post-viral fatigue syndrome – Page 5 – American ME and CFS Society

Possible upregulation of hypothalamic 5-hydroxytryptamine receptors in patients with postviral fatigue syndrome

Abstract:

OBJECTIVE: To study the dynamic function of hypothalamic 5-hydroxytryptamine receptors in patients with postviral fatigue syndrome.

DESIGN: Prospective comparison of patients with postviral fatigue syndrome with two control groups.

SETTING: Department of neurology, University of Glasgow, Southern General Hospital; department of psychiatry, St James’s Hospital, Dublin.

SUBJECTS: 15 patients with postviral fatigue syndrome, 13 age and sex matched healthy subjects, and 13 patients with primary depression.

MAIN OUTCOME MEASURES: Serum prolactin concentrations before and one, two, and three hours after administration of buspirone.

RESULTS: Because of the effects of sex hormones on prolactin secretion data for men and women were analysed separately. There was no significant difference in baseline prolactin concentrations between patients with postviral fatigue syndrome and healthy subjects or those with primary depression. However, the percentage difference between peak and baseline values was significantly higher in patients with postviral fatigue syndrome than the control groups (one way analysis of variance: women, p = 0.003; men, p = 0.004).

CONCLUSIONS: The results suggest upregulation of hypothalamic 5-hydroxytryptamine receptors in patients with postviral fatigue syndrome but not in those with primary depression. The buspirone challenge test may therefore be useful in distinguishing these two conditions. Larger studies are required to explore the potential value of drugs acting on central 5-hydroxytryptamine receptors in the treatment of patients with the postviral fatigue syndrome.

Comment in:

Postviral fatigue syndrome. [BMJ. 1992]

Source: Bakheit AM, Behan PO, Dinan TG, Gray CE, O’Keane V. Possible upregulation of hypothalamic 5-hydroxytryptamine receptors in patients with postviral fatigue syndrome.BMJ. 1992 Apr 18;304(6833):1010-2. http://www.ncbi.nlm.nih.gov/pubmed/1586780

Note: You can read the full article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1881733/

Illness perception and symptom components in chronic fatigue syndrome

Abstract:

Two-hundred and eight patients with chronic fatigue syndrome (post-viral fatigue syndrome) completed a questionnaire which dealt both with their illness in general and with the extent to which they experienced specific symptoms. A factor analysis of the symptom data yielded four components: emotional distress; fatigue; somatic symptoms; and cognitive difficulty.

Emotional disturbance is a common feature of the disorder and its role has been widely debated. When the symptom components were considered independently, fatigue, somatic symptoms and cognitive difficulty were associated with questionnaire items relating to general illness severity, but emotional distress was not.

Thus negative emotions did not contribute directly to patients’ perception of illness severity. They were, however, correlated with the other symptom components. It is argued that this correlation reflects a reciprocal influence, with negative emotions exacerbating fatigue and other key symptoms and the debilitating nature of these symptoms enhancing emotional vulnerability.

Source: Ray C, Weir WR, Cullen S, Phillips S. Illness perception and symptom components in chronic fatigue syndrome. J Psychosom Res. 1992 Apr;36(3):243-56. http://www.ncbi.nlm.nih.gov/pubmed/1564677

Psychiatric management of PVFS

Abstract:

Psychiatric management of PVFS (considered as a subtype of CFS) is a pragmatic approach to a disorder for which strictly biomedical treatments have so far had little to offer. Psychiatric assessment embraces a comprehensive (biopsychosocial) approach, and distinguishes factors that perpetuate the condition from those that may have precipitated it. Treatments are targeted at perpetuating factors.

Few controlled treatment trials have been reported in patients selected specifically as meeting criteria for CFS. There is evidence available, however, that suggests useful management strategies. An uncontrolled study of treatment of CFS with combined antidepressant drug and psychological treatment has produced promising results. In addition there is useful evidence arising from the study and treatment of the individual symptoms of CFS, occurring both in isolation as part of other syndromes.

