Altered glucocorticoid regulation of the immune response in the chronic fatigue syndrome

Abstract:

It is increasingly recognized that glucocortiocoids (GCs) can have subtle modulatory effects in immunoregulation rather than having generalized immunosuppressive effects. GCs suppress Th1 cells and cellular immunity, but may favor Th2 responses and humoral immunity. The chronic fatigue syndrome (CFS) appears to be associated with a disturbed HPA-axis. Moreover, CFS patients show several immunological changes suggestive of decreased cellular immunity. It is postulated herein that in CFS patients a decreased Th1/Th2 balance may be the result of selective effects of GC on the IL-10/IL-12 regulatory circuit.

 

Source: Visser JT, De Kloet ER, Nagelkerken L. Altered glucocorticoid regulation of the immune response in the chronic fatigue syndrome. Ann N Y Acad Sci. 2000;917:868-75. http://www.ncbi.nlm.nih.gov/pubmed/11268418

 

Cognitive behaviour therapy for chronic fatigue syndrome: a multicentre randomised controlled trial

Abstract:

BACKGROUND: Cognitive behaviour therapy (CBT) seems a promising treatment for chronic fatigue syndrome (CFS), but the applicability of this treatment outside specialised settings has been questioned. We compared CBT with guided support groups and the natural course in a randomised trial at three centres.

METHODS: Of 476 patients diagnosed with CFS, 278 were eligible and willing to take part. 93 were randomly assigned CBT (administered by 13 therapists recently trained in this technique for CFS), 94 were assigned the support-group approach, and 91 the control natural course. Multidimensional assessments were done at baseline, 8 months, and 14 months. The primary outcome variables were fatigue severity (on the checklist individual strength) and functional impairment (on the sickness impact profile) at 8 and 14 months. Data were analysed by intention to treat.

FINDINGS: 241 patients had complete data (83 CBT, 80 support groups, 78 natural course) at 8 months. At 14 months CBT was significantly more effective than both control conditions for fatigue severity (CBT vs support groups 5.8 [2.2-9.4]; CBT vs natural course 5.6 [2.1-9.0]) and for functional impairment (CBT vs support groups 263 [38-488]; CBT vs natural course 222 [3-441]). Support groups were not more effective for CFS patients than the natural course. Among the CBT group, clinically significant improvement was seen in fatigue severity for 20 of 58 (35%), in Karnofsky performance status for 28 of 57 (49%), and self-rated improvement for 29 of 58 (50%). Prognostic factors for outcome after CBT were a higher sense of control predicting more improvement, and a passive activity pattern and focusing on bodily symptoms predicting less improvement.

INTERPRETATION: CBT was more effective than guided support groups and the natural course in a multicentre trial with many therapists. Our study showed a lower proportion of patients with improvement than CBT trials with a few highly skilled therapists.

Comment in:

Cognitive behaviour therapy for chronic fatigue syndrome. [Lancet. 2001]

Cognitive behaviour therapy for chronic fatigue syndrome. [Lancet. 2001]

Cognitive behaviour therapy for chronic fatigue syndrome. [Lancet. 2001]

Cognitive behaviour therapy for chronic fatigue syndrome. [Lancet. 2001]

ACP J Club. 2001 Sep-Oct;135(2):47.

Cognitive behaviour therapy for chronic fatigue syndrome. [Lancet. 2001]

Cognitive behaviour therapy for chronic fatigue syndrome. [Lancet. 2001]

 

Source: Prins JB, Bleijenberg G, Bazelmans E, Elving LD, de Boo TM, Severens JL, van der Wilt GJ, Spinhoven P, van der Meer JW. Cognitive behaviour therapy for chronic fatigue syndrome: a multicentre randomised controlled trial. Lancet. 2001 Mar 17;357(9259):841-7. http://www.ncbi.nlm.nih.gov/pubmed/11265953

 

Chronic fatigue syndrome: a woman’s dilemma

Abstract:

Chronic Fatigue Syndrome (CFS) is an illness characterized by fatigue with varying levels of disability. According to the Centers for Disease Control (CDC) there are 2 to 5 million people in the United States who suffer from CFS and a disproportionate number are women.

