Category: Psychiatry/Psychology

Chronic fatigue syndrome: prevalence and outcome

This week’s journal contains two papers from multidisciplinary teams that shed light on syndromes of chronic fatigue and so move us towards resolving the often bitter controversy over myalgic encephalomyelitis. A large community survey by Pawlikowska and colleagues provides estimates of the prevalence of the symptom of fatigue,’ operationally defined chronic fatigue syndrome,2 and self declared (possibly self diagnosed) chronic fatigue syndrome in young and middle aged adults in south east England (p 763).1

They found that fatigue was common, occurred as a continuum, and was highly correlated with emotional distress. Most people attributed their fatigue to social or psychological factors. While 02% of the respondents reported that they had chronic fatigue syndrome, as many as 1% of respondents satisfied several of the criteria for the syndrome. As with many illnesses, the cases were found at the severe end of the continuum of fatigue, without any sharp cut off. Associations of self reported chronic fatigue syndrome with female sex and upper social class confirm what has been found in primary care and hospital studies 34 but are less typical in community surveys.’ 6 Previous studies have consistently identified a strong association between emotional morbidity and chronic fatigue syndrome,7 but this “is inevitable given the similarities of the criteria and the measures used to define them.”‘ Interestingly, the closer cases fulfil the definition of chronic fatigue syndrome the stronger the association with emotional morbidity.

Comment in:

Chronic fatigue syndrome. Prevalence study overlooked. [BMJ. 1994]

Chronic fatigue syndrome. …and study them separately. [BMJ. 1994]

Chronic fatigue syndrome. ME Association is honest about prognosis. [BMJ. 1994]

Comment on: Professional and popular views of chronic fatigue syndrome. [BMJ. 1994]

 

Source: Lawrie SM, Pelosi AJ. Chronic fatigue syndrome: prevalence and outcome. BMJ. 1994 Mar 19;308(6931):732-3. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2539646/

You can read the full article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2539646/pdf/bmj00432-0006.pdf

 

Population based study of fatigue and psychological distress

Abstract:

OBJECTIVES: To determine the prevalence of fatigue in the general population and the factors associated with fatigue.

DESIGN: Postal survey.

SETTING: Six general practices in southern England.

SUBJECTS: 31,651 men and women aged 18-45 years registered with the practices.

MAIN OUTCOME MEASURES: Responses to the 12 item general health questionnaire and a fatigue questionnaire which included self reported measures of duration, severity, and causes of fatigue.

RESULTS: 15,283 valid questionnaires were returned, giving a response rate of 48.3%, (64% after adjustment for inaccuracies in the practice registers). 2798 (18.3%) of respondents reported substantial fatigue lasting six months or longer. Fatigue and psychological morbidity were moderately correlated (r = 0.62). Women were more likely to complain of fatigue than men, even after adjustment for psychological distress. The commonest cited reasons for fatigue were psychosocial (40% of patients). Of 2798 patients with excessive tiredness, only 38 (1.4%) attributed this to the chronic fatigue syndrome.

CONCLUSION: Fatigue is distributed as a continuous variable in the community and is closely associated with psychological morbidity.

Comment in:

Patients with a self diagnosis of myalgic encephalomyelitis. [BMJ. 1995]

Twists in the tale of impossible means. The reviewer shows that the gremlins might have attacked on several fronts. [BMJ. 2000]

Twists in the tale of impossible means. In which a copy of the original manuscript is found safe in Norway. [BMJ. 2000]

Fatigue and psychological distress. Statistics are improbable. [BMJ. 2000]

 

Source: Pawlikowska T, Chalder T, Hirsch SR, Wallace P, Wright DJ, Wessely SC. Population based study of fatigue and psychological distress. BMJ. 1994 Mar 19;308(6931):763-6. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2539651/

You can read the full article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2539651/pdf/bmj00432-0041.pdf

 

Measuring the functional impact of fatigue: initial validation of the fatigue impact scale

Abstract:

The fatigue impact scale (FIS) was developed to improve our understanding of the effects of fatigue on quality of life. The FIS examines patients’ perceptions of the functional limitations that fatigue has caused over the past month. FIS items reflect perceived impact on cognitive, physical, and psychosocial functioning.

This study compared 145 patients referred for investigation of chronic fatigue (ChF) with 105 patients with multiple sclerosis (MS) and 34 patients with mild hypertension (HT). Internal consistency for the FIS and its three subscales was > .87 for all analyses. Fatigue impact was highest for the ChF group although the MS group’s reported fatigue also exceeded that of the HT group. Discriminant function analysis correctly classified 80.0% of the ChF group and 78.1% of the MS group when these groups were compared.

