Category: Psychiatry/Psychology

Chronic fatigue syndrome

Comment on: Chronic fatigue syndrome. [J Neurol Neurosurg Psychiatry. 1991]

 

As neurologists in a country where the chronic fatigue syndrome (CFS) has almost no recognized official existence, we often feel bewildered by the papers on the subject we read in the Anglo-Saxon literature. We wonder whether the clinical experience of some of their authors is so different from ours that they do not consider that their approach may result in a disservice to their patients. The JNNP has followed a sensitive line culminating in Wessely’s excellent editorial. We still, however, feel that his kid-glove handling of the subject reflects the controversy that surrounds it in the UK.

Avoiding the futile organic versus functional debate, in our neurology department we refer to many of the problems we see in our practice as the “chronic vigilance syndromes”: specific patterns of enhanced attention centred on particular bodily structures and functions. Naturally, the commonest in a neurologist’s outpatient clinic are the “cephalic vigilance syndromes” in their two main forms: the painful, with its several varieties of chronic headaches, and the operational one with its subjective unsteadiness, concentration problems and various odd turns. “Thoracic vigilance” patients are often referred to cardiologists or pneumologists but a fair number also come to us, especially if they have hyperventilation symptoms such as dizziness and paraesthesiae. Among the different types of patients with fatigue we are also familiar with the occasional “neuro-muscular vigilance” patient whose symptoms parallel your CFS cases. We have the noncontrolled impression that in our environment such patients often have a premorbid preoccupation with their locomotor system.

You can read the rest of this comment here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC488951/pdf/jnnpsyc00486-0096a.pdf

 

Source: Digon A, Goicoechea A, Moraza MJ. Chronic fatigue syndrome. J Neurol Neurosurg Psychiatry. 1992 Jan;55(1):85. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC488951/

 

Chronic fatigue syndrome and women: can therapy help?

Abstract:

This article presents current research on chronic fatigue syndrome, which currently afflicts mostly females between the ages of 25 and 55. Because depression is a common symptom of chronic fatigue syndrome, mental health practitioners are often involved with the victims and must formulate an appropriate treatment strategy that considers the physiological, intrapsychic, interpersonal, and environmental aspects of the client. This article includes case material focusing on a woman who was medically diagnosed with the Epstein-Barr virus and was in psychotherapy with the author. The difficulty of managing the interplay of the real health problems and the emotional issues presented by the client is highlighted.

Comment in:

“Chronic fatigue syndrome and women: can therapy help?”. [Soc Work. 1992]

“Chronic fatigue syndrome and women: can therapy help?”. [Soc Work. 1992]

“Chronic fatigue syndrome and women: can therapy help?”. [Soc Work. 1992]

Source: Burke SG. Chronic fatigue syndrome and women: can therapy help? Soc Work. 1992 Jan;37(1):35-9.  http://www.ncbi.nlm.nih.gov/pubmed/1542805

 

Chronic fatigue syndromes in clinical practice

Abstract:

Chronic fatigue is a common and difficult challenge in clinical practice. The majority of patients with this chief complaint have treatable mood or anxiety disorders, complicated by a tendency toward somatization. A minority of patients suffer from sleep disorders, endocrinologic abnormalities, or chronic inflammatory conditions. Prolonged recovery after viral infections is only rarely the cause of chronic fatigue. Specific pharmacologic interventions and cognitive-behavioral therapy are effective in an environment that is sensitive to the patient’s interpretation of symptoms and avoids unproven medical investigations and therapies.

 

Source: Manu P, Lane TJ, Matthews DA. Chronic fatigue syndromes in clinical practice. Psychother Psychosom. 1992;58(2):60-8. http://www.ncbi.nlm.nih.gov/pubmed/1484921

 

The pathophysiology of chronic fatigue syndrome: confirmations, contradictions, and conjectures

Abstract:

OBJECTIVE: To examine published data regarding patient cohorts with the recently defined chronic fatigue syndrome.

METHOD: Review of thirty-two peer-assessed research publications that included full disclosure of the methodology employed; classification of the findings as confirmed, contradictory, or non-duplicated.

