Tag: depression

Urinary free cortisol excretion in chronic fatigue syndrome, major depression and in healthy volunteers

Abstract:

Urinary free cortisol excretion (UFC) was compared in 21 patients with chronic fatigue syndrome (CFS), in 10 melancholic depressives and in 15 healthy controls.

Patients with depression had UFC values which were significantly higher than healthy comparison subjects, whereas UFC excretion of CFS patients was significantly lower than the comparison group.

These findings are in keeping with currently held hypotheses of hyperactivity and hypoactivity of the hypothalamic-pituitary-adrenal (HPA) axis in depression and chronic fatigue syndrome respectively. Five of the 21 CFS patients had a co-morbid depressive illness. This sub-group retained the profile of UFC excretion of those with CFS alone, suggesting a different pathophysiological basis for depressive symptoms in CFS.

 

Source: Scott LV, Dinan TG. Urinary free cortisol excretion in chronic fatigue syndrome, major depression and in healthy volunteers. J Affect Disord. 1998 Jan;47(1-3):49-54. http://www.ncbi.nlm.nih.gov/pubmed/9476743

 

Cognitive deficits in patients suffering from chronic fatigue syndrome, acute infective illness or depression

Abstract:

BACKGROUND: Patients with chronic fatigue syndrome (CFS) report neuro-psychological symptoms as a characteristic feature. We sought to assess cognitive performance in patients with CFS, and compare cognitive performance and subjective workload experience of these patients with that of two disease comparison groups (non-melancholic depression and acute infection) and healthy controls.

METHOD: A computerized performance battery employed to assess cognitive functioning included tests of continuous attention, response speed, performance accuracy and memory. Severity of mood disturbance and subjective fatigue were assessed by questionnaire.

RESULTS: All patient groups demonstrated increased errors and slower reaction times, and gave higher workload ratings than healthy controls. Patients with CFS and non-melancholic depression had more severe deficits than patients with acute infection. All patient groups reported more severe mood disturbance and fatigue than healthy controls, but patients with CFS and those with acute infection reported less severe mood disturbance than patients with depression.

CONCLUSIONS: As all patients demonstrated similar deficits in attention and response speed, it is possible that common pathophysiological processes are involved. The differences in severity of mood disturbance, however, suggest that the pathophysiological processes in patients with CFS and acute infection are not simply secondary to depressed mood.

 

Source: Vollmer-Conna U, Wakefield D, Lloyd A, Hickie I, Lemon J, Bird KD, Westbrook RF. Cognitive deficits in patients suffering from chronic fatigue syndrome, acute infective illness or depression. Br J Psychiatry. 1997 Oct;171:377-81. http://www.ncbi.nlm.nih.gov/pubmed/9373430

 

Cognitive distortions of somatic experiences: revision and validation of a measure

Abstract:

The article reports on the revision of the Cognitive Errors Questionnaire (CEQ). The CEQ which was originally developed to measure cognitive distortions specific to chronic pain, has been significantly shortened and made applicable to a wider range of somatic problems.

The Cognitive Errors Questionnaire-Revised (CEQ-R) contains two subscales: Somatic–distortions specific to somatic experiences; and General–distortions to everyday life events. Validation of the scale with CFS, depressed, and chronic pain groups and healthy controls confirms the CEQ-R loads onto general and somatic factors. Both subscales have high internal consistency and good test-retest reliability.

The pattern of subjects’ responses to the CEQ-R scores showed that the depressed group scored significantly higher on the General CEQ-R scale than the other groups, whereas the CFS andchronic pain groups scored higher than healthy controls on the Somatic CEQ-R. Somatic CEQ-R scores showed a significant decrease over the course of a pain management program, with a concomitant decrease in disability and depression scores. Further analyses showed the Somatic CEQ-R to be significantly related to self and symptom focusing, whereas the General CEQ-R was found to be significantly correlated with higher depression, lower self-esteem, and self focusing.

The CEQ-R may be a useful instrument to examine the relationship between cognitive distortions and disability in a variety of illnesses, and to differentiate primary depression from overlapping somatic disorders.

 

Source: Moss-Morris R, Petrie KJ. Cognitive distortions of somatic experiences: revision and validation of a measure. J Psychosom Res. 1997 Sep;43(3):293-306. http://www.ncbi.nlm.nih.gov/pubmed/9304555

 

The relation of sleep difficulties to fatigue, mood and disability in chronic fatigue syndrome

Abstract:

The relationship of sleep complaints to mood, fatigue, disability, and lifestyle was examined in 69 chronic fatigue syndrome (CFS) patients without psychiatric disorder, 58 CFS patients with psychiatric disorder, 38 psychiatric out-patients with chronic depressive disorders, and 45 healthy controls. The groups were matched for age and gender.

There were few differences between the prevalence or nature of sleep complaints of CFS patients with or without current DSM-IIIR depression, anxiety or somatization disorder. CFS patients reported significantly more naps and waking by pain, a similar prevalence of difficulties in maintaining sleep, and significantly less difficulty getting off to sleep compared to depressed patients.

