A comparison of patients with chronic fatigue syndrome in two “ideologically” contrasting clinics

Abstract:

Aim of the present study was to compare chronic fatigue syndrome (CFS) patients, attending 2 “ideologically” contrasting clinics for CFS, on various patient and illness characteristics. Fifty-nine CFS patients of each clinic, located in Leuven and Brussels (Belgium), participated. Patients did not differ with regard to age, levels of fatigue, psychopathology, and self-efficacy. However, patients from the psychosocially-oriented clinic had a lower level of education, reported more progressive illness onset, and attributed their illness more to psychological causes.

Patients in the biologically-oriented clinic reported more pain, and showed higher levels of social functioning, motivation and vitality, as well as fewer limitations related to emotional problems. It is concluded that CFS patients attending the 2 clinics could not be distinguished along dualistic biological/psychosocial lines, but those reporting sudden illness onset and making somatic attributions were more likely to be represented in the biologically-oriented clinic.

 

Source: Van Houdenhove B, Van Hoof E, Becq K, Kempke S, Luyten P, De Meirleir K.A comparison of patients with chronic fatigue syndrome in two “ideologically” contrasting clinics. J Nerv Ment Dis. 2009 May;197(5):348-53. doi: 10.1097/NMD.0b013e3181a2081f. https://www.ncbi.nlm.nih.gov/pubmed/19440108

 

Chronic fatigue syndrome and mitochondrial dysfunction

Abstract:

This study aims to improve the health of patients suffering from chronic fatigue syndrome (CFS) by interventions based on the biochemistry of the illness, specifically the function of mitochondria in producing ATP (adenosine triphosphate), the energy currency for all body functions, and recycling ADP (adenosine diphosphate) to replenish the ATP supply as needed.

Patients attending a private medical practice specializing in CFS were diagnosed using the Centers for Disease Control criteria. In consultation with each patient, an integer on the Bell Ability Scale was assigned, and a blood sample was taken for the “ATP profile” test, designed for CFS and other fatigue conditions. Each test produced 5 numerical factors which describe the availability of ATP in neutrophils, the fraction complexed with magnesium, the efficiency of oxidative phosphorylation, and the transfer efficiencies of ADP into the mitochondria and ATP into the cytosol where the energy is used. With the consent of each of 71 patients and 53 normal, healthy controls the 5 factors have been collated and compared with the Bell Ability Scale.

The individual numerical factors show that patients have different combinations of biochemical lesions. When the factors are combined, a remarkable correlation is observed between the degree of mitochondrial dysfunction and the severity of illness (P<0.001). Only 1 of the 71 patients overlaps the normal region.

The “ATP profile” test is a powerful diagnostic tool and can differentiate patients who have fatigue and other symptoms as a result of energy wastage by stress and psychological factors from those who have insufficient energy due to cellular respiration dysfunction. The individual factors indicate which remedial actions, in the form of dietary supplements, drugs and detoxification, are most likely to be of benefit, and what further tests should be carried out.

 

Source: Myhill S, Booth NE, McLaren-Howard J. Chronic fatigue syndrome and mitochondrial dysfunction. Int J Clin Exp Med. 2009;2(1):1-16. Epub 2009 Jan 15. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2680051/ (Full article)

 

High slow-wave sleep and low-light sleep: chronic fatigue syndrome is not likely to be a primary sleep disorder

Abstract:

The status of chronic fatigue syndrome (CFS) is still under debate. Mainstream views still often consider it as an undetected primary sleep disorder or as the psychosomatic expression of a related anxiety or depression syndrome. Both primary sleep disorder and CFS are often related to unrefreshing sleep and affective daytime symptoms.

The present study compares nonrapid eye movement sleep distribution between patients with a primary sleep disorder and “pure” CFS patients without sleep or mood disorders. Intensity measures of affective symptoms are also analyzed. Sleep variables of 32 pure CFS (mean age, 41.9 +/- 8.7 years; 25 women), 30 Sleep Apnea Hypopnea Syndrome patients (mean age, 43.7 +/- 6.7 years; 13 women), and 14 healthy controls (mean age, 40.2 +/- 7.6 years; 9 women) were compared. Related affective symptoms were assessed using the self-reported Zung anxiety and depression scales.

