piet snoeck

The Great Contradiction in ME/CFS and Long Covid Care 🚨 Why Are We Using ‘Psychiatric’ Drugs but Still Shunning Psychiatry? Lamotrigine.
Stimulants.
Memantine.
Guanfacine.
Fluvoxamine.
Clonidine.
Naltrexone.
NAC. Benzodiazepines ….. Why do so many medications used to target symptoms in ME/CFS and Long Covid overlap with everyday psychiatric prescribing… yet the very mention of psychiatry is shunned? Before a psychiatrist even sees them, many patients are already on layers of “medical” treatments: 
antihistamines, beta blockers, ivabradine, supplements, sleep agents, pain agents…… As a clinician treating these conditions what is striking for me is so many modifiable targets remain untouched because each specialty keeps viewing the problem through its own silo. Several things can be true at once: 1. Brain-body dualism is dead. 2. Many psychiatric medications have immunomodulatory, anti-inflammatory, autonomic, cognitive, and central regulatory effects. 3. Once illness becomes chronic, the brain’s predictive processing changes around that state. Expectation, salience, threat signalling, effort regulation, sleep, reward, and interoception all become part of the illness. 4. Excluding psychiatry because of past conceptual errors leaves multiple treatable targets untouched. 5. And a message for Psychiatrists - We should stop seeing ME/CFS and Long Covid as “not ours”.
 These conditions sit directly within our skill set, if we are willing to build the expertise. Clinicians who preserve the mind-body split only reinforce the very dualism these illnesses expose; our role is to integrate, provide clear psychoeducation about brain-body regulation.

The Brain doesn't divide itself into labels 🚨 We hear : ‘It’s BPD not ADHD’ OR ‘it's not BPD, its ASD’ This debate keeps amusing me. As though the brain expresses itself in labels. It doesn’t. We created labels because heuristics reduce cognitive load. They help us organise complexity. But that does not mean they always help us solve human problems better. When helping a person- 
1. we start with the described experience 2. translate it into phenomenology 3. connect it to models and known mechanisms 4. implement, test, and revise a plan. Neurodevelopment and personality development are linked and occurred as parellel processes. Neurodevelopment, as the word suggests, refers to the development of key neural systems during critical periods of life. Early in life, the brain is far more ‘limbic-dominant’, while the prefrontal cortex is still maturing. So what is being developed? 
Not just attention. Not just impulse control. Not just sensory processing. A major part of neurodevelopment is relational regulation. ✅ The developing brain is learning, through relationships: -Is the world safe? -Am I understood? -Are my emotions understood and responded to? - Can I trust other people? That is where neurodevelopment intersects with personality development. In one sense, personality is the relational expression of development over time. Just as prefrontal maturation helps the adolescent move from concrete to abstract thinking in school for maths it also helps them move from concrete social appraisals 
E..g “you upset me, therefore you are bad” 
 to more integrated ones: 
E.g “You frustrated me, but that does not define all of you.” That is also development. Different constructs BUT intricately linked The brain develops across systems: -arousal -attachment -salience -emotion regulation -cognition -self-other representation -social learning…. And from that, patterns emerge. Some of those patterns get called ADHD.
 Some ASD. 
Some BPD traits. 
Some trauma-related expressions and the list goes on.. The aim is to integrate not split