Tag: children

Psychological symptoms in chronic fatigue and juvenile rheumatoid arthritis

Abstract:

OBJECTIVE: To determine if psychological morbidity in youth with chronic fatigue is caused by the stress of coping with a chronic illness.

STUDY DESIGN: Case-control study comparing pediatric patients with debilitating chronic fatigue and matched subjects with juvenile rheumatoid arthritis, a chronic medical illness with similar functional sequelae.

SETTING: Pediatric Infectious Diseases Clinic and Juvenile Rheumatoid Arthritis Clinic of Kosair Children’s Hospital.

PARTICIPANTS: Nineteen children and adolescents with debilitating chronic fatigue and 19 age- and sex-matched peers with juvenile rheumatoid arthritis. Outcome. Structured Interview, Kaufman Brief Intelligence Test, Child Behavior Checklist, and Youth Self-Report.

RESULTS: Intellectual functioning on the Kaufman Brief Intelligence Test Composite was average (103, standard score) for both groups. Pediatric patients with chronic fatigue had higher levels of internalizing psychological distress than patients suffering from juvenile rheumatoid arthritis, despite the fact that both groups had a similar pattern of decline in social and physical activities. Duration of illness did not explain the difference in psychological symptoms.

CONCLUSIONS: Psychological factors may play a more active role in debilitating chronic fatigue in pediatric patients than can be explained by the stress of coping with a similar chronic, non-life-threatening illness.

 

Source: Carter BD, Kronenberger WG, Edwards JF, Marshall GS, Schikler KN, Causey DL. Psychological symptoms in chronic fatigue and juvenile rheumatoid arthritis. Pediatrics. 1999 May;103(5 Pt 1):975-9. http://www.ncbi.nlm.nih.gov/pubmed/10224175

 

How I manage chronic fatigue syndrome

About 12 years ago, I was asked to do a domicillary visit to see a 10 year old girl who in the spring had taken her secondary school entrance examination; caught a heavy cold with a persistent sore throat, which was taking a long time to clear; had a perpetual headache; dizziness on standing; extreme tiredness, which became worse if she tried to do anything; paraesthesia of the hands and feet intermittently; and disturbed sleep. Her general practitioner suggested postural hypotension, but I could find little abnormal except for some unsteadiness when she tried to walk. Routine haematological and biochemical tests were normal, as was computed tomography of her head. The physiotherapist that I referred her to reported that their attempts to mobilise her were actually making her worse, and wondered if she had a neuromuscular disease.

You can read the rest of this article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1717724/pdf/v079p00375.pdf

 

Source: Franklin A. How I manage chronic fatigue syndrome. Arch Dis Child. 1998 Oct;79(4):375-8. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1717724/pdf/v079p00375.pdf (Full article)

 

Chronic fatigue syndrome

The media has shown some interest in children with chronic fatigue syndrome, although national coverage does not always accurately reflect the position of the current medical publications. For example, one television programme indicated that most adolescents with the illness might expect to be ill for at least four years, a suggestion that research papers do not confirm. It is thus prudent to consider what current research tells us, particularly when there is an apparent disparity of views about the illness between parents, support groups, and professionals.

An editorial in the British Medical Journal1 and a report from the joint working group of the Royal Colleges of Physicians, Psychiatrists and General Practitioners2 both called for more work to be carried out on the assessment and management of children and adolescents with chronic fatigue syndrome. This review seeks to delineate our knowledge from published work as it currently stands and suggests an important area of further work.

You can read the rest of this article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1717705/pdf/v079p00368.pdf

 

Source: Wright JB, Beverley DW. Chronic fatigue syndrome. Arch Dis Child. 1998 Oct;79(4):368-74. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1717705/pdf/v079p00368.pdf

 

Neurally mediated hypotension and autonomic dysfunction measured by heart rate variability during head-up tilt testing in children with chronic fatigue syndrome

Abstract:

Recent investigations suggest a role for neurally mediated hypotension (NMH) in the symptomatology of chronic fatigue syndrome (CFS) in adults. Our previous observations in children with NMH and syncope (S) unrelated to CFS indicate that the modulation of sympathetic and parasympathetic tone measured by indices of heart rate variability (HRV) is abnormal in children who faint during head-up tilt (HUT). In order to determine the effects of autonomic tone on HUT in children with CFS we performed measurements of HRV during HUT in 16 patients aged 11-19 with CFS.

Data were compared to 26 patients evaluated for syncope and with 13 normal control subjects. After 30 minutes supine, patients were tilted to 80 degrees for 40 minutes or until syncope occurred. Time domain indices included RR interval, SDNN, RMSSD, and pNN50. An autoregressive model was used to calculate power spectra. LFP (.04-.15 Hz), HFP (.15-.40Hz), and TP (.01-.40Hz). Data were obtained supine (baseline) and after HUT.