Sleep continuity complaints preceded fatigue in only 20% of CFS patients, but there was a strong association between relapse and sleep disturbance. Certain types of sleep disorder were associated with increased disability or fatigue in CFS patients. Disrupted sleep appears to complicate the course of CFS. For the most part, sleep complaints are either attributable to the lifestyle of CFS patients or seem inherent to the underlying condition of CFS. They are generally unrelated to depression or anxiety in CFS.

 

Source: Morriss RK, Wearden AJ, Battersby L. The relation of sleep difficulties to fatigue, mood and disability in chronic fatigue syndrome. J Psychosom Res. 1997 Jun;42(6):597-605. http://www.ncbi.nlm.nih.gov/pubmed/9226607

 

The effects of fatigue on neuropsychological performance in patients with chronic fatigue syndrome, multiple sclerosis, and depression

Abstract:

The effects of fatigue on neuropsychological performance were examined in patients with fatiguing illnesses. Repeated testing with the Paced Auditory Serial Addition Test (PASAT; Gronwall, 1977) was employed over the course of a demanding neuropsychological testing session. It was hypothesized that if fatigue affects performance, one would expect to observe “blunting” of the PASAT practice effect.

Fifteen of the study participants live with chronic fatigue syndrome (CFS), 15 with multiple sclerosis (MS), 14 with depression (DEP), and 15 are healthy, sedentary controls. Overall PASAT performance was significantly reduced for CFS and DEP participants compared to controls, whereas mean performance did not differ across the three fatiguing illness groups. Degree of improvement across trials (i.e., practice effect) for the groups did not differ from controls’. Neither subjective fatigue or DEP were significantly related to PASAT performance.

These findings suggest that fatigue does not universally impair performance during neuropsychological assessment even in groups in which fatigue is a prominent symptom.

 

Source: Johnson SK, Lange G, DeLuca J, Korn LR, Natelson B. The effects of fatigue on neuropsychological performance in patients with chronic fatigue syndrome, multiple sclerosis, and depression. Appl Neuropsychol. 1997;4(3):145-53. http://www.ncbi.nlm.nih.gov/pubmed/16318477

 

Neuroendocrine correlates of chronic fatigue syndrome: a brief review

Abstract:

Chronic fatigue syndrome remains one of the more perplexing syndromes in contemporary clinical medicine. One approach to understanding this condition has been to acknowledge its similarities to other disorders of clearer pathophysiology.

In this review, a rationale for the study of neuroendocrine correlates of chronic fatigue syndrome is presented, based in part on the clinical observation that asthenic or fatigue states share many of the somatic symptom characteristics seen in recognized endocrine disorders. Of additional interest is the observation that psychological symptoms, particularly disturbances in mood and anxiety, are equally prominent in this condition.

At this time, several reports have provided replicated evidence of disruptions in the integrity of the hypothalamic-pituitary-adrenal axis in patients with chronic fatigue syndrome. It is notable that the pattern of the alteration in the stress response apparatus is not reminiscent of the well-understood hypercortisolism of melancholic depression but, rather, suggests a sustained inactivation of central nervous system components of this system.

Recent work also implicates alterations in central serotonergic tone in the overall pathophysiology of this finding. The implications of these observations are far from clear, but they highlight the fact that, though chronic fatigue syndrome overlaps with the well-described illness category of major depression, these are not identical clinical conditions.

 

Source: Demitrack MA. Neuroendocrine correlates of chronic fatigue syndrome: a brief review. J Psychiatr Res. 1997 Jan-Feb;31(1):69-82. http://www.ncbi.nlm.nih.gov/pubmed/9201649

 

An open study of the efficacy and adverse effects of moclobemide in patients with the chronic fatigue syndrome

Abstract:

There is a strong association between the chronic fatigue syndrome and both depressive illness and sleep disturbance, but the efficacy of antidepressants is uncertain. We studied the efficacy and adverse effects of moclobemide in patients with chronic fatigue syndrome, stratifying the sample both by co-morbid major depressive illness and by sleep disturbance.

Forty-nine patients with chronic fatigue syndrome were recruited. Patients were given moclobemide up to 600 mg a day for 6 weeks. Four (8%) patients dropped out, three because of adverse effects. Adverse effects were otherwise mild and transient. On analysing the whole sample, there were significant but small reductions in fatigue, depression, anxiety and somatic amplification, as well as a modest overall improvement.

The greatest improvement occurred in those individuals who had a co-morbid major depressive illness, with seven out of 14 (50%) of such individuals rating themselves as “much better” by 6 weeks, compared to six out of 31 (19%) of those who were not depressed (31% difference, 95% CI 1-60%, P = 0.04). Sleep disturbance had no effect on outcome.

Moclobemide may be indicated in patients with chronic fatigue syndrome and a co-morbid major depressive disorder. A randomized, placebo-controlled trial is needed to confirm this. These results do not support moclobemide as an effective treatment of chronic fatigue syndrome in the absence of a major depressive disorder.

