Tag: fatigue

Managing patients suffering from acute and chronic fatigue

Abstract:

The subjective experience of fatigue is common and debilitating, and affects many individuals in various healthcare settings. The condition requires adequate assessment, innovative planning and interventions, and patient-centred evaluations by the nursing profession. Fatigue, whether acute or chronic, needs to be recognized as a true and valid condition in order for treatment to be successful. There are many considerations to be taken into account when working with the fatigued, and this article suggests how the areas needing most attention may be tackled. Chronic fatigue and acute fatigue can be quite different conditions, requiring different approaches, of which nurses need to be aware. In order to reduce the effects of fatigue on the client, nurses need to fully understand the factors surrounding the phenomenon of fatigue to provide expert care, to help educate the patient, and improve the quality of life.

 

Source: Cook NF, Boore JR. Managing patients suffering from acute and chronic fatigue. Br J Nurs. 1997 Jul 24-Aug 13;6(14):811-5. http://www.ncbi.nlm.nih.gov/pubmed/9283306

 

Definition of “chronic fatigue syndrome” (CFS)

Abstract:

The definition of “Chronic Fatigue Syndrome” (CFS) in 1988 was an attempt to establish a uniform basis for the previously heterogeneous approaches to research of this severe and inexplicable state of fatigue. At the same time, researchers wished to narrow down a pathogenetically founded disease entity a priori by specifying precise disease criteria.

The empirical data gathered in accordance with the CFS definition, however, have failed to confirm the assumption that the disease entity is pathogenetically uniform. Furthermore, the originally selected criteria have proven to be impracticable ore theoretically questionable. In the period that followed, modifications that permitted a more comprehensive and yet more differentiated classification of fatigue states of unclear etiology were proposed.

The new research approach avoids postulation of causal entities and puts CFS back in a category with other descriptive states of fatigue.

 

Source: Heyll U, Wachauf P, Senger V, Diewitz M. Definition of “chronic fatigue syndrome” (CFS). Med Klin (Munich). 1997 Apr 15;92(4):221-7. [Article in German] http://www.ncbi.nlm.nih.gov/pubmed/9221305

 

Increased concentrations of homocysteine in the cerebrospinal fluid in patients with fibromyalgia and chronic fatigue syndrome

Abstract:

Twelve outpatients, all women, who fulfilled the criteria for both fibromyalgia and chronic fatigue syndrome were rated on 15 items of the Comprehensive Psychopathological Rating Scale (CPRS-15). These items were chosen to constitute a proper neurasthenic subscale.

Blood laboratory levels were generally normal. The most obvious finding was that, in all the patients, the homocysteine (HCY) levels were increased in the cerebrospinal fluid (CSF). There was a significant positive correlation between CSF-HCY levels and fatiguability, and the levels of CSF-B12 correlated significantly with the item of fatiguability and with CPRS-15.

The correlations between vitamin B12 and clinical variables of the CPRS-scale in this study indicate that low CSF-B12 values are of clinical importance. Vitamin B12 deficiency causes a deficient remethylation of HCY and is therefore probably contributing to the increased homocysteine levels found in our patient group.

We conclude that increased homocysteine levels in the central nervous system characterize patients fulfilling the criteria for both fibromyalgia and chronic fatigue syndrome.

 

Source: Regland B, Andersson M, Abrahamsson L, Bagby J, Dyrehag LE, Gottfries CG. Increased concentrations of homocysteine in the cerebrospinal fluid in patients with fibromyalgia and chronic fatigue syndrome. Scand J Rheumatol. 1997;26(4):301-7. http://www.ncbi.nlm.nih.gov/pubmed/9310111

 

An epidemiologic study of fatigue with relevance for the chronic fatigue syndrome

Abstract:

We surveyed households in four rural Michigan communities to confirm a reported cluster of cases resembling chronic fatigue syndrome (CFS) and to study the epidemiology of fatigue in a rural area. Data were collected from 1698 households. We did not confirm the reported cluster. The prevalence of households containing at least one fatigued person was similar between communities thought to harbor the cluster and communities selected for comparison. Symptoms and features of generic forms of fatigue were very similar to those often attributed to CFS.

 

Source: Fukuda K, Dobbins JG, Wilson LJ, Dunn RA, Wilcox K, Smallwood D. An epidemiologic study of fatigue with relevance for the chronic fatigue syndrome. J Psychiatr Res. 1997 Jan-Feb;31(1):19-29. http://www.ncbi.nlm.nih.gov/pubmed/9201644

 

Clinical improvement in chronic fatigue syndrome is not associated with lymphocyte subsets of function or activation

Abstract:

The relationship between markers of immune function and chronic fatigue syndrome (CFS) is controversial. To examine the relationship directly, 43 subjects with CFS entering a randomized controlled trial of a nonpharmacological treatment for CFS gave samples for immunological analysis before and after treatment. Percentage levels of total CD3+ T cells, CD4 T cells, CD8 T cells, and activated subsets did not differ between CFS subjects and controls. Naive (CD45RA+ RO-) and memory (CD45RA- RO+) T cells did not differ between subjects and controls.