The results of controlled trials of antidepressant drugs, and of psychological and rehabilitative treatment are awaited. It is already possible to offer provisional guidelines for treatment.

Source: Sharpe M. Psychiatric management of PVFS. Br Med Bull. 1991 Oct;47(4):989-1005. http://www.ncbi.nlm.nih.gov/pubmed/1794095

Post-viral fatigue syndrome. Epidemiology: lessons from the past

Abstract:

This chapter outlines the recorded epidemiological history of PVFS (including the early epidemics of myalgic encephalomyelitis) and the development of the concept, including the realisation that endemic cases also occur.

Cases of PVFS are still not recorded by the Surveillance Centre for Communicable Diseases, so it is very difficult to detect and monitor any outbreak in the community, since each GP may only have two or three such patients and would, therefore, not be aware of an epidemic in the community as a whole if it occurred.

Epidemiological issues raised by the early epidemics, including the delineation of the syndrome, the question of bias, the role of hysteria and the role of depression; the issue of symptom distribution, and its implications for aetiology; and a multiaxial framework for understanding the association with psychological symptoms are discussed. The value of a future multidisciplinary research programme designed to disentangle direct and predisposing causes of PVFS is emphasised.

Source: Jenkins R. Post-viral fatigue syndrome. Epidemiology: lessons from the past. Br Med Bull. 1991 Oct;47(4):952-65. http://www.ncbi.nlm.nih.gov/pubmed/1794093

Post-viral fatigue syndrome. Epidemiology: a critical review

Abstract:

Numerous reports in medical journals, lay magazines, and newspapers bear witness to the level of interest in the postviral fatigue syndrome and the heated controversy about the true nature of this condition. For many, it represents a ‘rag bag’ diagnosis into which unsolved diagnostic problems are discarded. Others are in no doubt that there is a discrete syndrome, probably with a specific causation.

The real answer almost certainly lies somewhere in between, but the truth can only be established through epidemiological studies designed to answer key questions. Does it exist at all, and, if so, how frequently does it occur? Who is most likely to get it and what is its cause? What is the nature of its implied association with viral infections and what is the role of other frequently postulated factors, such as psychiatric morbidity? What is its natural history and is there any evidence that any of the treatment/management regimes on offer can effectively lead to symptomatic relief or improve prognosis?

In this chapter, we consider the evidence on these key questions, identify some of the deficiencies in our current knowledge and highlight the kind of research which is still required.

Source: Wallace PG. Post-viral fatigue syndrome. Epidemiology: a critical review. Br Med Bull. 1991 Oct;47(4):942-51. http://www.ncbi.nlm.nih.gov/pubmed/1794092

History of postviral fatigue syndrome

Abstract:

In writing a history of any illness there is always a dilemma whether to attempt the story of the condition ‘itself’, the medical attempts to define its nature, or to glimpse it via our changing reactions. The easiest is a straightforward account of the attempts of scientists to solve a problem–the classic medical detective story. However, this is often more fiction than fact.

Medicine rarely moves smoothly from ignorance to knowledge, but often in a more circular fashion. A historical approach is thus not solely a record of who did what, but also contributes to our understanding of the problems under scrutiny in this issue. Terminology is never easy in this subject, but the following conventions will be used: The terms neurasthenia and ME will be used in their actual context (as authors themselves used them), without defining either. Post-infectious fatigue syndrome (PIFS) will cover similar conditions when related to infective episodes. All will be used in a neutral fashion, to refer to changing realities as understood by doctors and historians.

This chapter attempts both chronological description and social analysis. The justification for this approach is clear in the case of neurasthenia, since ‘as so little was known of its pathological basis physicians’ statements regarding the disease were composed more of social and cultural elements than of scientific knowledge. Although much has changed, a contemporary account still reveals as much about cultural attitudes as the advance of science.

