Illness intrusiveness in myalgic encephalomyelitis: an exploratory study

Abstract:

This study assessed the relationship between illness intrusiveness, symptoms, disability and depression in patients with myalgic encephalomyelitis (ME). Participants were 16 patients with ME and eight patients with ME plus co-morbid disorders. The patients with co-morbid disorders reported greater illness intrusiveness than the patients with ME alone, but there were no differences between the groups on the other variables. Significant correlations were found between illness intrusiveness on the one hand, and fatigue, cognitive dysfunction, disability and depression, on the other. We conclude that ME is a disabling illness, which has a major impact on various life domains.

 

Source: Goudsmit EM, Stouten B, Howes S. Illness intrusiveness in myalgic encephalomyelitis: an exploratory study. J Health Psychol. 2009 Mar;14(2):215-21. Doi: 10.1177/1359105308100205. https://www.ncbi.nlm.nih.gov/pubmed/19237488

 

Does hypothalamic-pituitary-adrenal axis hypofunction in chronic fatigue syndrome reflect a ‘crash’ in the stress system?

Abstract:

The etiopathogenesis of chronic fatigue syndrome (CFS) remains poorly understood. Although neuroendocrine disturbances – and hypothalamic-pituitary-adrenal (HPA) axis hypofunction in particular – have been found in a large proportion of CFS patients, it is not clear whether these disturbances are cause or consequence of the illness.

After a review of the available evidence we hypothesize that that HPA axis hypofunction in CFS, conceptualized within a system-biological perspective, primarily reflects a fundamental and persistent dysregulation of the neurobiological stress system. As a result, a disturbed balance between glucocorticoid and inflammatory signaling pathways may give rise to a pathological cytokine-induced sickness response that may be the final common pathway underlying central CFS symptoms, i.e. effort/stress intolerance and pain hypersensitivity.

This comprehensive hypothesis on HPA axis hypofunction in CFS may stimulate diagnostic refinement of the illness, inform treatment approaches and suggest directions for future research, particularly focusing on the neuroendocrine-immune interface and possible links between CFS, early and recent life stress, and depression.

 

Source: Van Houdenhove B, Van Den Eede F, Luyten P. Does hypothalamic-pituitary-adrenal axis hypofunction in chronic fatigue syndrome reflect a ‘crash’ in the stress system? Med Hypotheses. 2009 Jun;72(6):701-5. doi: 10.1016/j.mehy.2008.11.044. Epub 2009 Feb 23. https://www.ncbi.nlm.nih.gov/pubmed/19237251

 

Can sustained arousal explain the Chronic Fatigue Syndrome?

Abstract:

We present an integrative model of disease mechanisms in the Chronic Fatigue Syndrome (CFS), unifying empirical findings from different research traditions. Based upon the Cognitive activation theory of stress (CATS), we argue that new data on cardiovascular and thermoregulatory regulation indicate a state of permanent arousal responses – sustained arousal – in this condition.

We suggest that sustained arousal can originate from different precipitating factors (infections, psychosocial challenges) interacting with predisposing factors (genetic traits, personality) and learned expectancies (classical and operant conditioning).

Furthermore, sustained arousal may explain documented alterations by establishing vicious circles within immunology (Th2 (humoral) vs Th1 (cellular) predominance), endocrinology (attenuated HPA axis), skeletal muscle function (attenuated cortical activation, increased oxidative stress) and cognition (impaired memory and information processing). Finally, we propose a causal link between sustained arousal and the experience of fatigue.

The model of sustained arousal embraces all main findings concerning CFS disease mechanisms within one theoretical framework.

 

Source: Wyller VB, Eriksen HR, Malterud K. Can sustained arousal explain the Chronic Fatigue Syndrome? Behav Brain Funct. 2009 Feb 23;5:10. doi: 10.1186/1744-9081-5-10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2654901/ (Full article)

 

Clinical observation on the effects of Bo’s abdominal acupuncture in 40 cases of chronic fatigue syndrome

Abstract:

OBJECTIVE: To observe the curative effect of Bo’s abdominal acupuncture on chronic fatigue syndrome (CFS).

METHODS: Forty cases with CFS were treated by Bo’s abdominal acupuncture at the points for conducting qi back to its origin and 4 points on the abdomen once a day for 2 weeks. Scores for symptoms and scores for fatigue questionnaires were compared before and after treatment.

RESULTS: After treatment, the clinical symptoms of patients were differently alleviated, and scores for symptoms, mental condition and neural feeling in questionnaires on fatigue were obviously reduced (P<0.01-0.05).

CONCLUSION: Bo’s abdominal acupuncture has a good curative effect on general disease with complex symptoms, especially on lassitude, anorexia, insomnia, amnesia, diarrhea, and general pain.

