Asthenia in adolescents

Abstract:

Fatigue is defined as a subjective sensation of tiredness or weariness that occurs at rest. The perception of fatigue among 12-15 years-old Italian adolescents in a school survey was about 70%. Generally the symptoms are reported after a viral illness or an infection. In adolescents with persistent or severe fatigue a selected screening evaluation to look for an underlying organic disorder is warranted. A practical diagnostic approach is given and a brief description of chronic fatigue syndrome is reported according to CDC revised diagnostic criteria published in 1997.

 

Source: De Sanctis V, Mangiagli A, Campisi S, Raiola G. Asthenia in adolescents. Minerva Pediatr. 2002 Dec;54(6):631-7. [Article in Italian] http://www.ncbi.nlm.nih.gov/pubmed/12388954

 

Immunological variables mediate cognitive dysfunction in gulf war veterans but not civilians with chronic fatigue syndrome

Abstract:

We explored the relationship between a set of immunological variables and a set of cognitive and functional status measures and a diagnosis of chronic fatigue syndrome (CFS) in civilians and veterans using various regression and factor analytic methods.

Our approach emphasized the extraction of a few distinct factors in order to limit statistical problems associated with doing large numbers of multiple comparisons. This approach led to our finding cytokine data grouping into type 1 and type 2 clusters. A type 2 cluster plus a T and B cell factor predicted CFS caseness for Gulf War veterans but not for civilians with CFS. When a cognitive variable, reaction time, was added into the model, both immunological factors lost statistical significance; this indicates that the cognitive variable reaction time moderated the effects of the immunological factors in predicting patient status.

We did a similar analysis on the roles of the immunological and cognitive variables in functional status using SF-36 data. Higher levels of these same two immunological factors predicted poorer general health as well as poorer physical and social functioning in Gulf War veterans but not in civilians with CFS. When the reaction time factor was added, only the lymphocyte factor remained significant. This implies that lymphocytes are directly related to functional status in Gulf War veterans with CFS, but the Th2 factor produces its effect on functional status via changes in cognitive abilities.

Copyright 2002 S. Karger AG, Basel

 

Source: Brimacombe M, Zhang Q, Lange G, Natelson B. Immunological variables mediate cognitive dysfunction in gulf war veterans but not civilians with chronic fatigue syndrome. Neuroimmunomodulation. 2002-2003;10(2):93-100. http://www.ncbi.nlm.nih.gov/pubmed/12372983

 

Birth order and its association with the onset of chronic fatigue syndrome

Abstract:

Chronic fatigue syndrome (CFS) is a medically unexplained illness that is diagnosed on the basis of a clinical case definition; so it probably is an illness with multiple causes producing the same clinical picture. One way of dealing with this heterogeneity is to stratify patients based on illness onset. We hypothesized that either the whole group of CFS patients or that group which developed CFS gradually would show a relation with birth order, while patients who developed CFS suddenly, probably due to a viral illness, would not show such a relation. We hypothesized the birth order effect in the gradual onset group because those patients have more psychological problems, and birth order effects have been shown for psychological characteristics.

We compared birth order in our CFS patients to that in a comparison group derived from U.S. demographic data. We found a tendency that did not reach formal statistical significance for a birth order effect in the gradual onset group, but not in either the sudden onset or combined total group. However, the birth order effect we found was due to relatively increased rates of CFS in second-born children; prior birth order studies of personality characteristics have found such effects to be skewed toward first-born children. Thus, our data do support a birth order effect in a subset of patients with CFS. The results of this study should encourage a larger multicenter study to further explore and understand this relation.

Comment in: Response to Brimacombe et al., birth order and its association with the onset of chronic fatigue syndrome. [Hum Biol. 2003]

 

Source: Brimacombe M, Helmer DA, Natelson BH. Birth order and its association with the onset of chronic fatigue syndrome. Hum Biol. 2002 Aug;74(4):615-20. http://www.ncbi.nlm.nih.gov/pubmed/12371687

 

Homeopathic treatment of Chronic Fatigue Syndrome: three case studies using Jan Scholten’s methodology

Abstract:

This paper explores the treatment of Chronic Fatigue Syndrome following a viral infection in young people. The methodology is based on that of Dr Jan Scholten, Holland, who has systematically described the homeopathic themes of all elements in the periodic table. Three case studies are presented, Cobaltum Phosphoricum, Calcium Phosphoricum and Cadmium Phosphoricum were prescribed. The common themes and the differentiating features of these Phosphate salts are described in detail to show how the homeopathic similimum is found and cure achieved.

