A possible role for mitochondrial-derived peptides humanin and MOTS-c in patients with Q fever fatigue syndrome and chronic fatigue syndrome

Abstract:

Background: Q fever fatigue syndrome (QFS) is a well-documented state of prolonged fatigue following around 20% of acute Q fever infections. It has been hypothesized that low grade inflammation plays a role in its aetiology. In this study, we aimed to identify transcriptome profiles that could aid to better understand the pathophysiology of QFS.

Methods: RNA of monocytes was collected from QFS patients (n = 10), chronic fatigue syndrome patients (CFS, n = 10), Q fever seropositive controls (n = 10), and healthy controls (n = 10) who were age- (± 5 years) and sex-matched. Transcriptome analysis was performed using RNA sequencing.

Results: Mitochondrial-derived peptide (MDP)-coding genes MT-RNR2 (humanin) and MT-RNR1 (MOTS-c) were differentially expressed when comparing QFS (− 4.8 log2-fold-change P = 2.19 × 10−9 and − 4.9 log2-fold-change P = 4.69 × 10−8), CFS (− 5.2 log2-fold-change, P = 3.49 × 10−11 − 4.4 log2-fold-change, P = 2.71 × 10−9), and Q fever seropositive control (− 3.7 log2-fold-change P = 1.78 × 10−6 and − 3.2 log2-fold-change P = 1.12 × 10−5) groups with healthy controls, resulting in a decreased median production of humanin in QFS patients (371 pg/mL; Interquartile range, IQR, 325–384), CFS patients (364 pg/mL; IQR 316–387), and asymptomatic Q fever seropositive controls (354 pg/mL; 292–393).

Conclusions: Expression of MDP-coding genes MT-RNR1 (MOTS-c) and MT-RNR2 (humanin) is decreased in CFS, QFS, and, to a lesser extent, in Q fever seropositive controls, resulting in a decreased production of humanin. These novel peptides might indeed be important in the pathophysiology of both QFS and CFS.

Source: Ruud P. H. Raijmakers, Anne F. M. Jansen, Stephan P. Keijmel, Rob ter Horst, Megan E. Roerink, Boris Novakovic, Leo A. B. Joosten, Jos W. M. van der Meer, Mihai G. Netea and Chantal P. Bleeker-Rovers. A possible role for mitochondrial-derived peptides humanin and MOTS-c in patients with Q fever fatigue syndrome and chronic fatigue syndrome. Journal of Translational Medicine 2019 17:157  https://translational-medicine.biomedcentral.com/articles/10.1186/s12967-019-1906-3  (Full article)

Myalgia and chronic fatigue syndrome following immunization: macrophagic myofasciitis and animal studies support linkage to aluminum adjuvant persistency and diffusion in the immune system

Abstract:

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a multifactorial and poorly undersood disabling disease. We present epidemiological, clinical and experimental evidence that ME/CFS constitutes a major type of adverse effect of vaccines, especially those containing poorly degradable particulate aluminum adjuvants.

Evidence has emerged very slowly due to the multiplicity, lack of specificity, delayed onset, and frequent medical underestimation of ME/CFS symptoms. It was supported by an epidemiological study comparing vaccinated vs unvaccinated militaries that remained undeployed during Gulf War II.

Affected patients suffer from cognitive dysfunction affecting attention, memory and inter-hemispheric connexions, well correlated to brain perfusion defects and associated with a stereotyped and distinctive pattern of cerebral glucose hypometabolism. Deltoid muscle biopsy performed to investigate myalgia typically yields macrophagic myofasciitis (MMF), a histological biomarker assessing longstanding persistency of aluminum agglomerates within innate immune cells at site of previous immunization. MMF is seemingly linked to altered mineral particle detoxification by the xeno/autophagy machinery.

Comparing toxicology of different forms of aluminum and different types of exposure is misleading and inadequate and small animal experiments have turned old dogma upside down. Instead of being rapidly solubilized in the extracellular space, injected aluminum particles are quickly captured by immune cells and transported to distant organs and the brain where they elicit an inflammatory response and exert selective low dose long-term neurotoxicity. Clinical observations and experiments in sheep, a large animal like humans, confirmed both systemic diffusion and neurotoxic effects of aluminum adjuvants. Post-immunization ME/CFS represents the core manifestation of “autoimmune/inflammatory syndrome induced by adjuvants” (ASIA).

