Tag: anxiety

Chronic fatigue syndrome criteria. A critique of the requirement for multiple physical complaints

Abstract:

OBJECTIVE: The purpose of this study was to test the hypothesis that the patients with chronic fatigue who have the highest number of medically unexplained physical symptoms over their lifetime would also have the highest prevalence of current and lifetime affective and anxiety disorders, lifetime affective symptoms, and the most functional disability. A further goal was to use this information to modify the current case definition to better identify a subgroup of patients with chronic fatigue syndrome who are less likely to have psychiatric illness.

DESIGN: Two hundred eighty-five consecutive patients with chronic fatigue were interviewed with the National Institute of Mental Health Diagnostic Interview Schedule and completed four self-rating questionnaires measuring psychologic distress, functional disability, and the tendency to amplify symptoms. Based on previously published data, patients were divided into four groups with a progressively higher number of lifetime medically unexplained physical symptoms. The prevalence of current and lifetime psychiatric disorders, lifetime psychologic symptoms, and extent of functional impairment was then compared in these four groups of patients.

MAIN RESULTS: The prevalence of current and lifetime psychiatric diagnosis and lifetime depressive symptoms increased linearly with the number of lifetime physical symptoms that the patient experienced. The extent of impairment in activities of daily living and the tendency to amplify symptoms also increased linearly with the number of medically unexplained physical symptoms.

CONCLUSION: The patients with the highest numbers of medically unexplained physical symptoms had extraordinarily high rates of current and lifetime psychiatric disorders. These data suggest that the current case definition for chronic fatigue syndrome inadvertently selects for patients with the highest prevalence of lifetime psychiatric diagnoses. A recommendation based on these results is to modify the case criteria for chronic fatigue syndrome to include patients with fatigue and few physical symptoms and to identify and consider excluding patients with high numbers of physical complaints.

Comment in: Defining the chronic fatigue syndrome. [Arch Intern Med. 1992]

 

Source: Katon W, Russo J. Chronic fatigue syndrome criteria. A critique of the requirement for multiple physical complaints. Arch Intern Med. 1992 Aug;152(8):1604-9. http://www.ncbi.nlm.nih.gov/pubmed/1497394

 

Chronic fatigue syndrome: a joint paediatric-psychiatric approach

Comment in: Chronic fatigue syndrome: a joint paediatric-psychiatric approach. [Arch Dis Child. 1992]

 

Prolonged fatigue after an apparent viral infection, occurring sporadically or as an epidemic, has been described over the past 50 years. It has been given various names including Royal Free disease (1) and myalgic encephalomyelitis, but the preferred terms in the medical literature have been postviral fatigue syndrome (2) or chronic fatigue syndrome (CFS). (3)

However, the validity of this syndrome as a nosological entity has created a good deal of controversy and remains in doubt. (4) A constellation of symptoms make up the syndrome. There is fatigue of defined onset that is generally reported to follow a viral illness, often an influenza-like illness or an infection of the upper respiratory tract. The patient experiences profound fatigue with the initial illness and then fails to make the expected recovery, with fatigue that can persist over months or years. Fatigue is defined as a subjective sensation, which the patient often describes as tiredness or weariness and that occurs at rest. These patients also report a clear relationship of fatigue to activity. The term fatiguability has been used to describe the greater than normal fatigue that occurs after physical and sometimes after mental exertion in these patients. A great variety of associated symptoms have been described that include increased sleepiness, dizziness, vertigo, headache, difficulty in concentrating, sore throat, muscle weakness, and myalgia. The majority of patients have some emotional symptoms. There can be irritability and anxiety, tearfulness and depression. The fatigue and associated symptoms are of such severity as to impair significantly normal daily activities. There is a remarkable absence of physical signs and physical investigations fail to detect any organic pathology or current infection to account for the symptoms.

You can read the rest of this article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1793327/pdf/archdisch00639-0088.pdf

 

Source: Vereker MI. Chronic fatigue syndrome: a joint paediatric-psychiatric approach. Arch Dis Child. 1992 Apr;67(4):550-5. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1793327/

 

Intense fatigue in humans. Psychosocial and cultural aspects

Abstract:

A differentiation between the normal sensation of tiredness and the symptom “fatigue” is often difficult. Both are influenced by cultural, social, psychological and biological factors, which can lead–interactively–to symptom formation. Psychiatric disorders frequently associated with fatigue are all forms of depression, somatization and anxiety disorders, chronic pain states and drug abuse among many others. In at least 2/3 of patients with the fashionable chronic fatigue syndrome–formerly called neurasthenia–a psychiatric diagnosis can be made, most of them also suffer from many symptoms attributes to the autonomous nervous system. The clinical approach should be cautious avoiding diagnostic and therapeutic overaction and therapy should emerge from a diagnosis properly assessed.

 

Source: Radvila A. Intense fatigue in humans. Psychosocial and cultural aspects. Ther Umsch. 1991 Nov;48(11):756-61. [Article in German] http://www.ncbi.nlm.nih.gov/pubmed/1754973

 

Myalgic encephalomyelitis

Note: This letter appeared in the Journal of the Royal Society of Medicine in March 1990.

 

We accept that Martin Lev (November 1989 JRSM, p 693) is correct to point out that the anxiety and depression noted in patients labelled as suffering from ‘ME’ are the consequence of ‘underlying organic processes’. The demonstration of hyperventilation in the overwhelming majority of these patients (Rosen SD, King JC, Nixon PGF, unpublished results), provides a clear metabolic reason for the anxiety (1-3). ‘Depression’ is a predictable reaction to the inability to make and sustain effort due in part to the ease of acidosis of muscle cells depleted of buffer base reserves(4).

We agree with Sargant(5), that the sufferers from the late stages of effort syndrome, who have nothing to gain from their ill health and much to lose, are among the most gifted and energetic of people, and consequently the most upset about the frustration caused by loss of performance.

~S D ROSEN Cardiac Registrar

~J C KING Honorary Head Occupational Therapist (Research)

~P G F NIXON Consultant Cardiologist Charing Cross Hospital London

 

 References

1 Lewis T, et al. Breathlessness in soldiers suffering from irritable heart. Br Med J 14 October 1916:517-19

2 Lum LC. The syndrome of chronic habitual hyperventilation. In: Hill OW, ed. Modern trends in psychosomatic medicine, vol. 3. London: Butterworths, 1976: 196-230

3 Groen JJ. The measurement of emotion and arousal in the clinical physiological laboratory and in medical practice. In: Levi L, ed. The emotions: their parameters and measurement. New York: Raven Press, 1975:727-46

4 Rosen SD, King JC, Nixon PGF. Magnetic resonance muscle studies. J R Soc Med 1988;81:676-7 5 Sargant W. Battle for the mind Aphysiology ofconversion and brain-washing. London: Heinemann 1957

 

Source:  Rosen, SD, King, JC, Nixon, PGF. Myalgic encephalomyelitis. Journal of the Royal Society of Medicine Volume 83 March 1990.  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1292587/

 

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