Source: Wessely S. History of postviral fatigue syndrome. Br Med Bull. 1991 Oct;47(4):919-41. http://www.ncbi.nlm.nih.gov/pubmed/1794091

Muscle biochemistry and pathophysiology in postviral fatigue syndrome

Abstract:

Patients with postviral fatigue syndrome (PVFS) usually complain of the skeletal muscle-related symptoms of fatigue and myalgia. It is not surprising therefore that the muscles have recently been the object of intensive studies which have used a variety of biochemical and physiological techniques. The aim of this chapter is to review these findings, and to discuss their significance or otherwise to the presenting symptoms and course of the condition.

Source: Edwards RH, Newham DJ, Peters TJ. Muscle biochemistry and pathophysiology in postviral fatigue syndrome. Br Med Bull. 1991 Oct;47(4):826-37. http://www.ncbi.nlm.nih.gov/pubmed/1794087

Neurophysiology of postviral fatigue syndrome

Abstract:

The exact pathophysiology of excessive fatigue in patients with postviral fatigue syndrome (PVFS) remains uncertain in spite of increasing investigation. One objective abnormality of neuromuscular function is the increased jitter on single fibre EMG studies. While this is a sensitive technique which indicates a disturbance in the peripheral part of the motor unit, it is non-specific and its role in the pathophysiology remains unclear.

Impaired muscular activation with added force in response to superimposed electrical stimulation suggests an extra-muscular and/or central component of fatigue. Conventional neurophysiological studies and those of strength and endurance have shown no objective abnormality in patients compared with controls. The previous reports of disturbed muscle metabolism on NMR spectroscopy have not been confirmed in more recent studies and no consistent abnormality of excitation-contraction coupling has so far emerged.

Finally, unlike patients with depression, cognitive evoked potential studies suggest impaired attention, memory and stimulus evaluation in postviral fatigue syndrome. In future studies, the importance of utilising approved clinical criteria for patient inclusion cannot be overemphasized. Control groups should include sedentary or deconditioned as well as depressed subjects to help standardise these important variables.

Source: Jamal GA, Miller RG. Neurophysiology of postviral fatigue syndrome. Br Med Bull. 1991 Oct;47(4):815-25. http://www.ncbi.nlm.nih.gov/pubmed/1794086

Clinical spectrum of postviral fatigue syndrome

Abstract:

Many different neurological and psychiatric syndromes follow viral infections, but their clinical pictures and pathogeneses are poorly understood. The syndromes include acute disseminated encephalomyelitis (post-infectious encephalomyelitis), the Guillain-Barre syndrome (post-infectious neuritis) and Reye’s syndrome.

Recently, attention has been focused on another common postviral neurological syndrome, i.e. the postviral fatigue syndrome (PVFS)–termed myalgic encephalomyelitis (ME) and a host of other designations. PVFS occurs both sporadically and in epidemics, with cases being reported from all over Europe, the United States, Australasia and South Africa.

It is difficult to make the diagnosis and this has meant, in the past, that it is not until an epidemic has occurred that random cases which presented in the preceding years are realised to represent the same condition. With renewed interest in the syndrome and greater attention from physicians, however, diagnosis of sporadic cases is now becoming more common.

Source: Behan PO, Bakheit AM. Clinical spectrum of postviral fatigue syndrome. Br Med Bull. 1991 Oct;47(4):793-808. http://www.ncbi.nlm.nih.gov/pubmed/1794085

Immunology of postviral fatigue syndrome

Abstract:

Postviral fatigue syndrome is associated with persistent infection by a virus. The patient with the condition has failed to eliminate the virus in the usual time. There is little evidence of a deficient immune response by the patient as the explanation for the viral persistence, and it must be assumed that most of the explanation lies in down-regulation of virus expression in infected cells. The general symptomatology of postinfectious syndromes may be mediated by cytokines liberated as part of the infection. Part of the syndrome may also be due to local effects of virus infection in muscles or the central nervous system (CNS).

Source: Mowbray JF, Yousef GE. Immunology of postviral fatigue syndrome. Br Med Bull. 1991 Oct;47(4):886-94. http://www.ncbi.nlm.nih.gov/pubmed/1724405