Category: Pediatric ME/CFS

Fatigue, depression, and social adjustment in chronic fatigue syndrome

Abstract:

The aims of this study were to determine the characteristics and perceived levels of fatigue and the prevalence of depression in children with chronic fatigue syndrome and to assess the effects of illness on schooling and social functioning.

Twelve children with chronic fatigue syndrome were compared with a matched group of children with cystic fibrosis and matched healthy controls. Levels of fatigue (fatigue questionnaire), depression (children’s depression inventory), and social adjustment (semistructured interview with parents) were compared between groups.

Children with chronic fatigue syndrome had significantly higher median scores for physical and mental fatigue and depressive symptomatology than either comparison group and five children scored as depressed on the children’s depression inventory.

Schooling and social functioning were seriously disrupted. Children with chronic fatigue syndrome reported high levels of fatigue affecting both physical and mental functioning, the association with depression found in adult studies was confirmed, and social adjustment was poor.

 

Source: Walford GA, Nelson WM, McCluskey DR. Fatigue, depression, and social adjustment in chronic fatigue syndrome. Arch Dis Child. 1993 Mar;68(3):384-8. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1793898/ (Full article)

 

Chronic fatigue syndrome: a joint paediatric-psychiatric approach

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

 

SIR,-While agreeing that physical, psychological, and social factors must all be taken into account in the management of this complex and controversial syndrome I would disagree with Dr Margaret Vereker’s statement that no organic pathology can be detected to account for any of the symptoms. This conclusion has been made without reference to a number of research papers describing persisting viral infection, neuromuscular abnormalities in both structure and function, and immune system dysfunction.

Gow et al using polymerase chain reaction techniques, have been able to demonstrate the presence of enteroviral genome in muscle biopsies from a significant number of patients (53%) compared with controls (15%). None of the healthy control group in this study had evidence of viral particles in their muscle, this was only found in those with colonic or breast malignancies. Precisely what cytopathological effect this intracellular virus is having within muscle remains open to debate. However, Behan et al have published electron microscopic evidence of structural damage to the muscle mitochondria along with type II fibre atrophy; this is a finding which is not normally considered to be consistent with simple disuse.

You can read the rest of this letter here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1793782/pdf/archdisch00632-0102a.pdf

 

Source: Shepherd C. Chronic fatigue syndrome: a joint paediatric-psychiatric approach. Arch Dis Child. 1992 Nov;67(11):1410. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1793782/

 

Chronic fatigue syndrome in school children

Abstract:

Chronic fatigue syndrome (CFS) is characterized by persistent or relapsing debilitating fatigue for at least 6 months without any apparent medical diagnosis that would explain the clinical presentation.

Although, most of the reported patients are over age 30, CFS also affects school children. To better understand CFS, the network of the central nervous-endocrine-immune systems should be considered, and one must be careful to distinct CFS from school absenteeism and other psychosomatic disorders often seen among them.

 

Source: Kawa K. Chronic fatigue syndrome in school children. Nihon Rinsho. 1992 Nov;50(11):2606-11. [Article in Japanese] http://www.ncbi.nlm.nih.gov/pubmed/1287237

 

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 and Fibromyalgia in Adolescence

Abstract:

A complaint of persistent, debilitating fatigue in an adolescent, accompanied by symptoms that meet the recently adopted criteria for chronic fatigue syndrome (CFS), presents a difficult challenge for the clinician. This article describes the diagnostic criteria for CFS and fibromyalgia, and discusses the epidemiology, etiology, and management of these conditions.

 

Source: Kulig JW. Chronic Fatigue Syndrome and Fibromyalgia in Adolescence. Adolesc Med. 1991 Oct;2(3):473-484. http://www.ncbi.nlm.nih.gov/pubmed/10350771

 

Pain syndromes, disability, and chronic disease in childhood

Abstract:

Childhood disability and chronic disease are common, and their prevalence is increasing as children survive with conditions that were previously fatal. It is important that physicians in training learn about disability and handicap, and the functioning of multidisciplinary teams to manage these problems. Chronic ill-health is often very expensive to manage, and some serious and creative thinking about the best way to fund such health care is urgently needed.

Pediatric rheumatologists are involved with the care of many children with chronic and recurrent musculoskeletal pain; however, they have not perhaps focused enough research effort on the investigation of pain and its management. Whether reflex neurovascular dystrophy, fibromyalgia, and chronic fatigue syndrome are part of a disease continuum is unclear, but it seems probable that psychosocial problems are often important contributing factors in all three conditions.

Immunoglobulin subclass deficiencies are being increasingly delineated, occurring in chronic fatigue syndrome as well as many other disease states. Their clinical relevance still remains, for the most part, uncertain. Short stature occurs in many chronic illnesses, and the role of growth hormone treatment in these conditions is beginning to be investigated.