 

Source: White PD, Cleary KJ. An open study of the efficacy and adverse effects of moclobemide in patients with the chronic fatigue syndrome. Int Clin Psychopharmacol. 1997 Jan;12(1):47-52. http://www.ncbi.nlm.nih.gov/pubmed/9179634

 

Cognitive performance and complaints of cognitive impairment in chronic fatigue syndrome (CFS)

Abstract:

Patients with chronic fatigue syndrome (CFS) complain that they have difficulties with concentration and memory but studies to date have not found consistent objective evidence of performance deficits.

Two groups of CFS patients, depressed and non-depressed, and healthy controls, were asked about concentration problems in general and specifically when reading. CFS subjects were more likely than controls to report that they had concentration problems when reading, that they needed to re-read text and that they failed to take in what they were reading.

Subjects then performed a task in which their reading behaviour and text recall was measured. While all CFS subjects complained of general cognitive failures and of difficulties with reading, only depressed CFS subjects recalled significantly less of the text than controls. Severity of complaints about reading problems was not related to amount of text recalled, but was related to severity of depressed mood. However, subjects were able to evaluate accurately their ability to remember the text immediately after reading it and before being tested for recall.

Additionally, subjects performed a paired-associate learning task on which no significant differences between the subject groups was found. It is concluded that deficits in cognitive functioning in CFS patients are more likely to be found on naturalistic than on laboratory tasks.

 

Source: Wearden A, Appleby L. Cognitive performance and complaints of cognitive impairment in chronic fatigue syndrome (CFS). Psychol Med. 1997 Jan;27(1):81-90. http://www.ncbi.nlm.nih.gov/pubmed/9122311

 

Cognitive slowing and working memory difficulties in chronic fatigue syndrome

Abstract:

OBJECTIVE: Patients with chronic fatigue syndrome (CFS) commonly report problems with attention, memory, learning, and speed of cognitive processing. This study attempted to evaluate these complaints using objective test criteria.

METHOD: A test battery composed of six tests assessing these cognitive functions was given on two consecutive days. Twenty CFS patients were compared with 20 healthy control subjects and 14 patients with a history of major depression or dysthymia matched by age, intelligence, education level, and sex.

RESULTS: Compared with control subjects, CFS patients consistently scored lower on tests in which motor and cognitive processing speeds were a critical factor, eg, reaction-time tasks. They also had more difficulty on working-memory tests in which rapid cognitive processing speed is also an important factor. The effort made on the first day of testing did not result in a decline in cognitive function on the following day. CFS patients did not qualify as having affective disorder by several different diagnostic criteria. Nonetheless, CFS patients’ test performances did not differ from patients with a history of major depression or dysthymia.

CONCLUSIONS: It is concluded that, although CFS and major depression and dysthymia have distinct clinical features, these disorders have slowed motor and cognitive processing speed in common.

Comment in: Cognitive slowing in chronic fatigue syndrome (CFS) [Psychosom Med. 1997]

 

Source: Marshall PS, Forstot M, Callies A, Peterson PK, Schenck CH. Cognitive slowing and working memory difficulties in chronic fatigue syndrome. Psychosom Med. 1997 Jan-Feb;59(1):58-66. http://www.ncbi.nlm.nih.gov/pubmed/9021867

 

Decreased postexercise facilitation of motor evoked potentials in patients with chronic fatigue syndrome or depression

Abstract:

We studied the effects of exercise on motor evoked potentials (MEPs) elicited by transcranial magnetic stimulation (TMS) in 18 normal (control) subjects, 12 patients with chronic fatigue syndrome, and 10 depressed patients. Subjects performed repeated sets of isometric exercise of the extensor carpi radialis muscle until they were unable to maintain half maximal force.

MEPs were recorded before and after each exercise set and for up to 30 minutes after the last set. The mean amplitude of MEPs recorded from the resting muscle immediately after each exercise set was 218% of the mean pre-exercise MEP amplitude in normal subjects, 126% in chronic fatigue patients, and 155% in depressed patients, indicating postexercise MEP facilitation in all three groups. The increases in the patient groups, however, were significantly lower than normal.

The mean amplitudes of MEPs recorded within the first few minutes after the last exercise sets in all three groups were approximately half their mean pre-exercise MEP amplitudes. This postexercise MEP depression was similar in all groups. We conclude that postexercise cortical excitability is significantly reduced in patients with chronic fatigue syndrome and in depressed patients compared with that of normal subjects.

 

Source: Samii A, Wassermann EM, Ikoma K, Mercuri B, George MS, O’Fallon A, Dale JK, Straus SE, Hallett M. Decreased postexercise facilitation of motor evoked potentials in patients with chronic fatigue syndrome or depression. Neurology. 1996 Dec;47(6):1410-4. http://www.ncbi.nlm.nih.gov/pubmed/8960719