There are many theories of etiology of the condition and controversy has surrounded recommendations for diagnosis and treatment. CFS can mimic other diseases and women are doubly affected since many have comorbid conditions. While diagnoses and treatment are critical to the health of women, having the disease and coping with the symptoms may have a greater impact on their well-being and quality of life.

The authors report qualitative data describing the experience of having CFS (N = 22) and quantitative responses of 42 CFS sufferers reporting psychosocial factors. The psychosocial factors were measured by the Derogatis Stress Profile (DSP), Spielberger Trait-Anger Scale, Ways of Coping Survey, Profile of Moods States (POMS) Survey, and the Perceived Stress Scale. The findings indicate that CFS changes the lives of women who suffer with the disease and disrupts their relationships, careers, and perceptions of themselves.

 

Source: Tuck I, Wallace D. Chronic fatigue syndrome: a woman’s dilemma. Health Care Women Int. 2000 Jul-Aug;21(5):457-66. http://www.ncbi.nlm.nih.gov/pubmed/11261112

 

Voluntary motor function in patients with chronic fatigue syndrome

Abstract:

INTRODUCTION: The pathogenesis of chronic fatigue syndrome (CFS) remains unknown. In particular, little is known of the involvement of the motor cortex and corticospinal system.

METHODS: Transcranial magnetic stimulation (TMS) was used to assess corticospinal function in terms of latency and threshold of motor-evoked potentials (MEPs) in thenar muscles. Reaction times and speed of movement were assessed using button presses in response to auditory tones.

RESULTS: Patients had higher (P<.05) self-assessed indices of fatigue (7/10) than for pain (5/10), anxiety (4/10) or depression (3/10). Mean (+/-S.E.M.) simple reaction times (SRTs) were longer (P<.05) in the patients (275+/-19 ms) than in the controls (219+/-9 ms); choice reaction times (CRTs) were not significantly longer in the patients. Movement times, once a reaction task had been initiated, were longer (P<.05) in the patients in both SRTs (patients, 248+/-13 ms; controls, 174+/-9 ms) and CRTs (patients, 269+/-13 ms; controls, 206+/-12 ms). There was no difference (P>.05) in threshold or latency of MEPs in hand muscles between the patients (threshold, 54.5+/-2.2% maximum stimulator output [% MSO]; latency 22+/-0.3 ms) and controls (threshold 54.6+/-3.6% MSO; latency 22.9+/-0.5 ms). Regression analysis showed no correlation (P>.05) of SRTs with either threshold for MEPs or fatigue index.

CONCLUSION: Corticospinal conduction times and excitability were within the normal range despite a slower performance time for motor tasks and an increased feeling of fatigue. This suggests that the feeling of fatigue and the slowness of movement seen in CFS are manifest outside the corticospinal system.

 

Source: Davey NJ, Puri BK, Nowicky AV, Main J, Zaman R. Voluntary motor function in patients with chronic fatigue syndrome. J Psychosom Res. 2001 Jan;50(1):17-20. http://www.ncbi.nlm.nih.gov/pubmed/11259796

 

Multiple chemical sensitivity and chronic fatigue syndrome in British Gulf War veterans

Abstract:

The objective of this study was to measure the prevalence of multiple chemical sensitivity (MCS) and chronic fatigue syndrome (CFS) in British Gulf War veterans and to investigate their association with reported exposures and psychologic morbidity. In 1997–1998, the authors undertook a cross-sectional survey of three cohorts of British military personnel comprising Gulf veterans (n = 3,531), those who had served in Bosnia (n = 2,050), and those serving during the Gulf War but not deployed there (Era cohort, n = 2,614). MCS and CFS were defined according to operational criteria.

