Category: Psychiatry/Psychology

Chronic fatigue syndrome and dieting disorders: diagnosis and management problems

Abstract:

OBJECTIVE: This paper illustrates the importance of conducting an initial and ongoing psychiatric assessment of patients with chronic fatigue syndrome in order to diagnose dieting disorders. The diagnostic issues and management problems of three case vignettes, two with anorexia nervosa and one with bulimia nervosa, are described.

METHOD: The treatment response of dieting disordered patients is generally prolonged after a previous diagnosis of chronic fatigue syndrome has been made and the patient and family favour a disease diagnosis.

RESULTS: Several management problems arise and family members may also be reluctant to accept a dieting disorder diagnosis.

CONCLUSIONS: Early detection of dieting disorders by adequate screening and assessment is necessary so that a significant reduction in morbidity may occur.

 

Source: Griffiths RA, Beumont PJ, Moore GM, Touyz SW. Chronic fatigue syndrome and dieting disorders: diagnosis and management problems. Aust N Z J Psychiatry. 1996 Dec;30(6):834-8. http://www.ncbi.nlm.nih.gov/pubmed/9034474

 

Fatigue in the chronic fatigue syndrome: a cognitive phenomenon?

Abstract:

What is the source of the perception of excessive fatigue in the chronic fatigue syndrome (CFS)? Studies of physiological response to aerobic activity, of muscle pathology and muscle function in CFS, are reviewed, and suggest that the subjective report of fatigue is not due to any peripheral impairment. In addition, current technological methods such as electroencephalography have failed to uncover the nature of any abnormality in the central motor unit. A physiological model which proposes that patients with CFS possess a reduced threshold for sensory fatigue signals is rejected, because it fails to account for recent findings. Instead, it is suggested that the perception of fatigue in CFS is enhanced by idiosyncrasies in cognitive processing. The implications of this view to our understanding of the perpetuation of CFS as a whole are explored.

 

Source: Fry AM, Martin M. Fatigue in the chronic fatigue syndrome: a cognitive phenomenon? J Psychosom Res. 1996 Nov;41(5):415-26. http://www.ncbi.nlm.nih.gov/pubmed/9032706

 

Chronic fatigue syndrome. Summary of a report of a joint committee of the Royal Colleges of Physicians, Psychiatrists and General Practitioners

Abstract:

Chronic Fatigue Syndrome (CFS) is not a single diagnostic entity. It is a symptom complex which can be reached by many different routes. The conceptual model of CFS needs to be changed from one determined by a single cause/agent to one in which dysfunction is the end stage of a multifactorial process. Although it is important to recognise the role of factors that precipitate the condition, greater understanding is required of factors that predispose individuals to develop the illness, and those that perpetuate disability.

 

Source: Wessely S. Chronic fatigue syndrome. Summary of a report of a joint committee of the Royal Colleges of Physicians, Psychiatrists and General Practitioners. J R Coll Physicians Lond. 1996 Nov-Dec;30(6):497-504. http://www.ncbi.nlm.nih.gov/pubmed/8961200

 

Psychosocial risk factors for chronic fatigue and chronic fatigue syndrome following presumed viral illness: a case-control study

Abstract:

This study investigated psychosocial morbidity, coping styles and health locus of control in 64 cases with and without chronic fatigue identified from a cohort of primary care patients recruited 6 months previously with a presumed, clinically diagnosed viral illness. A significant association between chronic fatigue and psychosocial morbidity, somatic symptoms and escape-avoidance coping styles was shown.

Chronic fatigue cases were significantly more likely to have a past psychiatric history and a current psychiatric diagnosis based on a standardized clinical interview. Twenty-three of the cases fulfilled criteria for chronic fatigue syndrome (CFS). Such cases were significantly more fatigued than those not fulfilling criteria, but had little excess psychiatric disorder.

A principal components analysis provided some evidence for chronic fatigue being separable from general psychosocial morbidity but not from the tendency to have other somatic complaints. Past psychiatric history and psychological distress at the time of the viral illness were risk factors for psychiatric ‘caseness’ 6 months later, while presence of fatigue, psychologising attributional style and sick certification were significant risk factors for CFS. These findings extend a previous questionnaire study of predictors of chronic ‘post-viral’ fatigue.

