Objective measurement of personality variables in epidemic neuromyasthenia patients

Abstract:

The psychological symptoms of patients diagnosed as having epidemic neuromyasthenia were investigated using the Minnesota Multiphasic Personality Inventory, the Social Readjustment Rating Scale, the Mehrabian Achieving Tendency Scale for Females, a personal data questionnaire, and a subjective anxiety rating.

Twenty-five women with epidemic neuromyasthenia were compared with 25 women who were not ill. Multivariate analysis using the Hotelling T-test on the group data indicated that the patient and non-patient groups differed significantly (P less than 0.001) in respect of psychological characteristics. Stress as a possible predisposing factor in the illness was supported (P less than 0.001).

The data do not support the concept of epidemic neuromyasthenia as being ‘mass hysteria’ as mentioned by McEvedy and Beard, but rather seem to support the suggestion that diagnosis can be made by use of a combination of logical, objective medical and physiological measures. The use of biofeedback as a possible treatment is also proposed.

 

Source: Stricklin A, Sewell M, Austad C. Objective measurement of personality variables in epidemic neuromyasthenia patients. S Afr Med J. 1990 Jan 6;77(1):31-4. http://www.ncbi.nlm.nih.gov/pubmed/2294610

 

The neuropsychological dimensions of postinfectious neuromyasthenia (chronic fatigue syndrome): a preliminary report

Abstract:

Postinfectious neuromyasthenia (PIN) is a clinical syndrome of protracted and incomplete recovery after an apparent viral-like illness. Medical investigation yields few abnormalities which might account for the symptomatology. A substantial number of PIN patients complain of cognitive changes.

Specific complaints include impaired attention, concentration and abstraction skills. This study was designed to systematically investigate whether the aforementioned subjective complaints could be quantified objectively using standard neuropsychological instruments. Results indicated that on all tests but one, the subjects’ performances were significantly higher than those of their age matched groups in the normative data.

Specifically, PIN patients scored significantly better than their age matched norms on tests of concentration, attention and abstraction. What is most striking is the discrepancy between the subjective complaints of cognitive impairment and the objective results of the subjects’ performances on all tests.

These findings suggest that psychological factors may play an important role in the cognitive functioning of individuals diagnosed with postinfectious neuromyasthenia.

 

Source: Altay HT, Toner BB, Brooker H, Abbey SE, Salit IE, Garfinkel PE. The neuropsychological dimensions of postinfectious neuromyasthenia (chronic fatigue syndrome): a preliminary report. http://www.ncbi.nlm.nih.gov/pubmed/2394541

 

Attributions and self-esteem in depression and chronic fatigue syndromes

Abstract:

There is considerable overlap in symptomatology between chronic fatigue syndrome (CFS) and affective disorder.

We report a comparison of depressive phenomenology and attributional style between a group of CFS subjects seen in a specialized medical setting, which included a high proportion with depression diagnosed by Research Diagnostic Criteria (RDC), and depressed controls seen in a specialized psychiatric setting.

Significant symptomatic differences between the depressed CFS group and depressed controls were observed for features such as self-esteem and guilt as well as attribution of illness. All the CFS groups tended to attribute their symptoms to external causes whereas the depressed controls experienced inward attribution.

This may have resulted from differences in the severity of mood disorder between the samples, but it is also suggested that an outward style of attribution protects the depressed CFS patients from cognitive changes associated with low mood but at the expense of greater vulnerability towards somatic symptoms such as fatigue.

 

Source: Powell R, Dolan R, Wessely S. Attributions and self-esteem in depression and chronic fatigue syndromes. J Psychosom Res. 1990;34(6):665-73.  http://www.ncbi.nlm.nih.gov/pubmed/2290139

 

Neurasthenia in the 1980s: chronic mononucleosis, chronic fatigue syndrome, and anxiety and depressive disorders

Abstract:

In the 1980s, patients suffering from unexplained fatigue and what seemed like a prolonged attack of acute mononucleosis were given the diagnosis of chronic mononucleosis or chronic infection with the Epstein-Barr virus.