Thirteen CFS patients fainted (CFS+, 5/13 pure vasodepressor syncope) and three patients did not (CFS-). Sixteen syncope patients fainted (S+, all mixed vasodepressor-cardioinhibitory) and 10 did not (S-). Four control patients fainted (Control+, all mixed vasodepressor-cardioinhibitory) and nine did not (Control-). Baseline indices of HRV were not different between Control+ and S+, and between Control- and S-, but were depressed in S+ compared to S-. HRV indices were strikingly decreased in CFS patients compared to all other groups.

With tilt, SDNN, RMSSD, and pNN50 and spectral indices decreased in all groups, remaining much depressed in CFS compared to S or control subjects. With HUT, sympathovagal indices (LFP/HFP, nLFP, and nHFP) were relatively unchanged in CFS, which contrasts with the increase in nLFP with HUT in all other groups. With syncope RMSSD, SDNN, LFP, TP, and HFP increased in S+ (and Control+), suggesting enhanced vagal heart rate regulation. These increases were not observed in CFS+ patients.

CFS is associated with NMH during HUT in children. All indices of HRV are markedly depressed in CFS patients, even when compared with already low HRV in S+ or Control+ patients. Sympathovagal balance does not shift toward enhanced sympathetic modulation of heart rate with HUT and there is blunting in the overall HRV response with syncope during HUT. Taken together these data may indicate autonomic impairment in patients with CFS.

 

Source: Stewart J, Weldon A, Arlievsky N, Li K, Munoz J. Neurally mediated hypotension and autonomic dysfunction measured by heart rate variability during head-up tilt testing in children with chronic fatigue syndrome. Clin Auton Res. 1998 Aug;8(4):221-30. http://www.ncbi.nlm.nih.gov/pubmed/9791743

 

Course and outcome of chronic fatigue in children and adolescents

Abstract:

PURPOSE: To describe the epidemiology, symptoms, and psychosocial characteristics of children and adolescents evaluated in a chronic fatigue program and determine the course and outcome of the syndrome in these patients.

METHODS: During the summer of 1994, chart review was performed for the 58 patients evaluated between 1990 and 1994 and a telephone follow-up was conducted with 42 of the 58 families. Patients were predominantly female (71%) and white (94%), with 50% between the ages of 7 and 14 years and 50% between the ages of 15 and 21 years (mean age 14.6 years).

RESULTS: At time of presentation, 50% of patients had been fatigued for 1 to 6 months and 50% had been fatigued for 7 to 36 months. Sixty percent indicated the fatigue had begun with an acute illness and 60% had a history of allergies. Most commonly reported symptoms were fatigue (100%), headache (74%), sore throat (59%), abdominal pain (48%), fever (36%), and difficulties with concentration and/or memory (33%). Most patients had a worsening of school performance and a decrease in social activities. On follow-up, there was significant improvement in many patients during the summer after the first visit, with continued improvement in most patients during the second and third years. At time of the follow-up telephone call, 43% of families considered their child “cured” and 52% considered their child “improved,” whereas only 5% considered their child to be “the same.” Statistical analyses demonstrated no demographic or clinical factors that distinguished between those who did or did not participate in the follow-up study, or between those who did or did not do well on follow-up.

CONCLUSIONS: These data demonstrate that children and adolescents with chronic fatigue have a syndrome that is similar to that described in adults, but that the syndrome differs in several ways, most specifically, presentation earlier in the course of the illness and a more optimistic outcome.

 

Source: Krilov LR, Fisher M, Friedman SB, Reitman D, Mandel FS. Course and outcome of chronic fatigue in children and adolescents. Pediatrics. 1998 Aug;102(2 Pt 1):360-6. http://www.ncbi.nlm.nih.gov/pubmed/9685439

 

Chronic fatigue syndrome in children. Patient organisations are denied a voice

Comment on: Managing chronic fatigue syndrome in children. [BMJ. 1997]

 

Editor—Action for ME is one of the two patient support groups referred to in “editor’s choice” in the issue of 7 June. The organisation, which represents 8000 members, accepts that any illness can have both physical and psychological components. In fact, for the past five years it has offered psychological support in the form of professional telephone counselling, and our journal has carried numerous articles testifying to a more complex understanding than the editor implies.

What we have a problem with, however, is some medical journals’ overemphasis on psychological factors when they refer to myalgic encephalomyelitis. Provocative features about hysteria and wandering wombs have not helped.1 Because of the possibility of cognitive malfunction,2 we believe that getting better is more complex that letting go of “symptom dependency” and “therapeutic nihilism”—terms that are frequently used in research attempting to show that abnormalities are not components of a primary pathological process but are secondary to behavioural aspects of myalgic encephalomyelitis, such as reduced physical activity.

