Category: Psychiatry/Psychology

Illness experience, depression, and anxiety in chronic fatigue syndrome

Abstract:

OBJECTIVE: Given the high rate of psychiatric comorbidity with chronic fatigue syndrome (CFS), we considered two possible correlates of anxiety and depression: lack of illness legitimization and beliefs about limiting physical activity.

METHOD: A total of 105 people diagnosed with CFS reported on their experiences with medical professionals and their beliefs about recovery and completed the depression and anxiety subscales of the Brief Symptom Inventory.

RESULTS: Those who said that their physician did not legitimize their illness (36%) had higher depression and anxiety scores (P’s<.05) than their counterparts. Those who believed that limiting their physical exertion was the path to recovery (55%) had lower depression and anxiety scores (P’s<.01) than their counterparts.

CONCLUSION: Lack of illness legitimization ranked high as a source of dissatisfaction for CFS patients, and it may aggravate psychiatric morbidity. Many CFS patients believed that staying within what they felt to be their physical limits would improve their condition. This belief, and possibly an accompanying sense of control over their symptoms, may alleviate psychiatric morbidity.

 

Source: Lehman AM, Lehman DR, Hemphill KJ, Mandel DR, Cooper LM. Illness experience, depression, and anxiety in chronic fatigue syndrome. J Psychosom Res. 2002 Jun;52(6):461-5. http://www.ncbi.nlm.nih.gov/pubmed/12069870

 

Perception of cognitive performance in patients with chronic fatigue syndrome

Abstract:

This study examined discrepancies between perceived and actual performance by patients with chronic fatigue syndrome (CFS) confronted with a challenging cognitive task. Before and after completing a modified version of the Stroop task, 40 patients and 40 healthy control participants estimated their own performance and the performance that would normally be achieved by someone of equal age and education level. After correcting for differences between the groups in depression, we found no differences in actual performance on the Stroop. However, patients with CFS consistently underestimated their performance relative to normal performance. This difference was observed for both depressed and nondepressed subgroups of patients, persisted after adjusting the results for depression, and correlated with patients’ ratings of the mental effort and fatigue evoked by the task. The results are discussed in light of cognitive models of CFS that suggest the setting of impossibly high standards of personal performance may contribute to the dynamism of this disease.

 

Source: Metzger FA, Denney DR. Perception of cognitive performance in patients with chronic fatigue syndrome. Ann Behav Med. 2002 Spring;24(2):106-12. http://www.ncbi.nlm.nih.gov/pubmed/12054315

 

Chronic fatigue syndrome in the psychiatric practice

Abstract:

BACKGROUND: Chronic fatigue syndrome (CFS) is a complex syndrome with a psychiatric comorbidity of 70-80%. A psychiatric interview is necessary in order to exclude psychiatric illness and to identify psychiatric comorbidity. Studies have demonstrated that in general medical practice and in the non-psychiatric specialist practice, physicians tend to underdiagnose psychopathology in patients with CFS. There are many questions unanswered about the treatment of CFS Aim: Typical issues for the psychiatric practice are reviewed: psychiatric comorbidity, dysregulation of the PHA-axis and the treatment of CFS.

CONCLUSIONS: Depression, somatization, sleeping disorders and anxiety disorders are the most important psychopathological symptoms found in CFS patients. CFS should not be regarded as a masked (somatoform) depression. Although the results from neuroendocrinological studies assessing the hypothalamic-pituitary-adrenal axis (HPA-axis) are inconsistent, they suggest that there is a subgroup of CFS patients suffering from a discrete dysregulation of the HPA-axis resulting in basal hypocortisolaemia. These findings, however, do not reveal a causal relationship. Antidepressants do not seem to have a positive influence on the symptom of fatigue, but appear to be beneficial in alleviating the symptoms of depression and social functioning. Cognitive behaviour therapy and graded exercise show a significant improvement on fatigue and other symptoms and are the only treatments available for CFS patients.

 

Source: Van Duyse A, Mariman A, Poppe C, Michielsen W, Rubens R. Chronic fatigue syndrome in the psychiatric practice. Acta Neuropsychiatr. 2002 Jun;14(3):127-33. doi: 10.1034/j.1601-5215.2002.140306.x. http://www.ncbi.nlm.nih.gov/pubmed/26984154

 

Caring for a relative with chronic fatigue syndrome: difficulties, cognition and acceptance over time

Abstract:

The present study explored the difficulties experienced by carers of chronic fatigue syndrome (CFS) sufferers, their cognitions, and their efforts to accept the illness. Semi-structured interviews were conducted with 17 carers to study these issues, retrospectively, over three stages: before the diagnosis of CFS, shortly after the diagnosis, and at present.

