Category: Management

The treatment of chronic fatigue syndrome: science and speculation

Abstract:

The chronic fatigue syndrome (CFS) is a heterogeneous disorder characterized by fatigue, neuropsychiatric symptoms, and various other somatic complaints. Treatment studies to date reflect both the diversity of medical disciplines involved in the management of patients with CFS and the multiple pathophysiologic mechanisms proposed.

There have been few attempts to study integrated treatment programs, and although several controlled studies have been reported, no treatment has been shown clearly to result in long-term benefit in the majority of patients. Good clinical care integrating medical and psychologic concepts, together with symptomatic management, may prevent significant secondary impairment in the majority of patients.

Future treatment studies should examine differential response rates for possible subtypes of the disorder (eg, documented viral onset, concurrent clinical depression), evaluate the extent of any synergistic effects between therapies (ie, medical and psychologic), and employ a wide range of biologic and psychologic parameters as markers of treatment response.

 

Source: Wilson A, Hickie I, Lloyd A, Wakefield D. The treatment of chronic fatigue syndrome: science and speculation. Am J Med. 1994 Jun;96(6):544-50. http://www.ncbi.nlm.nih.gov/pubmed/8017453

 

Ways of coping with chronic fatigue syndrome: development of an illness management questionnaire

Abstract:

Chronic fatigue syndrome (CFS) is a disorder of uncertain aetiology, and there is uncertainty also about the appropriate way in which patients should manage the illness. An illness management questionnaire (IMQ) was designed to assess coping in CFS. This was completed by 207 patients, in parallel with the COPE scales (a general measure of coping that can be applied situationally), and measures of functional impairment, anxiety and depression.

The IMQ yielded four factors: maintaining activity, accommodating to the illness, focusing on symptoms and information-seeking. Scales based upon these factors together predicted 26, 27 and 22% of the variance in functional impairment, anxiety and depression, respectively, and each scale had significant relationships with relevant scales of the COPE, supporting the interpretation of the factors. It is suggested that the IMQ may be employed to relate ways of coping to outcomes in CFS, and to assess coping as a mediator of change in cognitive-behavioural interventions.

 

Source: Ray C, Weir W, Stewart D, Miller P, Hyde G. Ways of coping with chronic fatigue syndrome: development of an illness management questionnaire. Soc Sci Med. 1993 Aug;37(3):385-91. http://www.ncbi.nlm.nih.gov/pubmed/8356486

 

Service delivery for people with chronic fatigue syndrome: a pilot action research study

Abstract:

Chronic fatigue syndrome (CFS) is a symptom complex which while mild in some cases is severely debilitating in others. Long-term ill health leads to greater use of resources but in the case of long-term CFS the anecdotal evidence suggested a low compliance with the available options and a high level of both patient and general practitioner dissatisfaction.

This pilot study sought through repeated action research cycles to start to identify culturally and contextually sensitive forms of language and models for service delivery suitable for people with CFS in a general practice setting. It worked through a number of action research cycles, to initiate the identification of conceptual models acceptable to both doctors and to patients suffering from CFS, self-management options which encouraged the body’s ability to heal itself and services and delivery mechanisms which met patient needs within health provider options.

 

Source: Denz-Penhey H, Murdoch JC. Service delivery for people with chronic fatigue syndrome: a pilot action research study. Fam Pract. 1993 Mar;10(1):14-8. http://www.ncbi.nlm.nih.gov/pubmed/8477887

 

Chronic fatigue syndrome. A fresh look at an old problem

Abstract:

Chronic fatigue syndrome (CFS), an organic disease of unexplained origin, affects about three people in 100,000. Symptoms last approximately 2 1/2 years, and most CFS patients return to normal health. Diagnosis of CFS is by exclusion. No single remedy has yet proven consistently beneficial. Family physicians can help by providing medical validation of disability to persons who might otherwise be seen as malingerers.

You can read the full article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2379748/pdf/canfamphys00108-0118.pdf

 

Comment in: Disagreeing on how to treat CFS patients. [Can Fam Physician. 1993]

 

Source: McSherry J. Chronic fatigue syndrome. A fresh look at an old problem. Can Fam Physician. 1993 Feb;39:336-40. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2379748/

 

Chronic fatigue syndrome. Recent advances in diagnosis and treatment

Abstract:

Chronic fatigue syndrome is a chronic debilitating illness that is marked in the majority of cases by sudden onset of fatigue and flulike symptoms. Symptoms subsequently relapse and remit and may persist for years. Physical examination typically reveals relatively minor, nonspecific abnormalities in an apparently well patient. Although immunologic abnormalities are associated with chronic fatigue syndrome, tests for these features are expensive, nonspecific, and generally reserved for research purposes. The diagnosis is made on the basis of new onset of severe fatigue, a characteristic pattern of symptoms, and exclusion of other illnesses. Treatment is aimed at alleviating symptoms and helping patients adjust to the debilitating and chronic nature of the illness.

