Tag: psychosocial factors

Chronic fatigue syndrome

Abstract:

Chronic fatigue syndrome (CFS) is a medically unexplained illness characterized by chronic, disabling fatigue, impaired concentration, muscle pain, and other somatic symptoms. The conceptual difficulties associated with all medically unexplained illnesses contribute to the controversy surrounding CFS, which has centered around whether it is best regarded as a medical or as a psychiatric condition. Clinically, such an approach is not helpful, and current research suggests that both pathophysiologic changes and psychosocial factors are important. Pragmatic management based on a detailed assessment of the individual is outlined.

 

Source: Sharpe M. Chronic fatigue syndrome. Psychiatr Clin North Am. 1996 Sep;19(3):549-73. http://www.ncbi.nlm.nih.gov/pubmed/8856816

 

Chronic fatigue syndrome–psychiatric aspects

Abstract:

Diagnosis of the chronic fatigue syndrome depends on various somatic and psychopathological symptoms. Somatic symptoms of the syndrome have been subject of an extensive body of literature. In comparison, psychiatric aspects have caught relatively less attention.

Psychiatric aspects of etiological, diagnostic, and therapeutic concepts are essential for evaluation of the syndrome. Application of CDC-criteria to a well known disease does not solve the nosological problem, but may define the syndrome more accurately. In this respect, issues including psychiatric comorbidity and specificity of neuropathological symptoms are discussed.

Psychological variables seem to have a high predictor value for time course and outcome of the symptoms. Etiological concepts emphasize on biological or psychosocial factors. Alterations of biological parameters including immune functions, sleep regulation, and hypothalamic-pituary-adrenocortical function have been reported. The role of cultural factors has been discussed extensively. Somatic and psychological stress may result in the same clinical syndrome via psychoimmunological mechanisms. An integrated, interdisciplinary approach to further refine diagnostic criteria, understanding of etiology and development of adequate therapeutic measures seems necessary.

 

Source: Lemke MR. Chronic fatigue syndrome–psychiatric aspects. Fortschr Neurol Psychiatr. 1996 Apr;64(4):132-41. [Article in German] http://www.ncbi.nlm.nih.gov/pubmed/8655125

 

Physical symptoms of chronic fatigue syndrome are exacerbated by the stress of Hurricane Andrew

Abstract:

This study examined the effects of Hurricane Andrew on physical symptoms and functional impairments in a sample of chronic fatigue syndrome(CFS) patients residing in South Florida. In the months after Hurricane Andrew (September 15-December 31, 1992), 49 CFS patients were assessed for psychosocial and physical functioning with questionnaires, interviews, and physical examinations.

This sample was made up of 25 CFS patients living in Dade county, a high impact area, and 24 patients in Broward and Palm Beach counties, areas less affected by the hurricane. Based on our model for stress-related effects on CFS, we tested the hypothesis that the patients who had the greatest exposure to this natural disaster would show the greatest exacerbation in CFS symptoms and related impairments in activities of daily living (illness burden). In support of this hypothesis, we found that the Dade county patients showed significant increases in physician-rated clinical relapses and exacerbations in frequency of several categories of self-reported CFS physical symptoms as compared to the Broward/Palm Beach county patients.

Illness burden, as measured on the Sickness Impact Profile, also showed a significant increase in the Dade county patients. Although extent of disruption due to the storm was a significant factor in predicting relapse, the patient’s posthurricane distress response was the single strongest predictor of the likelihood and severity of relapse and functional impairment.

Additionally, optimism and social support were significantly associated with lower illness burden after the hurricane, above and beyond storm-related disruption and distress responses. These findings provide information on the impact of environmental stressors and psychosocial factors in the exacerbation of CFS symptoms.

 

Source: Lutgendorf SK, Antoni MH, Ironson G, Fletcher MA, Penedo F, Baum A, Schneiderman N, Klimas N. Physical symptoms of chronic fatigue syndrome are exacerbated by the stress of Hurricane Andrew. Psychosom Med. 1995 Jul-Aug;57(4):310-23. http://www.ncbi.nlm.nih.gov/pubmed/7480560

 

Chronic fatigue syndrome in the community. Prevalence and associations

Abstract:

BACKGROUND: Chronic fatigue syndrome (CFS) is a poorly understood condition, apparently related to both psychiatric disturbance and infectious illness. Little progress has been made in identifying aetiology, owing to a lack of epidemiological studies using case-definition criteria.

