Tag: chronic fatigue

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

 

Chronic tiredness and idiopathic chronic fatigue–a connection?

Abstract:

Evidence is adduced to support the proposal that pathological fatigue is a consequence of impaired capillary blood flow resulting in inadequate oxygen delivery, which is in accordance with physiological concepts of fatigue. Case reports are presented.

Comment in: Chronic fatigue syndrome. [N J Med. 1992]

 

Source: Simpson LO. Chronic tiredness and idiopathic chronic fatigue–a connection? N J Med. 1992 Mar;89(3):211-6. http://www.ncbi.nlm.nih.gov/pubmed/1574202

 

Hypothesis: cytokines may be activated to cause depressive illness and chronic fatigue syndrome

Abstract:

Abnormalities in the regulation of the hypothalamo-pituitary-adrenal (HPA) axis are a well recognised feature of endogenous depression. The mechanism underlying this phenomenon remains obscure although there is strong evidence suggesting excessive CRH activity at the level of the hypothalamus.

We propose a novel hypothesis in which we suggest that the aetiological antecent to CRH hyperactivity is cytokine activation in the brain. It is now well established both that interleukins -1 and -6 are produced in a number of central loci and that cytokines are potent stimulators of the HPA axis.

Hence, we suggest that activation of IL-1 and IL-6 by specific mechanisms (such as neurotropic viral infection) in combination with the consequent CRH-41 stimulation, may (via their known biological effects) underly many of the features found in major depression and other related disorders, particularly where chronic fatigue is a prominent part of the symptom complex.

This theory has considerable heuristic value and suggests a number of experimental stratagems which may employed in order to confirm or reject it.

 

Source: Ur E, White PD, Grossman A. Hypothesis: cytokines may be activated to cause depressive illness and chronic fatigue syndrome. Eur Arch Psychiatry Clin Neurosci. 1992;241(5):317-22. http://www.ncbi.nlm.nih.gov/pubmed/1606197

 

Tired all the time

General practitioners often see a syndrome they call “tired all the time.” How often doctors see it depends on how tiredness is defined and where it is measured. Morrell recorded fatigue as the most important reason for consultation in 24 per 2000 registered patients in one year 1; Jerrett recorded fatigue as a presenting or supporting symptom in 150 per 2000 registered patients.2 Yet patients may not necessarily mention fatigue when they consult. A survey of patients waiting in one surgery found that a tenth reported “substantial fatigue” for a month or more 3; 18-34% of respondents in a community survey reported always feeling tired in the past month 4; and when young women patients were asked to record symptoms in diaries 400 episodes of fatigue were recorded for every one reported to the doctor.5 Clinicians may regard this iceberg as a puzzle, and a blessing. But how should they manage the cases that do present?

Little has been published on tiredness in primary care, with only one prospective study from Britain2 and two retrospective ones from American family practice.67 The results suggest that psychosocial causes are paramount in 40-51% of cases and physical causes in 21-39%.267 The remaining cases are of mixed or undetermined cause. Fatigue presents three times more often in women of childbearing age,2 who often have a working day that is long and difficult to organise, with no boundary between home and work.8 The wise doctor steers between the extremes of trivialising and medicalising such “social” fatigue. If the cause is existential rather than medical counselling may help the patient consider various alternatives and make new choices.

You can read the rest of this article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1671843/pdf/bmj00157-0008.pdf

 

Source: Ridsdale L. Tired all the time. BMJ. 1991 Dec 14;303(6816):1490-1. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1671843/

 

Depression and somatization in the chronic fatigue syndrome

Abstract:

PURPOSE: To report the prevalence, clinical features, and diagnostic associations of the proposed chronic fatigue syndrome (CFS) in a cohort of patients with chronic fatigue and to assess the usefulness of a structured psychiatric interview for detecting previously unrecognized psychiatric morbidity in patients with CFS.

PATIENTS AND METHODS: A consecutive sample of 200 adult patients with a chief complaint of chronic fatigue was prospectively evaluated in a referral-based clinic within a university general medicine practice. All patients received a thorough medical history, physical examination, diagnostic laboratory testing, and portions of the Diagnostic Interview Schedule, version III-A. The criteria for CFS were applied, and patients with CFS were compared with matched control subjects from the inception cohort.

RESULTS: The 60 patients with CFS had similar likelihoods of current psychiatric disorders (78% versus 82%), active mood disorders (73% versus 77%), and preexisting psychiatric disorders (42% versus 43%) when compared with fatigued control subjects. Patients with CFS were more likely to have somatization disorder (p less than 0.001) and to attribute their illness to a physical cause (p less than 0.005) than fatigued controls. Patients with CFS also displayed functional symptoms, often lifelong, which are not part of the case definition of CFS. Depressive features in patients with CFS were similar to those of control subjects, but a trend toward suicidal behavior was noted.