The study confirms previous reports on increased slow-wave sleep in CFS patients. Both patient groups showed similar sleep duration and efficiency. Sleep efficiency was lower in both patient groups compared with controls. CFS patients showed a higher microarousal index than controls. Anxiety, but not depression symptoms were more intense in the CFS group. The distribution of nonrapid eye movement sleep in CFS differs sizeably from what can be observed in a primary sleep disorder.

 

Source: Neu D, Cappeliez B, Hoffmann G, Verbanck P, Linkowski P, Le Bon O. High slow-wave sleep and low-light sleep: chronic fatigue syndrome is not likely to be a primary sleep disorder. J Clin Neurophysiol. 2009 Jun;26(3):207-12. doi: 10.1097/WNP.0b013e3181a1841b. https://www.ncbi.nlm.nih.gov/pubmed/19424087

 

Cognitive behavioural therapy and psycho-education for chronic fatigue syndrome in young people: reflections from the families’ perspective

Abstract:

OBJECTIVES: Recent trials have produced optimistic results for family-focussed cognitive behavioural therapy (CBT) for chronic fatigue syndrome (CFS) in young people. This study sought to examine the under-researched question of the views and experiences of patients and families who take part.

DESIGN: Semi-structured interviews and qualitative analysis were chosen in order to address clients’ perspectives in depth.

METHODS: Sixteen young people and sixteen parents who participated in a trial of CBT versus psycho-education (PE) for CFS were interviewed. Key themes were discerned using inductive thematic analysis.

RESULTS: Most families had low expectations of a cure but hope for improvement. Generally speaking, participants found both CBT and PE acceptable and helpful. Behavioural aspects of CBT (e.g. goal-setting, graded activity) were found helpful. The opportunity to gain support, recognition and validation was important. Cognitive elements of therapy were sometimes deemed inappropriate and some felt emotional aspects of CFS were not adequately addressed. Participants were ambivalent towards the extent of family involvement. Negative experiences related to the therapy setting and feeling inappropriately labeled. Most participants felt therapy was a stepping-stone towards normal life, although many felt recovery was incomplete. Very few differences were found between themes from CBT and PE participants. A notable exception was that every young person who experienced CBT described therapy as helpful, whereas the participants who strongly opposed the therapy approach had all experienced PE.

CONCLUSIONS: The detailed insights regarding families’ therapy experiences suggest areas of improvement for service delivery and topics for further investigation.

 

Source: Dennison L, Stanbrook R, Moss-Morris R, Yardley L, Chalder T. Cognitive behavioural therapy and psycho-education for chronic fatigue syndrome in young people: reflections from the families’ perspective. Br J Health Psychol. 2010 Feb;15(Pt 1):167-83. doi: 10.1348/135910709X440034. Epub 2009 May 6. https://www.ncbi.nlm.nih.gov/pubmed/19422732

 

Plasma IL-6, its soluble receptors and F2-isoprostanes at rest and during exercise in chronic fatigue syndrome

Abstract:

The aim of the current study was to investigate the levels of interleukin-6 (IL-6), its soluble receptors (sIL-6R and sgp130) and F(2)-isoprostanes, at rest and during exercise, in patients with chronic fatigue syndrome (CFS).

Six male CFS patients and six healthy controls performed an incremental exercise test to exhaustion and a submaximal exercise bout to exhaustion. Blood samples taken in the submaximal test at rest, immediately post-exercise and 24 h post-exercise were analyzed for IL-6, sIL-6R, sgp130 and F(2)-isoprostanes. A further 33 CFS and 33 healthy control participants gave a resting blood sample for IL-6 and sIL-6R measurement.

During the incremental exercise test only power output at the lactate threshold was lower (P<0.05) in the CFS group. F(2)-isoprostanes were higher (P<0.05) in CFS patients at rest and this difference persisted immediately and 24 h post-exercise. The exercise study found no differences in IL-6, sIL-6R or sgp130 at any time point between groups. In the larger resting group, there were no differences in IL-6 and sIL-6R between CFS and control groups. This investigation has demonstrated that patients with CFS do not have altered plasma levels of IL-6, sIL-6R or sgp130 either at rest or following exercise. F(2)-isoprostanes, however, were consistently higher in CFS patients.

