Abstract:
This article looks at chronic fatigue syndrome, a common condition affecting 1-2.5% of the population. The criteria for diagnosis are described and the nurse’s role in treatment is discussed.
Source: Ross E. The history and treatment of chronic fatigue syndrome. Nurs Times. 1996 Oct 30-Nov 5;92(44):34-6. http://www.ncbi.nlm.nih.gov/pubmed/8945330
Abstract:
Fatigue is a frequent and sometimes dominant symptom of some endocrinopathies. It may be associated with other symptoms which are included among the criteria of the chronic fatigue syndrome. These units are not always quite distinct and frequently endocrine diseases and chronic fatigue syndrome (CFS) overlap. From this ensue differential diagnostic problems and ideas on possible causal relations.
The authors concentrate in particular on autoimmune endocrinopathies and the polyglandular autoimmune syndrome (APS) with emphasis on the necessity of an accurate endocrinological diagnosis, where is some patients with suspected CFS a defined endocrinopathy was revealed.
Attention will be also paid to recent views on the possible participation of disorders of the hypothalamus-pituitary-adrenal axis in the etiopathogenesis of CFS where endocrine and immune regulation overlap and condition each other.
Source: Sterzl I, Zamrazil V. Endocrinopathy in the differential diagnosis of chronic fatigue syndrome. Vnitr Lek. 1996 Sep;42(9):624-6. [Article in Czech] http://www.ncbi.nlm.nih.gov/pubmed/8984770
Abstract:
The chronic fatigue syndrome (CFS) was formally defined to describe disabling fatigue of unknown etiology with immunologic disfunctions. In most cases occur abnormalities of neurophysiological tests.
In this paper the Authors use the low (11 pps) and high (51-71 pps) frequency ABR for detecting the electrophysiological function of auditory brainstem responses and propose the “Prolonged Decay Test”, a modified impedenzometric technique that explores any alterations of the stapedial contraction, as a new diagnostic test for CFS.
Twenty-one patients with suspected CFS, with an age between 17 and 50 years, were examined and the instrumental data were correlated with the clinical findings. The results of the ABR study showed in the examined subjects no many abnormalities in the 11 pps frequency test. The high frequency stimulation trials (with 51 and 71 pps) proved many alterations in 10 patients (absence of the first wave in 6 cases, in 5 many wave latency delay and in 1 patient absence of the first wave and many wave latency delay). The high frequency trials showed no abnormalities in the 11 remaining patients.
The clinical-audiological correlation showed a 61.9% of comparison with 33.3% of false negatives and 4.8% of false positives. The Prolonged Decay Test showed a 71.4% of clinical-audiological comparison with 23.8% of false negatives and 4.8% of false positives. The Prolonged Decay Test together with the ABR showed a 81.8% of clinical-audiological comparison with 18.2% of false negatives and 0% of false positives.
These preliminary data show that the stapedial reflex together with the ABR test could be useful for the diagnosis of CFS.
Source: Neri G, Bianchedi M, Croce A, Moretti A. “Prolonged” decay test and auditory brainstem responses in the clinical diagnosis of the chronic fatigue syndrome. Acta Otorhinolaryngol Ital. 1996 Aug;16(4):317-23. [Article in Italian] http://www.ncbi.nlm.nih.gov/pubmed/9082825
Abstract:
Not everybody who is chronically tired has a chronic fatigue syndrome. The diagnosis of the chronic fatigue syndrome is still a problem, and is becoming a problem in health insurance medicine too. There is a lack of knowledge concerning the causes, the diagnosis and the therapy of the chronic fatigue syndrome. And there is still the question if the chronic fatigue syndrome is an entity of its own. For these reasons we should apply the few facts we really know about the chronic fatigue syndrome. This is the working case definition of Kaplan et al. from 1988. Otherwise there will be done hundreds of expensive laboratory tests, which are useless for the patient and very costly for the health insurance companies.
Source: Hakimi R. Chronic fatigue syndrome–also an insurance medicine problem. Versicherungsmedizin. 1996 Apr 1;48(2):59-61. [Article in German] http://www.ncbi.nlm.nih.gov/pubmed/8659056
Abstract:
A battery of self-report questionnaires and structured diagnostic interviews was administered to 20 children and adolescents who presented to a pediatric specialty clinic with chronic fatigue. Matched groups of healthy and depressed control subjects (aged 8 to 19 years) were also studied. Criteria were established to identify those items in the assessment battery that reliably differentiated among the three groups.
