Tag: chronic fatigue

Breathing retraining: effect on anxiety and depression scores in behavioural breathlessness

Abstract:

Thirty-six patients underwent assessment of behavioural breathlessness which included monitoring of breathing patterns and end tidal CO2 concentration and completion of questionnaires relating to hyperventilation (HV), anxiety and depression. Twenty-two patients had a positive assessment and underwent breathing retraining. Assessments were repeated immediately after re-training and 2 months later. Ten of the patients (Group A) had behavioural breathlessness either as the primary problem or secondary to an established clinical condition, and twelve (Group B) in association with chronic fatigue.

Before re-training, resting end-tidal PCO2 was significantly lower in Group A than Group B (p < 0.05), but there was no significant difference in mean scores for HV-related symptoms, anxiety or depression. Following breathing retraining, both groups showed improvements in breathing patterns, end tidal CO2 levels and scores for HV-related symptoms which were sustained. In Group A the mean score for anxiety decreased (p < 0.01) and the score for depression was significantly lower than in Group B (p < 0.05). Although mean scores for anxiety and depression in Group B did not change significantly, some individuals in the group did show sustained improvement.

There was no improvement in symptoms associated with chronic fatigue in Group B. In behavioural breathlessness, breathing retraining is of benefit, not only in restoring more normal patterns of breathing but also in reducing anxiety, particularly in patients without the complication of chronic fatigue.

 

Source: Tweeddale PM, Rowbottom I, McHardy GJ. Breathing retraining: effect on anxiety and depression scores in behavioural breathlessness. J Psychosom Res. 1994 Jan;38(1):11-21. http://www.ncbi.nlm.nih.gov/pubmed/8126685

 

Seasonal symptom variation in patients with chronic fatigue: comparison with major mood disorders

Abstract:

The psychobiology of idiopathic fatigue has received renewed interest in the medical literature in recent years. In order to examine the relation between chronic, idiopathic fatigue and specific subtypes of depressive illness, we characterized the pattern and severity of seasonal symptom variation in 73 patients with chronic, idiopathic fatigue, compared to patients with major depression (n = 55), atypical depression (n = 35), and seasonal affective disorder (n = 16) Fifty of the fatigued subjects also met the specific Centers for Disease Control and Prevention case criteria for chronic fatigue syndrome, though this definition was unable to discriminate a distinct subgroup of patients, based on their seasonality scores alone. As a group, the fatigued subjects reported the lowest levels of symptom seasonality of any of the study groups. Further, even in those fatigued subjects with scores in the range of those seen in patients with seasonal affective disorder, seasonality was not reported to be a subjectively distressing problem. These findings lend support to the idea that although chronic fatigue shares some clinical features with certain mood disorders, they are not the same illnesses. These data are also consistent with the emerging view that chronic fatigue represents a heterogeneously determined clinical condition.

 

Source: Zubieta JK, Engleberg NC, Yargiç LI, Pande AC, Demitrack MA. Seasonal symptom variation in patients with chronic fatigue: comparison with major mood disorders. J Psychiatr Res. 1994 Jan-Feb;28(1):13-22. http://www.ncbi.nlm.nih.gov/pubmed/8064638

 

Chronic fatigue in primary care attenders

Abstract:

From 686 patients attending primary care physicians, 77 were identified by a screening procedure as having chronic fatigue. Of these, 65 were given a comprehensive psychological, social and physical evaluation.

Seventeen cases (26%) met criteria for the chronic fatigue syndrome. Forty-seven (72%) received an ICD-9 diagnosis of whom 23 had neurotic depression, with a further 5 meeting criteria for neurasthenia.

Forty-nine were ‘cases’ as defined by the revised Clinical Interview Schedule (CIS-R), and 42 if the fatigue item was excluded. Psychiatric morbidity was more related to levels of social stresses than was severity of fatigue.

The main difference between these subjects and those examined in hospital settings is that the former are less liable to attribute their symptoms to wholly physical causes, including viruses, as opposed to social or psychological factors. Identification and management of persistent fatigue in primary care may prevent the secondary disabilities seen in patients with chronic fatigue syndromes.

 

Source: McDonald E, David AS, Pelosi AJ, Mann AH. Chronic fatigue in primary care attenders. Psychol Med. 1993 Nov;23(4):987-98. http://www.ncbi.nlm.nih.gov/pubmed/8134522

 

Human herpesvirus 6 and chronic fatigue syndrome

Abstract:

The cause of chronic fatigue syndrome (CFS) is still enigmatic. Using indirect immunofluorescence testing for measuring antibody against human herpesvirus 6 (HHV-6), this study investigated the association of CFS with infection by HHV-6. Seventeen patients (group A) fulfilling the Centers for Disease Control (CDC) definition for CFS were compared with eight patients (group B) with chronic fatigue but not meeting the CDC criteria.