 

Source: Robinson M, Gray SR, Watson MS, Kennedy G, Hill A, Belch JJ, Nimmo MA. Plasma IL-6, its soluble receptors and F2-isoprostanes at rest and during exercise in chronic fatigue syndrome. Scand J Med Sci Sports. 2010 Apr;20(2):282-90. doi: 10.1111/j.1600-0838.2009.00895.x. Epub 2009 Apr 13. https://www.ncbi.nlm.nih.gov/pubmed/19422646

 

Psychiatric comorbidity in persons with chronic fatigue syndrome identified from the Georgia population

Abstract:

OBJECTIVE: To compare the prevalence of psychiatric disorders in persons with chronic fatigue syndrome (CFS) identified from the general population and a chronically ill group of people presenting with subsyndromic CFS-like illness (“insufficient symptoms or fatigue” (ISF)). Previous studies in CFS patients from primary and tertiary care clinics have found high rates of psychiatric disturbance, but this may reflect referral bias rather than true patterns of comorbidity with CFS.

METHODS: We used random digit dialing to identify unwell individuals. A detailed telephone interview identified those with CFS-like illness. These individuals participated in a 1-day clinical evaluation to confirm CFS or ISF status. We identified 113 cases of CFS and 264 persons with ISF. To identify current and lifetime psychiatric disorders, participants completed the Structured Clinical Interview for DSM-IV.

RESULTS: Sixty-four persons (57%) with CFS had at least one current psychiatric diagnosis, in contrast to 118 persons (45%) with ISF. One hundred one persons (89%) with CFS had at least one lifetime psychiatric diagnosis compared with 208 persons (79%) with ISF. Of note, only 11 persons (9.8%) with CFS and 25 persons (9.5%) with ISF reported having seen a mental healthcare specialist during the past 6 months.

CONCLUSIONS: Our findings indicate that current and lifetime psychiatric disorders commonly accompany CFS in the general population. Most CFS cases with comorbid psychiatric conditions had not sought appropriate help during the past 6 months. These results demonstrate an urgent need to address psychiatric disorders in the clinical care of CFS cases.

Comment in: Criteria used to define chronic fatigue syndrome questioned. [Psychosom Med. 2010]

 

Source: Nater UM, Lin JM, Maloney EM, Jones JF, Tian H, Boneva RS, Raison CL, Reeves WC, Heim C. Psychiatric comorbidity in persons with chronic fatigue syndrome identified from the Georgia population. Psychosom Med. 2009 Jun;71(5):557-65. doi: 10.1097/PSY.0b013e31819ea179. Epub 2009 May 4. https://www.ncbi.nlm.nih.gov/pubmed/19414619

 

Chronic fatigue syndrome and high allostatic load: results from a population-based case-control study in Georgia

Abstract:

OBJECTIVE: To confirm the association of chronic fatigue syndrome (CFS) with high allostatic load (AL) level, examine the association of subsyndromal CFS with AL level, and investigate the effect of depression on these relationships and the association of AL with functional impairment, fatigue, symptom severity, fatigue duration, and type of CFS onset. AL represents the cumulative physiologic effect of demands to adapt to stress.

METHODS: Population-based case-control study of 83 persons with CFS, 202 persons with insufficient symptoms or fatigue for CFS (ISF), and 109 well controls living in Georgia. Unconditional logistic regression was used to generate odds ratios (ORs) as measures of the association of AL with CFS.

RESULTS: Relative to well controls, each 1-point increase in allostatic load index (ALI) was associated with a 26% increase in likelihood of having CFS (OR(adjusted) = 1.26, 95% Confidence Interval (CI) = 1.00, 1.59). This association remained in the presence and absence of depression (OR(adjusted) = 1.35, CI = 1.07, 1.72; OR(adjusted) = 1.35, CI = 1.10, 1.65). Compared with the ISF group, each 1-point increase in ALI was associated with a 10% increase in likelihood of having CFS (OR(adjusted) = 1.10, CI = 0.93, 1.31). Among persons with CFS, the duration of fatigue was inversely correlated with ALI (r = -.26, p = .047).

CONCLUSIONS: Compared with well controls, persons with CFS were significantly more likely to have a high AL. AL increased in a gradient across well, ISF, and CFS groups.

 

Source: Maloney EM, Boneva R, Nater UM, Reeves WC. Chronic fatigue syndrome and high allostatic load: results from a population-based case-control study in Georgia. Psychosom Med. 2009 Jun;71(5):549-56. doi: 10.1097/PSY.0b013e3181a4fea8. Epub 2009 May 4. https://www.ncbi.nlm.nih.gov/pubmed/19414615 (Full article)

 

Detection of herpesviruses and parvovirus B19 in gastric and intestinal mucosa of chronic fatigue syndrome patients

Abstract:

BACKGROUND: Human herpesvirus-6 (HHV-6), Epstein-Barr virus and parvovirus B19 have been suggested as etiological agents of chronic fatigue syndrome but none of these viruses is consistently detected in all patients. However, active viral infections may be localized in specific tissues, and, therefore, are not easily detectable. The aim of this study was to investigate the presence of HHV-6, HHV-7, EBV and parvovirus B19 in the gastro-intestinal tract of CFS patients.

