Category: Psychiatry/Psychology

Premorbid “overactive” lifestyle in chronic fatigue syndrome and fibromyalgia. An etiological factor or proof of good citizenship?

Abstract:

OBJECTIVE: In a former study, we have shown that patients suffering from chronic fatigue syndrome (CFS) or chronic pain, when questioned about their premorbid lifestyle, reported a high level of “action-proneness” as compared to control groups. The aim of the present study was to control for the patients’ possible idealisation of their previous attitude towards action.

METHODS: A validated Dutch self-report questionnaire measuring “action-proneness” (the HAB) was completed by 62 randomly selected tertiary care CFS and fibromyalgia (FM) patients, as well as by their significant others (SOs).

RESULTS: HAB scores of the patients and those of the SOs were very similar and significantly higher than the norm values. Whether or not the SO showed sympathy for the patient’s illness did not influence the results to a great extent. SOs with a negative attitude towards the illness even characterized the patients as more “action-prone.”

CONCLUSIONS: These results provide further support for the hypothesis that a high level of “action-proneness” may play a predisposing, initiating and/or perpetuating role in CFS and FM.

 

Source: Van Houdenhove B, Neerinckx E, Onghena P, Lysens R, Vertommen H. Premorbid “overactive” lifestyle in chronic fatigue syndrome and fibromyalgia. An etiological factor or proof of good citizenship? J Psychosom Res. 2001 Oct;51(4):571-6. http://www.ncbi.nlm.nih.gov/pubmed/11595245

 

Chronic fatigue syndrome

Comment in: Chronic fatigue syndrome. [Br J Gen Pract. 2001]

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

 

The study of Hamilton et al in the July issue of the BJGP, 1 claims that a higher consultation rate in people with chronic fatigue syndrome (CFS) before they develop the diagnosis supports the hypothesis that behavioural factors have a role in its aetiology. A similar case-control study of mothers and fathers of Down’s syndrome children showed that both mothers and fathers had significantly more recorded illnesses before the birth of the child and that the mothers had significantly more psychosis, neurosis or self-poisoning.2

The problem with such findings is deciding what they mean. No-one would suggest that Down’s syndrome is caused by ‘behavioural factors,’ so why should anyone believe that of CFS? There is no more evidence that increased frequency of attendance before diagnosis points to behavioural factors in CFS than that it points to non-dysjunction in the germ cells of mothers of Down’s syndrome children.

You can read the rest of this comment here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1314117/pdf/11593850.pdf

 

Source: Murdoch JC. Chronic fatigue syndrome. Br J Gen Pract. 2001 Sep;51(470):758. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1314117/pdf/11593850.pdf (Full comment)

 

A comparison of individual and family psychology of adolescents with chronic fatigue syndrome, rheumatoid arthritis, and mood disorders

Abstract:

Chronic fatigue syndrome (CFS) is a controversial diagnosis with unknown cause. Adult studies indicate high rates of psychosocial dysfunction and psychiatric comorbidity. The authors compared three groups of pediatric patients selected by diagnosis-(1l) CFS (n = 15), (2) juvenile rheumatoid arthritis (n = 15), and (3) mood disorders (n = 15)-across many psychological measures.

CFS subjects had dramatic elevation of the Somatic Complaints subscale (mean T score = 75), whereas the mood disorders group had higher externalizing scores (mean T score = 68) on the Child Behavior Checklist. The CFS subjects missed significantly more school compared with the two control groups. After the onset of CFS, 13 of 15 of the CFS patients required significant educational accommodation. Only 4 of the 15 CFS patients had an Axis I psychiatric diagnosis, as determined by the Computerized Diagnostic Interview for Children.

Despite a low rate of psychiatric diagnosis in the CFS sample, these data attest to their psychosocial and school dysfunction.

 

Source: Gray D, Parker-Cohen NY, White T, Clark ST, Seiner SH, Achilles J, McMahon WM. A comparison of individual and family psychology of adolescents with chronic fatigue syndrome, rheumatoid arthritis, and mood disorders. J Dev Behav Pediatr. 2001 Aug;22(4):234-42. http://www.ncbi.nlm.nih.gov/pubmed/11530896

 

The Family Response Questionnaire: a new scale to assess the responses of family members to people with chronic fatigue syndrome

Abstract:

OBJECTIVE: Family responses to patients with chronic fatigue syndrome (CFS) may influence the course of the disorder and family members themselves are likely to be adversely affected. However, the beliefs and responses of relatives of CFS patients have been under-researched. The aim of this study was to produce an easy-to-administer questionnaire to assess the responses of family members to people with CFS.

METHODS: Seventy-eight people, all close relatives of (physician-diagnosed) CFS sufferers, completed the first version of the Family Response Questionnaire (FRQ).