Copyright © 2019. Published by Elsevier B.V.

Source: Gherardi RK, Crépeaux G, Authier FJ. Myalgia and chronic fatigue syndrome following immunization: macrophagic myofasciitis and animal studies support linkage to aluminum adjuvant persistency and diffusion in the immune system. Autoimmun Rev. 2019 May 3. pii: S1568-9972(19)30109-0. doi: 10.1016/j.autrev.2019.05.006. [Epub ahead of print] https://www.ncbi.nlm.nih.gov/pubmed/31059838

Remembering The Forgotten: How AMMES Combats Isolation And Neglect

May is the month for acknowledging the Millions Missing – the millions of ME/CFS patients who, through the years, have suffered from poor medical care, insufficient research into the cause and mechanisms of the disease, and a paucity of clinical trials to discover effective treatment. May 12, Florence Nightingale’s birthday, is the day we recognize the toll ME/CFS takes on those who have the disease and on their families, who suffer alongside them.

Among the millions missing is a group that is often overlooked. These are the people for whom isolation does not simply mean the loss of friends and the inability to attend weddings, family gatherings, and social events. Isolation, for this group, means rejection, not just by society at large, but by the people closest to them. It means neglect on a scale that is incomprehensible to patients who have loving parents, siblings, and partners.

These “missing” people do not participate in advocacy actions – on any level. They are not to be found on forums, or social media. Their lives are lived silently, unseen by the ME/CFS community at large. These are the impoverished ill, people who have been abandoned by friends and family. Nobody will put their photos on a billboard, or write a news article about them, because these severely ill patients have not one living soul to defend them.

In May, the ME/CFS community remembers patients who have been neglected by the medical establishment as well as the government agencies responsible for their care. This month, the American ME and CFS Society (AMMES) remembers the patients who have been forgotten by everyone.

“Get me out of here!”

The first patient who came to AMMES for help was a black woman in her early thirties. She was pregnant at the time and needed help paying her security deposit. The AMMES financial crisis fund paid her landlord for the deposit and covered an outstanding water bill as well. Not too long afterwards, we received a frantic phone call from her: “Please, get me out of here!”

Our client had been the victim of abuse by a former boyfriend. In spite of a restraining order, her ex had broken into her house and assaulted her. She called her social worker, who phoned the police. When the police arrived they did not take a statement and, in spite of visible bruises on her face, they handcuffed our client and threw her into the back of a police car. They took her to a hospital, where she was placed in a psych ward and given antipsychotics. When I asked our client how it transpired that the police had taken her to a psych ward, she said it was at the request of her social worker. Our client had been diagnosed with CFS. She had no psychiatric diagnoses, and had never been evaluated by a psychiatrist.

Once we discovered what had happened, AMMES immediately wrote a letter to the hospital explaining that our client’s diagnosis was for a neuroimmune disease that had been well established as a physiological, not psychological, illness. We sent copies of the letter to her caregiver, who in turn gave them to the court, as well as to a team of social workers now on her case. A few days later our client was released.

This severely ill woman is black, poor, and female, and she had a diagnosis of CFS, which nobody in her circle of doctors and social workers understood. As a consequence, the full weight of societal prejudice fell on her. She is one of the forgotten.

 

“My family thinks I am making it up”

With the exception of the first applicant to the AMMES financial crisis fund, who had children, all of our applicants have lived alone. This does not necessarily mean that they do not have living parents or siblings. All of them have had at least some living family members, but their families have rejected them.

Those who have loving relatives find it hard to imagine how families can reject someone who is sick. Yet they do, mostly because they do not believe them. In the words of one applicant: “Over the last 11 years I have been treated like a lazy, worthless, liar.” Nobody believed that she was ill.

A number of applicants have reported similar experiences with family members who do not believe they are really sick. Some have had family members who have ostracized them or who – despite having comfortable incomes – refused to help, or even make a loan.

Other applicants have been treated with outright cruelty: “My brother told me to just kill myself, but before he did he told me that our mother’s condo that I am living in should be his not mine. So I really don’t have family that cares, or understands, or is safe for me to seek help from.”

In some cases, a state of homelessness has been caused by family rejection.

“My family, whose therapist said, “no one sleeps that much, unless they are a drug addict,” kicked me out last year. They have always chosen to have “willful ignorance”, so they did not feel any need to help. I don’t know which is worse anymore, the disease itself and how it hurts me or the hatred and selfish disregard for my life from other people.”