 

Source: Geraghty J. Homeopathic treatment of Chronic Fatigue Syndrome: three case studies using Jan Scholten’s methodology. Homeopathy. 2002 Apr;91(2):99-105. http://www.ncbi.nlm.nih.gov/pubmed/12371465

 

Chronic fatigue syndrome. More and more differential diagnoses suggest a new view of this syndrome

Abstract:

The diagnosis of chronic fatigue syndrome (CFS) requires a number of symptoms beyond chronic fatigue, according to the criteria developed in 1994 by the US Centers for Disease Control (CDC) International CFS Study Group. CFS is thus no synonym for chronic fatigue but rather an unusual syndrome afflicting no more than 0.1% of the population. Several CFS definitions have been developed over the years, and it is common for investigators to erroneously compare studies based on different definitions, which nevertheless all use the term CFS. Much of our “understanding” of CFS does not apply to the small group of patients who fulfill the current (1994) CDC definition (above). Recent studies have shown that a number of somatic diseases can present with CFS symptoms and thus be misdiagnosed as CFS. This review presents a list of such differential diagnoses, mainly chronic infections, endocrine diseases, and allergies. In view of these differential diagnoses (1) investigation and therapy must be individualized, and (2) we should offer rehabilitation where different specialists work as a coordinated team.

Comment in:

Chronic fatigue syndrome is a condition still without medical explanation. [Lakartidningen. 2002]

Chronic fatigue belongs to the emotional life’s domains. [Lakartidningen. 2002]

Research on chronic fatigue syndrome face to face with a paradigm shift. [Lakartidningen. 2002]

 

Source: Merz S. Chronic fatigue syndrome. More and more differential diagnoses suggest a new view of this syndrome. Lakartidningen. 2002 Aug 22;99(34):3282-7. [Article in Swedish] http://www.ncbi.nlm.nih.gov/pubmed/12362846

 

Hemodynamic and neurohumoral responses to head-up tilt in patients with chronic fatigue syndrome

Abstract:

BACKGROUND: Data on the prevalence of orthostatic intolerance (OI) in patients with chronic fatigue syndrome (CFS) are limited and controversial. We tested the hypothesis that a majority of CFS patients exhibit OI during head-up tilt.

METHODS: Hemodynamic and neurohumoral responses to 40 minutes of head-up tilt were studied in 36 CFS patients and 36 healthy controls. Changes in stroke volume, cardiac output and peripheral vascular resistance were estimated from finger arterial pressure waveform analysis (Modelflow). Blood samples were drawn before and at the end of head-up tilt for measurement of plasma catecholamines.

RESULTS: At baseline, supine heart rate was higher in CFS patients (CFS: 66.4 +/- 8.4 bpm; controls: 57.4 +/- 6.6 bpm; p < 0.001) as was the plasma epinephrine level (CFS: 0.11 +/- 0.07 nmol/l; controls: 0.08 +/- 0.07 nmol/l: p = 0.015). An abnormal blood pressure and/or heart rate response to head-up tilt was seen in 10 (27.8 %) CFS patients (6 presyncope, 2 postural tachycardia, 2 tachycardia and presyncope) and 6 (16.7 %, p = 0.26) controls (5 presyncope, 1 tachycardia, 2 tachycardia and presyncope). Head-up tilt-negative CFS patients showed a larger decrease in stroke volume during tilt (-46.9 +/- 10.6) than head-up tilt-negative controls (-40.3 +/- 13.6 %, p = 0.008). Plasma catecholamine responses to head-up tilt did not differ between these groups.

CONCLUSION: Head-up tilt evokes postural tachycardia or (pre)syncope in a minority of CFS patients. The observations in head-up tilt-negative CFS patients of a higher heart rate at baseline together with a marked decrease in stroke volume in response to head-up tilt may point to deconditioning.

 

Source: Timmers HJ, Wieling W, Soetekouw PM, Bleijenberg G, Van Der Meer JW, Lenders JW. Hemodynamic and neurohumoral responses to head-up tilt in patients with chronic fatigue syndrome. Clin Auton Res. 2002 Aug;12(4):273-80. http://www.ncbi.nlm.nih.gov/pubmed/12357281

 

Fractal analysis and recurrence quantification analysis of heart rate and pulse transit time for diagnosing chronic fatigue syndrome

Abstract:

This study aimed to develop a method to distinguish between the cardiovascular reactivity in chronic fatigue syndrome (CFS) and other patient populations.