 

Source: Huang Y, Liao XM, Li XX, Song YB. Clinical observation on the effects of Bo’s abdominal acupuncture in 40 cases of chronic fatigue syndrome. J Tradit Chin Med. 2008 Dec;28(4):264-6. http://www.journaltcm.com/modules/Journal/contents/stories/084/7.pdf (Full article)

 

The lifestyle of patients with chronic fatigue syndrome and the effect on fatigue and functional impairments

Abstract:

BACKGROUND: Little is known about the lifestyle of patients with chronic fatigue syndrome (CFS) and its influence on symptoms of CFS. The present study aimed to investigate the lifestyle of patients with CFS, and to assess whether lifestyle factors are related to fatigue and functional impairments.

METHODS: Two hundred and forty-seven patients fulfilling the Center for Disease Control criteria for CFS were included. Validated questionnaires were used to collect data on lifestyle factors, smoking, intake of alcohol, fat, fibres, fruit and vegetables, body mass index (BMI), fatigue severity and functional impairments.

RESULTS: Of the CFS patients, 23% smoked, 32% had an unhealthy BMI, and none had an unhealthy alcohol intake. A majority had an unhealthy food intake: 70% had unhealthy fat, fruit and vegetable intake, and 95% had unhealthy fibre intake. Compared with the general Dutch population, significantly fewer CFS patients were overweight. Significantly more female CFS patients abstained from alcohol, and fewer male CFS patients smoked. Unhealthy lifestyle factors were not significantly associated with fatigue severity or functional impairments.

CONCLUSIONS: CFS patients tend to lead a healthier lifestyle compared to the general Dutch population. However, no relationship was found between lifestyle factors and fatigue severity and functional impairments in CFS.

 

Source: Goedendorp MM, Knoop H, Schippers GM, Bleijenberg G. The lifestyle of patients with chronic fatigue syndrome and the effect on fatigue and functional impairments. J Hum Nutr Diet. 2009 Jun;22(3):226-31. doi: 10.1111/j.1365-277X.2008.00933.x. Epub 2009 Feb 17. https://www.ncbi.nlm.nih.gov/pubmed/19226353

 

Cognitive-behavior therapy in chronic fatigue syndrome: is improvement related to increased physical activity?

Abstract:

This multiple case study of cognitive-behavioral treatment (CBT) for chronic fatigue syndrome (CFS) compared self-report and behavioral outcomes. Eleven relatively high-functioning participants with CFS received 6-32 sessions of outpatient graded-activity oriented CBT.

Self-report outcomes included measures of fatigue impact, physical function, depression, anxiety, and global change. Behavioral outcomes included actigraphy and the 6-minute walking test. Global change ratings were very much improved (n=2), much improved (n=2), improved (n=5), and no change (n=2).

Of those reporting improvement, clinically significant actigraphy increases (n=3) and decreases (n=4) were found, as well as no significant change (n=2). The nature of clinical improvement in CBT trials for high-functioning CFS patients may be more ambiguous than that postulated by the cognitive-behavioral model.

 

Source: Friedberg F, Sohl S. Cognitive-behavior therapy in chronic fatigue syndrome: is improvement related to increased physical activity? J Clin Psychol. 2009 Apr;65(4):423-42. doi: 10.1002/jclp.20551. https://www.ncbi.nlm.nih.gov/pubmed/19213007

 

Protective effects of antidepressants against chronic fatigue syndrome-induced behavioral changes and biochemical alterations

Abstract:

Chronic fatigue syndrome (CFS) is characterized by profound fatigue, which substantially interferes with daily activities. The aim of this study was to explore the protective effects of antidepressants in an animal model of CFS in mice. Male albino mice were forced to swim individually for a period of 6-min session each for 7 days. Imipramine (10 and 20 mg/kg), desipramine (10 and 20 mg/kg) and citalopram (5 and 10 mg/kg) were administered 30 min before forced swimming test on each day.

Various behavior tests (immobility time, locomotor activity, anxiety-like behavior by plus maze and mirror chamber) followed by biochemical parameters (lipid peroxidation, reduced glutathione, catalase and nitrite level) were assessed in chronic stressed mice. Chronic forced swimming for 7 days significantly caused increase in immobility period, impairment in locomotor activity, anxiety-like behavior, and oxidative stress (raised lipid peroxidation, nitrite activity and reduced glutathione and catalase activity) as compared with naïve mice (P < 0.05).

Seven days of pretreatment with imipramine (10 and 20 mg/kg), desipramine (10 and 20 mg/kg), and citalopram (5 and 10 mg/kg) significantly reduced immobility time, improved locomotor activity and anti-anxiety effect (in both plus maze and mirror chamber test), and attenuated oxidative stress in chronic stressed mice as compared with control (chronic fatigues) (P < 0.05). These results suggested that these drugs have protective effect and could be used in the management of chronic fatigue like conditions.

 

Source: Kumar A, Garg R. Protective effects of antidepressants against chronic fatigue syndrome-induced behavioral changes and biochemical alterations. Fundam Clin Pharmacol. 2009 Feb;23(1):89-95. doi: 10.1111/j.1472-8206.2008.00638.x. Epub 2009 Jan 10. https://www.ncbi.nlm.nih.gov/pubmed/19207541

 

Comparative epidemiology of chronic fatigue syndrome in Brazilian and British primary care: prevalence and recognition

Abstract:

BACKGROUND: Although fatigue is a ubiquitous symptom across countries, clinical descriptions of chronic fatigue syndrome have arisen from a limited number of high-income countries. This might reflect differences in true prevalence or clinical recognition influenced by sociocultural factors.

