Category: Overview

Practitioner review: chronic fatigue syndrome in childhood

Abstract:

BACKGROUND: Chronic fatigue syndrome (CFS) is being increasingly recognized in children and adolescents. Yet comparatively little attention has been given in the literature to management.

METHODS: Description of the main features of the disorder, precipitating and maintaining factors and diagnostic assessment. Outline of different views on the nature and treatment of CFS in childhood. Description of a rehabilitation program based on cognitive behavior therapy and graded activity.

RESULTS: Using adult research criteria, CFS can be diagnosed in children and adolescents. In its severe form it is often triggered by infectious illness episodes. It is commonly associated with mood disorders in the child and with mental distress and high levels of emotional involvement in parents. A number of patient support groups hold the view that CFS is a medical disorder, contest a psychiatric contribution and advocate ‘pacing’ as an approach to rehabilitation which includes avoiding activities. To date there is no empirical evidence for the efficacy of this approach. Research in adults, open and clinical reports in children support the use of graded activity and family cognitive behavior therapy. The main aim is to enable children, with the help of their family, to carry out their own rehabilitation with some support and guidance from a health professional. Engaging the child and family in treatment and forming a therapeutic alliance is a continual process and a crucial aspect of management, as many families view the condition as a medical disorder and are initially ambivalent towards this approach.

CONCLUSIONS: There is controversy about the nature and management of CFS in childhood but a rehabilitation program based on family cognitive behavior therapy can be implemented and seems to hold most promise in the management of children with CFS. Family engagement is a crucial aspect of management.

 

Source: Elena Garralda M, Chalder T. Practitioner review: chronic fatigue syndrome in childhood. J Child Psychol Psychiatry. 2005 Nov;46(11):1143-51. http://www.ncbi.nlm.nih.gov/pubmed/16238661

 

Chronic fatigue syndrome: an overview

Medically unexplained symptoms (MUS) – those lacking identifiable underlying physical disease – are common in all levels of the health care system, and can be associated with severe disability and distress to patients and high cost to health services. Common MUS include pain (including back, chest, abdominal pain, and headache), fatigue, dizziness and ENT (Ear, Nose and Throat) symptoms. Similarly, functional somatic syndromes refer to groups of symptoms lacking disease-specific, demonstrable abnormalities of structure, and are usually defined by specialty or organ system.1 They include irritable bowel syndrome, fibromyalgia, chronic fatigue syndrome, multiple chemical sensitivity, chronic pelvic pain, temporomandibular joint dysfunction and more recently Gulf War syndrome. These conditions overlap in their symptoms, aetiology and treatment; prompting some to point out that the similarities outweigh differences between them and that there is utility in considering them collectively rather than separately.2

You can read the rest of this article here: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-44462005000300003&lng=en&nrm=iso&tlng=en

 

Source: Cho HJ, Wessely S. Chronic fatigue syndrome: an overview. Rev Bras Psiquiatr. 2005 Sep;27(3):174-5. Epub 2005 Oct 4. http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-44462005000300003&lng=en&nrm=iso&tlng=en (Full article)

 

Chronic fatigue syndrome: a review

Abstract:

Chronic fatigue syndrome is a relatively unknown and underdiagnosed entity in Italy where its epidemiology remains uncertain, as well as its etiology, although it causes important disability in those affected. Classification criteria by Fukuda are available to diagnose the syndrome. Its epidemiology indicates that it is probably more frequent in Northern countries and it is described in Gulf War veterans. Etiological hypotheses include infectious diseases, immunology and neurology. Among these hypotheses sickness behavior mimes certain aspects of this syndrome and is characterized by a cytokine imbalance in the central nervous system and in the periphery. There are no valid therapies available at the moment. In the laboratory of Immunogenetics, we are constituting a biological bank of the syndrome to study the immunogenetic aspects of the disease in the hope of elucidating some of the obscure areas of its etiopathogenesis.