No significant difference was found between the two groups for 30 parameters including sex, age, exposure to children and serology for Epstein-Barr virus, cytomegalovirus, herpes simplex virus, and toxoplasma. Univariate analysis showed that patients in group A complained more frequently of a sore throat, headache and of recurrent type of fatigue.

These three parameters are discriminant in identifying patients who will meet the CDC case definition of CFS. The titre of antibody against HHV-6 in group A (1:99) was significantly higher than in group B (1:15) (P=0.007). Elevated HHV-6 titres suggests that this virus could be a cofactor in the pathogenesis of CFS.

 

Source: Eymard D, Lebel F, Miller M, Turgeon F. Human herpesvirus 6 and chronic fatigue syndrome. Can J Infect Dis. 1993 Jul;4(4):199-202. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3250792/  (Full article)

 

Chronic fatigue: electromyographic and neuropathological evaluation

Abstract:

Single fibre electromyography of extensor digitorum communis muscle (EDC) was performed on 35 patients with chronic fatigue, the majority of whom also had creatine kinase estimation and biopsy of EDC.

The subjects were categorised as having an acute-onset post-viral fatigue syndrome, a non-specific chronic fatigue or possible muscle disease in view of pronounced myalgia.

Of 11 subjects who had myalgia as a significant symptom, abnormalities in fibre density were found in 6, and 5 of these had some non-specific abnormalities on muscle biopsy, with creatine kinase levels being normal in all cases. Fibre density estimation may be a useful way of identifying a subgroup of chronic fatigue sufferers with a possible primary muscle disorder.

 

Source: Connolly S, Smith DG, Doyle D, Fowler CJ. Chronic fatigue: electromyographic and neuropathological evaluation. J Neurol. 1993 Jul;240(7):435-8. http://www.ncbi.nlm.nih.gov/pubmed/8410086

 

Red cell shape changes following trigger finger fatigue in subjects with chronic tiredness and healthy controls

Abstract:

AIMS: To investigate the possibility of a correlation between the percentage of nondiscocytic erythrocytes and muscle fatiguability in subjects with the symptom of chronic tiredness.

METHODS: Sixty nine volunteers suffering from persisting or intermittent tiredness and 72 healthy controls provided 3-drop samples of venous blood for red cell shape analysis before and after inducing fatigue in the trigger finger muscles by repeatedly pulling the trigger of an antique revolver. Elapsed time and the number of pulls were recorded. A work index was calculated from the number of trigger pulls divided by the time in seconds then multiplied by the number of trigger pulls.

RESULTS: Subjects with tiredness had fewer discoid cells (males 62.5% vs 69.2%, p = 0.029; females 65.8% vs 71.8%, p = 0.002) than controls. They also had fewer trigger pulls (males 62.3 vs 84.0, p = 0.003; females 29.5 vs 36.8, p = 0.042) and lower “work indices” (males 75.6 vs 104.7, p = 0.001; females 26.1 vs 39.6, p = 0.001) than controls at the first trigger pulling. After 5 minutes rest the number of trigger pulls for males was fewer than the controls (56.0 vs 64.2) but the difference was not significant, but the female values (24.3 vs 33.2) were significantly different (p = 0.008). Work indices for both sexes were significantly different from controls (males p = 0.020, females p = 0.001).

CONCLUSIONS: The association of increased nondiscocytes and impaired muscle function could indicate a cause and effect relationship. This would be in agreement with the physiological concept of fatigue as a consequence of inadequate oxygen delivery.

 

Source: Simpson LO, Murdoch JC, Herbison GP. Red cell shape changes following trigger finger fatigue in subjects with chronic tiredness and healthy controls. N Z Med J. 1993 Mar 24;106(952):104-7. http://www.ncbi.nlm.nih.gov/pubmed/8474717

 

Estimating the prevalence of chronic fatigue syndrome and associated symptoms in the community

Abstract:

Chronic fatigue syndrome is a poorly understood disease characterized by debilitating fatigue and neuromuscular and neuropsychological symptoms. Despite numerous studies on the subject, the epidemiology of the syndrome in the community remains largely unexplored.