This initial validation study indicates that the FIS has considerable merit as a measure of patient’s attribution of functional limitations to symptoms of fatigue.

 

Source: Fisk JD, Ritvo PG, Ross L, Haase DA, Marrie TJ, Schlech. Measuring the functional impact of fatigue: initial validation of the fatigue impact scale. Clin Infect Dis. 1994 Jan;18 Suppl 1:S79-83. http://www.ncbi.nlm.nih.gov/pubmed/8148458

 

Psychosocial correlates of illness burden in chronic fatigue syndrome

Abstract:

We related reported physical symptoms, cognitive appraisals (e.g., negative style of thinking), and coping strategies (e.g., denial/disengagement strategies) with illness burden across several functional domains separately in subsets of chronic fatigue syndrome (CFS) patients with (n = 26) and without (n = 39) concurrently diagnosed major depressive disorder (MDD).

In regard to cognitive appraisal measures, automatic thoughts and dysfunctional attitudes were strongly associated with a higher illness burden, as indicated in sickness impact profile (SIP) scores. Active-involvement coping strategies measured on COPE scales (active coping, planning, and positive reinterpretation and growth) were not associated with SIP scores, while other coping strategies (mental disengagement, behavioral disengagement, and denial) were positively correlated with psychosocial and physical SIP scales, especially those pertaining to interpersonal life-style arenas.

After we accounted for the number of different CFS-specific physical complaints reported and DSM-III-R depression diagnosis status, cognitive appraisals and coping strategies predicted a substantial proportion of the variance in the severity of illness burden. For the most part, the magnitude of these relationships between our predictor model variables and illness burden severity was similar in the MDD and non-MDD subgroups.

 

Source: Antoni MH, Brickman A, Lutgendorf S, Klimas N, Imia-Fins A, Ironson G, Quillian R, Miguez MJ, van Riel F, Morgan R, et al. Psychosocial correlates of illness burden in chronic fatigue syndrome. Clin Infect Dis. 1994 Jan;18 Suppl 1:S73-8. http://www.ncbi.nlm.nih.gov/pubmed/8148457

 

A comparison of cognitive behavioral treatment for chronic fatigue syndrome and primary depression

Abstract:

To evaluate the effect of cognitive behavioral intervention on chronic fatigue syndrome (CFS), we studied three patient groups: a CFS-treatment group (n = 22), a primary depression-treatment group (n = 20), and a no-treatment control group of subjects with CFS (n = 22). For the CFS-treatment group, a trend toward reduced depression-symptom scores was noted, but there were no significant changes in stress-related symptoms or fatigue severity.

For the most depressed treated subjects with CFS, significant score reductions were observed in measures of depression, stress, fatigue severity, and fatigue-related thinking. In the depression group, significant reductions in depression, stress, and fatigue severity scores were found. No significant changes in any measure were observed in the CFS control group.

A new fatigue-related cognitions scale, developed to assess cognitive and emotional reactions to fatigue, showed a significant reduction in such reactions in the CFS-treatment group, a finding suggesting that depression in this group was mediated by maladaptive thinking. The results suggest that a subset of CFS patients with cognition-related depressive symptomatology may respond to short-term behavioral intervention.

Comment in: Cognitive behavioral therapy for chronic fatigue syndrome. [Clin Infect Dis. 1995]

 

Source: Friedberg F, Krupp LB. A comparison of cognitive behavioral treatment for chronic fatigue syndrome and primary depression. Clin Infect Dis. 1994 Jan;18 Suppl 1:S105-10. http://www.ncbi.nlm.nih.gov/pubmed/8148435

 

Illness behaviour of patients with chronic fatigue syndrome

Abstract:

The study examines the illness behaviour of patients with Chronic Fatigue Syndrome (CFS). The Illness Behaviour Questionnaire (IBQ), the twenty-eight version of the General Health Questionnaire (GHQ-28), and the Beck Depression Inventory (BDI) were administered to forty patients with a diagnosis of CFS. The results revealed that CFS patients in comparison with general practice patients, scored significantly higher on the IBQ sub-scales of General Hypochonriasis, t(188) = 5.2, p < 0.001 and Disease Conviction, t(188) = 13.28, p < 0.001 but lower on the Psychological/Somatic sub-scale, t(188) = -5.88, p < 0.001. The CFS and psychiatric patients did not differ significantly on the general hypochondriasis sub-scale. Results of the GHQ-28 revealed 66.7% of the CFS patients scored above the cut-off for psychiatric morbidity. In comparison to a previous study of CFS patients [1], the current findings indicate a significantly higher score on general hypochondriasis. The implications of these findings are discussed.