AIMS: To compare the prevalence, physician recognition and diagnosis of chronic fatigue syndrome in London and São Paulo.

METHOD: Primary care patients in London (n=2459) and São Paulo (n=3914) were surveyed for the prevalence of chronic fatigue syndrome. Medical records were reviewed for the physician recognition and diagnosis.

RESULTS: The prevalence of chronic fatigue syndrome according to Centers for Disease Control 1994 criteria was comparable in Britain and Brazil: 2.1% v. 1.6% (P=0.20). Medical records review identified 11 diagnosed cases of chronic fatigue syndrome in Britain, but none in Brazil (P<0.001).

CONCLUSIONS: The primary care prevalence of chronic fatigue syndrome was similar in two culturally and economically distinct nations. However, doctors are unlikely to recognise and label chronic fatigue syndrome as a discrete disorder in Brazil. The recognition of this illness rather than the illness itself may be culturally induced.

Comment in: Diagnosing chronic fatigue syndrome. [Br J Psychiatry. 2009]

 

Source: Cho HJ, Menezes PR, Hotopf M, Bhugra D, Wessely S. Comparative epidemiology of chronic fatigue syndrome in Brazilian and British primary care: prevalence and recognition. Br J Psychiatry. 2009 Feb;194(2):117-22. doi: 10.1192/bjp.bp.108.051813. http://bjp.rcpsych.org/content/194/2/117.long (Full article)

 

Validation of the energy index point score to serially measure the degree of disability in patients with chronic fatigue syndrome

Abstract:

BACKGROUND: A simple quantitative accurate method for assessing the degree of fatigue in patients with chronic fatigue syndrome (CFS) is necessary for physicians and patients. Severity of the disease and recovery can, thus, be assayed.

PATIENT AND METHODS: From February 1-27, 2007, fifty-six consecutive CFS patients at a single treatment center were simultaneously evaluated by the patient with the fatigue severity score (FSS), and by consensus of both patient and physician by the energy index (EI) point score.

RESULTS: The FSS and EI correlated well, 0.67, p<0.001.

CONCLUSION: The El point score is a validated reliable method to assess fatigue in CFS patients.

 

Source: Lerner AM, Beqaj SH, Fitzgerald JT. Validation of the energy index point score to serially measure the degree of disability in patients with chronic fatigue syndrome. In Vivo. 2008 Nov-Dec;22(6):799-801. http://iv.iiarjournals.org/content/22/6/799.long (Full article)

 

Change in grey matter volume cannot be assumed to be due to cognitive behavioural therapy

Comment on: Can CBT substantially change grey matter volume in chronic fatigue syndrome? [Brain. 2009]

Sir, In their reply to Dr Bramsen, De Lange et al. (2008) use a type of circular reasoning: cognitive behavioural therapy (CBT), they say, has previously been shown to be ‘effective’ for chronic fatigue syndrome (CFS) so the change they measured must be due to CBT.

First, it needs to be pointed out that CBT is far from a panacea for CFS. A recent meta-analysis (Malouff et al., 2008) of the efficacy of CBT in treating CFS found an effect size of d = 0.48 (95% CI 0.27–0.69).

In their letter, De Lange et al. (2008) refer to a review by Whiting et al. (2001) as part-evidence for their claim that CBT is effective for CFS. However, this review recommended the use of objective outcome measures e.g.

Outcomes such as ‘improvement,’ in which participants were asked to rate themselves as better or worse than they were before the intervention began, were frequently reported. However, the person may feel better able to cope with daily activities because they have reduced their expectations of what they should achieve, rather than because they have made any recovery as a result of the intervention. A more objective measure of the effect of any intervention would be whether participants have increased their working hours, returned to work or school, or increased their physical activities’.

Given one of the aims of CBT (for CFS) has been said to be ‘increased confidence in exercise and physical activity’ (O’Dowd et al.), we cannot have complete confidence that the improvements recorded in CBT trials thus far represent objective improvements [such as improvements in grey matter volume (GMV)], rather than simply being due to altering how patients answer questionnaires. An INAMI report (2006) on the use of CBT (combined with GET) in over 600 CFS patients in Belgium found that while patients reported improvements on their fatigue scores, there was negligible change on the tests of exercise capacity and there was actually a worsening of their employment status (as measured by the amount of hours worked per week), both at the end of the intervention and at follow-up.

You can read the rest of this comment here: http://brain.oxfordjournals.org/content/132/7/e119.long

 

Source: Kindlon T. Change in grey matter volume cannot be assumed to be due to cognitive behavioural therapy. Brain. 2009 Jul;132(Pt 7):e119; author reply e120. doi: 10.1093/brain/awn358. Epub 2009 Jan 29. http://brain.oxfordjournals.org/content/132/7/e119.long (Full article)