Surprisingly, the results suggested that carers, several of them absent from home during the day, felt that their lives were only minimally constrained by the illness. Nevertheless, all carers reported specific coping efforts to manage both the illness and their own distress, and indicated that they learned to accept the illness over time. However, acceptance appeared to be a form of resignation rather than a positive appreciation of the illness.

In light of the uncertainties surrounding the origin of CFS and carers’ apparent confusion, the results obtained in the present study are significant in that they increase our understanding of CFS carers’ quality of life, their efforts to cope with the illness, and the physical and emotional help they may provide to the sufferer. Such information can be usefully employed in the increasing development of counselling interventions and instrumental support networks that involve both sufferers and their carers.

 

Source:  Ax S, Gregg VH, Jones D.  Caring for a relative with chronic fatigue syndrome: difficulties, cognition and acceptance over time. J R Soc Promot Health. 2002 Mar;122(1):35-42. http://www.ncbi.nlm.nih.gov/pubmed/11989141

 

An interdisciplinary therapeutic approach for dealing with patients attributing chronic fatigue and functional memory disorders to environmental poisoning–a pilot study

Abstract:

Nonspecific symptoms and a general feeling of ill health that is difficult to objectify are the commonest health problems with which patients present to an Environmental Medicine Outpatient Department (OPD). Of this group, a great proportion meets the classification criteria for Chronic Fatigue Syndrome (CFS) or Functional Memory Disorders in association with Idiopathic Chronic Fatigue (FMD-ICF).

This is a longitudinal study of the OPD of Environmental Medicine, Freiburg University Hospital, Germany, to determine the feasibility and impact of an interdisciplinary therapeutic approach (self-help program, acupuncture, psychosomatic support by group interventions) in 8 patients with CFS, FMD-ICF, or CFS in association with self-reported Multiple Chemical Sensitivities (sr-MCS). The intervention took into consideration the patients’ need for treatment of physical aspects of their disease. This is an important step to motivate patients into required psychosomatic support.

Although none of the patients was willing to accept psychosomatic support or psychotherapy at study outset, acceptance of psychosomatic group interventions was high during the study course. Additionally five patients started with personal counseling at the Psychosomatic Clinic, and, without feeling stigmatized, 4 patients started with specific psychotherapy.

The patients’ quality of life showed no increase after four months, but, as shown by the Sum-Score of SF-36, it had improved significantly at the end of the study, which covered eight months’ treatment (p = 0.015). Two follow-up investigations showed that this improvement probably persisted in part (mainly in the dimensions mental health, social function, physical role function, and vitality).

In conclusion our interdisciplinary therapeutic approach indicates successful treatment of patients attributing CFS, CFS/sr-MCS, and FMD-ICF to environmental poisoning. We now plan to conduct a randomized controlled trial in the future.

 

Source: Lacour M, Zunder T, Dettenkofer M, Schönbeck S, Lüdtke R, Scheidt C. An interdisciplinary therapeutic approach for dealing with patients attributing chronic fatigue and functional memory disorders to environmental poisoning–a pilot study. Int J Hyg Environ Health. 2002 Feb;204(5-6):339-46. http://www.ncbi.nlm.nih.gov/pubmed/11885358

 

Women’s experiences of stigma in relation to chronic fatigue syndrome and fibromyalgia

Abstract:

Chronic fatigue syndrome and fibromyalgia are characterized by being difficult to diagnose and having an elusive etiology and no clear-cut treatment strategy. The question of whether these illnesses are stigmatizing was investigated through interviews with 25 women with these illnesses. The women experienced stigmatization primarily before receiving a diagnosis, and the diffuse symptomatology associated with the illnesses were significant for stigmatization. Stigma consisted of questioning the veracity, morality, and accuracy of patient symptom descriptions and of psychologizing symptoms. Coping with stigma was also explored and found to comprise both withdrawal and approach strategies, depending on the individual’s circumstances and goals.

Comment in: Women experienced chronic fatigue syndrome and fibromyalgia as stigmatising. [Evid Based Ment Health. 2002]

 

Source: Asbring P, Närvänen AL. Women’s experiences of stigma in relation to chronic fatigue syndrome and fibromyalgia. Qual Health Res. 2002 Feb;12(2):148-60. http://www.ncbi.nlm.nih.gov/pubmed/11837367

 

Family cognitive behaviour therapy for chronic fatigue syndrome: an uncontrolled study

Abstract:

AIM: To examine the efficacy of family focused cognitive behaviour therapy for 11-18 year olds with chronic fatigue syndrome.