Analysis of item content suggested several clusters of characteristics that discriminated among the subject groups, including life changes, cognitive difficulties, negative self-attributions, social relationship disruption, and somatic symptom presentation.
The results suggest that certain psychological factors can discriminate chronic fatigue from depressive symptomatology, as well as normal functioning. Items discriminating among groups are presented in an organized questionnaire format to assist with the understanding and assessment of pediatric chronic fatigue cases.
Source: Carter BD, Kronenberger WG, Edwards JF, Michalczyk L, Marshall GS. Differential diagnosis of chronic fatigue in children: behavioral and emotional dimensions. J Dev Behav Pediatr. 1996 Feb;17(1):16-21. http://www.ncbi.nlm.nih.gov/pubmed/8675709
Abstract:
BACKGROUND: The interaction between a clinician and a patient who put his problems down to myalgic encephalomyelitis is described. Despite attempting a patient-centred approach, the doctor acted on his own understanding of the meaning of this diagnosis without gaining proper insight into what it meant for the patient. This failure not only led to damaged rapport, it may have contributed to delayed recovery.
OBJECTIVES: The unsatisfactory nature of this encounter led the clinician to consider more effective consulting techniques.
METHODS AND RESULTS: A hypothetical interaction is constructed in which the clinician uses reflective listening statements to understand the patient’s true meaning of this self-diagnosis.
CONCLUSIONS: Despite well intentioned attempts to be patient-centered through widening the consultation beyond the biomedical to include personal and contextual factors, clinicians may still end up imposing their own medical meaning on patient’s words. Damaged rapport is a signal that another track could be more fruitful and reflective listening is one strategy which enables clinicians to check that they fully understand the patient’s meaning. Provoking resistance by following strategies which are not appropriate for the patient might then be avoided.
Source: Butler C, Rollnick S. Missing the meaning and provoking resistance; a case of myalgic encephalomyelitis. Fam Pract. 1996 Feb;13(1):106-9. http://fampra.oxfordjournals.org/content/13/1/106.long (Full article)
Abstract:
This study was conducted to examine the rates of somatization disorder (SD) in the chronic fatigue syndrome (CFS) relative to other fatiguing illness groups. It further addressed the arbitrary nature of the judgments made in assigning psychiatric vs. physical etiology to symptoms in controversial illnesses such as CFS.
Patients with CFS (N = 42), multiple sclerosis (MS) (N = 18), and depression (N = 21) were compared with healthy individuals (N = 32) on a structured psychiatric interview. The SD section of the Diagnostic Interview Schedule (DIS) III-R was reanalyzed using different criteria sets to diagnose SD. All subjects received a thorough medical history, physical examination, and DIS interview. CFS patients received diagnostic laboratory testing to rule out other causes of fatigue.
This study revealed that changing the attribution of SD symptoms from psychiatric to physical dramatically affected the rates of diagnosing SD in the CFS group. Both the CFS and depressed subjects endorsed a higher percentage of SD symptoms than either the MS or healthy groups, but very few met the strict DSM-III-R criteria for SD. The present study illustrates that the terminology used to interpret the symptoms (ie, psychiatric or physical) will determine which category CFS falls into. The diagnosis of SD is of limited use in populations in which the etiology of the illness has not been established.
Source: Johnson SK, DeLuca J, Natelson BH. Assessing somatization disorder in the chronic fatigue syndrome. Psychosom Med. 1996 Jan-Feb;58(1):50-7. http://www.ncbi.nlm.nih.gov/pubmed/8677289
Abstract:
The complaint of chronic fatigue is ubiquitous in the primary care setting. Because of the nonspecific nature of chronic fatigue, practitioners do not focus on this complaint. Furthermore, most physicians use a problem-based approach. Such a prematurely narrowed focus could overlook the chronic fatigue complaint. Omissions in the data collection process would prove this oversight.
Therefore, we postulated that a retrospective review of evaluations for chronic fatigue would demonstrate significant categorical deficiencies. These deficiencies would indicate a problem focus different than the chronic fatigue complaint itself.
