Tag: depression

Cerebral perfusion in chronic fatigue syndrome and depression

Abstract:

BACKGROUND: Patients with chronic fatigue syndrome (CFS) and depressive illness share many, but not all, features.

AIMS: To test the hypothesis that patients with CFS have abnormal cerebral perfusion, that differs from that in patients with depressive illness.

METHOD: We recruited 30 patients with CFS who were not depressed, 12 depressed patients and 15 healthy volunteers. Regional cerebral perfusion at rest was assessed using region of interest (ROI) and voxel-based statistical parametric mapping (SPM) techniques.

RESULTS: On SPM analysis there was increased perfusion in the right thalamus, pallidum and putamen in patients with CFS and in those with depressive illness. CFS patients also had increased perfusion in the left thalamus. Depressed patients differed from those with CFS in having relatively less perfusion of the left prefrontal cortex. The results were similar on ROI analysis.

CONCLUSIONS: Abnormal cerebral perfusion patterns in CFS subjects who are not depressed are similar but not identical to those in patients with depressive illness. Thalamic overactivity may be a correlate of increased attention to activity in CFS and depression; reduced prefrontal perfusion in depression may be associated with the greater neuropsychological deficits in that disorder.

Comment in: Chronic fatigue syndrome and depression. [Br J Psychiatry. 2000]

 

Source: MacHale SM, Lawŕie SM, Cavanagh JT, Glabus MF, Murray CL, Goodwin GM, Ebmeier KP. Cerebral perfusion in chronic fatigue syndrome and depression. Br J Psychiatry. 2000 Jun;176:550-6. http://bjp.rcpsych.org/content/176/6/550.long (Full article)

 

Strength and physiological response to exercise in patients with chronic fatigue syndrome

Abstract:

OBJECTIVE: To measure strength, aerobic exercise capacity and efficiency, and functional incapacity in patients with chronic fatigue syndrome(CFS) who do not have a current psychiatric disorder.

METHODS: Sixty six patients with CFS without a current psychiatric disorder, 30 healthy but sedentary controls, and 15 patients with a current major depressive disorder were recruited into the study. Exercise capacity and efficiency were assessed by monitoring peak and submaximal oxygen uptake, heart rate, blood lactate, duration of exercise, and perceived exertion during a treadmill walking test. Strength was measured using twitch interpolated voluntary isometric quadriceps contractions. Symptomatic measures included physical and mental fatigue, mood, sleep, somatic amplification, and functional incapacity.

RESULTS: Compared with sedentary controls, patients with CFS were physically weaker, had a significantly reduced exercise capacity, and perceived greater effort during exercise, but were equally unfit. Compared with depressed controls, patients with CFS had significantly higher submaximal oxygen uptakes during exercise, were weaker, and perceived greater physical fatigue and incapacity. Multiple regression models suggested that exercise incapacity in CFS was related to quadriceps muscle weakness, increased cardiovascular response to exercise, and body mass index. The best model of the increased exercise capacity found after graded exercise therapy consisted of a reduction in submaximal heart rate response to exercise.

CONCLUSIONS: Patients with CFS were weaker than sedentary and depressed controls and as unfit as sedentary controls. Low exercise capacity in patients with CFS was related to quadriceps muscle weakness, low physical fitness, and a high body mass ratio. Improved physical fitness after treatment was associated with increased exercise capacity. These data imply that physical deconditioning helps to maintain physical disability in CFS and that a treatment designed to reverse deconditioning helps to improve physical function.

Comment in: Chronic fatigue syndrome: is it physical? [J Neurol Neurosurg Psychiatry. 2000]

 

Source: Fulcher KY, White PD. Strength and physiological response to exercise in patients with chronic fatigue syndrome. J Neurol Neurosurg Psychiatry. 2000 Sep;69(3):302-7. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1737090/ (Full article)

 

The difference in patterns of motor and cognitive function in chronic fatigue syndrome and severe depressive illness

Abstract:

BACKGROUND: Chronic fatigue syndrome (CFS) and major depressive disorder (MDD) share many symptoms and aetiological factors but may have different neurobiological underpinnings. We wished to determine the profile of the biological variables disturbed in CFS and MDD, and identify any critical factors that differentiate the disorders.

