Tag: 2006

Differential diagnosis of chronic fatigue syndrome and major depressive disorder

Abstract:

The goal of this study was to identify variables that successfully differentiated patients with chronic fatigue syndrome, major depressive disorder, and controls. Fifteen participants were recruited for each of these three groups, and discriminant function analyses were conducted.

Using symptom occurrence and severity data from the Fukuda et al. (1994) definitional criteria, the best predictors were postexertional malaise, unrefreshing sleep, and impaired memory-concentration. Symptom occurrence variables only correctly classified 84.4% of cases, whereas 91.1% were correctly classified when using symptom severity ratings. Finally, when using percentage of time fatigue reported, postexertional malaise severity, unrefreshing sleep severity, confusion-disorientation severity, shortness of breath severity, and self-reproach to predict group membership, 100% were classified correctly.

 

Source: Hawk C, Jason LA, Torres-Harding S. Differential diagnosis of chronic fatigue syndrome and major depressive disorder. Int J Behav Med. 2006;13(3):244-51. https://www.ncbi.nlm.nih.gov/pubmed/17078775

 

The therapeutic effects of electrical acupuncture and auricular-plaster in 32 cases of chronic fatigue syndrome

Abstract:

OBJECTIVE: To observe the therapeutic effects of electrical acupuncture and auricular-plaster therapy for chronic fatigue syndrome (CFS).

METHOD: 64 CFS patients were randomly divided into two groups. 32 cases in the treatment group were treated by the electrical acupuncture and auricular-plaster therapy, and 32 cases in the control group with oral hydrocortisone.

RESULTS: The total effective rates were respectively 93.75% in the treatment group and 75.00% in the control group, with a statistically significant difference between the two groups (P < 0.05).

CONCLUSION: Electrical acupuncture and auricular-plaster therapy may show a better anti-fatigue effect than that of routine Western drugs.

 

Source: Yuemei L, Hongping L, Shulan F, Dongfang G. The therapeutic effects of electrical acupuncture and auricular-plaster in 32 cases of chronic fatigue syndrome.  J Tradit Chin Med. 2006 Sep;26(3):163-4. https://www.ncbi.nlm.nih.gov/pubmed/17078435

 

Screening for psychological distress using internet administration of the Hospital Anxiety and Depression Scale (HADS) in individuals with chronic fatigue syndrome

Abstract:

OBJECTIVES: To investigate the factor structure and internal consistency of the Hospital Anxiety and Depression Scale (HADS) in individuals with Chronic Fatigue Syndrome (CFS) using an Internet administered version of the instrument.

DESIGN: Between subjects.

METHOD: Confirmatory factor analysis (CFA) and internal consistency analysis of the HADS was used to determine the psychometric characteristics of the instrument in individuals with CFS and a control group with data captured via an Internet data collection protocol.

RESULTS: CFA revealed that a 3-factor solution offered the most parsimonious account of the data. Internal consistency estimations of the anxiety and depression subscales were found to be acceptable for both groups. The CFS group was found to have significantly higher HADS-assessed anxiety and depression scores compared with controls, however, there was also evidence found that Internet administration of the instrument may inflate HADS subscale scores as an artifact of testing medium.

CONCLUSIONS: The HADS is suitable for use for screening individuals with CFS in terms of the factor structure of the instrument, however, clinicians should be aware that this instrument assesses 3 domains of affective disturbance rather than 2 as is interpreted within the current HADS anxiety and depression subscale scoring system. Researchers need also be aware that Internet administration of negative affective state measures such as the HADS is likely to inflate scores and need to ensure that comparisons between clinical groups are made with control group data gathered using the same collection methodology.

 

Source: McCue P, Buchanan T, Martin CR. Screening for psychological distress using internet administration of the Hospital Anxiety and Depression Scale (HADS) in individuals with chronic fatigue syndrome. Br J Clin Psychol. 2006 Nov;45(Pt 4):483-98. https://www.ncbi.nlm.nih.gov/pubmed/17076959

 

Cognitive-behaviour therapy for chronic fatigue syndrome: comparison of outcomes within and outside the confines of a randomised controlled trial

Abstract:

Outcomes for cognitive-behaviour therapy (CBT) in randomised controlled trials (RCTs) have rarely been compared to those in routine clinical practice. Taking the case of CBT for chronic fatigue syndrome (CFS), we evaluated the results of a successful RCT against those of the same treatment given in the same setting as part of routine practice. Fatigue and social adjustment scores were compared for patients who received CBT for CFS as part of a RCT (N=30) and patients who received CBT as part of everyday clinical practice (N=384). The results in the RCT were superior to those in routine clinical practice. Between pre-treatment and 6-month follow-up, the RCT showed a larger reduction in fatigue and greater improvement in social adjustment than those in routine treatment. The changes in fatigue scores were similar for both groups during treatment but were greater in the RCT between post-treatment and follow-up. Potential reasons for the superior results of the RCT include patient selection, therapist factors and the use of a manualised treatment protocol. Practitioners need to pay particular attention to relapse prevention and ensuring adequate follow-up in addition to encouraging patients to continue with cognitive-behavioural strategies once treatment has ended.