The truth is that no matter how much pain the illness causes, there is no pain that compares to being rejected by people who are supposed to love you. When doctors dismiss patients, or social services deny care, it is infuriating, frustrating, and humiliating. But when your own family does not care, or treats you worse than strangers do, it is heartbreaking.

“Your existence gives me hope in the future”

For the past year, AMMES has been stepping up to help severely ill patients with little to no income pay their bills. Most of our resources have gone to pay rent for patients on the verge of homelessness. We have also paid utility bills, medical copays, transportation costs, food expenses, medical bills and other necessities. We have even paid for a bed for one patient who had been sleeping on her couch. But the most valuable commodity we have to offer is love.

To say we love our applicants may sound like a Hallmark card, but when you demonstrate that you care, you are showing love. When you listen to patients who for years have suffered disappointment, rejection, and denial from all of the people surrounding them, you show them love. When you do your best to alleviate the isolation, humiliation, and hopelessness that these patients have had to endure, you show them love.

This May, AMMES would like you to show our clients some love as well. Our funds are depleted, which means we cannot take on new clients who are in danger of eviction. Nor can we take care of the clients we already have. We cannot bear to see our people evicted or going hungry because of lack of money. We can’t turn our backs on them.

AMMES’ May Fundraiser

Please DONATE to our cause! We launched our spring fundraiser on May 1. We need $15,000 to see us through until the fall, but any amount will keep us going.

Our fundraiser is HERE. Please spread the word everywhere you can!

You can also donate directly to AMMES HERE.

Our overhead is very low, so all donations will go directly into the financial crisis fund. AMMES is a 501(c)(3) nonprofit, so your donation is tax deductible.

Read more about what we do!

HOMELESS: How AMMES Is Keeping People With ME/CFS In Their Homes

Food, Clothing, And Shelter: Providing The Basics To People With ME/CFS

For my birthday, I would like…

It just so happens that my birthday falls on May 10th ! In addition to a pony, I would very much like to have some board members join AMMES. (A social worker would be almost as nice as a pony.) I am looking for people who are healthy, but who have a family member or friend with ME/CFS. You can find out more about Board positions HERE.

There is nothing more satisfying than the work we do! Join us!

Continue reading “Remembering The Forgotten: How AMMES Combats Isolation And Neglect”

Advances in ME/CFS: Past, Present, and Future

Abstract:

The forerunner of what is today termed myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) was described by the U.S. Public Health Service in 1934. At the present time, we still do not know its cause and/or how to detect it by routine clinical laboratory tests. In consequence, the pathological nature of ME/CFS has been overlooked and the disease has been stigmatized by being mislabeled as psychosomatic or somatoform illness. Such misperceptions of the disease have led to insufficient research exploration of the disease and minimal to absent patient care.

A 2015 Institute of Medicine report on the illness declared ME/CFS a disease affecting up to 2.5 million Americans and chastised the U.S. government for doing little to research the disease and to support its patients. Clinicians who currently treat this disease declare it to be more devastating than HIV/AIDS. A comparison of the histories of the two diseases, an examination of the current status of the two diseases, and a listing of the accomplishments that would be needed for ME/CFS to achieve the same level of treatment and care as currently experienced by patients with HIV/AIDS is provided.

Source: Friedman KJ. Advances in ME/CFS: Past, Present, and Future. Front Pediatr. 2019 Apr 18;7:131. doi: 10.3389/fped.2019.00131. eCollection 2019. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6482157/ (Full article)

Searching for Serum Antibodies to Neuronal Proteins in Patients With Myalgic Encephalopathy/Chronic Fatigue Syndrome

Abstract:

PURPOSE: A role for the immune system in causing myalgic encephalopathy/chronic fatigue syndrome (ME/CFS) is long suspected, but few studies have looked for specific autoantibodies that might contribute to the symptoms. Our aim was to look for evidence of antibodies to neuronal proteins in patients with ME/CSF.

METHODS: Sera samples from 50 patients and 50 healthy individuals were sent coded to the Neuroimmunology Laboratory in Oxford. Screening for antibody binding to neuronal tissue was performed on brain tissue and neuronal cultures. Specific serum antibodies were assessed by antigen-specific cell-based assays and radioimmunoassays. After antibody testing, the associations between seropositive status and clinical data were investigated.

