Fatigue secondary to chronic illness: postpolio syndrome, chronic fatigue syndrome, and multiple sclerosis

Abstract:

Estimates of the percentage of patients with postpolio syndrome, chronic fatigue syndrome, and multiple sclerosis who experience fatigue range from approximately 75% to 100%. In this study we describe the severity of fatigue and its impact on subjects with these three diagnoses.

The Fatigue Severity Scale, the Human Activity Profile, and the Nottingham Health Profile were used to measure fatigue, activity, and health status respectively of each diagnostic group as well as a control group. Using a Kruskal-Wallis one-way analysis of variance followed by a Bonferroni-adjusted Mann Whitney U test all diagnostic groups reported significantly higher levels (p = .0000 to p = .002) of fatigue and lower perceived health status than the control group.

Subjects with chronic fatigue and multiple sclerosis also had significantly reduced activity levels (p = .002 to p = .01) compared with the control group. Further attention should be directed toward understanding the relationship between fatigue and ability to engage in activities as well as strategies for remediation and/or compensation of the fatigue.

 

Source: Packer TL, Sauriol A, Brouwer B. Fatigue secondary to chronic illness: postpolio syndrome, chronic fatigue syndrome, and multiple sclerosis. Arch Phys Med Rehabil. 1994 Oct;75(10):1122-6. http://www.ncbi.nlm.nih.gov/pubmed/7944918

 

Prevalence of chronic fatigue syndrome in Italian patients with persistent fatigue

Abstract:

Our study was carried out to determine the prevalence of chronic fatigue syndrome (CFS) within a selected population of patients suffering from persistent fatigue. We studied subjects with recurrent or persistent fatigue lasting 6 months and fulfilling at least four minor Center for Disease Control (CDC) criteria for the diagnosis of CFS.

Evaluation included both clinical examination and laboratory testing. All subjects filled out a questionnaire specifically designed to gain information about the length and severity of symptoms, and patients with a previously diagnosed illness associated with fatigue were excluded.

The study was carried out at the Fatigue Clinic of an internal medicine unit (Clinica Medica I) of the University of Rome “La Sapienza”. Sixty-three subjects, residents of the Lazio region (central Italy), completed the diagnostic assessment. Alternative diagnoses were established in 37 (59%) of the 63 patients. A diagnosis of CFS based on the CDC criteria was established in only 6 cases.

In 2 subjects, CFS had appeared following infectious mononucleosis, and no definitive diagnosis could be formulated for 18 patients. In Italy, CFS seems to be an infrequent cause of severe and persistent fatigue in a selected population. Numerous morbid conditions may be responsible for a clinical picture closely resembling CFS. We recommend that patients suffering from fatigue be thoroughly evaluated.

 

Source: Conti F, Priori R, De Petrillo G, Rusconi AC, Arpino C, Valesini G. Prevalence of chronic fatigue syndrome in Italian patients with persistent fatigue. Ann Ital Med Int. 1994 Oct-Dec;9(4):219-22. http://www.ncbi.nlm.nih.gov/pubmed/7893570

 

Neurasthenic fatigue, chemical sensitivity and GABAa receptor toxins

Abstract:

Following observation of fatigue syndromes in people who have been occupationally exposed to pesticides and insecticides which exert their toxicity through the GABAa receptor, we have formulated the hypothesis that fatigue syndromes in general may be secondary to altered sensitivity of the GABAa receptor. We discuss the possible involvement of organochlorine compounds which are widespread in the environment. Organophosphate compounds may have similar toxic effects through damaged cholinergic input to the dentate gyrus of the hippocampus where cholinergic and GABAergic transmission are closely linked.

 

Source: Corrigan FM, MacDonald S, Brown A, Armstrong K, Armstrong EM. Neurasthenic fatigue, chemical sensitivity and GABAa receptor toxins. Med Hypotheses. 1994 Oct;43(4):195-200. http://www.ncbi.nlm.nih.gov/pubmed/7838000

 

Comparison of patients with chronic fatigue syndrome, fibromyalgia, and multiple chemical sensitivities

Abstract:

BACKGROUND: Chronic fatigue syndrome (CFS), fibromyalgia (FM), and multiple chemical sensitivities (MCS) are conditions associated with fatigue and a variety of other symptoms that appear to share many clinical and demographic features. Our objectives were to describe the similarities and differences among patients with CFS, FM, and MCS. Additional objectives were to determine how frequently patients with MCS and FM met the criteria for CFS and if they differed in their health locus of control.

