BackgroundChronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME), in its most severe clinical presentation, can result in patients becoming housebound and bedbound so unable to access most available specialist services. This presents particular clinical risks and treatment needs for which the National Institute for Health and Care Excellence (NICE) advises specialist medical care and monitoring. The extent of National Health Service (NHS) specialist provision in England for severe CFS/ME is currently unknown.ObjectivesTo establish the current NHS provision for patients with severe CFS/ME in England.Setting and participantsAll 49 English NHS specialist CFS/ME adult services in England, in 2013.MethodCross-sectional survey by email questionnaire.Primary outcome measuresAdherence to NICE guidelines for severe CFS/ME.ResultsAll 49 services replied (100%). 33% (16/49) of specialist CFS/ME services provided no service for housebound patients. 55% (27/49) services did treat patients with severe CFS/ME and their interventions followed the NICE guidelines. The remaining services (12%, 6/49) offered occasional or minimal support where funding allowed. There was one NHS unit providing specialist inpatient CFS/ME provision in England.ConclusionsStudy findings highlight substantial variation in access to specialist care for patients with severe presentation of CFS/ME. Where treatment was provided, this appeared to comply with NICE recommendations for this patient group.
Vanish 1. intr. To disappear from sight or become invisible, esp. in a rapid and mysterious way (Shorter Oxford English Dictionary, 1972).There is a well-known view that hysteria has virtually disappeared in the Western world. There are two versions of this argument: one is that there was never a clinical disorder that coincided with the diagnosis, and hysteria has now been reconstructed as something else (e.g. Micale, 1993). The other is that hysteria did exist but has now become much rarer than it was (most famously, Veith, 1965). According to this view, hysteria is to be found in patients from developing countries, but in Western countries it is ‘virtually a historical curiosity’ (BMJ 1976). It is the latter view that is – in our experience – most commonly held by our colleagues in general psychiatry. Yet, this opinion is not shared by those who are involved in the clinical care of patients with neurological disorders: ‘to a psychiatrist who sees patients on the medical and surgical services of a general hospital, it appears that hysteria remains a rather common phenomenon’ (Brownsberger, 1966). A number of descriptions from liaison psychiatry services support this opinion (Akagi & House, 2001). There are good reasons why it might be difficult to judge just how common (or rare) hysteria really is. Epidemiology depends on reliable case definition, case ascertainment and selection of a suitable population to study (Neugebauer et al. 1980), and each of these poses problems in the study of hysterical disorders.
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