Category: Psychiatry/Psychology

The effect of social adversity on the fatigue syndrome, psychiatric disorders and physical recovery, following glandular fever

Abstract:

Two hundred and fifty patients attending primary care with glandular fever or an upper respiratory tract infection were studied prospectively up to 6 months after onset. Of these patients 228 were interviewed with the Life Events and Difficulties Schedule and the Schedule for Affective Disorders and Schzophrenia, giving Research Diagnostic Criteria for psychiatric disorders.

The experience of severe social adversity (provoking agents) had a significant association with psychiatric disorder at 2 months (odds ratio = 5.3) and 6 months (odds ratio = 5.8) after onset of infection. This association was especially significant for depressive illness (odds ratio = 9.1 at 2 months and 11.9 at 6 months).

In contrast, social adversity had little association with the development of the post-infectious fatigue syndrome, or delayed physical recovery. Social adversity may be an important maintaining factor for psychiatric disorders, especially depressive illness, following acute infections.

 

Source: Bruce-Jones WD, White PD, Thomas JM, Clare AW. The effect of social adversity on the fatigue syndrome, psychiatric disorders and physical recovery, following glandular fever. Psychol Med. 1994 Aug;24(3):651-9. http://www.ncbi.nlm.nih.gov/pubmed/7991747

 

Cognitive functioning and depression in patients with chronic fatigue syndrome and multiple sclerosis

Abstract:

OBJECTIVE: To assess cognitive function in patients with chronic fatigue syndrome (CFS) and multiple sclerosis (MS) and to evaluate the role of depressive symptoms in cognitive performance.

DESIGN: Case-control. All subjects were given a neuropsychological battery, self-report measures of depression and fatigue, and a global cognitive impairment rating by a neuropsychologist “blinded” to clinical diagnosis. Patients with MS and CFS were additionally evaluated with a Structured Clinical Interview for DSM-III-R (Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition) disorders.

SETTING: Institutional and private neurological practices and the community at large.

PATIENTS: Twenty patients with CFS diagnosed in accord with the Centers for Disease Control and Prevention-revised criteria who had cognitive complaints; 20 patients with clinically definite MS who were ambulatory and were matched for fatigue severity, age, and education to CFS subjects; and 20 age- and education-matched healthy controls.

RESULTS: Patients with CFS had significantly elevated depression symptoms compared with patients with MS and healthy controls (P < .001) and had a greater lifetime prevalence of depression and dysthymia compared with MS subjects. Patients with CFS, relative to controls, performed more poorly on the Digit Symbol subtest (P = .023) and showed a trend for poorer performance on logical memory (P = .087). Patients with MS compared with controls had more widespread differences of greater magnitude on the Digit Span (P < .004) and Digit Symbol (P < .001), Trail Making parts A (P = .022) and B (P = .037), and Controlled Oral Word Association (P = .043) tests. Patients with MS also showed a trend of poorer performance on the Booklet Category Test (P = .089). When patients with CFS and MS were directly compared, MS subjects had lower scores on all measures, but the differences reached significance only for the Digit Span measure of attention (P = .035).

CONCLUSIONS: Patients with CFS compared with MS have more depressive symptoms but less cognitive impairment. Relative to controls, a subset of CFS subjects did poorly on tests of visuomotor search and on the logical memory measure of the Wechsler Memory Scale-revised. Poor performance of logical memory in CFS appears to be related to depression, while visuomotor deficits in CFS are unrelated. Cognitive deficits in patients with MS are more widespread compared with those in patients with CFS and are independent of depressive symptoms.

 

Source: Krupp LB, Sliwinski M, Masur DM, Friedberg F, Coyle PK. Cognitive functioning and depression in patients with chronic fatigue syndrome and multiple sclerosis. Arch Neurol. 1994 Jul;51(7):705-10. http://www.ncbi.nlm.nih.gov/pubmed/8018045

 

Dimensional assessment of chronic fatigue syndrome

Abstract:

The absence of laboratory tests and clear criteria to identify homogeneous (sub)groups in patients presenting with unexplained fatigue, and to assess clinical status and disability in these patients, calls for further assessment methods. In the present study, a multi-dimensional approach to the assessment of chronic fatigue syndrome (CFS) is evaluated.