 

Source: Carlo-Stella N, Lorusso L, Candura SM, Cuccia M. Chronic fatigue syndrome: a review. Recenti Prog Med. 2004 Nov;95(11):546-52; quiz 560. [Article in Italian] http://www.ncbi.nlm.nih.gov/pubmed/15598093

 

Chronic/post-viral fatigue syndrome

Chronic / post-viral fatigue syndrome is the diagnosis term Rikstrygdeverket opted for the ICD-10 called “benign myalgic encephalomyelitis / post-viral fatigue syndrome.” Benign myalgic encephalomyelitis has since 1956 designated the epidemic form of this disease picture.”Chronic Fatigue Syndrome” is the Norwegian translation of “chronic fatigue syndrome” which has different meanings according to how it is defined.

Methodological differences from evaluation and diagnosis of chronic / post-viral fatigue syndrome from a study of chronic fatigue syndrome, and states have different therapeutic implications. Rikstrygdeverket bases its diagnosis in the original research definition of “chronic fatigue syndrome” from the Centers for Disease Control in 1988, an illness which later was recognized as benign myalgic encephalomyelitis.

You can read the rest of this article here: http://tidsskriftet.no/article/1072526

 

Source: Kreyberg S. Chronic/post-viral fatigue syndrome. Tidsskr Nor Laegeforen. 2004 Sep 23;124(18):2382-3. [Article in Norwegian] http://tidsskriftet.no/article/1072526  (Full article)

 

Chronic fatigue syndrome (cfs)

Abstract:

The Chronic Fatigue Syndrome (CFS) is described based on the revision of Fukuda et al. The question “whether CFS can be discussed as a homogenous disorder?” has been reviewed and the answer is “no”. Other overlapping syndromes are mentioned. Disorders with fatigue as a symptom are depression, somatisation, irritable bowel syndrome, effort-syndrome, hyperventilation, conservation-withdrawal.

Among the pathogenetic factors of CFS immune systems disorders, neuroendocrine abnormalities, autonomic activity, neuroimaging, neuropsychological abnormalities, exercise capacity and muscle function and psychological processes (attribution, perception, symptom avoidance and neutralisation of conflicts) are discussed.

Since CFS cannot be comprehended without knowledge of the ontogenetic development of the affect “fatigue”, it is extensively described. Based on this knowledge, fatigue as an affect and the CFS are embedded in a context, which has as its basis the fight-flight reaction and the conservation-withdrawal reaction. Weighing the evidence, it is concluded that CFS in its varieties can best be understood as a manifestation of the activation of the two biological emergency reactions: fight-flight and conservation-withdrawal.

The physician should interview and examine each individual patient according to the Harvey Cushing dictum: The physician should not only study the diseased organ, but the man with his diseased organ, and not only these. He should comprehend the man with his diseased organ in his environment. This leads to study of the biological, psychological and social factors contributing to each patient’s illness. Work-up and therapy have to be based on this integrated approach. The latter encompasses conflict centred psychotherapy, stepwise increasing physical activation and antidepressive drugs.

 

Source: Adler RH. Chronic fatigue syndrome (cfs). Swiss Med Wkly. 2004 May 15;134(19-20):268-76. http://www.smw.ch/for-readers/archive/backlinks/?url=/docs/archive200x/2004/19/smw-10213.html (Full article)

 

Chronic fatigue and chronic fatigue syndrome in the general population

Both chronic fatigue (CF) connected to a chronic or serious disease, and Chronic Fatigue Syndrome (CFS) form a serious problem in our Western society. It causes a lot of suffering for patients and may lead to disability to work. Doctors are frequently confronted with these patients, but it is unknown how many of these patients are suffering without help-seeking.