 

Source: Schweitzer R, Robertson DL, Kelly B, Whiting J. Illness behaviour of patients with chronic fatigue syndrome. J Psychosom Res. 1994 Jan;38(1):41-9. http://www.ncbi.nlm.nih.gov/pubmed/8126689

 

Chronic Fatigue Syndrome: New hope from psychoneuroimmunology and community psychology

Abstract:

Chronic Fatigue Syndrome is a baffling disease potentially affecting millions of Americans. New insights and developments in the fields of psychoneuroimmunology and community psychology may offer promising new leads in helping people recover from this debilitating illness. The experiences of a CFS-afflicted person in struggling to overcome this disease are used to illustrate the usefulness to recovery of concepts in the fields of psychoneuroimmunology, community psychology, and primary prevention.

 

Source: Jason LA. Chronic Fatigue Syndrome: New hope from psychoneuroimmunology and community psychology. J Prim Prev. 1993 Sep;14(1):51-71. doi: 10.1007/BF01324655. http://www.ncbi.nlm.nih.gov/pubmed/24258626

 

Ways of coping with chronic fatigue syndrome: development of an illness management questionnaire

Abstract:

Chronic fatigue syndrome (CFS) is a disorder of uncertain aetiology, and there is uncertainty also about the appropriate way in which patients should manage the illness. An illness management questionnaire (IMQ) was designed to assess coping in CFS. This was completed by 207 patients, in parallel with the COPE scales (a general measure of coping that can be applied situationally), and measures of functional impairment, anxiety and depression.

The IMQ yielded four factors: maintaining activity, accommodating to the illness, focusing on symptoms and information-seeking. Scales based upon these factors together predicted 26, 27 and 22% of the variance in functional impairment, anxiety and depression, respectively, and each scale had significant relationships with relevant scales of the COPE, supporting the interpretation of the factors. It is suggested that the IMQ may be employed to relate ways of coping to outcomes in CFS, and to assess coping as a mediator of change in cognitive-behavioural interventions.

 

Source: Ray C, Weir W, Stewart D, Miller P, Hyde G. Ways of coping with chronic fatigue syndrome: development of an illness management questionnaire. Soc Sci Med. 1993 Aug;37(3):385-91. http://www.ncbi.nlm.nih.gov/pubmed/8356486

 

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)

 

Immunologic and psychologic therapy for patients with chronic fatigue syndrome: a double-blind, placebo-controlled trial

Abstract:

PURPOSE: To evaluate the potential benefit of immunologic therapy with dialyzable leukocyte extract and psychologic treatment in the form of cognitive-behavioral therapy (CBT) in patients with chronic fatigue syndrome (CFS).

PATIENTS AND METHODS: Immunologic and psychologic treatments were administered to 90 adult patients who fulfilled diagnostic criteria for CFS in a double-blind, randomized, and placebo-controlled study. A four-cell trial design allowed the assessment of benefit from immunologic and psychologic treatment individually or in combination. Outcome was evaluated by measurement of global well-being (visual analogue scales), physical capacity (standardized diaries of daily activities), functional status (Karnofsky performance scale), and psychologic morbidity (Profile of Mood States questionnaire), and cell-mediated immunity was evaluated by peripheral blood T-cell subset analysis and delayed-type hypersensitivity skin testing.

RESULTS: Neither dialyzable leukocyte extract nor CBT (alone or in combination) provided greater benefit than the nonspecific treatment regimens.

CONCLUSIONS: In this study, patients with CFS did not demonstrate a specific response to immunologic and/or psychologic therapy. The improvement recorded in the group as a whole may reflect both nonspecific treatment effects and a propensity to remission in the natural history of this disorder.

Comment in:

Treatment for chronic fatigue syndrome. [Am J Med. 1994]

Cognitive behavior therapy for chronic fatigue syndrome. [Am J Med. 1995]

Cognitive behavior therapy for chronic fatigue syndrome. [Am J Med. 1995]

 

Source: Lloyd AR, Hickie I, Brockman A, Hickie C, Wilson A, Dwyer J, Wakefield D. Immunologic and psychologic therapy for patients with chronic fatigue syndrome: a double-blind, placebo-controlled trial. Am J Med. 1993 Feb;94(2):197-203. http://www.ncbi.nlm.nih.gov/pubmed/8430715