 

Source: Quarmby L, Rimes KA, Deale A, Wessely S, Chalder T. Cognitive-behaviour therapy for chronic fatigue syndrome: comparison of outcomes within and outside the confines of a randomised controlled trial. Behav Res Ther. 2007 Jun;45(6):1085-94. Epub 2006 Oct 30. https://www.ncbi.nlm.nih.gov/pubmed/17074300

 

A step backwards for the patients

During the publication of the report on the diagnosis and treatment of chronic fatigue syndrome / myalgic encephalomyelitis (CFS / ME) 9.6.2006 I expressed strong concerns that the report would have negative consequences for patients. Especially I expressed the requirement to undergo graded exercise and cognitive behavioral therapy for the granting of benefits would have disastrous consequences for those affected.

It was unfortunately not many weeks before the statement was true – discounts in insurance law with reference to the findings of the report. In the meta-analysis of the Knowledge Centre  is included internationally criticized studies. They have methodological weaknesses, partly because treatment trials are done on heterogeneous populations (selection bias). It is problematic to generalize findings to patients with myalgic encephalomyelitis, because one cannot know which patients in a heterogeneous group that has benefited from the treatment. Those who wrote the report chose knowingly omitting information about major user surveys showing that graded exercise therapy and cognitive behavioral therapy generally either do not work or are injured.

You can read the rest of this comment here:  http://tidsskriftet.no/2006/10/brev-til-redaktoren/et-tilbakeskritt-pasientene

 

Source: Stormorken E. A step backwards for the patients. Tidsskr Nor Laegeforen. 2006 Oct 19;126(20):2688-9; author reply 2689. [Article in Norwegian] http://tidsskriftet.no/2006/10/brev-til-redaktoren/et-tilbakeskritt-pasientene (Full article)

With the back to the future

Health care is confronted regularly with patients we understand little of and where our advice is inadequate. Chronic fatigue syndrome is one such condition. It is now more important to think than to summarize the discouraging research findings that have emerged so far.

You can read the rest of this comment here:  http://tidsskriftet.no/2006/10/kommentar/med-ryggen-mot-fremtiden

 

Source: Bruusgaard D. With the back to the future. Tidsskr Nor Laegeforen. 2006 Oct 19;126(20):2686. [Article in Norwegian] http://tidsskriftet.no/2006/10/kommentar/med-ryggen-mot-fremtiden (Full article)

 

Translation and validation of the Dutch language version of the CDC Symptom Inventory for assessment of Chronic Fatigue Syndrome (CFS

Abstract:

BACKGROUND: In a study by Wagner et al., the CDC Symptom Inventory was validated in a population selected from the inhabitants of a city in the USA, and proofed reliable for the assessment of the accompanying symptoms of CFS. The Dutch translation of the CDC Symptom Inventory is compared to the original and the psychometric properties are presented for patients in a tertiary care setting.

METHODS: One hundred thirty-nine consecutive patients who visited the CFS Center Amsterdam for the first time were asked to complete the CDC Symptom Inventory in the Dutch Language Version (DLV) together with the usual set of questionnaires. Sixty-one patients had Chronic Fatigue (CF) and 78 patients fulfilled the criteria for CFS. Forty-three healthy accompanying persons completed the CDC Symptom Inventory DLV, the Physical Functioning scale of the Medical Outcome Survey Short Form-36 DLV, and the Fatigue and Concentration scales of the Checklist Individual Strength (CIS-20).

RESULTS: The healthy controls group contained fewer women and was overall older than the patient groups. The influence of gender on the CDC Symptom Inventory DLV was significant but the effect of age was not. The Dutch version had a good internal consistency and convergent validity. The results were comparable to the original English version, but the sex-related difference needs further study.

CONCLUSION: The Dutch version of the CDC Symptom Inventory is a reliable tool for the assessment of the secondary criteria for CFS. The results show that it is comparable to the outcome of studies in English speaking countries.

 

Source: Vermeulen RC. Translation and validation of the Dutch language version of the CDC Symptom Inventory for assessment of Chronic Fatigue Syndrome (CFS). Popul Health Metr. 2006 Oct 18;4:12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1621077/ (Full article)

 

Favourable results of a rehabilitation programme with cognitive behavioural therapy and graded physical activity in patients with the chronic-fatigue syndrome

Abstract:

OBJECTIVE: To determine whether a specific course of interdisciplinary rehabilitation might lead to clinically significant changes in fatigue, experienced disability and physical function in patients with the chronic-fatigue syndrome (CFS).

DESIGN: Prospective and uncontrolled.

METHOD: ‘Het Roessingh’, a rehabilitation centre in Enschede, the Netherlands, has developed an interdisciplinary clinical rehabilitation programme for patients with CFS in cooperation with the ‘Nijmeegs Kenniscentrum Chronische Vermoeidheid’ [Chronic-Fatigue Knowledge Centre] in Nijmegen, the Netherlands. In this programme, physical, mental and social activities are gradually increased on the basis of cognitive behavioural principles and graded activity. Of the 127 successive persons who enrolled for the therapy during the period from August 2000 to December 2004, 99 fulfilled the inclusion criteria; they had a median duration of symptoms of 6 years. The results of treatment were evaluated by a measurement with the ‘Checklist individuele spankracht’ [Checklist individual muscle tone] before and after treatment and the scores on the ‘Patiëntspecifieke beperkingen’ [Patient-specific disability] and the Short form-36. The measured data were complete in 74 patients.