Two-hundred and ninety-eight patients with CFS completed a set of postal questionnaires that assessed the behavioural, emotional, social, and cognitive aspects of CFS. By means of statistical analyses nine relatively independent dimensions of CFS were identified along which CFS-assessment and CFS-research can be directed.

These dimensions were named: psychological well-being, functional impairment in daily life, sleep disturbances, avoidance of physical activity, neuropsychological impairment, causal attributions related to the complaints, social functioning, self-efficacy expectations, and subjective experience of the personal situation. A description of the study sample on these dimensions is presented.

 

Source: Vercoulen JH, Swanink CM, Fennis JF, Galama JM, van der Meer JW, Bleijenberg G. Dimensional assessment of chronic fatigue syndrome. J Psychosom Res. 1994 Jul;38(5):383-92. http://www.ncbi.nlm.nih.gov/pubmed/7965927

 

Neuropsychology and psychology of MCS

Abstract:

Neurological symptoms are frequently reported by patients with multiple chemical sensitivities (MCS). Methods to compare the psychiatric, personality, and neuropsychological function of patients with MCS, chronic fatigue syndrome (CFS), and normal controls are described. Increased rates of Axis I psychiatric diagnoses are observed in the literature for MCS and CFS subjects relative to controls.

Findings on the MMPI-2 and the Toronto Alexithymia Scale reveal profiles consistent with the tendency to report somatic rather than emotional symptoms in response to stress. However, many of the reported somatic symptoms also coincide with those found in neurologic disorders. The overall neuropsychological profile for MCS subjects does not reflect cognitive impairment.

Relative to normal controls, the only difference in neuropsychological performance observed is reduced recognition of nontarget designs on a visual memory task. More fruitful areas for future psychological research will include measurement of the interaction between behavioral response styles and attentional processes in cognition, as well as observations under controlled challenge conditions.

 

Source: Fiedler N, Kipen H, Deluca J, Kelly-McNeil K, Natelson B. Neuropsychology and psychology of MCS. Toxicol Ind Health. 1994 Jul-Oct;10(4-5):545-54. http://www.ncbi.nlm.nih.gov/pubmed/7778113

 

Neuropsychiatric status of patients with chronic fatigue syndrome: an overview

Abstract:

Chronic fatigue syndrome (CFS) is an illness that results in debilitating fatigue as well as rheumatological, infectious, and neuropsychiatric symptoms. The present paper is a brief overview of the neuropsychological and psychiatric research on CFS. Studies from our laboratory contrasting CFS with patients with multiple sclerosis, depression, and healthy controls are detailed. Our hypothesis of neuropsychological impairments in CFS is discussed.

 

Source: Deluca J, Johnson SK, Natelson BH. Neuropsychiatric status of patients with chronic fatigue syndrome: an overview. Toxicol Ind Health. 1994 Jul-Oct;10(4-5):513-22. http://www.ncbi.nlm.nih.gov/pubmed/7778111

 

Chronic fatigue syndrome: what’s in a name?

Comment on: Deeper diagnosis. Multiple determinants of an illness experience. [Can Fam Physician. 1993]

 

I n the article “Deeper Diagnosis,”‘ it is evident that the various physicians involved had gone to great lengths to diagnose the patient’s condition. What is also apparent is the tendency of traditional medicine to “psychologize” any medical presentation that baffles physicians.

Chronic fatigue syndrome was considered during one of the emergency room visits that the patient made. This patient has postviral fatigue syndrome (as researchers in Glasgow, Scotland, call it), chronic fatigue syndrome (as Americans call it), chronic fatigue immune dysfunction syndrome (as patients in North America call it), and benign myalgic encephalomyelitis (as the English and sometimes Canadians call it). Fatigue does not have to be the predominant symptom of postviral fatigue syndrome, and the symptoms can include those of the patient in the article and much more.

