Thread by @CBammerMD

Schomerus et al. 2026 (Psychiatrische Praxis): A substantive essay from an unexpected direction.
A call for psychiatry to exercise self-restraint in LC + ME/CFS, as evidence-based and ethically necessary.
A remarkable development.
1/8thieme-connect.de/products/ejour…

From my perspective, practice-changing for guidelines, expert assessment, and clinical attitudes in the GAS region:
- Psychologisation is not evidence-based and harms patients.
- 5 categories of harm: iatrogenic harm through activation, invalidation of the illness experience,
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neglect of somatic treatment, disadvantage in expert assessment, and burden on families. Converging evidence for all 5.
Key findings:
- Psychotherapy improves psychological outcomes; however, fatigue, PEM and somatic symptoms remain unchanged. This supports the essay’s thesis
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with regard to the intervention studies cited.
- CBT/rehabilitation studies show methodological shortcomings: PEM is rarely screened for, severely affected patients are excluded, outcomes are subjective, adverse effects are scarcely recorded, and psychotherapy studies
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mostly do not report side effects.
- Systematic overestimation of psychiatric comorbidity due to inadequate PROMs such as the PHQ-9 (in LC + ME/CFS, a “positive” score can result solely from somatic items, thus formally indicating “depression”
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without the presence of core depressive symptoms) or the SF-36 (MID threshold not reached, missing data, bedbound patients excluded).
- Psychosomatic diagnoses must not become a dumping ground for diseases that are not understood yet
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=> For me, this is the sentence with the greatest practice changing potential!

My mental addition:
Deconditioning and avoidance models fail against all four criteria of Renz-Polster’s tetralogy, because they cannot explain:
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multimodal PEM triggers, convergence to the same clinical picture, delayed onset, and typical duration.

My brief wish list: a reference to the PACE trial debate and Renz-Polster’s brainstem hypothesis, plus a brief justification of the partly asymmetric evidence standards.
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