Natural killer cells (CD16+/CD56+/CD3-) were significantly increased in CFS patients compared to controls, as was the percentage of CD11b+ CD8 cells.

There were no correlations between any immune variable and measures of clinical status, with the exception of a weak correlation between total CD4 T cells and fatigue. There was a positive correlation between memory CD4 and CD8 T cells and depression scores and a negative correlation between naive CD4 T cells and depression.

No immune measures changed during the course of the study, and there was no link between clinical improvement as a result of the treatment program and immune status. Immune measures did not predict response or lack of response to treatment.

In conclusion, we have been unable to replicate previous findings of immune activation in CFS and unable to find any important associations between clinical status, treatment response, and immunological status.

 

Source: Peakman M, Deale A, Field R, Mahalingam M, Wessely S. Clinical improvement in chronic fatigue syndrome is not associated with lymphocyte subsets of function or activation. Clin Immunol Immunopathol. 1997 Jan;82(1):83-91. http://www.ncbi.nlm.nih.gov/pubmed/9000046

 

Fatigue in the chronic fatigue syndrome: a cognitive phenomenon?

Abstract:

What is the source of the perception of excessive fatigue in the chronic fatigue syndrome (CFS)? Studies of physiological response to aerobic activity, of muscle pathology and muscle function in CFS, are reviewed, and suggest that the subjective report of fatigue is not due to any peripheral impairment. In addition, current technological methods such as electroencephalography have failed to uncover the nature of any abnormality in the central motor unit. A physiological model which proposes that patients with CFS possess a reduced threshold for sensory fatigue signals is rejected, because it fails to account for recent findings. Instead, it is suggested that the perception of fatigue in CFS is enhanced by idiosyncrasies in cognitive processing. The implications of this view to our understanding of the perpetuation of CFS as a whole are explored.

 

Source: Fry AM, Martin M. Fatigue in the chronic fatigue syndrome: a cognitive phenomenon? J Psychosom Res. 1996 Nov;41(5):415-26. http://www.ncbi.nlm.nih.gov/pubmed/9032706

 

Susceptibility to immunologically mediated fatigue in C57BL/6 versus Balb/c mice

Abstract:

Proinflammatory cytokines such as interleukin (IL)-1 and tumor necrosis factor (TNF)-alpha have been proposed to play a role in the pathogenesis of fatigue. In the present study we compared the susceptibility of two mouse strains to immunologically induced fatigue.

Daily running of two strains of mice, Balb/c and C57BL/ 6, was assessed after a single injection of Corynebacterium parvum antigen (2 mg/mouse). Spontaneous running activity of each animal was compared to mean running distance prior to injection. To evaluate the involvement of cytokines in fatigue development, C57BL/6 mice were treated with antibodies to specific cytokines at the time of challenge with C. parvum antigen. Also, cytokine mRNA expression was analyzed in the brains of mice at different time periods after immunologic challenge.

A significant difference in running activity between the two mice strains was observed after C. parvum antigen inoculation: C57BL/6 mice showing a greater (P < 0.05) reduction in running activity (relative to preinjection levels) and slower recovery to baseline than Balb/c mice. Injection of antibodies specific to either IL-1beta or TNF-alpha did not alter immunologically induced fatigue, suggesting a lack of involvement of these cytokines produced outside of the central nervous system (CNS).

However, increased TNF-alpha and IL-1beta mRNA expression was found in the brains of C57BL/6 compared to that seen in Balb/c mice at 6, 10, and 15 days after C. parvum antigen injection. The elevated CNS cytokine mRNA expression corresponded to development of fatigue. These findings are consistent with the hypothesis that expression of proinflammatory cytokines within the CNS plays a role in the pathogenesis of immunologically mediated fatigue.

 

Source: Sheng WS, Hu S, Lamkin A, Peterson PK, Chao CC. Susceptibility to immunologically mediated fatigue in C57BL/6 versus Balb/c mice. Clin Immunol Immunopathol. 1996 Nov;81(2):161-7. http://www.ncbi.nlm.nih.gov/pubmed/8906747

 

Is perfectionism associated with fatigue?