Most research has been done in CFS, and in specialised CFS clinics. Much less is known about other types of chronic fatigue, connected with a serious disabling disease, or with a psychiatric condition. There is hardly any knowledge about the prevalence and characteristics of these types of chronic fatigue and especially CFS, and the course of CFS in the general population. If we would know more about fatigue and chronic fatigue in the general population then, for example, the development of prevention programs would become nearer.

You can read the rest of this article here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC269992/

 

Comment on:

Functional status of persons with chronic fatigue syndrome in the Wichita, Kansas, population. [Health Qual Life Outcomes. 2003]

A population-based study of the clinical course of chronic fatigue syndrome. [Health Qual Life Outcomes. 2003]

 

Source: Bleijenberg G. Chronic fatigue and chronic fatigue syndrome in the general population. Health Qual Life Outcomes. 2003 Oct 6;1:52. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC269992/ (Full article)

 

Systematic review of the current literature related to disability and chronic fatigue syndrome

Abstract:

Objective: The objective of this evidence report was to perform a systematic review of the published literature to provide the Social Security Administration (SSA) with the best available evidence and most current medical knowledge regarding disability in persons with Chronic Fatigue Syndrome (CFS).

Search Strategy: English language and adult population published literature from 1988 to November 2001 was searched using MEDLINE, Current Contents, Cochrane Library, and PsychINFO databases and supplemented by a manual review of bibliographies of all accepted papers.

Selection Criteria: Interventional or observational studies of at least two adult patients reporting CFS according to either the CDC 1988, CDC 1994, Oxford 1991, or Australia 1990 criteria were accepted. Studies were required to report disability (evidence of a medically determinable physical or mental impairment) and data regarding employment or work.

Data Collection and Analysis: Data on patients, interventions, and outcomes were extracted from accepted studies. Studies were scored for quality and level of evidence. Data were summarized for study, patient, and treatment level characteristics as well as outcomes of interest. A panel of diverse technical experts and peer reviewers provided review and commentary on the draft report.

Main Results: Of 3,840 citations identified, 53 studies describing 4,558 patients with CFS met all eligibility criteria. Twenty-two of these studies described comparator groups of healthy controls totaling 775 patients. The majority of CFS patients represented in the 37 studies reporting employment status were unemployed. The evidence suggests that some individuals with CFS have cognitive or affective impairments on neuropsychological tests, but results are not consistent. Depression of greater severity is associated with unemployment, but no other impairment appeared to be consistently associated with disability or work outcomes. No specific interventions have been proven to be effective in restoring the ability to work. No specific patient characteristics have been identified as best predictors of positive employment outcomes in CFS patients. The patient’s level of functioning at the time of diagnosis should be compared to functioning prior to the onset of illness especially as it relates to work, school, social and home activities.

The major limitations of this review are related to the weaknesses inherent in the current medical and scientific published literature regarding CFS. Study designs were not sufficiently homogeneous to allow quantitative synthesis of individual study results, and external validity was low. While some studies reported test and scale results, this was highly variable with relatively sparse and inconsistent reporting of both baseline and outcome data. No studies specifically measured the impact of baseline impairment data or treatment interventions on work function or employment outcomes.

Conclusions: While relationships between various impairment measures and work/disability status might be explored in some cases, the best available evidence from the literature did not allow for determination of causality. The limitations inherent in the current literature review are noted and the research community is urged to conduct methodologically rigorous, longitudinal, interventional studies to determine what baseline characteristics are associated with inability to work, and what interventions are effective in restoring the ability to work in the CFS population.

 

Source: Ross SD, Levine C, Ganz N, Frame D, Estok R, Stone L, Ludensky V. Systematic review of the current literature related to disability and chronic fatigue syndrome. Evid Rep Technol Assess (Summ). 2002 Dec;(66):1-3. http://www.ncbi.nlm.nih.gov/books/NBK36735/ (Full article)

 

Chronic fatigue syndrome: a review

Abstract:

OBJECTIVE: Chronic fatigue syndrome is an illness characterized by disabling fatigue of at least 6 months, accompanied by several other symptoms. This review summarizes the current state of knowledge about chronic fatigue syndrome.