RESULTS: Research studies have confirmed that the majority of patients with the chronic fatigue syndrome: 1) are white middle-aged women, 2) have a high prevalence of current major depression and somatization disorder, 3) have abnormal personality traits, 4) believe that their fatigue has a physical cause, and 5) show mild abnormalities of humoral immunity. Contradictory data have been presented with regard to: 1) the time of onset of depressive disorders, 2) the etiologic role of herpetic and enteroviral infections, 3) the presence of abnormal cellular immunity, and 4) the clinical utility of immunoglobulin therapy. Non-duplicated research has indicated 1) hypothalamic-pituitary-adrenal axis dysfunction, 2) abnormalities on magnetic resonance images of the brain, 3) altered cytokine production, and 4) the possibility of retroviral infection.

CONCLUSIONS: As presently defined, the chronic fatigue syndrome has many of the clinical and biological features associated with depressive and somatoform disorders. A specific etiologic role for infections or immune dysfunction has not been confirmed.

 

Source: Manu P, Lane TJ, Matthews DA. The pathophysiology of chronic fatigue syndrome: confirmations, contradictions, and conjectures. Int J Psychiatry Med. 1992;22(4):397-408. http://www.ncbi.nlm.nih.gov/pubmed/1338059

 

Neurasthenia and chronic fatigue syndrome: the role of culture in the making of a diagnosis

Abstract:

Chronic fatigue syndrome is an increasingly popular diagnosis consisting of multiple psychiatric and somatic symptoms. It bears a striking resemblance to the nineteenth-century diagnosis of . Both disorders arose during periods characterized by a preoccupation with commerce and material success and major changes in the role of women. They illustrate the role of culture in the development of a new diagnosis that emphasizes a “medical” rather than “psychiatric” etiology. The authors argue that chronic fatigue syndrome will meet the same fate as neurasthenia–a decline in social value as it is demonstrated that the majority of its sufferers are experiencing primary psychiatric disorders or psychophysiological reactions and that the disorder is often a culturally sanctioned form of illness behavior.

Comment in:

Taking chronic fatigue syndrome seriously. [Am J Psychiatry. 1992]

Taking chronic fatigue syndrome seriously. [Am J Psychiatry. 1992]

Taking chronic fatigue syndrome seriously. [Am J Psychiatry. 1992]

Taking chronic fatigue syndrome seriously. [Am J Psychiatry. 1992]

Taking chronic fatigue syndrome seriously. [Am J Psychiatry. 1992]

Taking chronic fatigue syndrome seriously. [Am J Psychiatry. 1992]

Taking chronic fatigue syndrome seriously. [Am J Psychiatry. 1992]

 

Source: Abbey SE, Garfinkel PE. Neurasthenia and chronic fatigue syndrome: the role of culture in the making of a diagnosis. Am J Psychiatry. 1991 Dec;148(12):1638-46. http://www.ncbi.nlm.nih.gov/pubmed/1957925

 

Chronic fatigue syndrome

Comment on:

Antidepressant therapy in the chronic fatigue syndrome. [Br J Gen Pract. 1991]

General practitioners’ experience of the chronic fatigue syndrome. [Br J Gen Pract. 1991]

 

Sir, I read with interest the papers on the chronic fatigue syndrome (August Journal, p.324, 339). This syndrome has become an important diagnosis in both general practice and psychiatry. With the awareness of such a diagnostic entity, more patients are being recognized and managed (although the aetiology still remains unknown).

Depression as an inherent feature of chronic fatigue syndrome remains a controversial issue and great care is needed in treating these patients as ‘depressed’. Subjectively, many patients with the chronic fatigue syndrome describe their mood state as depressed, probably because of lack of any other socially approved metaphor. For a practitioner, however, it is important to make an objective assessment about the significance of this expression in terms of the range and reactivity of affect and the disproportion of depressive presentation in the context of the patient’s life situation and experiences. If depression is significant, the diagnosis of chronic fatigue syndrome becomes secondary to that of depressive disorder as fatigue may be a feature of depression. However, if chronic fatigue syndrome remains the primary diagnosis, one must remember that antidepressant drugs are neither euphoriants nor stimulants and that there is no empirical evidence for the benefit of antidepressant treatment in this syndrome, although there is a recommendation for it to be tried as an alternatp mode of treatment.

