Giving thyroid hormones to clinically hypothyroid but biochemically euthyroid patients. Long-term treatment is being used

Editor—During the past six months I have become aware of an increasing number of patients with normal results of thyroid function tests who are being treated with a daily dose of up to 100 ìg thyroxine—mainly as a result of publicity being given in the lay media to a hypothesis put forward by Gordon R B Skinner and colleagues.2 These biochemically euthyroid patients invariably have several symptoms that are compatible with a clinical diagnosis of hypothyroidism, but many of them also have agreed diagnostic criteria for the chronic fatigue syndrome, a condition that does involve dysfunction of the hypothalamic-pituitary axis but not hypothyroidism.

You can read the full article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2127520/pdf/9345188.pdf

 

Source: Shepherd C. Giving thyroid hormones to clinically hypothyroid but biochemically euthyroid patients. Long-term treatment is being used. BMJ. 1997 Sep 27;315(7111):814. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2127520/pdf/9345188.pdf

 

Coping and other predictors of outcome in chronic fatigue syndrome: a 1-year follow-up

Abstract:

In this prospective study, 137 patients with chronic fatigue syndrome were followed-up at a 1-year interval to determine factors relating to outcomes. Nearly two thirds reported an improvement on direct ratings of change.

In analyses with fatigue and functional impairment at follow-up as the criteria, and controlling for earlier status, poorer outcomes were predicted by illness duration, subjective cognitive difficulty, and somatic symptoms; there was no influence of anxiety, depression, or general emotional distress.

Fatigue was also predicted by information-seeking, and impairment by behavioral disengagement and a low internal locus of control. The belief that one’s actions can influence outcomes modified the relationship between illness accommodation and both fatigue and impairment; adverse outcomes were associated with accommodating to illness only in the context of lower levels of perceived control. Thus, it is suggested that interventions that either discourage avoidance of activity or enhance perceived control could benefit the course of the illness.

 

Source: Ray C, Jefferies S, Weir WR. Coping and other predictors of outcome in chronic fatigue syndrome: a 1-year follow-up. J Psychosom Res. 1997 Oct;43(4):405-15. http://www.ncbi.nlm.nih.gov/pubmed/9330240

 

The chronic fatigue syndrome and hyperventilation

Erratum in: J Psychosom Res 1998 Mar-Apr;44(3-4):517.

 

Abstract:

Chronic fatigue syndrome (CFS) is characterized by severe fatigue, lasting for at least 6 months, for which no somatic explanation can be found. Because hyperventilation can produce substantial fatigue, it seems worthwhile to investigate the relationship between it and CFS. It might be hypothesized that hyperventilation plays a causal or perpetuating role in CFS.

CFS patients, non-CFS patients known to experience hyperventilation, and healthy controls were compared on complaints of fatigue and hyperventilation. CFS patients and non-CFS patients known to experience hyperventilation offered substantial complaints of fatigue and hyperventilation, both to a similar degree. Physiological evidence of hyperventilation was found significantly more often in CFS patients than in healthy controls.

However, no significant differences between CFS patients with and CFS patients without hyperventilation were found on severity of fatigue, impairment, number of complaints, activity level, psychopathology, and depression. It is concluded that hyperventilation in CFS should probably be regarded as an epiphenomenon.

 

Source: Bazelmans E, Bleijenberg G, Vercoulen JH, van der Meer JW, Folgering H. The chronic fatigue syndrome and hyperventilation. J Psychosom Res. 1997 Oct;43(4):371-7. http://www.ncbi.nlm.nih.gov/pubmed/9330236

 

The prevalence and morbidity of chronic fatigue and chronic fatigue syndrome: a prospective primary care study

Abstract:

OBJECTIVES: This study examined the prevalence and public health impact of chronic fatigue and chronic  fatigue syndrome in primary care patients in England.

METHODS: There were 2376 subjects, aged 18 through 45 years. Of 214 subjects who fulfilled criteria for chronic fatigue, 185 (86%) were interviewed in the case-control study. Measures included chronic fatigue, psychological morbidity, depression, anxiety, somatic symptoms, symptoms of chronic fatigue syndrome, functional impairment, and psychiatric disorder.

RESULTS: The point prevalence of chronic fatigue was 11.3%, falling to 4.1% if comorbid psychological disorders were excluded. The point prevalence of chronic fatigue syndrome was 2.6%, falling to 0.5% if comorbid psychological disorders were excluded. Rates did not vary by social class. After adjustment for psychological disorder, being female was modestly associated with chronic fatigue. Functional impairment was profound and was associated with psychological disorder.

CONCLUSIONS: Both chronic fatigue and chronic fatigue syndrome are common in primary care patients and represent a considerable public health burden. Selection bias may account for previous suggestions of a link with higher socioeconomic status.