FINDINGS: Overall, 8 patients and 11 participants were found to have some serum immunoreactivity toward neuronal or neuromuscular junction proteins, but only 1 patient and 2 participants had specific serum antibodies. Nevertheless, seropositive status in patients with ME was associated with shorter duration since onset and a more severe disease.

IMPLICATIONS: The results indicate no overall increased frequency of antibodies to neuronal proteins in ME/CSF and no evidence of a specific antibody that might be causative or contribute to clinical features in patients. However, the association of seropositive status with shorter duration of disease and more severe symptoms suggests a possible role of antibodies at onset in some patients and should be the focus of future studies.

Copyright © 2019. Published by Elsevier Inc.

Source: Giannoccaro MP, Cossins J, Sørland K, Fluge Ø, Vincent A. Searching for Serum Antibodies to Neuronal Proteins in Patients With Myalgic Encephalopathy/Chronic Fatigue Syndrome. Clin Ther. 2019 Apr 30. pii: S0149-2918(19)30163-8. doi: 10.1016/j.clinthera.2019.04.001. [Epub ahead of print] https://www.ncbi.nlm.nih.gov/pubmed/31053295

Clinical symptoms and markers of disease mechanisms in adolescent chronic fatigue following Epstein-Barr virus infection: An exploratory cross-sectional study

Abstract:

INTRODUCTION: Acute Epstein-Barr virus (EBV) infection is a trigger of chronic fatigue (CF) and Chronic Fatigue Syndrome (CFS). The aim of this cross-sectional study was to explore clinical symptoms as well as markers of disease mechanisms in fatigued and non-fatigued adolescents 6 months after EBV-infection, and in healthy controls.

MATERIALS AND METHODS: A total of 200 adolescents (12-20 years old) with acute EBV infection were assessed 6 months after the initial infectious event and divided into fatigued (EBV CF+) and non-fatigued (EBV CF-) cases based on questionnaire score. The EBV CF+ cases were further sub-divided according to case definitions of CFS. In addition, a group of 70 healthy controls with similar distribution of sex and age was included. Symptoms were mapped with a questionnaire. Laboratory assays included EBV PCR and serology; detailed blood leukocyte phenotyping and serum high-sensitive C-reactive protein; and plasma and urine cortisol and catecholamines. Assessment of autonomic activity was performed with continuous, non-invasive monitoring of cardiovascular variables during supine rest, controlled breathing and upright standing. Differences between EBV CF+ and EBV CF- were assessed by simple and multiple linear regression adjusting for sex as well as symptoms of depression and anxiety. A p-value ≤ 0.05 was considered statistically significant. This study is part of the CEBA-project (Chronic fatigue following acute Epstein-Barr virus infection in adolescents).

RESULTS: The EBV CF+ group had significantly higher scores for all clinical symptoms. All markers of infection and most immune, neuroendocrine and autonomic markers were similar across the EBV CF+ and EBV CF- group. However, the EBV CF+ group had slightly higher serum C-reactive protein (0.48 vs 0.43 mg/L, p=0.031, high-sensitive assay), total T cell (CD3+) count (median 1573 vs 1481 x 106 cells/L, p=0.012), plasma norepinephrine (1420 vs 1113 pmol/L, p=0.01) and plasma epinephrine (363 vs 237 nmol/L, p=0.032); lower low-frequency:high frequency (LF/HF) ratio of heart rate variability at supine rest (0.63 vs 0.76, p=0.008); and an attenuated decline in LF/HF ratio during controlled breathing (-0.11 vs -0.25, p=0.002). Subgrouping according to different CFS diagnostic criteria did not significantly alter the results. Within the EBV CF+ group, there were no strong correlations between clinical symptoms and markers of disease mechanisms. In a multiple regression analysis, serum CRP levels were independently associated with serum cortisol (B= 4.5 x 10-4, p<0.001), urine norepinephrine (B=9.6 x 10-2, p=0.044) and high-frequency power of heart rate variability (B= -3.7 x 10-2, p=0.024).

CONCLUSIONS: In adolescents, CF and CFS 6 months after acute EBV infection are associated with high symptom burden, but no signs of increased viral load and only subtle alterations of immune, autonomic, and neuroendocrine markers of which no one is strongly correlated with symptom scores. A slight sympathetic over parasympathetic predominance is evident in CF and might explain slightly increased CRP levels.