RESULTS: Examination of the correlation matrix and a cluster analysis of the items support four scales rather than the original five. The four response scales were labelled: sympathetic-empathic, active engagement, rejecting-hostile, and concern with self. Measures of test-retest and internal reliability were high. Participants found the items both comprehensible and relevant to their experiences of living with people with CFS.

CONCLUSION: The new version of the FRQ will be useful in further examination of the responses of CFS on individuals and their families.

 

Source: Cordingley L, Wearden A, Appleby L, Fisher L. The Family Response Questionnaire: a new scale to assess the responses of family members to people with chronic fatigue syndrome. J Psychosom Res. 2001 Aug;51(2):417-24. http://www.ncbi.nlm.nih.gov/pubmed/11516763

 

Frequency of attendance in general practice and symptoms before development of chronic fatigue syndrome: a case-control study

Abstract:

BACKGROUND: Chronic fatigue syndrome (CFS) research has concentrated on infective, immunological, and psychological causes. Illness behaviour has received less attention, with most research studying CFS patients after diagnosis. Our previous study on the records of an insurance company showed a highly significant increase in illness reporting before development of CFS.

AIM: To investigate the number and type of general practitioner (GP) consultations by patients with CFS for 15 years before they develop their condition.

DESIGN OF STUDY: Case-control study in 11 general practices in Devon.

SETTING: Forty-nine patients with CFS (satisfying the Centers for Disease Control criteria), 49 age, sex, and general practice matched controls, and 37 patients with multiple sclerosis (MS) were identified from the general practices’ computerised databases.

METHOD: The number of general practice consultations and symptoms recorded in three five-year periods (quinquennia) were counted before development of the patients’ condition.

RESULTS: The median number of consultations was significantly higher for CFS patients than that of matched controls in each of the quinquennia: ratios for first quinquennium = 1.88, P = 0.01; second quinquennium = 1.70, P = 0.005; last quinquennium = 2.25, P < 0.001. More CFS patients than controls attended for 13 of the 18 symptoms studied. Significant increases were found for upper respiratory tract infection (P < 0.001), lethargy (P < 0.001), and vertigo (P = 0.02). Similar results were found for CFS patients when compared with MS.

CONCLUSIONS: CFS patients consulted their GP more frequently in the 15 years before development of their condition, for a wide variety of complaints. Several possibilities may explain these findings. The results support the hypothesis that behavioural factors have a role in the aetiology of CFS.

Comment in:

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

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

 

Source: Hamilton WT, Hall GH, Round AP. Frequency of attendance in general practice and symptoms before development of chronic fatigue syndrome: a case-control study. Br J Gen Pract. 2001 Jul;51(468):553-8. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1314047/ (Full article)

 

Chronic fatigue in general practice

Comment on: Chronic fatigue in general practice: is counselling as good as cognitive behaviour therapy? A UK randomised trial. [Br J Gen Pract. 2001]

 

Ridsdale and colleagues are to be congratulated on performing a randomised controlled trial of different treatments for chronic fatigue. However, their data do not substantiate their conclusions.

The trial was set up to demonstrate that cognitive behavioural therapy was better than counselling for patients seen in general practice with fatigue symptoms. No difference in the main outcome measures was found between the intervention and control groups. This has been interpreted as showing that the two treatments are equivalent. The sample size required for, and analysis of, equivalence studies are different than those required for trials designed to show differences,2 not least the requirement that equivalence be defined before the trial starts. This trial was not designed to show equivalence. Thus, although the results for the main outcome measures are similar they should not be reported as being equivalent. Without a definition of equivalence, calculating the study’s power to show equivalence is not possible. Also, part of the conclusions depend on a sub-group analysis which, while acknowledged as being underpowered, is given more weight than is justified. If equivalence is defined as six points on the fatigue score then, in this subgroup, the trial only has a power of 36% to show equivalence based on a 95% confidence interval. With a more conservative definition of equivalence even the main study lacks power.

You can read the rest of this comment here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1313987/pdf/11458490.pdf

 

Source: Underwood M, Eldridge S. Chronic fatigue in general practice. Br J Gen Pract. 2001 Apr;51(465):317-8. http://www.ncbi.nlm.nih.gov/pubmed/11458490

 

Cognitive behaviour therapy and chronic fatigue syndrome

Comment on: Chronic fatigue in general practice: is counselling as good as cognitive behaviour therapy? A UK randomised trial. [Br J Gen Pract. 2001]

 

Ridsdale and colleagues state that there is evidence that cognitive behaviour therapy (CBT) is effective for patients with chronic fatigue syndrome (CFS), but fail to point out that such evidence derives only from studies performed in the United Kingdom, where CFS is diagnosed on the basis of the Oxford criteria. There is no evidence that CBT is beneficial to patients fulfilling the Australian criteria for CFS or the American ones, namely, the original criteria of the Centers for Disease Control.

