Tag: 1994

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

 

Human adjuvant disease revisited: a review of eleven post-augmentation mammoplasty patients

Abstract:

OBJECTIVES: We have reviewed 11 women post-augmentation  who were referred to our clinic with diffuse rheumatic complaints. All patients had undergone mammoplasty with silicone gel-filled implants prior to the onset of their locomotor symptoms (mean latency time 7.8 years). One physician interviewed and examined each of these patients following a standardized format for clinical retrieval.

RESULTS: Of the patients reviewed, 6 patients had clinical fibromyalgia based on the ACR criteria, and the remaining 5 patients had symptoms consistent with the “chronic fatigue syndrome.” None of our patients were found to have evidence of a defined connective tissue disease. Antinuclear antibodies were detected in 4 (36%) patients and low level titres of extractable nuclear antigens in only 2 (18%).

CONCLUSIONS: Previously a causal relationship between the use of silicone gel-filled breast implants and the subsequent development of symptoms referred to as human adjuvant disease (HAD) has been proposed. On the basis of currently accepted criteria we have preferred to diagnose our post-mammoplasty patients without specific connective tissue disease, as having chronic fatigue syndrome (CFS), or when tender points are present, as having fibromyalgia (FMS), rather than implying that such cases represent a separate and unique rheumatological disease entity. In the light of our current understanding of CFS and FMS, a relationship between them and the previous silicone mammoplasty seems possible.

 

Source: Fenske TK, Davis P, Aaron SL. Human adjuvant disease revisited: a review of eleven post-augmentation mammoplasty patients. Clin Exp Rheumatol. 1994 Sep-Oct;12(5):477-81. http://www.ncbi.nlm.nih.gov/pubmed/7842527

 

Use of dynamic tests of muscle function and histomorphometry of quadriceps muscle biopsies in the investigation of patients with chronic alcohol misuse and chronic fatigue syndrome

Abstract:

Ischaemic lactate/ammonia tests, serum carnosinase and creatine kinase assays and percutaneous needle muscle biopsies were performed on 10 patients with chronic fatigue syndrome (CFS), and 10 with chronic alcohol misuse complaining of muscular symptoms.

Basal serum lactate levels were significantly elevated in the alcohol misusers compared to the CFS patients, but all were within the reference range. Lactate profiles after ischaemic forearm exercise did not differ significantly for the two patient groups.

In one patient previously diagnosed as having CFS, myoadenylate deaminase deficiency was identified on the basis of a flat ammonia response to ischaemia and absent muscle adenosine monophosphate deaminase activity. In addition, two further patients in the CFS group were subsequently shown to have other disorders: one had polymyositis and one had myopathy with mild type II fibre atrophy of unknown cause.

Histomorphometric examination of muscle needle biopsy in the alcohol misusers showed features of chronic alcohol-induced skeletal myopathy in six patients and polymyositis in one patient. Type II fibre atrophy factors were significantly elevated in the alcohol group but were within the reference range in CFS patients.

Dynamic tests of muscle function and muscle histology are valuable tools in excluding alternative pathology in CFS, whereas muscle histomorphometry is of the greatest value in the diagnosis of chronic alcoholic myopathy.

 

Source: Wassif WS, Sherman D, Salisbury JR, Peters TJ. Use of dynamic tests of muscle function and histomorphometry of quadriceps muscle biopsies in the investigation of patients with chronic alcohol misuse and chronic fatigue syndrome. Ann Clin Biochem. 1994 Sep;31 ( Pt 5):462-8. http://www.ncbi.nlm.nih.gov/pubmed/7832572

 

Normal red cell magnesium concentrations and magnesium loading tests in patients with chronic fatigue syndrome

Abstract:

Red blood cell magnesium concentrations were measured in samples from 89 patients who fulfilled the diagnostic criteria for chronic fatigue syndrome and the results compared to those found in an age and sex matched group selected from the normal population. No significant difference was found. Six patients were further investigated using a magnesium loading test to determine if there was any evidence of magnesium deficiency associated with this disorder. None was found. There is therefore no indication for the use of magnesium therapy in the management of this condition.

 

Source: Hinds G, Bell NP, McMaster D, McCluskey DR. Normal red cell magnesium concentrations and magnesium loading tests in patients with chronic fatigue syndrome. Ann Clin Biochem. 1994 Sep;31 ( Pt 5):459-61. http://www.ncbi.nlm.nih.gov/pubmed/7832571