METHODS: Thirty patients with CFS, 20 with MDD and 15 healthy controls matched group-wise for age and sex were recruited. Subjects were given a detailed battery of motor and cognitive tests, including measures of psychomotor speed, memory and maximal voluntary muscle contraction in both the morning and evening that were balanced to avoid order effects.

RESULTS: CFS patients generally performed worse on cognitive tests than healthy controls, but better than patients with MDD. Both patient groups had markedly impaired motor function compared with healthy controls. MDD subjects showed a significantly greater diurnal improvement in maximal voluntary contraction than healthy controls.

CONCLUSIONS: Patients with CFS and MDD show similarly substantial motor impairment, but cognitive deficits are generally more marked in MDD. Diurnal changes in some functions in MDD may differentiate the disorder from CFS.

 

Source: Lawrie SM, MacHale SM, Cavanagh JT, O’Carroll RE, Goodwin GM. The difference in patterns of motor and cognitive function in chronic fatigue syndrome and severe depressive illness. Psychol Med. 2000 Mar;30(2):433-42. http://www.ncbi.nlm.nih.gov/pubmed/10824663

 

Psychological profile and ventilatory response to inspiratory resistive loading

Abstract:

The purpose of this study was to explore the contribution of psychological state to both the ventilatory response and the intensity of dyspnea experienced after the addition of small inspiratory loads to breathing. We hypothesized that patients with either a specific psychiatric diagnosis or a specific psychological trait will associate a greater degree of dyspnea with a loaded breathing task than will control subjects.

To insure the inclusion of persons with relevant psychological profiles, we recruited both subjects enrolled in the Chronic Fatigue Center and normal control subjects. In all, 52 subjects inspired first through a small (1.34 cm H(2)O/L/s) and second through a moderate (3.54 cm H(2)O/L/s) inspiratory resistive load (IRL). Ventilation was monitored throughout the 5-min sessions. Dyspnea was quantified with the Borg scale at specified times during the protocol. Standard psychological tests were administered.

We found that subjects could be divided into two groups. One, the “responders,” reported Borg scores higher than those of the second, or “nonresponder” group, at all times during the protocol. By contrast, there was no difference between groups with respect to ventilation. Responders had higher scores on tests of depression (the Center for Epidemiological Study depression scale) than did nonresponders. We conclude that the variability observed in subjective responses to IRL is explained, in part, by differences in psychological state.

 

Source: Lavietes MH, Sanchez CW, Tiersky LA, Cherniack NS, Natelson BH. Psychological profile and ventilatory response to inspiratory resistive loading. Am J Respir Crit Care Med. 2000 Mar;161(3 Pt 1):737-44. http://www.ncbi.nlm.nih.gov/pubmed/10712316

 

Psychiatric morbidity and illness experience of primary care patients with chronic fatigue in Hong Kong

Abstract:

OBJECTIVE: The authors’ goal was to examine the prevalence and experience of psychiatric morbidity among primary care patients with chronic fatigue in Hong Kong.

METHOD: One hundred adult patients with medically unexplained fatigue for 6 or more months were assessed with the Explanatory Model Interview Catalogue, psychopathological rating scales, and an enhanced version of the Structured Clinical Interview for DSM-III-R.

RESULTS: The lifetime prevalence of DSM-III-R depressive and anxiety disorders was 54%. Current depressive and anxiety disorders were identified in 28 patients, who exhibited more psychopathology and functional impairment than other patients. Thirty-three patients had somatoform pain disorder, and 30 had undifferentiated somatoform disorder, but most of them could also be diagnosed as having shenjing shuairuo (weakness of nerves) and, to a lesser extent, ICD-10 neurasthenia. Chronic fatigue syndrome diagnosed according to the 1988 Centers for Disease Control criteria was rare (3%) and atypical. Generally, patients mentioned fatigue if asked, but pains (36%), insomnia (20%), and worries (13%) were the most troublesome symptoms. Most patients attributed illness onset to psychosocial sources.

CONCLUSIONS: Psychiatric morbidity was common among primary care patients with chronic fatigue. Subthreshold psychiatric morbidity was very common and was more validly represented by the disease construct of shenjing shuairuo or neurasthenia than somatoform disorder.