You can read the rest of this comment here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2127601/pdf/9361554.pdf

 

Source: Jacobs G. Chronic fatigue syndrome in children. Patient organisations are denied a voice. BMJ. 1997 Oct 11;315(7113):949. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2127601/

 

Chronic fatigue syndrome in children. Journal was wrong to criticise study in schoolchildren

Comment on: Managing chronic fatigue syndrome in children. [BMJ. 1997]

Editor—In his editorial on managing the chronic fatigue syndrome in children Harvey Marcovitch implies that a 37% response rate to our questionnaire about long term sickness absence in schools was poor and insufficiently explained, and he states that we overinterpreted the resulting data.1 2

You can read the full comment here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2127623/pdf/9361553.pdf

 

Source: Dowsett EG, Colby J. Chronic fatigue syndrome in children. Journal was wrong to criticise study in schoolchildren. BMJ. 1997 Oct 11;315(7113):949. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2127623/

 

The prognosis of chronic fatigue and chronic fatigue syndrome: a systematic review

Abstract:

The prognosis of chronic fatigue syndrome and chronic fatigue has been studied in numerous small case series. We performed a systematic review of all studies to determine the proportion of individuals with the conditions who recovered at follow-up, the risk of developing alternative physical diagnoses, and the risk factors for poor prognosis.

A literature search of all published studies which included a follow-up of patients with chronic fatigue syndrome or chronic fatigue were performed. Of 26 studies identified, four studied fatigue in children, and found that 54-94% of children recovered over the periods of follow-up. Another five studies operationally defined chronic fatigue syndrome in adults and found that < 10% of subjects return to pre-morbid levels of functioning, and the majority remain significantly impaired. The remaining studies used less stringent criteria to define their cohorts. Among patients in primary care with fatigue lasting < 6 months, at least 40% of patients improved.

As the definition becomes more stringent the prognosis appears to worsen. Consistently reported risk factors for poor prognosis are older age, more chronic illness, having a comorbid psychiatric disorder and holding a belief that the illness is due to physical causes.

Comment in:

Chronic fatigue syndrome. [QJM. 1997]

Chronic fatigue syndrome. [QJM. 1997]

 

Source: Joyce J, Hotopf M, Wessely S. The prognosis of chronic fatigue and chronic fatigue syndrome: a systematic review. QJM. 1997 Mar;90(3):223-33. http://qjmed.oxfordjournals.org/content/90/3/223.long (Full article)

 

Cognitive idiosyncrasies among children with the chronic fatigue syndrome: anomalies in self-reported activity levels

Abstract:

The possibility that children with the chronic fatigue syndrome (CFS) and their parents tend to display idiosyncratic cognitive processing concerning levels of activity was examined by means of subjective and objective measures of current activity, together with subjective and objective measures of desired and expected future activity.

The degree to which subjective reports of current activity level reflect objectively measured activity level was examined in a group of children with CFS and a healthy control group. All subjects were assessed over a 3-day period by means of ambulatory activity monitoring, and self-reports and parent-reports of current activity level were collected by means of visual analog scales.

Analysis of variance revealed a significant interaction between the method of measurement (objective versus subjective) and the participant group (CFS versus Healthy) with the CFS children and their parents underestimating actual level of activity relative to the healthy group. Desired and expected levels of future activity were also assessed by means of subjective report. Child and parent expected levels of future activity were compared with their desired levels.

Although expected levels of future activity were similar in the two groups, the divergence between expected levels and corresponding desired levels was significantly greater in the CFS group. These results are discussed in terms of idiosyncratic cognitive processes, which are hypothesized to be associated with CFS and which may play a role in the maintenance of the disorder.

 

Source: Fry AM, Martin M. Cognitive idiosyncrasies among children with the chronic fatigue syndrome: anomalies in self-reported activity levels. J Psychosom Res. 1996 Sep;41(3):213-23. http://www.ncbi.nlm.nih.gov/pubmed/8910244

 

Differential diagnosis of chronic fatigue in children: behavioral and emotional dimensions

Abstract:

A battery of self-report questionnaires and structured diagnostic interviews was administered to 20 children and adolescents who presented to a pediatric specialty clinic with chronic fatigue. Matched groups of healthy and depressed control subjects (aged 8 to 19 years) were also studied. Criteria were established to identify those items in the assessment battery that reliably differentiated among the three groups.

Analysis of item content suggested several clusters of characteristics that discriminated among the subject groups, including life changes, cognitive difficulties, negative self-attributions, social relationship disruption, and somatic symptom presentation.

The results suggest that certain psychological factors can discriminate chronic fatigue from depressive symptomatology, as well as normal functioning. Items discriminating among groups are presented in an organized questionnaire format to assist with the understanding and assessment of pediatric chronic fatigue cases.

 

Source: Carter BD, Kronenberger WG, Edwards JF, Michalczyk L, Marshall GS. Differential diagnosis of chronic fatigue in children: behavioral and emotional dimensions. J Dev Behav Pediatr. 1996 Feb;17(1):16-21. http://www.ncbi.nlm.nih.gov/pubmed/8675709