RESULTS: Before rehabilitation, the levels of fatigue, disability and distress were high. After treatment, the studied population showed significant improvement in fatigue, experienced disability and physical function. The magnitude of the improvement was generally ‘average’. At the end of treatment, 70% of the patients were clinically less fatigued, 68% experienced less disability and 55% functioned better physically. In 34% the level of fatigue was normalised after treatment, but 9.5% of the patients was more fatigue.

CONCLUSION: The rehabilitation programme offered for CFS led to significant improvements in function and fatigue.

Comment in: [Treatment of patients with the chronic-fatigue syndrome]. [Ned Tijdschr Geneeskd. 2006]

 

Source: Torenbeek M, Mes CA, van Liere MJ, Schreurs KM, ter Meer R, Kortleven GC, Warmerdam CG. Favourable results of a rehabilitation programme with cognitive behavioural therapy and graded physical activity in patients with the chronic-fatigue syndrome. Ned Tijdschr Geneeskd. 2006 Sep 23;150(38):2088-94. [Article in Dutch] https://www.ncbi.nlm.nih.gov/pubmed/17036861

 

 

Treatment of patients with the chronic-fatigue syndrome

Abstract:

In the last few years, the chronic-fatigue syndrome has been recognised as an important health problem. In a recent report, the Health Council of the Netherlands suggested that the capacity for treatment be increased. Cognitive behavioural therapy and graded exercise training are treatment options of first choice.

A recently published, uncontrolled evaluation of a Dutch clinical rehabilitation programme based partly on these methods proved to be successful. Unfortunately, due to the uncontrolled character of the study, it remains unclear which elements in the treatment were responsible for the success. Which patients should be included in a costly clinical rehabilitation programme also remains unclear. More in general, there is room for empirical studies of treatment allocation, not in the least because of the frequently occurring comorbidity. Good progress has been made in the treatment of the chronic-fatigue syndrome, but we are still far removed from evidence-based, stepped care, treatment programmes.

Comment on: [Favourable results of a rehabilitation programme with cognitive behavioural therapy and graded physical activity in patients with the chronic-fatigue syndrome]. [Ned Tijdschr Geneeskd. 2006]

 

Source: Jonker K, van Hemert AM. Treatment of patients with the chronic-fatigue syndrome. Ned Tijdschr Geneeskd. 2006 Sep 23;150(38):2067-8. [Article in Dutch] https://www.ncbi.nlm.nih.gov/pubmed/17036854

 

Chronic fatigue in complementary rehabilitative medicine–predictors of the outcomes

Abstract:

Chronic exhaustion and fatigue are increasingly important in rehabilitation medicine. Objectives of this study were (a) to describe the effects of in-patient rehabilitation on patients with chronic fatigue syndromes, (b) to identify predictors for treatment outcome, and (c) to analyze the impact of comprehensive diagnosing on these issues.

A total of 171 patients with chronic exhaustion or fatigue (90 % female, mean age 55 +/- 10 yrs) from a rehabilitation hospital with a complementary medicine-based treatment concept were included in a prospective observational study. Within the longitudinal study patients were examined three times (on admission to hospital, at discharge as well as six months later). Participation rate of the postal inquiry was 69 %. Besides items constructed ad hoc, Patient questionnaires included the Symptom Checklist and assessment instruments for depression, quality of life, sense of coherence as well as for changes in experience and behaviour. Treatment outcome was defined as sum score of binary-coded response criteria.

The pattern of complaints differed clearly between diagnostic subgroups (neurasthenia, affective disorders, adjustment disorders) before treatment. At discharge from hospital patients showed clinically relevant improvements lasting for six months after rehabilitation. Multiple regression analyses revealed a statistically significant relationship (R (mult) = 0.59) between predictors and outcome at discharge from hospital.

A better result was associated with higher trust in treatment success, active information seeking on complementary medicine, healthier feeding habits, better somatic health and a decreased mental status, with regard to the status before treatment. The prediction of outcome after six months was comparably poorer (R (mult) = 0.42).

Treatment success was higher in the absence of a diagnosis of neurasthenia, in patients accepting the group-oriented treatment concept and in patients not believing that their disease was due to their own way of living. Trust in the success of the treatment was a highly ranked predictor for longer lasting outcome, too. The results underline the importance of motivation aspects for treatment outcome indicating that individual expectations and attitudes should be considered in a more distinct way when allocating patients to rehabilitative programmes.

 

Source: Weidenhammer W, Wessel A, Hutter A, Melchart D, Schröder A. Chronic fatigue in complementary rehabilitative medicine–predictors of the outcomes. Rehabilitation (Stuttg). 2006 Oct;45(5):299-308. [Article in German] https://www.ncbi.nlm.nih.gov/pubmed/17024614