Although the diagnosis has great appeal, the Epstein-Barr virus does not cause the syndrome (CFS) of chronic fatigue, which has been renamed and redefined chronic fatigue syndrome to remove the inference that the virus is its cause.

From a historical perspective, both syndromes represent the 1980s equivalent of neurasthenia, a disease of fatigue that influenced the development of psychiatric nosology. Because patients with depression and anxiety also have chronic fatigue and because most patients with CFS have an affective disorder, the assessment of organic causes of this syndrome requires careful psychiatric diagnosis and treatment.

Defining chronic fatigue syndrome as a medical disorder may deprive patients of competent treatment of their affective disorder.

 

Source: Greenberg DB. Neurasthenia in the 1980s: chronic mononucleosis, chronic fatigue syndrome, and anxiety and depressive disorders. Psychosomatics. 1990 Spring;31(2):129-37. http://www.ncbi.nlm.nih.gov/pubmed/2184452

 

Isolation of human herpesvirus-6 from clinical specimens using human fibroblast cultures

Abstract:

The isolation and characterization of human herpesvirus-6 (HHV-6) has been hindered by the lack of cell lines useful for its rapid propagation. Recently, we have reported that the MRC-5 cell line (human diploid lung fibroblasts) was susceptible for HHV-6 infection.

In this study, we report on the isolation of HHV-6 from the peripheral blood or buffy coat of three chronic fatigue syndrome patients, one post-liver transplant patient, and one severe chronic active Epstein-Barr virus syndrome patient using the MRC-5 cell line.

Additionally, it was observed by Southern blot hybridization studies that four of five isolates had different restriction enzyme fragment patterns than the isolate obtained from the National Institutes of Health with Eco RI.

These data suggest the usefulness of the MRC-5 cell line in the isolation and characterization of HHV-6 from various patients.

 

Source: Luka J, Okano M, Thiele G. Isolation of human herpesvirus-6 from clinical specimens using human fibroblast cultures. J Clin Lab Anal. 1990;4(6):483-6. http://www.ncbi.nlm.nih.gov/pubmed/2178187

 

Severe chronic active Epstein-Barr virus infection syndrome and adenovirus type-2 infection

Abstract:

Four patients from 4 to 24 years of age (3 males, 1 female) with generalized lymphadenopathy, hepatosplenomegaly, and intermittent fever associated with chronic active Epstein-Barr virus (EBV) infection were investigated.

Laboratory data showed polyclonal gammopathy and a tendency for bone marrow suppression. Noteworthy were the extremely elevated immunoglobulin G (IgG) antibody titers to Epstein-Barr viral capsid antigen (VCA) (range, 10,240-81,920) and early antigen (EA) (range, 1,280-40,960). All patients had IgA antibodies to VCA and EA. Subtle, heterogeneous immune functional defects were observed in all four patients. Another unusual feature was our inability to establish spontaneous or B95-8 EBV-immortalized lymphoblastoid cell lines (LCLs) due to a marked cytopathic effect (CPE). Thus, we investigated for other viruses.

Both IgG and IgM antibodies to adenovirus type-2 (Ad-2) were positive by enzyme-linked immunosorbent assay (ELISA) and immunofluorescence (IF) test, suggesting recent or activated Ad-2 infection had occurred. Dual active EBV and Ad-2 infections were likely etiologic in this severe chronic active EBV infection syndrome.

 

Source: Okano M, Thiele GM, Purtilo DT. Severe chronic active Epstein-Barr virus infection syndrome and adenovirus type-2 infection. Am J Pediatr Hematol Oncol. 1990 Summer;12(2):168-73. http://www.ncbi.nlm.nih.gov/pubmed/2165745

 

Patient management of post-viral fatigue syndrome

Abstract:

A case definition for post-viral fatigue syndrome is proposed within which various subgroups of patients exist. Any one treatment may not apply to all the subgroups. In particular, patients’ experiences do not show that avoidance of exercise is maladaptive. It is proposed that the recently ill often try to exercise to fitness whereas the chronically ill have learnt to avoid exercise. Recovery is more likely to be achieved if patients learn about their illness and do not exhaust their available energy.