METHODS: Demographic, clinical, and psychosocial measures were prospectively collected in 90 patients, 30 each with CFS, FM, and MCS. Patients were recruited from a university-based referral clinic devoted to the evaluation and treatment of chronic fatigue and three private practices. Variables included demographic features, symptoms characteristic of each condition, psychological complaints, a measure of health locus of control, and information on health care use.

RESULTS: Overall, the three patient groups were remarkably similar in demographic characteristics and the presence of specific symptoms. Patients with CFS and FM frequently reported symptoms compatible with MCS. Likewise, 70% of patients with FM and 30% of those with MCS met the criteria for CFS. Health care use was substantial among patients with CFS, FM, and MCS, with an average of 22.1, 39.7, and 23.3 visits, respectively, to a medical provider during the prior year. Health locus of control did not differ among the three populations.

CONCLUSIONS: In general, demographic and clinical factors and health locus of control do not clearly distinguish patients with CFS, FM, and MCS. Symptoms typical of each disorder are prevalent in the other two conditions.

Comment in: Chronic fatigue, fibromyalgia, and chemical sensitivity: overlapping disorders. [Arch Intern Med. 1995]

 

Source: Buchwald D, Garrity D. Comparison of patients with chronic fatigue syndrome, fibromyalgia, and multiple chemical sensitivities. Arch Intern Med. 1994 Sep 26;154(18):2049-53. http://www.ncbi.nlm.nih.gov/pubmed/8092909

 

Predictors of chronic “postviral” fatigue

Abstract:

We set out to determine the relation between a general practitioner (GP) diagnosis of viral illness and development of chronic fatigue 6 months later. 618 subjects who attended GPs clinics in London, south, and southwest England and who received a diagnosis of viral illness were followed prospectively and fatigue was assessed by questionnaire after 6 months. At presentation, GPs recorded fatigue in 62.6% of subjects, usually since the onset of symptoms. 502 (81.2%) subjects completed the 6-month questionnaire, of whom 88 (17.5%) met criteria for chronic fatigue and 65 (12.9%) had no reported fatigue before the viral illness.

Compared with a similar group of non-postviral GP attenders, the risk ratio for chronic fatigue in the present cohort was 1.45 (95% CI 1.14-2.04). Infective symptoms did not predict fatigue 6 months later. Psychiatric morbidity, belief in vulnerability to viruses, and attributional style at initial presentation were all associated with self-designated postviral fatigue.

Logistic regression showed that somatic attributional style, less definite diagnosis by the GP, and sick certification were the only significant predictors of chronic fatigue after viral infection when other factors were controlled for. Chronic severe fatigue 6 months after GP-diagnosed viral illness is related to symptom-attributional style and doctor behaviour, rather than to features of the viral illness. Some subjects with apparent postviral fatigue had complained of tiredness before their presentation with a viral illness.

Comment in:

Chronic fatigue syndrome. [Lancet. 1994]

Chronic fatigue syndrome. [Lancet. 1994]

 

Source: Cope H, David A, Pelosi A, Mann A. Predictors of chronic “postviral” fatigue. Lancet. 1994 Sep 24;344(8926):864-8. http://www.ncbi.nlm.nih.gov/pubmed/7916407

 

Stealth viruses as neuropathogens

Abstract:

Neuropsychiatric diseases viewed as multifaceted expression of a dysfunctional brain in which atypical responses are evoked by various sensory inputs. Disease entities have traditionally been classified according to the predominant manifestation ( ) without regard to the overlapping features of many of the diseases (+/-). Thus, mild to moderate pain, mood, cognitive, and neurosomatic symptoms are frequently present in chronic fatigue syndrome (CFS) patients. Fibromyalgia syndrome (FMS) is listed as an example of a predominantly chronic pain syndrome. Affect (mood) disorders include depression (Depress.), anxiety, panic reactions, blunted affect, mania, etc. Schizophrenia (Schizo.) is listed as an example of a major cognitive psychosis. Autism as well as various forms of dementia would be included in this category. Irritable bowel syndrome (IBS) is an example of a neurosomatic disease.

