Tag: illness beliefs

Somatization, illness attribution and the sociocultural psychiatry of chronic fatigue syndrome

Abstract:

In addition to epidemiological and neurobiological perspectives on the relationship between chronic fatigue syndrome (CFS) and psychiatric disorders there has been increasing interest in the role of cognitive-behavioural, psychological, psychodynamic and social factors in the psychiatric aspects of this syndrome. These factors may be important in the initiation and/or maintenance of CFS and play important roles in the misdiagnosis of primary psychopathology as CFS. They may be important targets for intervention and treatment.

This paper examines the relevance of the following issues for better understanding the relationship between CFS and the results of psychiatric studies: (1) the concepts of somatization and abnormal illness behaviour; (2) the role of patients’ illness attributions; (3) psychological and psychodynamic constructs such as depressive vulnerability occurring in individuals dependent upon achievement for the maintenance of self-esteem and euthymic mood, perfectionism, and helplessness; (4) the role of personality characteristics and styles; (5) the potential iatrogenic role of the health care system in producing disability in individuals with a diagnosis of CFS; (6) the role of the media and other sociocultural forces in the patient’s choice of the CFS label; and (7) the impact of the CFS label on the patient. The importance of differentiating between initiating and maintaining or perpetuating factors is emphasized.

 

Source: Abbey SE. Somatization, illness attribution and the sociocultural psychiatry of chronic fatigue syndrome. Ciba Found Symp. 1993;173:238-52; discussion 252-61. http://www.ncbi.nlm.nih.gov/pubmed/8491101

 

Outcome in the chronic fatigue syndrome

Comment in: Self help organization’s advice on myalgic encephalomyelitis. [BMJ. 1992]

Comment on: Follow up of patients presenting with fatigue to an infectious diseases clinic. [BMJ. 1992]

 

EDITOR,-Michael Sharpe and colleagues’ paper confirms what many clinicians have long suspected -namely, that the prognosis for those with a chronic fatigue syndrome who reach specialist care is poor.’ The paper also suggests that membership of a self help organisation is associated with a poor outcome. Although the authors emphasise that this association is not necessarily causal, I fear that the self help organisations may interpret this as another attack on their credibility, which will further sour relations between the organisations and the profession.

What are the possible explanations for these disturbing findings? Sharpe and colleagues suggest that patients’ beliefs are an important mediator of disability, a view I share.2 An article written by a sufferer illustrates how this might happen: “These living viruses are erratic and unpredictable. The prickly-edged ones pierce their way into the body cells. If disturbed by the patient’s activity they become as aggressive as a disturbed wasps’ nest, and can be felt giving needle-like jabs (or stimulating the nerves to do so).” It is easy to understand how such beliefs, regardless of their scientific accuracy, amplify disability.

You can read the full comment here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1882994/pdf/bmj00086-0047b.pdf

 

Source: Wessely S. Outcome in the chronic fatigue syndrome. BMJ. 1992 Aug 8;305(6849):365. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1882994/

 

Outcome in the chronic fatigue syndrome

Comment on: Follow up of patients presenting with fatigue to an infectious diseases clinic. [BMJ. 1992]

 

EDITOR,-Michael Sharpe and colleagues report that most patients with the chronic fatigue syndrome rate contact with medical services as unhelpful or only slightly helpful. Many sufferers turn to alternative health care, again with varied success. Such dissatisfaction with medical care is well documented, and self help organisations flourish to provide the support, advice, and education that is not, or cannot be, provided by the medical profession; they potentially fulfil an important role.

The authors conclude that for patients with the chronic fatigue syndrome membership of a self help organisation is associated with a poorer outcome (although whether members were more functionally impaired at the outset is not known). Adopting coping strategies, particularly with regard to exercise and “stress,” and a belief in the persistence of a viral infection are also associated with continuing disability.

