Tag: outcome

Correlates of somatic causal attributions in primary care patients with fatigue

Abstract:

Researchers in the field of chronic fatigue in tertiary care found that patients’ somatic (e.g. viral) explanations for their condition may lead to chronicity of symptoms. We studied the influence of a somatic attributional bias on outcome and reported symptoms in primary care patients with fatigue.

We compared fatigue scores on a specific scale, and number of presented symptoms, in two groups of primary care patients with ‘functional’ fatigue: 75 with a high score on the somatic subscale of the Fatigue Attribution Scale (S-FAS), and 95 with a low score on the S-FAS. At the index visit, patients with low and high scores on the S-FAS were not different for age, sex, fatigue scores, and levels of depressive symptoms.

Patients with high scores on the S-FAS presented significantly more somatic and psychological symptoms-a total of 36 symptoms for 24 patients (25.3%) in the low-score group, and a total of 52 symptoms for 31 patients (41.3%) in the high-score group.

Forty-two days later, at the follow-up visit, the fatigue scores were similar in both groups. In primary care patients with fatigue not due to somatic illness or major depression, the tendency to attribute fatigue to somatic causes is not associated with a worse outcome, but with a higher number of reported symptoms.

 

Source: Cathébras P, Jacquin L, le Gal M, Fayol C, Bouchou K, Rousset H. Correlates of somatic causal attributions in primary care patients with fatigue. Psychother Psychosom. 1995;63(3-4):174-80. http://www.ncbi.nlm.nih.gov/pubmed/7624463

 

Longitudinal study of outcome of chronic fatigue syndrome

Abstract:

OBJECTIVE: To examine the predictors of long term outcome for patients with the chronic fatigue syndrome.

DESIGN: Cohort study.

SUBJECTS: 139 subjects previously enrolled in two treatment trials; 103 (74%) were reassessed a mean of 3.2 years after start of the trials.

SETTING: University hospital referral centre.

MAIN OUTCOME MEASURES: Age at onset, duration of illness, psychological and immunological status at initial assessment. Ongoing symptom severity, levels of disability, and immunological function at follow up.

RESULTS: 65 subjects had improved but only six reported no current symptoms. An alternative medical diagnosis had been made in two and psychiatric illness diagnosed in 20. The assignment of a primary psychiatric diagnosis at follow up and the strength of the belief that a physical disease process explained all symptoms at entry to the trials both predicted poor outcome. Age at onset of illness, duration of illness, neuroticism, premorbid psychiatric diagnoses, and cell mediated immune function did not predict outcome.

CONCLUSION: Though most patients with the chronic fatigue syndrome improve, a substantial proportion remain functionally impaired. Psychological factors such as illness attitudes and coping style seem more important predictors of long term outcome than immunological or demographic variables.

Comment in:

Chronic fatigue syndrome. Distinguish between syndromes… [BMJ. 1994]

Chronic fatigue syndrome. Immunological findings vary between populations. [BMJ. 1994]

Chronic fatigue syndrome. Role of psychological factors overemphasised. [BMJ. 1994]

 

Source: Wilson A, Hickie I, Lloyd A, Hadzi-Pavlovic D, Boughton C, Dwyer J, Wakefield D. Longitudinal study of outcome of chronic fatigue syndrome. BMJ. 1994 Mar 19;308(6931):756-9. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2539669/

You can read the full article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2539669/pdf/bmj00432-0032.pdf

 

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/