 

Source: Ho-Yen DO. Patient management of post-viral fatigue syndrome. Br J Gen Pract. 1990 Jan;40(330):37-9. http://www.ncbi.nlm.nih.gov/pubmed/2107839

Note: You may read the full article here:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1371214/

 

Usefulness of a standard battery of laboratory tests in investigating chronic fatigue in adults

Abstract:

Twenty-two adults with chronic fatigue were studied to determine the clinical usefulness of commonly applied laboratory tests. Subjects with the chief complaint of fatigue persisting for more than one year were followed for an average of seven months at a university family health centre.

During this time a group of commonly recommended tests were carried out and the patients had repeated physical examinations. Physical diseases and laboratory abnormalities were few, and patients with abnormal values and active problems were followed until their fatigue resolved or their abnormalities reverted to normal following therapy. The study demonstrated that the presence of an abnormal laboratory result in a fatigued individual does not necessarily indicate the cause of fatigue.

A psychiatric history was also performed and patients were tested with the symptom check list 90-R (SCL-90-R), a 90-item psychological symptom check list. Seven patients were receiving psychotherapy when they enrolled in the study. Two additional subjects entered therapy after the start of the study. Results on the symptom check list for the study group were largely abnormal, with a majority scoring in the highest quartile for depression, paranoid ideation and psychoticism.

It is concluded that the investigation of patients with fatigue which has lasted for longer than one year should focus on psychological causes. In this group of patients laboratory abnormalities are not useful in guiding evaluation or treatment for their fatigue.

 

Source: Valdini A, Steinhardt S, Feldman E. Usefulness of a standard battery of laboratory tests in investigating chronic fatigue in adults. Fam Pract. 1989 Dec;6(4):286-91. http://www.ncbi.nlm.nih.gov/pubmed/2632306

 

Postviral syndrome–how can a diagnosis be made? A study of patients undergoing a Monospot test

Abstract:

Eighty-nine of 150 patients having a Monospot test filled out a questionnaire about their illness, and the General Health Questionnaire. They completed a follow-up questionnaire 6 months later.

Twelve (8%) had a positive Monospot. Twenty-eight of 83 serum samples tested (34%) were positive for VP1 enteroviral antigen. Forty of the patients had a self limiting illness, 13 had a definite diagnosis (excepting glandular fever), 14 had a possible postviral syndrome, 10 had recurrent sore throats/flu, and 12 had a chronic non-specific illness.

Patients with a specific diagnosis were less likely to complain of aching muscles/joints, sore throat, tiredness or loss of concentration. Their GHQ scores were lower, although this just failed to reach significance (P = 0.08), and they scored significantly lower on the somatic symptoms subscale (P = 0.022). Overall 72% scored above the GHQ threshold for ‘psychological caseness’ which is higher than in other studies. Sixty-five per cent of the sample questioned at 6 months felt that their illness started with a viral infection.

The methodological problems involved in making a diagnosis of postviral syndrome are discussed.

 

Source:  Bowman SJ, Brostoff J, Newman S, Mowbray JF. Postviral syndrome–how can a diagnosis be made? A study of patients undergoing a Monospot test. J R Soc Med. 1989 Dec;82(12):712-6. http://www.ncbi.nlm.nih.gov/pubmed/2614761

Note: You may read the full article here:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1292411/

 

A flight surgeon’s personal view of an emerging illness

Abstract:

The personal experience of a retired Air Force flight surgeon and instrument-rated civilian pilot with an illness that has achieved recent prominence in both the popular and medical press is recounted. The author believes that the illness is widely prevalent and its incidence is increasing. His experience and conviction is that, during certain phases of the illness, both cognitive dysfunction and orthostatic intolerance occur that can pose grave safety risks in the aviation environment, and must be taken seriously by the practicing flight surgeon. As in all emerging illnesses, clinical experience and judgment must precede more definitive proof of the effects of this illness.

 

Source: Harvey WT. A flight surgeon’s personal view of an emerging illness. Aviat Space Environ Med. 1989 Dec;60(12):1199-201. http://www.ncbi.nlm.nih.gov/pubmed/2604676