METHOD: The case definition, prevalence, clinical presentation, evaluation, and prognosis of chronic fatigue syndrome are discussed. Research on the pathophysiology and treatment of chronic fatigue syndrome is reviewed.

RESULTS: Chronic fatigue syndrome is diagnosed on the basis of symptoms. Patients with chronic fatigue syndrome experience significant functional impairment. Pathophysiological abnormalities exist across many domains, suggesting that chronic fatigue syndrome is a heterogeneous condition of complex and multifactorial etiology. Evidence also is beginning to emerge that chronic fatigue syndrome may be familial. Although chronic fatigue syndrome has significant symptom overlap and comorbidity with psychiatric disorders, several lines of research suggest that the illness may be distinct from psychiatric disorders. Patients’ perceptions, attributions, and coping skills, however, may help perpetuate the illness. Treatment for chronic fatigue syndrome is symptom-based and includes pharmacological and behavioral strategies. Cognitive behavior therapy and graded exercise can be effective in treating the fatigue and associated symptoms and disability.

CONCLUSIONS: Chronic fatigue syndrome is unlikely to be caused or maintained by a single agent. Findings to date suggest that physiological and psychological factors work together to predispose an individual to the illness and to precipitate and perpetuate the illness. The assessment and treatment of chronic fatigue syndrome should be multidimensional and tailored to the needs of the individual patient.

Comment in:

On chronic fatigue syndrome. [Am J Psychiatry. 2004]

On chronic fatigue syndrome. [Am J Psychiatry. 2004]

 

Source: Afari N, Buchwald D. Chronic fatigue syndrome: a review. Am J Psychiatry. 2003 Feb;160(2):221-36. http://www.ncbi.nlm.nih.gov/pubmed/12562565

 

Interventions for the treatment and management of chronic fatigue syndrome/myalgic encephalomyelitis

This article summarises the research evidence presented in a recent issue of Effective Health Care on interventions for the treatment and management of chronic fatigue syndrome/ myalgic encephalomyelitis (CFS/ME). It provides an overview of the evidence from a systematic review of randomised controlled trials commissioned by the Department of Health. The results of the systematic review were found to be similar to those of another systematic review carried out in the USA at the same time, and the two have been combined and published together in 2001.

You can read the rest of this article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1743629/pdf/v011p00284.pdf

 

Source: Bagnall AM, Whiting P, Richardson R, Sowden AJ. Interventions for the treatment and management of chronic fatigue syndrome/myalgic encephalomyelitis. Qual Saf Health Care. 2002 Sep;11(3):284-8. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1743629/pdf/v011p00284.pdf (Full article)

 

The report of the Chief Medical Officer’s CFS/ME working group: what does it say and will it help?

Abstract:

Chronic fatigue syndrome (CFS) sometimes known as myalgic encephalomyelitis or encephalopathy (ME) has long been a controversial topic. This year has seen the publication of a report from an independent working party set up by the UK Chief Medical Officer (CMO) to make recommendations for the management of the condition. The report makes a number of general recommendations about the provision of appropriate care and services. The more controversial issues of what to call the illness, the nature of the illness and what treatment should be recommended are all addressed, but in the form of compromise rather than resolution. To the extent that this report is a step towards highlighting the needs not only of patients with CFS but the larger group of patients with symptom-defined conditions, it is to be welcomed. As a guide to management it raises as many questions as it answers. Much remains to be resolved before guidance that is both evidence based and acceptable to all parties is achieved.

Comment in: Medically unexplained symptoms. [Clin Med (Lond). 2002]

 

Source: Sharpe M. The report of the Chief Medical Officer’s CFS/ME working group: what does it say and will it help? Clin Med (Lond). 2002 Sep-Oct;2(5):427-9. http://www.ncbi.nlm.nih.gov/pubmed/12448589