 

Source: Wessely S, Chalder T, Hirsch S, Wallace P, Wright D. The prevalence and morbidity of chronic fatigue and chronic fatigue syndrome: a prospective primary care study. Am J Public Health. 1997 Sep;87(9):1449-55. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1380968/ (Full article)

 

Cognitive distortions of somatic experiences: revision and validation of a measure

Abstract:

The article reports on the revision of the Cognitive Errors Questionnaire (CEQ). The CEQ which was originally developed to measure cognitive distortions specific to chronic pain, has been significantly shortened and made applicable to a wider range of somatic problems.

The Cognitive Errors Questionnaire-Revised (CEQ-R) contains two subscales: Somatic–distortions specific to somatic experiences; and General–distortions to everyday life events. Validation of the scale with CFS, depressed, and chronic pain groups and healthy controls confirms the CEQ-R loads onto general and somatic factors. Both subscales have high internal consistency and good test-retest reliability.

The pattern of subjects’ responses to the CEQ-R scores showed that the depressed group scored significantly higher on the General CEQ-R scale than the other groups, whereas the CFS andchronic pain groups scored higher than healthy controls on the Somatic CEQ-R. Somatic CEQ-R scores showed a significant decrease over the course of a pain management program, with a concomitant decrease in disability and depression scores. Further analyses showed the Somatic CEQ-R to be significantly related to self and symptom focusing, whereas the General CEQ-R was found to be significantly correlated with higher depression, lower self-esteem, and self focusing.

The CEQ-R may be a useful instrument to examine the relationship between cognitive distortions and disability in a variety of illnesses, and to differentiate primary depression from overlapping somatic disorders.

 

Source: Moss-Morris R, Petrie KJ. Cognitive distortions of somatic experiences: revision and validation of a measure. J Psychosom Res. 1997 Sep;43(3):293-306. http://www.ncbi.nlm.nih.gov/pubmed/9304555

 

Politics, science, and the emergence of a new disease. The case of chronic fatigue syndrome

Abstract:

Chronic fatigue syndrome (CFS) emerged as a diagnostic category during the last decade. Initial research suggested that CFS was a relatively rare disorder with a high level of psychiatric comorbidity. Many physicians minimized the seriousness of this disorder and also interpreted the syndrome as being equivalent to a psychiatric disorder. These attitudes had negative consequences for the treatment of CFS.

By the mid-1990s, findings from more representative epidemiological studies indicated considerably higher CFS prevalence rates. However, the use of the revised CFS case definition might have produced heterogeneous patient groups, possibly including some patients with pure psychiatric disorders.

Social scientists have the expertise to more precisely define this syndrome and to develop appropriate and sensitive research strategies for understanding this disease.

Comment in: The biopsychosocial model and chronic fatigue syndrome. [Am Psychol. 1998]

 

Source: Jason LA, Richman JA, Friedberg F, Wagner L, Taylor R, Jordan KM. Politics, science, and the emergence of a new disease. The case of chronic fatigue syndrome. Am Psychol. 1997 Sep;52(9):973-83. http://www.ncbi.nlm.nih.gov/pubmed/9301342

 

Anxiety disorders: a result of long-term chronic fatigue–the psychiatric characteristics of the sufferers of Iceland disease

Abstract:

OBJECTIVE: In order to clarify the lifetime likelihood of developing psychiatric disorder following the Akureyri disease, we have investigated 55 well documented cases of the Akureyri disease.

MATERIALS AND METHODS: All participants were interviewed and diagnosed as to psychiatric disorders according to DSM-III.

RESULTS: Of the 55 subjects included in this analysis 53 were women. The mean age of the participants was 67.7 years. The most common problem was agoraphobia with panic attacks 12.7% (P < 0.0001); agoraphobia without panic attacks 21.8% (P < 0.0001); social phobia 14.5% (P < 0.001); simple phobia 18.1% (P < 0.05); schizophrenia 3.6% (P < 0.01); and alcohol dependence 5.4% (P < 0.05).

CONCLUSION: Prolonged chronic fatigue most commonly results in anxiety disorders. Following the infection, the more serious psychiatric disorders do not seem to play a major role in the long run.

 

Source: Líndal E, Bergmann S, Thorlacius S, Stefánsson JG. Anxiety disorders: a result of long-term chronic fatigue–the psychiatric characteristics of the sufferers of Iceland disease. Acta Neurol Scand. 1997 Sep;96(3):158-62. http://www.ncbi.nlm.nih.gov/pubmed/9300068

 

Prevalence of chronic fatigue syndrome in 4 family practices in Leiden

Abstract:

OBJECTIVE: To determine the prevalence of chronic fatigue syndrome (CFS) in general practice.

DESIGN: Descriptive.

SETTING: General practice and primary health care centres in Leyden region, the Netherlands.