The prevalence of MCS in the Gulf, Bosnia, and Era cohorts was 1.3%, 0.3%, and 0.2%, respectively. For CFS, the prevalence was 2.1% (Gulf cohort), 0.7% (Bosnia cohort), and 1.8% (Era cohort). In Gulf veterans, MCS was strongly associated with exposure to pesticides (adjusted odds ratio = 12.3, 95% confidence interval: 5.1, 30.0). Both syndromes were associated with high levels of psychologic morbidity.

These findings suggest that CFS and MCS account for some of the medically unexplained illnesses reported by veterans after deployment to the Gulf. MCS was particularly associated with Gulf deployment and self-reported exposure to pesticides, findings that merit further exploration given the controversial status of this diagnosis and the potential for recall bias in a questionnaire survey.

 

Source: Reid S, Hotopf M, Hull L, Ismail K, Unwin C, Wessely S. Multiple chemical sensitivity and chronic fatigue syndrome in British Gulf War veterans. Am J Epidemiol. 2001 Mar 15;153(6):604-9. http://aje.oxfordjournals.org/content/153/6/604.long (Full article)

 

Chronic fatigue syndrome and fibromyalgia: clinical assessment and treatment

Abstract:

Chronic fatigue syndrome (CFS) and fibromyalgia (FM) are closely related illnesses of uncertain etiology. This article reviews the research literature on these biobehavioral conditions, with an emphasis on explanatory models, clinical evaluation of comorbid psychiatric disorders, assessment of stress factors, pharmacologic and alternative therapies, and cognitive-behavioral treatment studies. Furthermore, clinical protocols suitable for professional practice are presented based on an integration of the authors’ clinical observations with published data. The article concludes with the recognition that mental health professionals can offer substantial help to these patients.

Copyright 2001 John Wiley & Sons, Inc.

 

Source: Friedberg F, Jason LA. Chronic fatigue syndrome and fibromyalgia: clinical assessment and treatment.  Clin Psychol. 2001 Apr;57(4):433-55. http://www.ncbi.nlm.nih.gov/pubmed/11255201

 

Comorbid clinical conditions in chronic fatigue: a co-twin control study

Abstract:

OBJECTIVES: Chronically fatiguing illness, defined as fatigue for at least 6 months, has been associated with various physical health conditions. Our objective was to determine whether there is a significant relationship between chronically fatiguing illness and 10 clinical conditions that frequently appear to be associated with fatigue, adjusting for the potentially confounding effects of psychiatric illness.

DESIGN: A co-twin control study controlling for genetic and many environmental factors by comparing chronically fatigued twins with their nonfatigued co-twins.

SETTING: A nationally distributed volunteer twin registry.

PARTICIPANTS: The study included 127 twin pairs in which one member of the pair experienced fatigue of at least 6 months’ duration and the co-twin was healthy and denied chronic fatigue. Fatigued twins were classified into 3 levels using increasingly stringent diagnostic criteria.

MEASUREMENTS AND MAIN RESULTS: Twins reported on a history of fibromyalgia, irritable bowel syndrome, multiple chemical sensitivities, temporomandibular disorder, interstitial cystitis, postconcussion syndrome, tension headache, chronic low back pain, chronic pelvic pain (women), and chronic nonbacterial prostatitis (men). The prevalence of these comorbid clinical conditions was significantly higher in the fatigued twins compared to their nonfatigued co-twins. Most notably, compared to their nonfatigued co-twins, the chronically fatigued twins had higher rates of fibromyalgia (> 70% vs < 10%) and irritable bowel syndrome (> 50% vs < 5%). The strongest associations were observed between chronic fatigue and fibromyalgia (odds ratios > 20), irritable bowel syndrome, chronic pelvic pain, multiple chemical sensitivities, and temporomandibular disorder (all with odds ratios > or = 4). Regression analysis suggested that the number of comorbid clinical conditions associated with chronic fatigue could not be attributed solely to psychiatric illness.