 

Source: Bell DS. Chronic fatigue syndrome. Recent advances in diagnosis and treatment. Postgrad Med. 1992 May 1;91(6):245-52. http://www.ncbi.nlm.nih.gov/pubmed/1579531

 

Chronic fatigue syndrome: a joint paediatric-psychiatric approach

Comment in: Chronic fatigue syndrome: a joint paediatric-psychiatric approach. [Arch Dis Child. 1992]

 

Prolonged fatigue after an apparent viral infection, occurring sporadically or as an epidemic, has been described over the past 50 years. It has been given various names including Royal Free disease (1) and myalgic encephalomyelitis, but the preferred terms in the medical literature have been postviral fatigue syndrome (2) or chronic fatigue syndrome (CFS). (3)

However, the validity of this syndrome as a nosological entity has created a good deal of controversy and remains in doubt. (4) A constellation of symptoms make up the syndrome. There is fatigue of defined onset that is generally reported to follow a viral illness, often an influenza-like illness or an infection of the upper respiratory tract. The patient experiences profound fatigue with the initial illness and then fails to make the expected recovery, with fatigue that can persist over months or years. Fatigue is defined as a subjective sensation, which the patient often describes as tiredness or weariness and that occurs at rest. These patients also report a clear relationship of fatigue to activity. The term fatiguability has been used to describe the greater than normal fatigue that occurs after physical and sometimes after mental exertion in these patients. A great variety of associated symptoms have been described that include increased sleepiness, dizziness, vertigo, headache, difficulty in concentrating, sore throat, muscle weakness, and myalgia. The majority of patients have some emotional symptoms. There can be irritability and anxiety, tearfulness and depression. The fatigue and associated symptoms are of such severity as to impair significantly normal daily activities. There is a remarkable absence of physical signs and physical investigations fail to detect any organic pathology or current infection to account for the symptoms.

You can read the rest of this article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1793327/pdf/archdisch00639-0088.pdf

 

Source: Vereker MI. Chronic fatigue syndrome: a joint paediatric-psychiatric approach. Arch Dis Child. 1992 Apr;67(4):550-5. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1793327/

 

Psychosocial management of chronic fatigue syndrome in adolescence

Abstract:

The state of chronic fatigue syndrome (CFS) as abnormal illness behaviour or as biologically determined disease is undecided. The ensuing, often public, debate has confused the community and has led to sharp differences in the therapeutic approach to individual patients. These challenges are compounded when the patient is an adolescent and intergenerational issues enter the picture. Two adolescent cases with different outcomes are presented and the principles of a rehabilitation approach to treatment are outlined which attempt to avoid being drawn into unproductive debates about aetiology.

Comment in: Chronic fatigue syndrome. [Aust N Z J Psychiatry. 1992]

 

Source: Rikard-Bell CJ, Waters BG. Psychosocial management of chronic fatigue syndrome in adolescence. Aust N Z J Psychiatry. 1992 Mar;26(1):64-72. http://www.ncbi.nlm.nih.gov/pubmed/1580887

 

Chronic fatigue syndrome. A review from the general practice perspective

Abstract:

There is no doubt that the chronic fatigue syndrome exists. It is a condition that is debilitating and of unknown cause. Research into chronic fatigue syndrome demonstrates possible psychiatric or organic causes. The truth may be somewhere in between. Evidence for the existence of an ongoing chronic infection is now not convincing. Treatment should be based on supportive counselling, explanation, psychiatric help (both pharmacological and non pharmacological) and a graded programme of increased activity with the eventual aim of resumption of full functioning.

Comment in: Chronic fatigue syndrome. [Aust Fam Physician. 1993]

 

Source: Holmwood C, Shannon C. Chronic fatigue syndrome. A review from the general practice perspective. Aust Fam Physician. 1992 Mar;21(3):278-9, 283-5. http://www.ncbi.nlm.nih.gov/pubmed/1318714

 

Nurse, is it ME? Understanding myalgic encephalomyelitis

Abstract:

Ignored or dismissed for years, myalgic encephalomyelitis (ME) is now recognised as a genuine illness, and sufferers are recommended strict rest until the symptoms of the virus subside. Public understanding of ME is still uncertain, and nurses are ideally placed to provide practical information and support.

 

Source: Dale S. Nurse, is it ME? Understanding myalgic encephalomyelitis. Prof Nurse. 1991 Mar;6(6):339-40. http://www.ncbi.nlm.nih.gov/pubmed/2000430

 

The chronic fatigue syndrome. A multifactorial approach and the treatment possibilities

Abstract:

The chronic fatigue syndrome is a poorly defined symptoms complex characterized primarily by chronic or recurrent debilitating fatigue and various combinations of other symptoms, including psychological symptoms, sore throat, lymph node pain, headache, myalgia, arthralgias. Psychological disturbances, ranging from mild depression or anxiety to severe behavioral abnormalities, are always present. Chronic fatigue syndrome is the name that more accurately describes this symptom complex of unknown cause.

A viral aetiology has long been hypothesized: many viruses are potential candidates, including any of the 23 Coxsackie A or 6 Coxsackie B viruses, herpes viruses, particularly Epstein-Barr virus and varicella. These studies, though interesting, remain unconvincing because of methodological flaws such as a poor case definition and inadequate control groups.

This syndrome may represent an infection by a yet unidentified virus. It is more likely due to an abnormal immune response toward different intracellular pathogens. There is no treatment to ameliorate the chronic fatigue syndrome. Epidemiological studies are essential with explicit operational case definition before progress can be made in the management of this distressing disorder.

 

Source: Pinardi G, Scarlato G. The chronic fatigue syndrome. A multifactorial approach and the treatment possibilities. Recenti Prog Med. 1990 Dec;81(12):773-7. [Article in Italian] http://www.ncbi.nlm.nih.gov/pubmed/2075278