Patients with CFS (n = 23), familial Mediterranean fever (n = 15), psoriatic arthritis (n = 10), generalized anxiety disorder (n = 12), neurally mediated syncope (n = 20), and healthy subjects (n = 20) were evaluated with a shortened head-up tilt test (HUTT). A 10-minute supine phase of the HUTT was followed by recording 600 cardiac cycles on tilt, i. e., 5 to 10 minutes. Beat-to-beat heart rate (HR) and pulse transit time (PTT) were acquisitioned. Data were processed by recurrence plot and fractal analysis. Fifty-two variables were calculated in each subject.

On multivariate analysis, the best predictors of CFS were HR-tilt-R/L, PTT-tilt-R/L, HR-supine-DET, PTT-tilt-WAVE, and HR-tilt-SD. Based on these predictors, the ‘Fractal & Recurrence Analysis-based Score’ (FRAS) was calculated: FRAS = 76.2 + 0.04*HR-supine-DET – 12.9*HR-tilt-R/L – 0.31*HR-tilt-SD – 19.27*PTT-tilt-R/L – 9.42* PTT-tilt-WAVE. The best cut-off differentiating CFS from the control population was FRAS = + 0.22. FRAS > + 0.22 was associated with CFS (sensitivity 70 % and specificity 88 %). The cardiovascular reactivity received mathematical expression with the aid of the FRAS. The shortened HUTT was well tolerated. The FRAS provides objective criteria which could become valuable in the assessment of CFS.

Comment in: Chronic fatigue syndrome and hidden happenings of the heartbeat. [Clin Auton Res. 2002]

 

Source: Naschitz JE, Sabo E, Naschitz S, Rosner I, Rozenbaum M, Priselac RM, Gaitini L, Zukerman E, Yeshurun D. Fractal analysis and recurrence quantification analysis of heart rate and pulse transit time for diagnosing chronic fatigue syndrome. Clin Auton Res. 2002 Aug;12(4):264-72. http://www.ncbi.nlm.nih.gov/pubmed/12357280

 

Chronic fatigue syndrome or neurasthenia?

Comment on: Neurasthenia: prevalence, disability and health care characteristics in the Australian community. [Br J Psychiatry. 2002]

 

The interesting study reported by Hickie et al (2002) draws attention to the prevalence of ICD-10 neurasthenia (World Health Organization, 1992) in a large sample of the Australian general population. The authors’ findings are of the utmost importance for clinicians concerned with the disabling effects of fatigue but also provide food for thought in the wake of the CFS/ME Working Group (2002) report to the Chief Medical Officer. In this report, the term chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is used as an ‘umbrella term’ because of the ‘need for patients and clinicians to agree a satisfactory term as a means of communication’ but the concept of neurasthenia is not used. The report’s authors state that CFS is ‘widely used among clinicians’ and seem to consider it to be a disorder more physical than psychiatric. Equally, CFS/ME is not included in DSM-IV (American Psychiatric Association, 1994) or ICD-10. On the other hand, neurasthenia as defined in the ICD-10 is a psychiatric disorder whose main feature is ‘persistent and distressing complaints of increased fatigue after mental effort, or persistent and distressing complaints of bodily weakness and exhaustion after minimal effort’. This fatigue could be associated with muscular aches, dizziness, tension headaches, sleep disturbances, irritability, dyspepsia and inability to relax. Neurasthenia includes ‘fatigue syndrome’ but excludes ‘post viral fatigue syndrome’. Using ICD-10 criteria in the general population, Hickie et al (2002) found that 1.5% of the 10 641 people who participated in the study met the criteria for neurasthenia in the past year. For females aged between 18 and 24 years, the 12-month prevalence rises to 2.4%.

You can read the rest of this comment here: http://bjp.rcpsych.org/content/181/4/350.2.long

 

Source: Bailly L. Chronic fatigue syndrome or neurasthenia?  Br J Psychiatry. 2002 Oct;181:350-1. http://bjp.rcpsych.org/content/181/4/350.2.long (Full article)

 

High rates of autoimmune and endocrine disorders, fibromyalgia, chronic fatigue syndrome and atopic diseases among women with endometriosis: a survey analysis

Abstract:

BACKGROUND: Women with endometriosis may also have associated disorders related to autoimmune dysregulation or pain. This study examined whether the prevalence of autoimmune, chronic pain and fatigue and atopic disorders is higher in women with endometriosis than in the general female population.