 

Source: Arya DK. Chronic fatigue syndrome. Br J Gen Pract. 1991 Nov;41(352):480. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1371803/

 

Seasonal affective disorder presenting as chronic fatigue syndrome

Abstract:

Although operational criteria have been recently proposed to better define chronic fatigue syndrome (CFS), it remains a controversial diagnosis. There are many overlapping symptoms between CFS and major depression. The author presents two patients with seasonal affective disorder, who responded to phototherapy and had previously been diagnosed as CFS. Because of the consequences of treatment, seasonal and non seasonal depression need to be ruled out in patients with chronic fatigue symptoms.

 

Source: Lam RW. Seasonal affective disorder presenting as chronic fatigue syndrome. Can J Psychiatry. 1991 Nov;36(9):680-2. http://www.ncbi.nlm.nih.gov/pubmed/1773405

 

Intense fatigue in humans. Psychosocial and cultural aspects

Abstract:

A differentiation between the normal sensation of tiredness and the symptom “fatigue” is often difficult. Both are influenced by cultural, social, psychological and biological factors, which can lead–interactively–to symptom formation. Psychiatric disorders frequently associated with fatigue are all forms of depression, somatization and anxiety disorders, chronic pain states and drug abuse among many others. In at least 2/3 of patients with the fashionable chronic fatigue syndrome–formerly called neurasthenia–a psychiatric diagnosis can be made, most of them also suffer from many symptoms attributes to the autonomous nervous system. The clinical approach should be cautious avoiding diagnostic and therapeutic overaction and therapy should emerge from a diagnosis properly assessed.

 

Source: Radvila A. Intense fatigue in humans. Psychosocial and cultural aspects. Ther Umsch. 1991 Nov;48(11):756-61. [Article in German] http://www.ncbi.nlm.nih.gov/pubmed/1754973

 

Biopsychosocial aspects of chronic fatigue syndrome (myalgic encephalomyelitis)

Abstract:

Fifteen patients, with a primary complaint of chronic fatigue, were referred to a physician by their general practitioners. Psychological distress, measured by simple psychiatric rating scales was common, but specific psychiatric diagnoses, derived from a comprehensive diagnostic interview, occurred less frequently.

One questionnaire (Montgomery-Asberg depression rating scale) found emotional distress in 93%, but the diagnostic instrument (Present State Examination) suggested depressive syndromes in only two patients (13%). There were significant occupational difficulties in 87%. No consistently abnormal indices of biochemical or immunological function were found, nor evidence of acute or chronic infection.

Chronic fatigue syndrome (CFS) is associated with physical, psychological and social distress. The illness cannot be defined using just one of these dimensions. Such a unilateral approach has resulted in unnecessary controversy over the nature of the ‘real’ core of CFS. A problem-oriented approach, recognising the multi-factorial and overlapping cause and effect issues in CFS, may be of more benefit to patients.

 

Source: Yeomans JD, Conway SP. Biopsychosocial aspects of chronic fatigue syndrome (myalgic encephalomyelitis). J Infect. 1991 Nov;23(3):263-9. http://www.ncbi.nlm.nih.gov/pubmed/1753134

 

Evaluation and management of patients with chronic fatigue

Abstract:

Chronic fatigue is a common and disabling problem in primary care practice. The differential diagnosis of chronic fatigue is extensive and includes medical disorders, altered physiologic states (eg, pregnancy, exertion), psychiatric disorders, lifestyle derangements, drugs, and controversial entities (eg, chronic candidiasis, food allergies, environmental illness, and chronic fatigue syndrome). The most common diagnoses are psychiatric disorders, including mood, anxiety, and somatoform disorders.

A comprehensive approach to diagnosis and management is necessary, including structured psychiatric interviewing, functional assessment, and elicitation of the patient’s diagnostic beliefs. Patients often believe they are suffering from an organic medical disorder (eg, viral or immunologic) and resist psychiatric labelling of their symptoms and referral to mental health practitioners. Establishing and maintaining rapport, having a flexible approach, and demonstrating a personal concern for the patient is essential. Drug therapy for specific psychiatric and medical illnesses and cognitive-behavioral approaches for enhancing coping mechanisms are effective.

 

Source: Matthews DA, Manu P, Lane TJ. Evaluation and management of patients with chronic fatigue. Am J Med Sci. 1991 Nov;302(5):269-77. http://www.ncbi.nlm.nih.gov/pubmed/1750445