 

Source: Cope H, Mann A, Pelosi A, David A. Psychosocial risk factors for chronic fatigue and chronic fatigue syndrome following presumed viral illness: a case-control study. Psychol Med. 1996 Nov;26(6):1197-209. http://www.ncbi.nlm.nih.gov/pubmed/8931166

 

Government’s expert group has reached consensus on prognosis of chronic fatigue syndrome

EDITOR,-The chronic fatigue syndrome is a complex problem that has attracted a great deal of controversy. Against this background, doctors working for the Department of Social Security and its executive agencies have to give informed and consistent advice. To help in this process I set up an expert group to give me advice on the subject. A consensus view was sought on prognosis and chronicity, which are critical factors in determining a person’s entitlement to a benefit or pension.

The expert group was drawn from a range of medical disciplines with an interest in the condition, so that it reflected a range of opinions; it first met on 6 March this year. A consensus emerged on most of the topics discussed. A report of the meeting has been published and circulated to to those who have a direct interest in the findings.

You can read the full article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2359054/pdf/bmj00562-0061b.pdf

 

Source: Aylward M. Government’s expert group has reached consensus on prognosis of chronic fatigue syndrome. BMJ. 1996 Oct 5;313(7061):885. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2359054/

 

Is perfectionism associated with fatigue?

Abstract:

Perfectionism has been implicated as a vulnerability factor in the development of chronic unexplained fatigue. In the present study, different components of fatigue and perfectionism were studied in 121 female nurses. They completed a postal questionnaire assessing current (state) and usual (trait) fatigue, and dimensions of personality including six components of perfectionism. Night-shift work was associated with state, but not trait, fatigue. Negative, but not positive, components of perfectionism were associated with mental trait fatigue in particular, but also with physical trait fatigue. In contrast, the associations with positive perfectionism tended to be inverse. Multiple regression modeling indicated that neuroticism as well as negative perfectionism were separately associated with trait fatigue. We suggest that negative aspects of perfectionism may cause maladaptive coping strategies which predispose individuals to fatigue.

 

Source: Magnusson AE, Nias DK, White PD. Is perfectionism associated with fatigue? J Psychosom Res. 1996 Oct;41(4):377-83. http://www.ncbi.nlm.nih.gov/pubmed/8971668

 

Chronic fatigue syndrome. Definition, diagnostic measures and therapeutic possibilities

Abstract:

This article reviews the chronic fatigue syndrome (CFS), a disorder whose etiology is unknown. The diagnostic criteria proposed in 1994 by the CDC and the International Chronic Fatigue Syndrome Study Group are introduced.

In contrast to widespread belief, there are no laboratory tests available to underpin the diagnosis of CFS; the diagnosis is made solely on the basis of clinical criteria. In the differential diagnosis, the exclusion of other conditions that can cause chronic fatigue, such as neuropsychiatric or sleep disorders, is of critical importance.

In this context, the question as to whether CFS is a clinical entity that can be differentiated from psychiatric diagnoses, such as depression, somatoform disorder, or neurasthenia, is discussed. At the moment, there is no specific therapy for CFS. Therefore, therapeutic approaches are limited to symptomatic management of the concomitant sleep disturbances, pain, or psychiatric symptoms, such as depression.

Patients may benefit from cognitive behavioral therapy, as this may help then to identify and exclude factors contributing to and maintaining chronic fatigue. An integrated medical and psychological approach should be adopted, with the aim of preventing significant secondary negative results of the illness, such as interpersonal conflicts or chronic disability.

Comment in: “Chronic fatigue syndrome“. Nervenarzt. 1997

 

Source: Lieb K, Dammann G, Berger M, Bauer J. Chronic fatigue syndrome. Definition, diagnostic measures and therapeutic possibilities. Nervenarzt. 1996 Sep;67(9):711-20. [Article in German] http://www.ncbi.nlm.nih.gov/pubmed/8992368

 

Cognitive idiosyncrasies among children with the chronic fatigue syndrome: anomalies in self-reported activity levels

Abstract:

The possibility that children with the chronic fatigue syndrome (CFS) and their parents tend to display idiosyncratic cognitive processing concerning levels of activity was examined by means of subjective and objective measures of current activity, together with subjective and objective measures of desired and expected future activity.