Copyright © 2019. Published by Elsevier Inc.

Source: Kristiansen MS, Stabursvik J, O’Leary EC, Pedersen M, Asprusten TT, Leegaard T, Osnes LT, Tjade T, Skovlund E, Godang K, Wyller VBB. Clinical symptoms and markers of disease mechanisms in adolescent chronic fatigue following Epstein-Barr virus infection: An exploratory cross-sectional study.Brain Behav Immun. 2019 Apr 27. pii: S0889-1591(19)30133-3. doi: 10.1016/j.bbi.2019.04.040. [Epub ahead of print] https://www.ncbi.nlm.nih.gov/pubmed/31039432

A nanoelectronics-blood-based diagnostic biomarker for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)

Abstract:

There is not currently a well-established, if any, biological test to diagnose myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). The molecular aberrations observed in numerous studies of ME/CFS blood cells offer the opportunity to develop a diagnostic assay from blood samples. Here we developed a nanoelectronics assay designed as an ultrasensitive assay capable of directly measuring biomolecular interactions in real time, at low cost, and in a multiplex format.

To pursue the goal of developing a reliable biomarker for ME/CFS and to demonstrate the utility of our platform for point-of-care diagnostics, we validated the array by testing patients with moderate to severe ME/CFS patients and healthy controls. The ME/CFS samples’ response to the hyperosmotic stressor observed as a unique characteristic of the impedance pattern and dramatically different from the response observed among the control samples. We believe the observed robust impedance modulation difference of the samples in response to hyperosmotic stress can potentially provide us with a unique indicator of ME/CFS. Moreover, using supervised machine learning algorithms, we developed a classifier for ME/CFS patients capable of identifying new patients, required for a robust diagnostic tool.

Source: R. Esfandyarpour, A. Kashi, M. Nemat-Gorgani, J. Wilhelmy, and R. W. Davis. A nanoelectronics-blood-based diagnostic biomarker for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). PNAS first published April 29, 2019 https://doi.org/10.1073/pnas.1901274116

Biomarker for chronic fatigue syndrome identified by Stanford researchers

People suffering from a debilitating and often discounted disease known as chronic fatigue syndrome may soon have something they’ve been seeking for decades: scientific proof of their ailment.

Researchers at the Stanford University School of Medicine have created a blood test that can flag the disease, which currently lacks a standard, reliable diagnostic test.

“Too often, this disease is categorized as imaginary,” said Ron Davis, PhD, professor of biochemistry and of genetics. When individuals with chronic fatigue syndrome seek help from a doctor, they may undergo a series of tests that check liver, kidney and heart function, as well as blood and immune cell counts, Davis said. “All these different tests would normally guide the doctor toward one illness or another, but for chronic fatigue syndrome patients, the results all come back normal,” he said.

The problem, he said, is that they’re not looking deep enough. Now, Davis; Rahim Esfandyarpour, PhD, a former Stanford research associate; and their colleagues have devised a blood-based test that successfully identified participants in a study with chronic fatigue syndrome. The test, which is still in a pilot phase, is based on how a person’s immune cells respond to stress. With blood samples from 40 people — 20 with chronic fatigue syndrome and 20 without — the test yielded precise results, accurately flagging all chronic fatigue syndrome patients and none of the healthy individuals.

The diagnostic platform could even help identify possible drugs to treat chronic fatigue syndrome. By exposing the participants’ blood samples to drug candidates and rerunning the diagnostic test, the scientists could potentially see whether the drug improved the immune cells’ response. Already, the team is using the platform to screen for potential drugs they hope can help people with chronic fatigue syndrome down the line.

A paper describing the research findings will be published online April 29 in the Proceedings of the National Academy of Sciences. Davis is the senior author. Esfandyarpour, who is now on the faculty of the University of California-Irvine, is the lead author.

Providing the proof

The diagnosis of chronic fatigue syndrome, when it actually is diagnosed, is based on symptoms — exhaustion, sensitivity to light and unexplained pain, among other things — and it comes only after other disease possibilities have been eliminated. It’s estimated that 2 million people in the United States have chronic fatigue syndrome, but that’s a rough guess, Davis said, and it’s likely much higher.

