudes, and psychological needs of members of the United Kingdom Armed Forces.
Peacekeeping operations form an increasing part of the role of the U.K. Armed Forces. This study identified perceived needs for training before such operations, experiences of stress during deployments, beliefs and attitudes regarding psychological support and debriefing on return, general attitudes toward peacekeeping duties, and positive aspects of the peacekeeping role. Although nearly all peacekeepers were exposed to a variety of experiences, most perceived stress came from professional difficulties and frustrations with the occupational role of being a peacekeeper, rather than from dangerous situations. The exception was a significant fear of land mines. For many, peacekeeping had a positive impact on soldiers' lives, most commonly an appreciation of "things back home." Respondents' opinions about the peacekeeping experience vary greatly. Additional training addressing and exploring potential conflicts between the traditional role of the soldier and the role of the peacekeeper may be useful.
Adult↗
Chronic fatigue syndrome: an overview.
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Fatigue Syndrome, Chronic↗
Psychological and behavioural reactions to the bombings in London on 7 July 2005: cross sectional survey of a representative sample of Londoners.
OBJECTIVES: To assess the impact of the bombings in London on 7 July on stress levels and travel intentions in London's population. DESIGN: A cross sectional telephone survey using random digit dialling was conducted to contact a representative sample of adults. Respondents were asked to participate in an interview enquiring about current levels of stress and travel intentions. SETTING: Interviews took place between 18 and 20 July. PARTICIPANTS: 1010 participants (10% of the eligible people we contacted) completed the interviews. MAIN OUTCOME MEASURES: Main outcomes were presence of substantial stress, measured by using an identical tool to that used to assess the emotional impact of 11 September 2001 in the US population, and intention to travel less on tubes, trains, and buses, or into central London, once the transport network had returned to normal. RESULTS: 31% of Londoners reported substantial stress and 32% reported an intention to travel less. Among other things, having difficulty contacting friends or family by mobile phone (odds ratio 1.7, 95% confidence interval 1.1 to 2.7), having thought you could have been injured or killed (3.8, 2.4 to 6.2), and being Muslim (4.0, 2.5 to 6.6) were associated with a greater presence of substantial stress, whereas being white (0.3, 0.2 to 0.4) and having previous experience of terrorism (0.6, 0.5 to 0.9) were associated with reduced stress. Only 12 participants (1%) felt that they needed professional help to deal with their emotional response to the attacks. CONCLUSIONS: Although the psychological needs of those intimately caught up in the attacks will require further assessment, we found no evidence of a widespread desire for professional counselling. The attacks have inflicted disproportionately high levels of distress among non-white and Muslim Londoners.
Adolescent↗
The London attacks--aftermath: Victimhood and resilience.
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Blast Injuries↗
Cognitive behaviour therapy in addition to antispasmodic treatment for irritable bowel syndrome in primary care: randomised controlled trial.
OBJECTIVE: To assess the efficacy of cognitive behaviour therapy delivered in primary care for treating irritable bowel syndrome. DESIGN: Randomised controlled trial. SETTING: 10 general practices in London. PARTICIPANTS: 149 patients with moderate or severe irritable bowel syndrome resistant to the antispasmodic mebeverine. INTERVENTIONS: Cognitive behaviour therapy delivered by trained primary care nurses plus 270 mg mebeverine taken thrice daily compared with mebeverine treatment alone. MAIN OUTCOME MEASURES: Primary measures were patients' scores on the irritable bowel syndrome symptom severity scale. Secondary measures were scores on the work and social adjustment scale and the hospital anxiety and depression scale. RESULTS: Of 334 referred patients, 72 were randomised to mebeverine plus cognitive behaviour therapy and 77 to mebeverine alone. Cognitive behaviour therapy had considerable initial benefit on symptom severity compared with mebeverine alone, with a mean reduction in score of 68 points (95% confidence interval 103 to 33), with the benefit persisting at three months and six months after therapy (mean reductions 71 points (109 to 32) and 11 points (20 to 3)) but not later. Cognitive behaviour therapy also showed significant benefit on the work and social adjustment scale that was still present 12 months after therapy (mean reduction 2.8 points (5.2 to 0.4)), but had an inconsistent effect on the hospital anxiety and depression scale. CONCLUSION: Cognitive behaviour therapy delivered by primary care nurses offered additional benefit over mebeverine alone up to six months, although the effect had waned by 12 months. Such therapy may be useful for certain patients with irritable bowel syndrome in primary care.
Adolescent↗
Can epidemiology clear the fog of war? Lessons from the 1990-91 Gulf War.
Despite over US $200 million having been spent researching illnesses following the 1990-91 Persian Gulf War, the nature and cause of such illnesses remains controversial. In this narrative review, we discuss some of the methodological issues that have affected epidemiological studies on this topic. These include low-response rates, ascertainment bias, recall bias, problems identifying suitable control groups, and problems defining the outcomes to study. From this we argue that difficulties have arisen partly owing to the significant delay between the point at which illnesses were first identified by veterans and the reporting of epidemiological studies and that health surveillance should be routine following future deployments.
Congenital Abnormalities↗