 

Source: Martin WJ. Stealth viruses as neuropathogens. CAP Today. 1994 Oct;8(10):67-70. http://www.ncbi.nlm.nih.gov/pubmed/10150189

 

Single fibre EMG studies in chronic fatigue syndrome: a reappraisal

Comment on: Single fibre EMG studies in chronic fatigue syndrome: a reappraisal. [J Neurol Neurosurg Psychiatry. 1994]

 

We were interested in the short report from Roberts and Byrne concerning single fibre EMG studies in chronic fatigue syndrome. They concluded that there was no evidence of abnormality at the terminal axon, neuromuscular junction, or muscle membrane in patients with chronic fatigue syndrome-a finding that concurs with our own of essentially normal jitter in 34 of 35 patients with chronic unexplained fatigue. We did detect some evidence of raised fibre density in a small subgroup of patients with pronounced myalgia who also had mild abnormalities on muscle biopsy.

Raised fibre density is usually a result of collateral sprouting after reinnervation, but can also be due to fibre splitting as can occur in some myopathic states. Therefore we believe that fibre density estimation performed in addition to jitter measurement adds considerably to the information obtained from single fibre EMG studies.

You can read the full comment here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1073160/pdf/jnnpsyc00039-0137a.pdf

 

Source: Connolly S, Fowler CJ. Single fibre EMG studies in chronic fatigue syndrome: a reappraisal. J Neurol Neurosurg Psychiatry. 1994 Sep;57(9):1157. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1073160/

 

A psychodynamic view of the chronic fatigue syndrome. The role of object relations in etiology and treatment

Abstract:

The chronic fatigue syndrome (CFS) is a constellation of physical and psychological symptoms including incapacitating fatigue associated with a marked reduction in activity. Although the etiology of CFS is unclear, reports in the literature suggest the presence of both physical and psychological dysfunction in this patient population. These findings have led to a debate between those who consider CFS to be primarily organic in origin and those who view CFS as a primary psychiatric disorder characterized by somatic preoccupations.

This debate led the authors to develop a working model for CFS designed to integrate the psychological and physiological findings, based on the hypothesis that early object relations have an etiologic relationship to CFS. This hypothesis then formed the rationale for a psychoanalytic treatment approach which will be described.

There are no published case reports describing psychoanalytic psychotherapy as a primary treatment modality for this patient population. The current paper attempts to fill a void. Two case reports of long-term (> 18 months), intensive (2-3 times per week) psychoanalytic psychotherapy with CFS patients referred by infectious disease specialists at a university teaching hospital will be presented.

The following aspects of the treatment will be highlighted: 1) the unique opportunity afforded by this treatment to view the nature of CFS, namely, the intimate relationship over time of fatigue symptoms to disturbances in object relationships, particularly within the transference; (2) the improvement in symptoms when this relationship is seen and understood by the patient; (3) the importance of the patient-therapist bond as a facilitating medium for clinical improvement; (4) the challenges involved in treating CFS patients with psychotherapy.

Comment in: Childhood abuse, personality disorder and chronic fatigue syndrome. [Gen Hosp Psychiatry. 1998]

 

Source: Taerk G, Gnam W. A psychodynamic view of the chronic fatigue syndrome. The role of object relations in etiology and treatment. Gen Hosp Psychiatry. 1994 Sep;16(5):319-25. http://www.ncbi.nlm.nih.gov/pubmed/7995502

 

Chronic fatigue syndrome

Abstract:

The major and minor diagnostic criteria of the chronic fatigue syndrome are described. The stages of the differential diagnosis, the diagnostic strategies and the controversies, while insisting on certain sleeping disorders are discussed. The cause of the syndrome may be a viral infection, and an anxious-depressive state may increase somatic complaints. Patients with chronic fatigue syndrome did not demonstrate a specific response to therapy. Spontaneous remission after a few years is a typical feature of this syndrome.

 

Source: Sternon J, Decaux G, Hoffmann G. Chronic fatigue syndrome. Rev Med Brux. 1994 Sep-Oct;15(5):311-5. [Article in French] http://www.ncbi.nlm.nih.gov/pubmed/7984848

 

Coming to terms with ME

Abstract:

Myalgic encephalomyelitis (ME) is a chronic, severely disabling condition, but one which is little understood and about which there are many misconceptions. Former health visitor Anne Hoad, diagnosed with ME in her mid-50s, describes her own struggle to come to terms with the illness and the limitations it has placed on her life.

 

Source: Hoad A. Coming to terms with ME. Health Visit. 1994 Sep;67(9):302-3. http://www.ncbi.nlm.nih.gov/pubmed/7960845