METHOD: RNUH-LEO is a computerized database which contains the anonymous patient information of one general practice (with two practitioners) and four primary health care centres. The fourteen participating general practitioners were asked what International Classification of Primary Care (ICPC) code they used to indicate a patient with chronic fatigue or with CFS. With these codes and with the code for depression patients were selected from the database. It then was determined whether these patients met the criteria of CFS by Holmes et al.

RESULTS: The general practitioners used 10 codes. Including the code for depression a total of 601 patients were preselected from a total of 23,000 patients in the database. Based on the information from the patients’ records in the database, 42 of the preselected patients were selected who might fulfill the Holmes’ criteria of CFS. According to the patients’ own general practitioner, 25 of the 42 patients would fulfil the Holmes’ criteria. The men:women ratio was 1:5. The prevalence of CFS in the population surveyed was estimated to be at least 1.1 per 1,000 patients.

 

Source: Versluis RG, de Waal MW, Opmeer C, Petri H, Springer MP. Prevalence of chronic fatigue syndrome in 4 family practices in Leiden. Ned Tijdschr Geneeskd. 1997 Aug 2;141(31):1523-6. [Article in Dutch] http://www.ncbi.nlm.nih.gov/pubmed/9543740

 

Prevalence of chronic fatigue syndrome and primary fibromyalgia syndrome in The Netherlands

Erratum in: Ned Tijdschr Geneeskd 1997 Sep 13;141(37):2686.

 

Abstract:

OBJECTIVE: To determine the prevalence of chronic fatigue syndrome (CFS) and of primary fibromyalgia syndrome (PFS) in the Netherlands.

DESIGN: Questionnaire.

SETTING: Department of Medical Psychology, University Hospital Nijmegen, the Netherlands.

METHOD: A questionnaire was mailed to all the 6657 general practitioners in the Netherlands in order to inform them of the existence of CFS and to ask them if they had any CFS or PFS patients in their practices.

RESULTS: Sixty percent (n = 4027) of the general practitioners returned the questionnaire. Of all the general practitioners, 27% said they had no CFS patients, 23% said they had 1 CFS patient, while 21% had 2 CFS patients, and 29% said they had 3 or more CFS patients in their practice. Concerning PFS the results were 17% (no PFS patients), 18%, 18% and 47%, respectively. With a mean practice of 2486 patients per general practice, the estimated prevalence of CFS was 112 per 100,000 and that of PFS 157 per 100,000 persons. Of the CFS patients 81% were women and 55% were 25-44 years old; for PFS these figures were 87% and 48% respectively.

CONCLUSION: Extrapolation of the study results indicates that there are at least 17,000 CFS patients and 24,000 PFS patients in the Netherlands. The found prevalence is probably an under-estimation.

 

Source: Bazelmans E, Vercoulen JH, Galama JM, van Weel C, van der Meer JW, Bleijenberg G. Prevalence of chronic fatigue syndrome and primary fibromyalgia syndrome in The Netherlands. Ned Tijdschr Geneeskd. 1997 Aug 2;141(31):1520-3. [Article in Dutch] http://www.ncbi.nlm.nih.gov/pubmed/9543739

 

Indications for management in long-term, physically unexplained fatigue symptoms

Abstract:

In meetings arranged by the minister of Public Health, Welfare and Sports between general practitioners and specialists concerning chronic fatigue syndrome (CFS), suggestions for the diagnosis, treatment and assistance and support of patients with protracted physically unexplained fatiguesymptoms, were established in the light of current scientific insight.

The term ‘CFS’ is applicable in cases of fatigue complaints, of at least 6 months’ standing, reported by the patient himself and evaluated medically, for which no physical explanation has been found and which cause considerable disabilities in professional social and/or personal functioning.

The management depends on the duration of the illness. A distinction is made between an acute phase (up to one month after the first consultation; the policy is mostly expectative), a subacute phase (until 6 months after the onset of the complaints and disabilities; the management is aimed at making the patient accept the condition and persuading him or her to make an effort to promote health) and a chronic phase (from 6 months after the onset of the complaints and disabilities; the management is aimed at health-promoting behaviour and cognitions). Further (laboratory) examinations are useful only if the symptoms have not disappeared after one month (this is the case in approximately 20% of the patients); such examinations may be useful in older patients earlier.

It is important that the CFS patient learns to realize that it is useless to continue to spend energy on searching for causes and possible therapies, but that he should try to promote his own health, for instance by means of a quantified programme of activities linked to a time schedule (instead of to a level of fatigue).

Comment in:

Chronic fatigue syndrome. Ned Tijdschr Geneeskd. 1997

Chronic fatigue syndrome. Ned Tijdschr Geneeskd. 1997

 

Source: van der Meer JW, Rijken PM, Bleijenberg G, Thomas S, Hinloopen RJ, Bensing JM. Indications for management in long-term, physically unexplained fatigue symptoms.Ned Tijdschr Geneeskd. 1997 Aug 2;141(31):1516-9. [Article in Dutch] http://www.ncbi.nlm.nih.gov/pubmed/9543738