METHODS: Twenty three patients were offered family focused cognitive behaviour therapy. The main outcome was a fatigue score of less than 4 and attendance at school 75% of the time.

RESULTS: Twenty patients completed treatment. Eighteen had completed all measures at six months follow up; 15 of these (83%) improved according to our predetermined criterion. Substantial improvements in social adjustment, depression, and fear were noted.

CONCLUSIONS: Family focused cognitive behaviour therapy was effective in improving functioning and reducing fatigue in 11-18 year olds. Gains were maintained at six months follow up.

 

Source: Chalder T, Tong J, Deary V. Family cognitive behaviour therapy for chronic fatigue syndrome: an uncontrolled study. Arch Dis Child. 2002 Feb;86(2):95-7. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1761081/ (Full article)

 

Chronic fatigue and anxiety/depression: a twin study

Abstract:

BACKGROUND: Up to three-quarters of patients with fatigue syndromes have comorbid mood or anxiety disorders, suggesting that chronic fatigue is a forme fruste of anxiety or depressive states.

AIMS: To establish whether the association of chronic fatigue with psychological distress is causal or due to a common genetic or environmental factor.

METHOD: 69 monozygotic (MZ) and 31 dizygotic (DZ) female twin pairs, with only one co-twin reporting at least 6 months of fatigue, completed questions on fatigue, the General Health Questionnaire (GHQ) and a structured psychiatric interview. We examined the effects of three progressively more stringent definitions of chronic fatigue on four GHQ sub-scales.

RESULTS: Fatigued MZ and DZ twins by all definitions were significantly more depressed, anxious, somatically preoccupied and socially dysfunctional than their non-fatigued co-twins. Intrapair differences were similar in DZ and MZ twins, but non-significant differences were observed for the somatic symptoms and anxiety/insomnia sub-scales.

CONCLUSIONS: In this sample, chronic fatigue and psychological distress are strongly associated without evidence for genetic covariation, implying that the association is environmental, or due to overlapping definitions. Any genetic covariation missed is likely to involve anxiety rather than depression.

 

Source: Roy-Byrne P, Afari N, Ashton S, Fischer M, Goldberg J, Buchwald D. Chronic fatigue and anxiety/depression: a twin study. Br J Psychiatry. 2002 Jan;180:29-34. http://www.ncbi.nlm.nih.gov/pubmed/11772848

 

Chronic fatigue syndrome

Comment on:

Chronic fatigue syndrome. [Br J Gen Pract. 2001]

Frequency of attendance in general practice and symptoms before development of chronic fatigue syndrome: a case-control study. [Br J Gen Pract. 2001]

 

Professor Murdoch in the September BJGP 1 uses his study of Down’s syndrome,2 which demonstrated that mothers had an increased number of reported illnesses in the year before the birth, to undermine our interpretation of the findings in our chronic fatigue syndrome (CFS) study in the July BJGP. 3 He asks why anyone should believe CFS is caused by behavioural factors.

You can read the rest of this comment here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1314178/pdf/11766858.pdf

 

Source: Hamilton W. Chronic fatigue syndrome. Br J Gen Pract. 2001 Dec;51(473):1015. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1314178/pdf/11766858.pdf (Full comment)

 

Cognitive behavioral therapy and fasting therapy for a patient with chronic fatigue syndrome

Abstract:

Cognitive behavioral therapy temporarily alleviated symptoms of a chronic fatigue syndrome patient but the anxiety about rehabilitation into work became stronger and his symptoms worsened. This patient was successfully rehabilitated by fasting therapy. Natural killer cell activity and serum acylcarnitine levels recovered after fasting therapy. Though fasting therapy transiently increased physical and mental subjective symptoms, the patient gained self-confidence by overcoming difficulties after fasting therapy. A combination of cognitive behavioral therapy and fasting therapy is promising as a treatment for chronic fatigue syndrome.

 

Source: Masuda A, Nakayama T, Yamanaka T, Hatsutanmaru K, Tei C. Cognitive behavioral therapy and fasting therapy for a patient with chronic fatigue syndrome. Intern Med. 2001 Nov;40(11):1158-61. https://www.jstage.jst.go.jp/article/internalmedicine1992/40/11/40_11_1158/_article (Full article)