For Davis, the quest to find scientific evidence of the malady is personal. It comes from a desire to help his son, who has suffered from chronic fatigue syndrome for about a decade. In fact, it was a biological clue that Davis first spotted in his son that led him and Esfandyarpour to develop the new diagnostic tool.

The approach, of which Esfandyarpour led the development, employs a “nanoelectronic assay,” which is a test that measures changes in miniscule amounts of energy as a proxy for the health of immune cells and blood plasma. The diagnostic technology contains thousands of electrodes that create an electrical current, as well as chambers to hold simplified blood samples composed of immune cells and plasma. Inside the chambers, the immune cells and plasma interfere with the current, changing its flow from one end to another. The change in electrical activity is directly correlated with the health of the sample.

The idea is to stress the samples from both healthy and ill patients using salt, and then compare how each sample affects the flow of the electrical current. Changes in the current indicate changes in the cell: the bigger the change in current, the bigger the change on a cellular level. A big change is not a good thing; it’s a sign that the cells and plasma are flailing under stress and incapable of processing it properly. All of the blood samples from chronic fatigue syndrome patients created a clear spike in the test, whereas those from healthy controls returned data that was on a relatively even keel.

“We don’t know exactly why the cells and plasma are acting this way, or even what they’re doing,” Davis said. “But there is scientific evidence that this disease is not a fabrication of a patient’s mind. We clearly see a difference in the way healthy and chronic fatigue syndrome immune cells process stress.” Now, Esfandyarpour and Davis are expanding their work to confirm the findings in a larger cohort of participants.

Doubling up

In addition to diagnosing chronic fatigue syndrome, the researchers are also harnessing the platform to screen for drug-based treatments, since currently the options are slim. “Using the nanoelectronics assay, we can add controlled doses of many different potentially therapeutic drugs to the patient’s blood samples and run the diagnostic test again,” Esfandyarpour said.

If the blood samples taken from those with chronic fatigue syndrome still respond poorly to stress and generate a spike in electrical current, then the drug likely didn’t work. If, however, a drug seems to mitigate the jump in electrical activity, that could mean it is helping the immune cells and plasma better process stress. So far, the team has already found a candidate drug that seems to restore healthy function to immune cells and plasma when tested in the assay. The drug, while successful in the assay, is not currently being used in people with chronic fatigue syndrome, but Davis and Esfandyarpour are hopeful that they can test their finding in a clinical trial in the future.

All of the drugs being tested are either already approved by the Food and Drug Administration or will soon be broadly accessible to the public, which is key to fast access and dissemination should any of these compounds pan out.

###

Other Stanford authors of the study are research scientists Neda Nemat-Gorgani and Julie Wilhelmy and research assistant, Alex Kashi.

The study was funded by the Open Medicine Foundation. Davis is the director of the foundation’s scientific advisory board.

Stanford’s departments of Genetics and of Biochemistry also supported the work

The Stanford University School of Medicine consistently ranks among the nation’s top medical schools, integrating research, medical education, patient care and community service. For more news about the school, please visit http://med.stanford.edu/school.html. The medical school is part of Stanford Medicine, which includes Stanford Health Care and Stanford Children’s Health. For information about all three, please visit http://med.stanford.edu.

The ‘cognitive behavioural model’ of chronic fatigue syndrome: Critique of a flawed model

Abstract:

Chronic fatigue syndrome/myalgic encephalomyelitis is a debilitating illness that greatly impacts the lives of sufferers. A cognitive behavioural model attempts to explain illness onset and continuance with a hypothesis that the illness is perpetuated by patients’ irrational beliefs and avoidance behaviours. This theory underpins the promotion of cognitive behavioural therapy, a treatment that aims to change beliefs and behaviours. This article reports on a detailed review of the cognitive behavioural model. Our review finds that the model lacks high-quality evidential support, conflicts with accounts given by most patients and fails to account for accumulating biological evidence of pathological and physiological abnormalities found in patients. There is little scientific credibility in the claim that psycho-behavioural therapies are a primary treatment for this illness.

Source: Keith Geraghty, Leonard Jason, Madison Sunnquist, David Tuller, Charlotte Blease, Charles Adeniji. The ‘cognitive behavioural model’ of chronic fatigue syndrome: Critique of a flawed model. Health Psychology Open, Volume: 6 issue: 1,
Article first published online: April 23, 2019; Issue published: January 1, 2019. https://journals.sagepub.com/doi/10.1177/2055102919838907 (Full article)