The authors reviewed the current literature to establish historical, physical, and laboratory findings pertinent to the evaluation of chronic fatigue. Six major categories and the associated data elements were identified for use in analyzing patient records. The patient records from the preceding 6 months were reviewed to find those containing a complaint of chronic fatigue. These records were analyzed to determine if a complete data set had been sought and if an associated diagnosis was made.
A total of 425 consecutive charts from an academic family practice clinic were retrospectively reviewed; 9.9% (42) mentioned chronic fatigue. Physicians were lax in performing the mental status and physical examinations; taking the patient’s psychiatric and sleep history, as well as the history of chief complaint; and ordering laboratory evaluations. The physician diagnoses included: depression (40.4%), nonspecific fatigue (35.7%), general medical disorders (16.6%), chronic fatigue syndrome (2.4%), fibromyalgia (2.4%), and sleep apnea (2.4%).
From these data, the investigators conclude that the workup for chronic fatigue is often incomplete or lacks documentation. This oversight is likely due to a problem focus not directed at the chronic fatigue complaints. Also complicating the evaluation process are the multiple associated disorders, the prevalence of the complaint, and cost/benefit issues facing the primary care physician.
Source: Ward MH, DeLisle H, Shores JH, Slocum PC, Foresman BH. Chronic fatigue complaints in primary care: incidence and diagnostic patterns. J Am Osteopath Assoc. 1996 Jan;96(1):34-46, 41. http://www.ncbi.nlm.nih.gov/pubmed/8626230
Abstract:
BACKGROUND: Different definitions of chronic fatigue syndrome (CFS) have different psychiatric exclusion criteria and this affects the type and frequency of associated psychiatric morbidity found. The operational criteria for neuraesthenia in ICD-10 vary in this and other respects from the Centers for Disease Control and Prevention (CDC) criteria for CFS. Neuraesthenia and associated psychiatric morbidity in CDC-defined CFS are evaluated.
METHOD: CFS subjects and controls were interviewed with the Schedule for the Clinical Assessment of Neuropsychiatry (SCAN). The computerised scoring program for SCAN (CATEGO5) facilitates the assignment of operational definitions according to DSM-III-R and ICD-10. Subjects were re-interviewed with SCAN an average of 11 months later. No specific treatments or interventions were given during this period.
RESULTS: The majority of subjects fulfilled ICD-10 operational criteria for neuraesthenia and had two and a half times the rate of psychiatric morbidity as the healthy comparison group according to the CATEGO5 Index of Definition (ID). Approximately 80% of subjects fulfilled both DSM-III-R and ICD-10 criteria for sleep disorders. There was a significant fall in the number of subjects fulfilling criteria for depression and anxiety disorders and a significant increase in the number of subjects with no diagnosis for DSM-III-R criteria over time. There were no significant changes over time for any diagnosis according to ICD-10 criteria or for overall levels of psychopathology as reflected in CATEGO5 ID levels.
CONCLUSIONS: The ICD-10 ‘neuraesthenia’ definition identifies almost all subjects with CDC-defined CFS. Fifty percent of CFS subjects also had depressive or anxiety disorders, some categories of which remit spontaneously over time.
Source: Farmer A, Jones I, Hillier J, Llewelyn M, Borysiewicz L, Smith A. Neuraesthenia revisited: ICD-10 and DSM-III-R psychiatric syndromes in chronic fatigue patients and comparison subjects. Br J Psychiatry. 1995 Oct;167(4):503-6. http://www.ncbi.nlm.nih.gov/pubmed/8829720
When patients walk through your door and declare they have “chronic fatigue syndrome” (CFS), they could well be chronically fatigued and need your help, but it is unlikely they fit the National Institute of Health’s (NIH) criteria for CFS, according to Dr Derrick Thompson, a Clinical Associate Professor in the University of Calgary’s Department of Medicine.
“Most patients with complaints of chronic fatigue don’t have CFS, but rather one or often a combination of overlapping sleep disorders, soft tissue pains, allergies, or autonomic nervous system disruptions, such as labile blood pressure, panic attacks, and irritable bowel,” he says.
You can read the rest of this article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2146574/pdf/canfamphys00088-0180.pdf
Source: Kermode-Scott B. Don’t worry about the label. Diagnose underlying perpetuating factors in chronic fatigue syndrome. Can Fam Physician. 1995 Jun;41:1126-8. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2146574/pdf/canfamphys00088-0180.pdf (Full article)