 

Source: Malleson PN. Pain syndromes, disability, and chronic disease in childhood. Curr Opin Rheumatol. 1991 Oct;3(5):860-6. http://www.ncbi.nlm.nih.gov/pubmed/1836344

 

Clinical and pathogenetic observations on children with chronic mononucleosis

Abstract:

Epstein-Barr virus is seldom the causative agent of a prolonged atypical illness, known as chronic mononucleosis syndrome, characterized by a persistent pattern of clinical manifestations and by a defective immune response to specific viral antigens. This paper refers about 6 children for whom clinical and serological findings suggest the chronic Epstein-Barr virus infection. The authors believe that this chronic state might be explained by the unusual antibody pattern to EBV virus, with the persistent presence of anti-EA and the absence of anti-EBNA titers, expression of a reduced EBV-specific cytotoxic T cell activity.

 

Source: Cataldo F, Ammatuna P, Bellia L, Sammartano F, Violante M, Albeggiani A. Clinical and pathogenetic observations on children with chronic mononucleosis. Pediatr Med Chir. 1991 Sep-Oct;13(5):489-94. [Article in Italian] http://www.ncbi.nlm.nih.gov/pubmed/1664943

 

Chronic fatigue in adolescents

Abstract:

Nine female and 6 male adolescents (mean age 14.5 +/- 1.7 [SD] years) were evaluated for chronic fatigue associated with at least three additional symptoms present for 18.4 +/- 8.4 months. Eleven subjects experienced the onset of symptoms with an acute illness (seven Monospot-positive). Medical history, physical examination, and laboratory testing yielded little helpful information. Serologic testing for Coxsackie B viruses 1 through 6, cytomegalovirus, Epstein-Barr virus, human herpesvirus 6, and Toxoplasma gondii in subjects and healthy controls provided little evidence for an infectious cause of persistent fatigue.

Children’s Depression Inventory scores and psychiatric interviews with the Schedule for Affective Disorders and Schizophrenia-Children’s Version (K-SADS) identified five subjects with major depression. On the K-SADS, the 10 fatigued subjects without major depression endorsed many secondary symptoms of depression but were less likely than depressed psychiatric clinic patients to endorse primary symptoms such as depressed mood, guilt, and suicidality. At telephone follow-up 13 to 32 months after intake, 4 subjects were completely well, 4 markedly improved, and 7 unimproved or worse.

Further research is necessary to determine whether chronic fatigue in adolescents is prodromal depression, a discrete psychosomatic condition, or an infectious or immunologic disorder that mimics depression.

Comment in:

Chronic fatigue in children: illness or disease? [Pediatrics. 1993]

Chronic fatigue immune dysfunction syndrome: an epidemic? [Pediatrics. 1992]

Chronic fatigue immune dysfunction syndrome: an epidemic? [Pediatrics. 1992]

Chronic fatigue immune dysfunction syndrome: an epidemic? [Pediatrics. 1992]

 

Source: Smith MS, Mitchell J, Corey L, Gold D, McCauley EA, Glover D, Tenover FC. Chronic fatigue in adolescents. Pediatrics. 1991 Aug;88(2):195-202. http://www.ncbi.nlm.nih.gov/pubmed/1861915

 

Chronic fatigue in children: clinical features, Epstein-Barr virus and human herpesvirus 6 serology and long term follow-up

Abstract:

During a 2-year period, 23 patients (14 girls, 9 boys) with chronic fatigue were referred to the Pediatric Infectious Disease Clinic of a tertiary care center, representing 19% of all out-patients seen in that clinic during that time. The median age was 14 years and the median duration of symptoms before referral was 6 months; 65% had missed at least 2 weeks of school and 30% required a home tutor.

There were few positive physical findings and no elevation of white blood cell count (median, 7000/mm3) or erythrocyte sedimentation rate (median, 5 mm/hour). Twenty-five percent had no evidence of Epstein-Barr virus infection, 15% had current or recent infection and 60% had past infection; 33% of the latter had detectable antibody to early antigen but the titers were low. Human herpesvirus 6 titers in 8 patients were similar to those in age- and sex-matched controls.

Of 17 patients contacted after a median of 26 months, 76% reported definite improvement, although 38% of these still experienced occasional symptoms. In this referral population chronic fatigue was a common presenting complaint, was associated with marked degrees of dysfunction and bore no relationship to Epstein-Barr virus or human herpesvirus 6 infection. In most children the disorder was self-limited, although a minority were persistently or severely affected.

 

Source: Marshall GS, Gesser RM, Yamanishi K, Starr SE. Chronic fatigue in children: clinical features, Epstein-Barr virus and human herpesvirus 6 serology and long term follow-up. Pediatr Infect Dis J. 1991 Apr;10(4):287-90. http://www.ncbi.nlm.nih.gov/pubmed/1648198