CONCLUSIONS: Chronically fatiguing illnesses were associated with high rates of many other clinical conditions. Thus, patients with chronic fatigue may present a complex clinical picture that poses diagnostic and management challenges. Nonetheless, clinicians should assess such patients for the presence of comorbid clinical conditions. Future research should provide a better understanding of the temporal relationship of the onset of fatigue and these conditions, and develop strategies for early intervention.

 

Source: Aaron LA, Herrell R, Ashton S, Belcourt M, Schmaling K, Goldberg J, Buchwald D. Comorbid clinical conditions in chronic fatigue: a co-twin control study. J Gen Intern Med. 2001 Jan;16(1):24-31. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1495162/ (Full article)

 

Couples’ perceptions of wives’ CFS symptoms, symptom change, and impact on the marital relationship

Abstract:

The purpose of this descriptive correlational study was to describe the differences in couples’ perceptions of wives’ Chronic Fatigue Syndrome (CFS) symptoms and to describe the relationship between changing symptoms and the marital relationship.

The convenience sample of 131 wives with CFS and their spouses reported symptom changes similarly. However, wives reported significantly higher problem levels for constitutional, fatigue, cognition, central nervous system (CNS), musculoskeletal, and allergy symptom domains and significantly less problem levels of mood disturbance domain than their husbands.

Husbands who reported more symptom changes also reported lower marital adjustment, less empathy and support from their wives, and more conflict within the relationship. Wives who reported more symptom changes reported lower marital adjustment, less empathy for their husbands, and more conflict within the relationship and had husbands who reported lower marital adjustment and less empathy and support by the wives.

 

Source: Goodwin SS. Couples’ perceptions of wives’ CFS symptoms, symptom change, and impact on the marital relationship. Issues Ment Health Nurs. 2000 Jun;21(4):347-63. http://www.ncbi.nlm.nih.gov/pubmed/11249354

 

Chronic fatigue syndrome and fibromyalgia resources on the world wide web: a descriptive journey

Abstract:

A wealth of information on chronic fatigue syndrome (CFS) and fibromyalgia is available on the World Wide Web for health care providers and patients. These illnesses have overlapping features, and their etiologies remain unknown. Multiple Web sites were reviewed, and selected sites providing useful information were identified. Sites were classified according to their content and target audience and were judged according to suggested standards of Internet publishing. Fifty-eight sites were classified into groups as follows: comprehensive and research Web sites for CFS and fibromyalgia, meetings, clinical trials, literature search services, bibliographies, journal, and CFS and fibromyalgia Web sites for the patient.

 

Source: Gantz NM, Coldsmith EE. Chronic fatigue syndrome and fibromyalgia resources on the world wide web: a descriptive journey. Clin Infect Dis. 2001 Mar 15;32(6):938-48. Epub 2001 Mar 9. http://cid.oxfordjournals.org/content/32/6/938.long (Full article)

 

Short-term group therapy for patients with chronic fatigue syndrome

Abstract:

BACKGROUND: This study presents experiences of focused short-term group therapy for patients with chronic fatigue syndrome (CFS).

METHODS: Fourteen women diagnosed as CFS patients were randomly placed into two groups. The control group received group therapy 5 months after the first group. The project consisted of 10 group sessions of 1.5 h per week. Sense of coherence (SOC) was used for measuring coping resources, and self-rating scales of quality of life and of fatigue were compared before and after group therapy.

RESULTS: The most valuable aspect was the sharing of experiences. More than half of the patients also felt that the sessions had improved psychological well-being through adjustment of ambitions and improved coping with symptoms.

CONCLUSION: The study encourages further research. If group therapy is chosen as treatment for these patients, a longer period is recommended. A possible alternative is individualized short-term therapy adapted to each patient’s needs, problems and circumstances.

Copyright 2001 S. Karger AG, Basel

 

Source: Söderberg S, Evengård B. Short-term group therapy for patients with chronic fatigue syndrome. Psychother Psychosom. 2001 Mar-Apr;70(2):108-11. http://www.ncbi.nlm.nih.gov/pubmed/11244392