You can read the rest of this comment here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1313986/pdf/11458489.pdf

 

Source: Baschetti R. Cognitive behaviour therapy and chronic fatigue syndrome. Br J Gen Pract. 2001 Apr;51(465):316-7. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1313986/ (Full comment)

 

Chronic fatigue: symptom and syndrome

Abstract:

Chronic fatigue is common, is difficult to measure, can be associated with considerable morbidity, and is rarely a subject of controversy. The chronic fatigue syndrome also presents problems in definition and measurement, is associated with even more morbidity than chronic fatigue itself, and is often controversial. Particularly unclear is the way in which chronic fatigue and the chronic fatigue syndrome relate to each other: Is one the severe form of the other, or are they qualitatively and quantitatively different? We know that many things can cause chronic fatigue, and this is probably true for the chronic fatigue syndrome, too. We can anticipate that discrete causes of the chronic fatigue syndrome will be found in the future, even if these causes are unlikely to fall neatly along the physical-psychological divide that some expect. The causes of chronic fatigue are undoubtedly many, both in a population and in any individual person, even when a discrete cause, such as depression or cancer, is identified. Social, behavioral, and psychological variables are important in both chronic fatigue and the chronic fatigue syndrome. Interventions that address these general variables can be successful, and currently they are often more successful than interventions directed at specific causes.

 

Source: Wessely S. Chronic fatigue: symptom and syndrome. Ann Intern Med. 2001 May 1;134(9 Pt 2):838-43. http://www.ncbi.nlm.nih.gov/pubmed/11346319

 

Chronic illness — a disruption in life: identity-transformation among women with chronic fatigue syndrome and fibromyalgia

Abstract:

BACKGROUND: People with chronic illnesses often suffer from identity-loss. Empirical research concerning patients with chronic fatigue syndrome (CFS) or fibromyalgia has not, however, adequately addressed the consequences of these illnesses for identity.

AIM: The aim of this article is to describe how women with CFS and fibromyalgia create new concepts of identity after the onset of illness, and how they come to terms with their newly arisen identities. I aim to illuminate the biographical work done by these individuals, which includes a re-evaluation of their former identity and life. This process is illustrated by the following themes: An earlier identity partly lost and Coming to terms with a new identity.

METHOD: The study is based on interviews with 25 women in Sweden, 12 with the diagnosis of CFS and 13 diagnosed with fibromyalgia. A grounded theory orientated approach was used when collecting and analysing the data.

FINDINGS: The main findings are that: (1) the illnesses can involve a radical disruption in the women’s biography that has profound consequences for their identity, particularly in relation to work and social life, (2) biographical disruptions are partial rather than total, calling for different degrees of identity transformation, (3) many of the women also experience illness gains in relation to the new identity.

CONCLUSIONS: Thus, the biographical disruption and illness experience comprised both losses and illness gains that had consequences for identity.

 

Source: Asbring P. Chronic illness — a disruption in life: identity-transformation among women with chronic fatigue syndrome and fibromyalgia. J Adv Nurs. 2001 May;34(3):312-9. http://www.ncbi.nlm.nih.gov/pubmed/11328436

 

Discriminating between chronic fatigue syndrome and depression: a cognitive analysis

Abstract:

BACKGROUND: Chronic fatigue syndrome (CFS) and depression share a number of common symptoms and the majority of CFS patients meet lifetime criteria for depression. While cognitive factors seem key to the maintenance of CFS and depression, little is known about how the cognitive characteristics differ in the two conditions.

METHODS: Fifty-three CFS patients were compared with 20 depressed patients and 38 healthy controls on perceptions of their health, illness attributions, self-esteem, cognitive distortions of general and somatic events, symptoms of distress and coping. A 6 month follow-up was also conducted to determine the stability of these factors and to investigate whether CFS-related cognitions predict ongoing disability and fatigue in this disorder.

RESULTS: Between-group analyses confirmed that the depressed group was distinguished by low self-esteem, the propensity to make cognitive distortions across all situations, and to attribute their illness to psychological factors. In contrast, the CFS patients were characterized by low ratings of their current health status, a strong illness identity, external attributions for their illness, and distortions in thinking that were specific to somatic experiences. They were also more likely than depressed patients to cope with their illness by limiting stress and activity levels. These CFS-related cognitions and behaviours were associated with disability and fatigue 6 months later.

CONCLUSIONS: CFS and depression can be distinguished by unique cognitive styles characteristic of each condition. The documented cognitive profile of the CFS patients provides support for the current cognitive behavioural models of the illness.

 

Source: Moss-Morris R, Petrie KJ. Discriminating between chronic fatigue syndrome and depression: a cognitive analysis. Psychol Med. 2001 Apr;31(3):469-79. http://www.ncbi.nlm.nih.gov/pubmed/11305855