CONCLUSIONS: Patients with CFS have a high prevalence of unrecognized, current psychiatric disorders, which often predate their fatigue syndrome. Assessment of patients with CFS should include a structured psychiatric evaluation.

 

Comment in:

Chronic fatigue syndrome and psychiatric disorders. [Am J Med. 1992]

Chronic fatigue syndrome (CFS) and psychiatric disorders. [Am J Med. 1994]

 

Source: Lane TJ, Manu P, Matthews DA. Depression and somatization in the chronic fatigue syndrome. Am J Med. 1991 Oct;91(4):335-44. http://www.ncbi.nlm.nih.gov/pubmed/1951377

 

Chronic fatigue in adolescents

Abstract:

Nine female and 6 male adolescents (mean age 14.5 +/- 1.7 [SD] years) were evaluated for chronic fatigue associated with at least three additional symptoms present for 18.4 +/- 8.4 months. Eleven subjects experienced the onset of symptoms with an acute illness (seven Monospot-positive). Medical history, physical examination, and laboratory testing yielded little helpful information. Serologic testing for Coxsackie B viruses 1 through 6, cytomegalovirus, Epstein-Barr virus, human herpesvirus 6, and Toxoplasma gondii in subjects and healthy controls provided little evidence for an infectious cause of persistent fatigue.

Children’s Depression Inventory scores and psychiatric interviews with the Schedule for Affective Disorders and Schizophrenia-Children’s Version (K-SADS) identified five subjects with major depression. On the K-SADS, the 10 fatigued subjects without major depression endorsed many secondary symptoms of depression but were less likely than depressed psychiatric clinic patients to endorse primary symptoms such as depressed mood, guilt, and suicidality. At telephone follow-up 13 to 32 months after intake, 4 subjects were completely well, 4 markedly improved, and 7 unimproved or worse.

Further research is necessary to determine whether chronic fatigue in adolescents is prodromal depression, a discrete psychosomatic condition, or an infectious or immunologic disorder that mimics depression.

Comment in:

Chronic fatigue in children: illness or disease? [Pediatrics. 1993]

Chronic fatigue immune dysfunction syndrome: an epidemic? [Pediatrics. 1992]

Chronic fatigue immune dysfunction syndrome: an epidemic? [Pediatrics. 1992]

Chronic fatigue immune dysfunction syndrome: an epidemic? [Pediatrics. 1992]

 

Source: Smith MS, Mitchell J, Corey L, Gold D, McCauley EA, Glover D, Tenover FC. Chronic fatigue in adolescents. Pediatrics. 1991 Aug;88(2):195-202. http://www.ncbi.nlm.nih.gov/pubmed/1861915

 

Psychiatric illness in patients with chronic fatigue and those with rheumatoid arthritis

Abstract

OBJECTIVES: To identify psychiatric differences between patients with chronic fatigue and those with rheumatoid arthritis and to investigate whether patients meeting Centers for Disease Control (CDC) criteria for chronic fatigue syndrome (CFS) can be differentiated from patients with chronic fatigue on measures of disability and psychosocial distress.

DESIGN: Cross-sectional study comparing 98 patients with chronic fatigue with 31 patients with rheumatoid arthritis on structured psychiatric interviews and patient questionnaires. Nineteen patients meeting CDC criteria for CFS were compared with 79 patients with chronic fatigue not meeting CDC criteria on questionnaires measuring disability and psychosocial distress.

SETTING: Consecutive patients with chronic fatigue were selected from a chronic fatigue clinic at the University of Washington, and 31 consecutive patients with rheumatoid arthritis were sampled from a private rheumatology practice.

MAIN RESULTS: Patients with chronic fatigue had a significantly higher prevalence of lifetime major depression and somatization disorder than did patients with rheumatoid arthritis. Patients with chronic fatigue also had a significantly higher prevalence of current and lifetime psychiatric diagnoses. Only 19 of 98 patients with chronic fatigue met CDC criteria for CFS. Patients meeting CDC criteria for CFS could not be differentiated from the larger group of patients with chronic fatigue on any study variable.

CONCLUSIONS: Patients with chronic fatigue have a significantly higher burden of psychiatric illness than do patients with rheumatoid arthritis. The psychiatric illness preceded the development of chronic fatigue in over half the patients. Centers for Disease Control criteria for CFS did not select a subset of chronic fatigue patients who could be differentiated on disability or psychosocial parameters from patients with chronic fatigue who did not meet CDC criteria.

Comment in The trouble with chronic fatigue. [J Gen Intern Med. 1991]

 

Source: Katon WJ, Buchwald DS, Simon GE, Russo JE, Mease PJ. Psychiatric illness in patients with chronic fatigue and those with rheumatoid arthritis. J Gen Intern Med. 1991 Jul-Aug;6(4):277-85. http://www.ncbi.nlm.nih.gov/pubmed/1890495