METHOD: A community postal survey of a random sample of over 1000 patients registered at a local health centre comprised a fatigue questionnaire and the 12-item General Health Questionnaire (GHQ).

RESULTS: Total fatigue scores were modestly higher in women than men. Fatigue was most frequently attributed to psychosocial factors. Fatigue and GHQ scores were strongly correlated. Two men and two women satisfied British criteria for CFS, a prevalence of 0.56% (95% Cl 0.16-1.47%); three were probable psychiatric cases.

CONCLUSIONS: Previously reported sociodemographic associations of CFS may reflect medical referral patterns. A strong association exists with psychological morbidity, but relabelling CFS as a psychiatric disorder is not justified.

 

Source: Lawrie SM, Pelosi AJ. Chronic fatigue syndrome in the community. Prevalence and associations. Br J Psychiatry. 1995 Jun;166(6):793-7. http://www.ncbi.nlm.nih.gov/pubmed/7663830

 

The chronically fatigued patient

Abstract:

This article illustrates that the diagnostic evaluation as well as the management of the patient presenting with chronic fatigue can be done in an orderly manner. If a medical illness is the cause of the patient’s fatigue, this is usually evident on initial presentation. A thorough history and complete physical examination, in conjunction with some screening laboratory tests, can rule out most medical causes of fatigue, and any remaining cases declare themselves over the next several visits. If a medical cause is not evident, a further “fishing expedition” is fruitless.

Psychiatric illness, such as depression or generalized anxiety disorder, accounts for another significant proportion of cases of chronic fatigue. As with medical illness, psychiatric illness should be suspected based on history and is not a diagnosis of exclusion. Some patients presenting with chronic fatigue have a history and symptom pattern consistent with the diagnosis of CFS. The cause of this syndrome is controversial and is still unknown. The clinician, however, can offer the patient care in an environment that is respectful of their physical and psychological discomfort and can provide significant symptomatic improvement to the patient.

Lastly, some patients with fatigue do not fit any diagnostic category, including CFS. As with many other common complaints, such as headaches or abdominal pain, although a diagnosis may not be given to the patient, the clinician can do a lot to reassure the patient and assist the patient in living with his or her symptoms. As Solberg eloquently wrote: “[E]valuation of the fatigued patient requires all of a physician’s best attributes–a broad view of disease, psychosocial sensitivity, and a good ongoing relationship with the patient.”

 

Source: Epstein KR. The chronically fatigued patient. Med Clin North Am. 1995 Mar;79(2):315-27. http://www.ncbi.nlm.nih.gov/pubmed/7877393

 

Research about fatigue in France over the past 20 years

Abstract:

The author reported the works of the “Fatigue Studies Group” founded 20 years ago to explore the different dimensions of “fatigue” complaint. The emphasis is placed on the asthenic syndromes evaluation instrument created by the group, which takes into account the socio-demographic data of the patient, clinical signs and their severity as well as the potential etiological factors. Its first version (GEF-3) enabled to isolate 4 groups of asthenia (overworking, somatic, psychosomatic and psychic), each of them requesting a specific treatment. An ulterior version (GEF-4) has been elaborated to describe better the psychiatric semeiology. Finally, a simplified version (GEF-10) was used as an evaluation instrument in different therapeutic researches. At the same time, the group continued its researches on the fatigue psychosocial dimensions and its nosographic status, especially in comparison with dysthymic disorders.

 

Source: Crocq L. Research about fatigue in France over the past 20 years. Encephale. 1994 Nov;20 Spec No 3:615-8. [Article in French] http://www.ncbi.nlm.nih.gov/pubmed/7843059

 

Psychosocial factors and chronic fatigue syndrome

Abstract:

This study investigated the number and severity of life events, Type A behaviour, coping strategies and social support differences between chronic fatigue and irritable bowel syndrome patients prior to illness and between these groups and healthy controls. Although few differences were found between the groups for life events, a number of interesting results emerged with regard to different aspects of Type A behaviour, various coping strategies and social support. These findings are discussed with respect to existing research in the field.

 

Source: Lewis S, Cooper CL, Bennett D. Psychosocial factors and chronic fatigue syndrome. Psychol Med. 1994 Aug;24(3):661-71. http://www.ncbi.nlm.nih.gov/pubmed/7991748