PATIENTS AND METHODS: Using real-time PCR, viral DNA loads were quantified in gastro-intestinal biopsies of 48 CFS patients and 35 controls.

RESULTS: High loads of HHV-7 DNA were detected in most CFS and control biopsies. EBV and HHV-6 were detected in 15-30% of all biopsies. Parvovirus B19 DNA was detected in 40% of the patients versus less than 15% of the controls.

CONCLUSION: Parvovirus B19 may be involved in the pathogenesis of CFS, at least for a subset of patients. The gastro-intestinal tract appears as an important reservoir of infection for several potentially pathogenic viruses.

 

Source: Frémont M, Metzger K, Rady H, Hulstaert J, De Meirleir K. Detection of herpesviruses and parvovirus B19 in gastric and intestinal mucosa of chronic fatigue syndrome patients. In Vivo. 2009 Mar-Apr;23(2):209-13. http://iv.iiarjournals.org/content/23/2/209.long (Full article)

 

Associations between pet ownership and self-reported health status in people suffering from chronic fatigue syndrome

Abstract:

OBJECTIVE: This study explored the association between pet ownership and self-reported health in people suffering from chronic fatigue syndrome (CFS).

METHODS: One hundred and ninety-three (193) people with medically diagnosed CFS completed a postal survey designed to collect information on illness severity, physical and psychologic health, and pet ownership practices.

RESULTS: Most of the participants were female (72.0%), over 45 years of age (57.1%) and married (41.1%) with no children (63.1%). Pets were owned by 58.3% of the sample, with dogs and cats being the most commonly kept types of companion animal. The general health of the participants was discovered to be poor, as assessed by scores on the Chalder Fatigue Questionnaire (CFQ), General Health Questionnaire-12 (GHQ-12), and Short-Form-36 (SF-36) health survey. Pet ownership was not significantly associated with scores on the CFQ, GHQ-12, or SF-36 scales, although pet owners considered their animals to offer them a range of health benefits, notably those associated with mental well-being.

CONCLUSIONS: Overall, findings suggest no statistically significant association between pet ownership and self-reported health in people with CFS. Nonetheless, people suffering from this condition believe that their pets have the potential to enhance quality of life. Although animals should not be regarded as a panacea for people with long-term conditions such as CFS, they may, nonetheless, serve a valuable, and currently underutilized, role in promoting well-being, whether in their own right, or in conjunction with more traditional forms of therapy.

 

Source: Wells DL. Associations between pet ownership and self-reported health status in people suffering from chronic fatigue syndrome. J Altern Complement Med. 2009 Apr;15(4):407-13. doi: 10.1089/acm.2008.0496. https://www.ncbi.nlm.nih.gov/pubmed/19388863

 

Use of the Temperament and Character Inventory (TCI) for assessment of personality in chronic fatigue syndrome

Abstract:

BACKGROUND: Chronic fatigue syndrome (CFS) is characterized by severe and prolonged fatigue, along with a set of nonspecific symptoms and signs, such as sore throat, muscle pain, headaches, and difficulties with concentration or memory.

OBJECTIVE: The study examined whether CFS is associated with specific dimensions of Cloninger’s psychobiological model of personality.

METHOD: Personality profiles were compared between 38 CFS patients and 42 control subjects by means of the Temperament and Character Inventory (TCI).

RESULTS: The CFS group showed significantly higher scores on Harm-Avoidance and Persistence.

CONCLUSION: The current study shows a significant association between specific personality characteristics and CFS. These personality traits may be implicated in the onset and/or perpetuation of CFS and may be a productive focus for psychotherapy.

 

Source: Van Campen E, Van Den Eede F, Moorkens G, Schotte C, Schacht R, Sabbe BG, Cosyns P, Claes SJ. Use of the Temperament and Character Inventory (TCI) for assessment of personality in chronic fatigue syndrome. Psychosomatics. 2009 Mar-Apr;50(2):147-54. doi: 10.1176/appi.psy.50.2.147. https://www.ncbi.nlm.nih.gov/pubmed/19377023