You can read the rest of this comment here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1883006/pdf/bmj00086-0047d.pdf

 

Source: Cope H, David AS. Outcome in the chronic fatigue syndrome. BMJ. 1992 Aug 8;305(6849):365. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1883006/

 

Follow up of patients presenting with fatigue to an infectious diseases clinic

Abstract:

OBJECTIVES: To determine the symptomatic and functional status during follow up of patients referred to hospital with unexplained fatigue and to identify patient variables associated with persistent functional impairment.

DESIGN: Follow up by postal questionnaire six weeks to four years (median 1 year) after initial clinical assessment of patients referred to hospital during 1984-8.

SETTING: Infectious diseases outpatient clinic in a teaching hospital.

PATIENTS: 200 consecutive patients with fatigue of uncertain cause for at least six weeks; 177 fulfilled the inclusion criteria.

MAIN OUTCOME MEASURES: Findings at initial assessment; current symptoms, beliefs about the cause of illness, coping behaviours emotional disorder, social variables including membership of self help organizations, and degrees of recovery and functional impairment from questionnaire responses.

RESULTS: 144 (81%) patients returned completed questionnaires. Initial assessment did not indicate the cause of fatigue, other than preceding infection. The proportion of patients with functional impairment was significantly smaller with longer follow up (33% (11/33) at two to four years, 73% (29/40) at six weeks to six months; chi 2 for trend = 12.5, df = 1; p less than 0.05). Functional impairment was significantly associated with belief in a viral cause of the illness (odds ratio = 3.9; 95% confidence interval 1.5 to 9.9), limiting exercise (3.2; 1.5 to 6.6), avoiding alcohol (4.5; 1.8 to 11.3), changing or leaving employment (3.1; 1.4 to 6.9), belonging to a self help organization (7.8; 2.5 to 23.9), and current emotional disorder (4.4; 2.0 to 9.3).

CONCLUSIONS: Short term prognosis for recovery of function was poor but improved with time. Most patients had made a functional recovery by two years after initial clinic attendance. Impaired functioning was more likely with certain patient characteristics. Prospective studies are required to clarify whether these associations are the consequences of a more disabling illness or indicate factors contributing to impaired function.

Comment in

Outcome in the chronic fatigue syndrome. [BMJ. 1992]

Outcome in the chronic fatigue syndrome. [BMJ. 1992]

Outcome in the chronic fatigue syndrome. [BMJ. 1992]

 

Source: Sharpe M, Hawton K, Seagroatt V, Pasvol G. Follow up of patients presenting with fatigue to an infectious diseases clinic. BMJ. 1992 Jul 18;305(6846):147-52. http://www.ncbi.nlm.nih.gov/pubmed/1515828

Note: You can read the full article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1883193/

 

Evaluation and management of patients with chronic fatigue

Abstract:

Chronic fatigue is a common and disabling problem in primary care practice. The differential diagnosis of chronic fatigue is extensive and includes medical disorders, altered physiologic states (eg, pregnancy, exertion), psychiatric disorders, lifestyle derangements, drugs, and controversial entities (eg, chronic candidiasis, food allergies, environmental illness, and chronic fatigue syndrome). The most common diagnoses are psychiatric disorders, including mood, anxiety, and somatoform disorders.

A comprehensive approach to diagnosis and management is necessary, including structured psychiatric interviewing, functional assessment, and elicitation of the patient’s diagnostic beliefs. Patients often believe they are suffering from an organic medical disorder (eg, viral or immunologic) and resist psychiatric labelling of their symptoms and referral to mental health practitioners. Establishing and maintaining rapport, having a flexible approach, and demonstrating a personal concern for the patient is essential. Drug therapy for specific psychiatric and medical illnesses and cognitive-behavioral approaches for enhancing coping mechanisms are effective.

 

Source: Matthews DA, Manu P, Lane TJ. Evaluation and management of patients with chronic fatigue. Am J Med Sci. 1991 Nov;302(5):269-77. http://www.ncbi.nlm.nih.gov/pubmed/1750445