 

Source: Lee S, Yu H, Wing Y, Chan C, Lee AM, Lee DT, Chen C, Lin K, Weiss MG. Psychiatric morbidity and illness experience of primary care patients with chronic fatigue in Hong Kong. Am J Psychiatry. 2000 Mar;157(3):380-4. http://www.ncbi.nlm.nih.gov/pubmed/10698813

 

The role of depression in pain, psychophysiological syndromes and medically unexplained symptoms associated with chronic fatigue syndrome

Abstract:

BACKGROUND: The association between depression and pain, function, medically unexplained symptoms and psychophysiological syndromes such as irritable bowel syndrome has not been explored before in chronic fatigue syndrome.

METHODS: Cross-sectional controlled study of the current prevalence of psychophysiological syndromes, pain, function and lifetime prevalence of medically unexplained symptoms in 77 out-patients with chronic fatigue syndrome (CFS) without DSM-III-R depression, 42 CFS out-patients with DSM-III-R depression and 26 out-patient with primary DSM-III-R depression.

RESULTS: Both CFS groups differed significantly from the primary depression group but not each other in the prevalence of tension headaches (P < 0.001), reporting of widespread bodily pain (P < 0.001) and the number of lifetime medically unexplained symptoms (P < 0.001). The three groups did not significantly differ in the prevalence of irritable bowel syndrome or fibromyalgia. CFS patients with depression were more impaired in social function than other CFS patients.

CONCLUSION: Depression is not associated with the reporting of pain, psychophysiological syndromes and medically unexplained symptoms in CFS patients. Depression is associated with decreased social function in CFS patients.

LIMITATIONS: Study depended on recall of symptoms, not confirmed by medical records and current investigations. Patients with depression were taking antidepressants.

CLINICAL RELEVANCE: Treating depression in chronic fatigue syndrome is unlikely to diminish reporting of pain and medically unexplained symptoms but may improve social function.

 

Source: Morriss RK, Ahmed M, Wearden AJ, Mullis R, Strickland P, Appleby L, Campbell IT, Pearson D. The role of depression in pain, psychophysiological syndromes and medically unexplained symptoms associated with chronic fatigue syndrome. J Affect Disord. 1999 Oct;55(2-3):143-8. http://www.ncbi.nlm.nih.gov/pubmed/10628883

 

Psychiatric adjustment in adolescents with a history of chronic fatigue syndrome

Abstract:

OBJECTIVE: To ascertain psychiatric adjustment in youngsters with a history of childhood chronic fatigue syndrome (CFS).

METHOD: Subjects were 25 children and adolescents with CFS who were seen in tertiary pediatric/psychiatric clinics (mean age 15.6 years, seen a mean of 45.5 months after illness onset; 17 subjects had recovered and 8 were still ill) and 15 healthy matched controls. Youngsters and their parents (usually mothers) were interviewed and completed questionnaires. Instruments used included the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS), the Child Behavior Checklist (CBCL), and the Harter Self-Esteem Questionnaire.

RESULTS: At assessment, psychiatric disorders (mainly anxiety and depressive disorders) were present in half the subjects with a history of CFS, a rate significantly higher than in healthy controls. On the CBCL youngsters with a history of CFS had an excess of psychological symptoms and decreased social competence. On the Harter Self-Esteem Questionnaire they reported reduced self-esteem, especially in social competence. Anxiety disorders were significantly more common in recovered subjects than in those with active CFS illness status.

CONCLUSIONS: Psychiatric disorders were found to be increased in adolescents with a history of severe CFS; CFS may enhance the risk for or share common predisposing factors with anxiety disorders.

Comment in: Chronic fatigue syndrome. [J Am Acad Child Adolesc Psychiatry. 2000]

 

Source: Garralda E, Rangel L, Levin M, Roberts H, Ukoumunne O. Psychiatric adjustment in adolescents with a history of chronic fatigue syndrome. J Am Acad Child Adolesc Psychiatry. 1999 Dec;38(12):1515-21. http://www.ncbi.nlm.nih.gov/pubmed/10596251

 

Prognostic factors for persons with idiopathic chronic fatigue

Abstract:

BACKGROUND: The simultaneous examination of a large number of patient characteristics in a prospective study of patients with chronic fatigue.

OBJECTIVE: To compare the relative importance of these characteristics as prognostic factors.

METHODS: The data analyzed were from 199 subjects in a registry of persons who were aged 18 years or older and had idiopathic fatigue for at least 6 months. All subjects completed an extensive baseline questionnaire that provided information about fatigue, demographic characteristics, medical conditions, lifestyle, sleeping habits, psychological characteristics, and the presence of criteria for chronic fatigue syndrome. Changes in fatigue severity from baseline to 2-year follow-up were tested for an association with risk factors at baseline and with changes in symptoms other than fatigue during the follow-up period.