The degree to which subjective reports of current activity level reflect objectively measured activity level was examined in a group of children with CFS and a healthy control group. All subjects were assessed over a 3-day period by means of ambulatory activity monitoring, and self-reports and parent-reports of current activity level were collected by means of visual analog scales.

Analysis of variance revealed a significant interaction between the method of measurement (objective versus subjective) and the participant group (CFS versus Healthy) with the CFS children and their parents underestimating actual level of activity relative to the healthy group. Desired and expected levels of future activity were also assessed by means of subjective report. Child and parent expected levels of future activity were compared with their desired levels.

Although expected levels of future activity were similar in the two groups, the divergence between expected levels and corresponding desired levels was significantly greater in the CFS group. These results are discussed in terms of idiosyncratic cognitive processes, which are hypothesized to be associated with CFS and which may play a role in the maintenance of the disorder.

 

Source: Fry AM, Martin M. Cognitive idiosyncrasies among children with the chronic fatigue syndrome: anomalies in self-reported activity levels. J Psychosom Res. 1996 Sep;41(3):213-23. http://www.ncbi.nlm.nih.gov/pubmed/8910244

 

Chronic fatigue syndrome

Abstract:

Chronic fatigue syndrome (CFS) is a medically unexplained illness characterized by chronic, disabling fatigue, impaired concentration, muscle pain, and other somatic symptoms. The conceptual difficulties associated with all medically unexplained illnesses contribute to the controversy surrounding CFS, which has centered around whether it is best regarded as a medical or as a psychiatric condition. Clinically, such an approach is not helpful, and current research suggests that both pathophysiologic changes and psychosocial factors are important. Pragmatic management based on a detailed assessment of the individual is outlined.

 

Source: Sharpe M. Chronic fatigue syndrome. Psychiatr Clin North Am. 1996 Sep;19(3):549-73. http://www.ncbi.nlm.nih.gov/pubmed/8856816

 

Psychological symptoms, somatic symptoms, and psychiatric disorder in chronic fatigue and chronic fatigue syndrome: a prospective study in the primary care setting

Abstract:

OBJECTIVE: This study assessed relationships among psychological symptoms, past and current psychiatric disorder, functional impairment, somatic symptoms, chronic fatigue, and chronic fatigue syndrome.

METHOD: A prospective cohort study was followed by a nested case-control study. The subjects, aged 18-45 years, had been in primary care for either clinical viral infections or a range of other problems. Questionnaire measures of fatigue and psychological symptoms were completed by 1,985 subjects 6 months later; 214 subjects with chronic fatigue were then compared with 214 matched subjects without fatigue. Assessments were made with questionnaires, interviews, and medical records of fatigue, somatic symptoms, psychiatric disorder, and functional impairment.

RESULTS: Subjects with chronic fatigue were at greater risk than those without chronic fatigue for current psychiatric disorder assessed by standardized interview (60% versus 19%) or by questionnaire (71% versus 31%). Chronic fatigue subjects were more likely to have received psychotropic medication or experienced psychiatric disorder in the past. There was a trend for previous psychiatric disorder to be associated with comorbid rather than noncomorbid chronic fatigue. Most subjects with chronic fatigue syndrome also had current psychiatric disorder when assessed by interview (75%) or questionnaire (78%). Both the prevalence and incidence of chronic fatigue syndrome were associated with measures of previous psychiatric disorder. The number of symptoms suggested as characteristics of chronic fatigue syndrome was closely related to the total number of somatic symptoms and to measures of psychiatric disorder. Only postexertion malaise, muscle weakness, and myalgia were significantly more likely to be observed in chronic fatigue syndrome than in chronic fatigue.

CONCLUSIONS: Most subjects with chronic fatigue or chronic fatigue syndrome in primary care also meet criteria for a current psychiatric disorder. Both chronic fatigue and chronic fatigue syndrome are associated with previous psychiatric disorder, partly explained by high rates of current psychiatric disorder. The symptoms thought to represent a specific process in chronic fatigue syndrome may be related to the joint experience of somatic and psychological distress.

 

Source: Wessely S, Chalder T, Hirsch S, Wallace P, Wright D. Psychological symptoms, somatic symptoms, and psychiatric disorder in chronic fatigue and chronic fatigue syndrome: a prospective study in the primary care setting. Am J Psychiatry. 1996 Aug;153(8):1050-9. http://www.ncbi.nlm.nih.gov/pubmed/8678174