An estimate of the prevalence in the population is presented, approximating the Centers for Disease Control criteria as well as the prevalence estimates of the fatigue symptom complex that include fatigue, disability, and neuromuscular and neuropsychological symptoms. The study population consisted of a very large, multicenter, stratified, and random sample of a general population health survey known as the Epidemiologic Catchment Area Program.

Data used for this study were gathered between 1981 and 1984. The Diagnostic Interview Schedule, a highly structured mental health interview, was used to assess the lifetime prevalence of medical and psychological symptoms. Chronic fatigue was common.

A total of 23 percent of the subjects reported having experienced the symptom of persistent fatigue sometime during their lives. Chronic fatigue syndrome, however, as defined by the Centers for Disease Control, appeared to be quite rare in the general population. Only 1 of 13,538 people examined was found to meet a diagnosis of the syndrome with an approximation of the CDC criteria. Fatigue symptom complex was frequently related to medical or psychiatric illness or substance abuse; thus, persons meeting partial criteria of chronic fatigue syndrome were also found to be rare when psychiatric or medical exclusions were applied.

 

Comment in: Taking exception to chronic fatigue syndrome prevalence findings by Price, et al. [Public Health Rep. 1993]

 

Source: Price RK, North CS, Wessely S, Fraser VJ. Estimating the prevalence of chronic fatigue syndrome and associated symptoms in the community. Public Health Rep. 1992 Sep-Oct;107(5):514-22. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1403692/ (Full article)

 

The epidemiology of fatigue: more questions than answers

Fatigue syndromes, though recognised for some time, have recently attracted a variety of new diagnostic labels, as well as both professional and media controversy. However, most of the arguments surround the interpretation of small hospital based case-control studies using highly selected groups of patients.’ There is relative silence on population based studies, which perhaps contributes to the lack of concensus. This paper reviews the epidemiology of fatigue in the general population and in primary care and examines potential sources of bias in hospital based studies

You can read the rest of this article here:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1059513/pdf/jepicomh00209-0006.pdf

 

Source: Lewis G, Wessely S. The epidemiology of fatigue: more questions than answers. J Epidemiol Community Health. 1992 Apr;46(2):92-7. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1059513/

 

The measurement of fatigue and chronic fatigue syndrome

Comment in: Chronic fatigue syndrome and heterogeneity. [J R Soc Med. 1992]

 

Fatigue remains as elusive a human experience as ever. At the turn of the century fatigue was almost an obsession of doctors, scientists, writers and even politicians. The scientists believed they could measure it, the doctors they could treat it, the writers describe it, and the politicians prevent it (1). Many confidently expected that fatigue could be eliminated from schools, factories, armies, and even society. That it had to be dealt with was not in doubt, since many authorities believed that if not checked, fatigue, the inevitable consequence of modern life in all its forms, would somehow destroy the nation’s health and its future. Perhaps only the writers achieved their objective (2) – certainly, the descriptions of fatigue and exhaustion in the turn of the century literature, and even in the medical journals, are far richer and detailed than the leaden descriptions which we now encounter.

You can read the rest of this article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1294719/pdf/jrsocmed00112-0007.pdf

 

Source: Wessely S. The measurement of fatigue and chronic fatigue syndrome. J R Soc Med. 1992 Apr;85(4):189-90. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1294719/

 

Unexplained fever and chronic fatigue: abnormal circadian temperature pattern

Abstract:

OBJECTIVES: Standard clinical and biological investigations can be used to determine the origin of persistent and moderate fever in a large number of otherwise asymptomatic patients. However, in a small proportion of cases, isolated fever and fatigue persist despite the absence of detectable organic malfunction. This study was conducted to investigate the circadian thermic pattern in patients with apparently unexplainable fever and chronic fatigue and in those with fever of recognized origin.

METHODS: We recorded central temperature continuously for 24 hours in patients with moderate fever of both unexplained and recognized origin, and in a control group of healthy volunteers. A Fourier series was used for harmonic analysis.

RESULTS: Thermic patterns specific to the three groups were identified by statistical and factorial analysis. The patients with fever of unknown origin and chronic fatigue were clearly characterized in terms of the phase, amplitude of the first (fundamental) harmonic and minimum circadian temperature.

CONCLUSION: The abnormal central temperature pattern in these patients may prove to be an important step in the management of febrile patients.

 

Source: Camus F, Henzel D, Janowski M, Raguin G, Leport C, Vildé JL. Unexplained fever and chronic fatigue: abnormal circadian temperature pattern. Eur J Med. 1992 Apr;1(1):30-6. http://www.ncbi.nlm.nih.gov/pubmed/1341974