RESULTS: The following characteristics at baseline significantly and independently predicted greater fatigue improvement: less unclear thinking, fewer somatoform symptoms not used to define chronic fatigue syndrome, infrequent awakening, fewer hours sleeping, and being married. Of 29 subjects who at baseline reported no somatoform symptoms unrelated to chronic fatigue syndrome and who thought clearly most of the time, 8 substantially improved, compared with 1 of 29 subjects who had more than 2 somatoform symptoms and never thought clearly (P = .01). Improvements in the following symptoms were significantly and independently associated with improvements in fatigue: unclear thinking, depression, muscle aches, and trouble falling asleep.

CONCLUSIONS: This study identified characteristics of subjects that seem to be of prognostic importance for idiopathic chronic fatigue. Symptoms that change concomitantly with changes in fatigue may be intrinsically linked to fatigue.

 

Source: Hartz AJ, Kuhn EM, Bentler SE, Levine PH, London R. Prognostic factors for persons with idiopathic chronic fatigue. Arch Fam Med. 1999 Nov-Dec;8(6):495-501. http://www.ncbi.nlm.nih.gov/pubmed/10575388

 

Associations between perfectionism, mood, and fatigue in chronic fatigue syndrome: a pilot study

Abstract:

This study investigated possible associations between perfectionistic personality traits, mood, and fatigue in chronic fatigue syndrome (CFS). Forty CFS sufferers referred to tertiary care and 31 control healthy subjects completed the Multidimensional Perfectionism Scale (MPS), Chalder Fatigue Questionnaire, and Hospital Anxiety and Depression (HAD) scale.

Total perfectionism scores did not correlate with fatigue, anxiety, or depression in either group. Other-oriented MPS scores were significantly lower among CFS sufferers (p = .0019), especially women, and correlated negatively with physical fatigue levels overall (R = -0.27, p = .02). Total and socially prescribed MPS scores correlated with age for the CFS group alone (p = .05).

Possible reasons why this study did not confirm a positive association between perfectionism and CFS are discussed. The finding that CFS sufferers set lower standards and have lower expectations for significant others may have implications for rehabilitation and recovery from this disorder.

 

Source: Blenkiron P, Edwards R, Lynch S. Associations between perfectionism, mood, and fatigue in chronic fatigue syndrome: a pilot study. J Nerv Ment Dis. 1999 Sep;187(9):566-70. http://www.ncbi.nlm.nih.gov/pubmed/10496512

 

Prolonged fatigue, anxiety and depression: exploring relationships in a primary care sample

Abstract:

OBJECTIVE: While prolonged fatigue states are frequently comorbid with other forms of distress, they are now the subject of independent aetiological and treatment research. The objective of this study was to use principal component analysis to clarify the relationships between proposed measures of prolonged fatigue and anxiety and depression in data obtained from patients attending primary care.

METHOD: Self-report measures of prolonged fatigue and psychological distress (anxiety and depression) were administered to consecutive ambulatory care patients attending primary care.

RESULTS: Data from 1593 subjects were obtained. A two-factor principal component solution (varimax rotation) demonstrated a clear separation between fatigue-related items (Cronbach’s alpha = 0.81) as compared with those items describing anxiety and/or depression (Cronbach’s alpha = 0.95). A four-factor solution produced similar results with two factors describing general psychological distress (contrasting anxiety and depression), with two other factors describing the profiles of mental and physical fatigue.

CONCLUSIONS: The results lend weight to the argument that prolonged fatigue states can be measured independently of conventional notions of anxiety and depression in patients attending primary care. Epidemiological, aetiological and treatment research in psychiatry may need to focus greater attention on such prolonged fatigue states.

Comment in: Response to: ‘Prolonged fatigue, anxiety and depression: exploring relationships in a primary care sample‘. [Aust N Z J Psychiatry. 2000]

 

Source: Koschera A, Hickie I, Hadzi-Pavlovic D, Wilson A, Lloyd A. Prolonged fatigue, anxiety and depression: exploring relationships in a primary care sample. Aust N Z J Psychiatry. 1999 Aug;33(4):545-52. http://www.ncbi.nlm.nih.gov/pubmed/10483850