Abstract:

Perfectionism has been implicated as a vulnerability factor in the development of chronic unexplained fatigue. In the present study, different components of fatigue and perfectionism were studied in 121 female nurses. They completed a postal questionnaire assessing current (state) and usual (trait) fatigue, and dimensions of personality including six components of perfectionism. Night-shift work was associated with state, but not trait, fatigue. Negative, but not positive, components of perfectionism were associated with mental trait fatigue in particular, but also with physical trait fatigue. In contrast, the associations with positive perfectionism tended to be inverse. Multiple regression modeling indicated that neuroticism as well as negative perfectionism were separately associated with trait fatigue. We suggest that negative aspects of perfectionism may cause maladaptive coping strategies which predispose individuals to fatigue.

 

Source: Magnusson AE, Nias DK, White PD. Is perfectionism associated with fatigue? J Psychosom Res. 1996 Oct;41(4):377-83. http://www.ncbi.nlm.nih.gov/pubmed/8971668

 

The measurement of fatigue in patients with multiple sclerosis. A multidimensional comparison with patients with chronic fatigue syndrome and healthy subjects

Abstract:

OBJECTIVE: To provide a multidimensional characterization of fatigue in patients with multiple sclerosis (MS).

DESIGN: Cross-sectional design. Fifty patients with clinically definite MS were compared on the dimensions of fatigue with 51 patients with chronic fatigue syndrome (CFS) and 53 healthy subjects.

RESULTS: Fourty-six percent of the patients with MS reported fatigue to be present at least once a week. Patients with MS and patients with CFS had significantly higher subjective fatigue severity scores than healthy subjects. Patients with MS and patients with CFS had significantly higher scores on measures of psychological well-being than healthy subjects. Patients with MS had scores similar to those of patients with CFS, except that patients with CFS had significantly higher somatization scores. High somatization scores reflect strong focusing on bodily sensations. Both groups of patients were significantly less active than the healthy subjects. The Kurtzke Expanded Disability Status Scale (EDSS) and the Beck Depression Inventory scores were not related to subjective fatigue severity. In patients with MS and in patients with CFS, subjective fatigue severity was related to impairment in daily life, low sense of control over symptoms, and strong focusing on bodily sensations. In CFS, but not in MS, evidence was found for a relationship between low levels of physical activity and attributing symptoms to a physical cause and between subjective fatigue severity and physical activity.

CONCLUSIONS: Patients with MS experienced significant fatigue, which had a significant impact on daily functioning and was not related to depression on Expanded Disability Status Scale score. Psychological factors, such as focusing on bodily sensations and low sense of control play a role in the experience of fatigue in MS and CFS.

 

Source: Vercoulen JH, Hommes OR, Swanink CM, Jongen PJ, Fennis JF, Galama JM, van der Meer JW, Bleijenberg G. The measurement of fatigue in patients with multiple sclerosis. A multidimensional comparison with patients with chronic fatigue syndrome and healthy subjects. Arch Neurol. 1996 Jul;53(7):642-9. http://www.ncbi.nlm.nih.gov/pubmed/8929171

 

Postinfectious fatigue: prospective cohort study in primary care

Abstract:

The idea that chronic fatigue has an infectious origin has become popular, but the main evidence for such an association has come from retrospective case-control studies, which are subject to ascertainment bias. We report a prospective study of the outcome of clinically diagnosed infections in patients presenting to UK general practitioners.

Questionnaires assessing fatigue and psychiatric morbidity were sent to all patients aged 18-45 years in the study practices. The prevalence of chronic fatigue and chronic fatigue syndrome was then ascertained among 1199 people aged 18-45 who presented to the general practitioners with symptomatic infections and in 1167 people who attended the surgeries for other reasons. 84% were followed up at 6 months. 9.9% of cases and 11.7% of controls reported chronic fatigue (odds ratio 1.0 [95% CI 0.6-1.1]). There were no differences in the proportions who met various criteria for chronic fatigue syndrome. No effect of infection was noted when we excluded subjects who reported fatigue or psychological morbidity at the baseline screening.

The strongest independent predictors of postinfectious fatigue were fatigue assessed before presentation with clinical infection (3.0 [1.9-4.7]) and psychological distress before presentation (1.8 [1.2-2.9]) and at presentation with the acute infection (1.8 [1.1-2.8]). There was no effect of sex or social class. Our study shows no evidence that common infective episodes in primary care are related to the onset of chronic fatigue or chronic fatigue syndrome.

Comment in:

Viral illness and chronic fatigue (syndrome). [Lancet. 1995]

Viral illness and chronic fatigue (syndrome) [Lancet. 1995]

Viral illness and chronic fatigue (syndrome). [Lancet. 1995]

Viral illness and chronic fatigue (syndrome) [Lancet. 1995]

Viral illness and chronic fatigue (syndrome). [Lancet. 1995]

 

Source: Wessely S, Chalder T, Hirsch S, Pawlikowska T, Wallace P, Wright DJ. Postinfectious fatigue: prospective cohort study in primary care. Lancet. 1995 May 27;345(8961):1333-8. http://www.ncbi.nlm.nih.gov/pubmed/7752755