You can read the rest of this article, along with the authors’ reply, here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2380224/pdf/canfamphys00100-0022a.pdf

 

Source: Trevor A. Chronic fatigue syndrome: what’s in a name? Can Fam Physician. 1994 Jun;40:1088-9. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2380224/

 

Chronic fatigue syndrome. Prevalence study overlooked

Comment on: Chronic fatigue syndrome: prevalence and outcome. [BMJ. 1994]

 

Editor,-It is sad that, in an issue in which Tony Delamothe considers biased reporting of the chronic fatigue syndrome, S M Lawrie and A J Pelosi’s editorial on the subject should be so one sided. The editorial’s title mentions the prevalence of the chronic fatigue syndrome, but the editorial fails to mention the most complete British study. In this study all general practices in two health boards were circulated with a questionnaire. There was a 91% response rate, with most respondents (71%) accepting the existence of the chronic fatigue syndrome when a strict definition was used. The doctors reported a prevalence among their patients of 1-3/1000 patients (range 0-3-2/1000 for the 10 areas surveyed). The higher prevalences were found in more populated areas.

You can read the rest of this comment here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2540208/pdf/bmj00440-0055a.pdf

 

Source: Ho-Yen DO, Shanks M. Chronic fatigue syndrome. Prevalence study overlooked. BMJ. 1994 May 14;308(6939):1299. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2540208/

 

Chronic fatigue syndrome. Role of psychological factors overemphasised

Comment in: Chronic fatigue syndrome and myalgic encephalomyelitis. [BMJ. 1994]

Comment on: Longitudinal study of outcome of chronic fatigue syndrome. [BMJ. 1994]

 

Editor,-In concluding that psychological factors are more important than immunological ones in determining the long term outcome of myalgic encephalomyelitis or the chronic fatigue syndrome Andrew Wilson and colleagues seem overconfident of the validity of their findings. Although the use of self rated measures of outcome is necessary, the validity of the investigators’ treatment of such data is questionable. For example, the five point self rated global illness outcome was dichotomised such that an original response of “not improved at all” was recorded to “worsened”-a decision the investigators fail to justify. It is also dubious whether patients’ recall of their own premorbid psychological state is accurate, given that the average onset was 9 years before recall and the finding that memory of an event is affected by subsequent events.

You can read the rest of this comment here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2540179/pdf/bmj00440-0053a.pdf

 

Source: Blatch C, Blatt T. Chronic fatigue syndrome. Role of psychological factors overemphasised. BMJ. 1994 May 14;308(6939):1297. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2540179/

 

Chronic fatigue syndrome: a follow up study

Abstract:

Forty-six of 47 patients diagnosed as having chronic fatigue and offered treatment four years previously were followed up. Twenty-nine patients were interviewed, three patients refused an interview, and information on the remaining 14 was obtained from their general practitioners. All the instruments used at interview had been used in the initial study. The long-term prognosis for patients with chronic fatigue syndrome who have initially responded to treatment is good. Spontaneous recovery in those who declined or who did not benefit from treatment is unlikely. Patients who continue to fulfil the criteria for chronic fatigue syndrome four years after they were initially diagnosed are likely to have had more somatic disorders, to have been more fatigued, and to have had a previous psychiatric history when they were initially assessed.

Comment in: Chronic fatigue syndrome. [J Neurol Neurosurg Psychiatry. 1995]

 

Source: Bonner D, Ron M, Chalder T, Butler S, Wessely S. Chronic fatigue syndrome: a follow up study. J Neurol Neurosurg Psychiatry. 1994 May;57(5):617-21. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1072927/

You can read the full article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1072927/pdf/jnnpsyc00035-0089.pdf

 

Chronic fatigue syndrome and psychiatric diseases

Abstract:

The chronic fatigue syndrome consists of a combination of non-specific symptoms. Some believe that the CFS is subcategory of major depression, because the symptoms are similar to those of major depression. We believe that the CFS is quite different from major depression or neurotic depression, since the CFS has no lack of initiative and effort, no inhibition which is seen in endogenous depression, and sharp fluctuations in general fatigue, anxiety, and various persisting somatic symptoms, such as, malaise and mild fever. CFS seems to be similar to the neurasthenia. It is harmful, at least, in aetiology and treatment, to neglect the diagnosis of the CFS.

 

Source: Matsuno T, Hikita K, Matsuo T. Chronic fatigue syndrome and psychiatric diseases. Nihon Rinsho. 1994 May;52(5):1339-44. [Article in Japanese] http://www.ncbi.nlm.nih.gov/pubmed/8007411