METHODS AND RESULTS: A cross-sectional survey was conducted in 1998 by the Endometriosis Association of 3680 USA members with surgically diagnosed endometriosis. Almost all responders had pain (99%), and many reported infertility (41%). Compared with published rates in the general USA female population, women with endometriosis had higher rates of hypothyroidism (9.6 versus 1.5%, P < 0.0001), fibromyalgia (5.9 versus 3.4%, P < 0.0001), chronic fatigue syndrome (4.6 versus 0.03%, P < 0.0001), rheumatoid arthritis (1.8 versus 1.2%, P = 0.001), systemic lupus erythematosus (0.8 versus 0.04%, P < 0.0001), Sjögren’s syndrome (0.6 versus 0.03%, P < 0.0001) and multiple sclerosis (0.5 versus 0.07%, P < 0.0001), but not hyperthyroidism or diabetes. Allergies and asthma were more common among women with endometriosis alone (61%, P < 0.001 and 12%, P < 0.001 respectively) and highest in those with fibromyalgia or chronic fatigue syndrome (88%, P < 0.001 and 25%, P < 0.001 respectively) than in the USA female population (18%, P < 0.001 and 5%, P < 0.001 respectively).

CONCLUSIONS: Hypothyroidism, fibromyalgia, chronic fatigue syndrome, autoimmune diseases, allergies and asthma are all significantly more common in women with endometriosis than in women in the general USA population.

 

Source: Sinaii N, Cleary SD, Ballweg ML, Nieman LK, Stratton P. High rates of autoimmune and endocrine disorders, fibromyalgia, chronic fatigue syndrome and atopic diseases among women with endometriosis: a survey analysis. Hum Reprod. 2002 Oct;17(10):2715-24. http://humrep.oxfordjournals.org/content/17/10/2715.long (Full article)

 

Doctor accused of “interfering” in girl’s treatment is cleared by GMC

A consultant paediatrician who disagreed with the parents of a girl with chronic fatigue syndrome about her treatment and obtained her medical records without their consent has been cleared of serious professional misconduct by the General Medical Council. The case resumed last week, having been adjourned in June (29 June, p 1539).

Christopher Cheetham, consultant paediatrician at Wycombe General Hospital, continued to involve himself in the case of the 12 year old girl after her parents, named only as Mr and Mrs B, made it clear they no longer wanted him to do so.

Dr Harvey Marcovitch, editor of Archives of Disease in Childhood, said the case had caused concern among paediatricians about their child protection role. “A lot of paediatricians have been contacting the college [the Royal College of Paediatrics and Child Health], saying they have a terrible dilemma when families won’t cooperate with them in knowing how far they’re allowed to go in spreading information.”

He said the college’s president, Professor David Hall, was seeking a meeting with the GMC president, Professor Graeme Catto, to discuss the issue.

The girl, now 17, was confined to bed for two years. Social services convened two child protection case conferences but decided she was not at risk.

Dr Cheetham recommended an inpatient programme of psychotherapy and physiotherapy. Mr and Mrs B disagreed, believing her illness to be organic, and told him by letter that they no longer wanted him involved in their daughter’s care.

The family’s GP called in Dr Nigel Speight, a consultant paediatrician from Durham with a special interest in chronic fatigue syndrome. He agreed with Mr and Mrs B that their daughter should be treated at home under the care of her GP.

Dr Cheetham sought to involve social services and continued to insist, in letters to Dr Speight and others, that the girl was being deprived of proper treatment.

Dr Cheetham’s counsel argued that the Children Act 1989, which provides for intervention when a child is thought to be suffering or likely to suffer significant harm, justified Dr Cheetham’s actions.

Taking into account the circumstances of the girl’s condition and management as known to Dr Cheetham at the time and his “integrity, expertise, and reputation as a senior paediatrician,” the GMC’s professional conduct committee “could not feel sure” that he had no reasonable cause to suspect significant harm. He could not, therefore, be said to have no right to intervene.

The committee said the Bs were “intelligent, loving, and devoted parents” who were entitled to have the treatment of their choice for their child. But that did not nullify the right of a doctor with legitimate concerns for his former patient.

You can read the rest of this article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1124209/

 

Source: Dyer C. Doctor accused of “interfering” in girl’s treatment is cleared by GMC. BMJ. 2002 Sep 28;325(7366):673. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1124209/ (Full article)