Tag: questionnaire

Taking exception to chronic fatigue syndrome prevalence findings by Price, et al.

Comment on: Estimating the prevalence of chronic fatigue syndrome and associated symptoms in the community. [Public Health Rep. 1992]

 

We would like to address some serious methodological issues in the article, “Estimating the Prevalence of Chronic Fatigue Syndrome and Associated Symptoms in the Community,” by Rumi K. Price, et al., published in the September-October issue of Public Health Reports. We believe that because of the deficiencies in the design of this research, the authors’ conclusions are totally illogical and invalid.

In this article, the authors conclude that Chronic Fatigue Syndrome (CFS), as defined by the Centers for Disease Control (CDC) Diagnostic Criteria, might be “quite rare” in the general population, as only 1 of 13,538 individuals studied was deemed to have CFS. The official CDC Diagnostic Criteria, however, were not utilized to diagnose cases of CFS. Instead, the researchers reviewed interview questionnaire data collected between 1981 and 1984 for a purpose unrelated to diagnosing CFS. In fact, the CDC Diagnostic Criteria were not formulated and published until 1988.

You can read the rest of this comment as well as the rely from the authors here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1403345/pdf/pubhealthrep00069-0137c.pdf

 

Source: Robin R, Lipkin DM, Hume GW. Taking exception to chronic fatigue syndrome prevalence findings by Price, et al. Public Health Rep. 1993 Jan-Feb;108(1):135-7. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1403345/

 

Ocular manifestations of chronic fatigue and immune dysfunction syndrome

Abstract:

Chronic fatigue and immune dysfunction syndrome (CFIDS) is a disease presenting with systemic, sensory, cognitive, and psychological manifestations. Ocular symptomatology is reported in the visual, functional, perceptual, and pathological aspects of the visual system. The purpose of the research was to evaluate ocular symptoms in patients with CFIDS.

One hundred and ninety CFIDS patients [155 females, 35 males; mean age of 41 years (range 15 to 72)] and 198 healthy controls [133 females, 65 males; mean age of 42 years (range 8 to 89)] were surveyed via written questionnaire. Evaluation of data showed statistical significance at levels ranging from 0.0001 to 0.007 for all but one symptom surveyed. It appears that the ocular symptoms of CFIDS are genuine. Further research is needed to determine the etiology and appropriate treatment of this disease.

 

Source: Potaznick W, Kozol N. Ocular manifestations of chronic fatigue and immune dysfunction syndrome. Optom Vis Sci. 1992 Oct;69(10):811-4. http://www.ncbi.nlm.nih.gov/pubmed/1437004

 

Chronic fatigue syndrome criteria. A critique of the requirement for multiple physical complaints

Abstract:

OBJECTIVE: The purpose of this study was to test the hypothesis that the patients with chronic fatigue who have the highest number of medically unexplained physical symptoms over their lifetime would also have the highest prevalence of current and lifetime affective and anxiety disorders, lifetime affective symptoms, and the most functional disability. A further goal was to use this information to modify the current case definition to better identify a subgroup of patients with chronic fatigue syndrome who are less likely to have psychiatric illness.

DESIGN: Two hundred eighty-five consecutive patients with chronic fatigue were interviewed with the National Institute of Mental Health Diagnostic Interview Schedule and completed four self-rating questionnaires measuring psychologic distress, functional disability, and the tendency to amplify symptoms. Based on previously published data, patients were divided into four groups with a progressively higher number of lifetime medically unexplained physical symptoms. The prevalence of current and lifetime psychiatric disorders, lifetime psychologic symptoms, and extent of functional impairment was then compared in these four groups of patients.

MAIN RESULTS: The prevalence of current and lifetime psychiatric diagnosis and lifetime depressive symptoms increased linearly with the number of lifetime physical symptoms that the patient experienced. The extent of impairment in activities of daily living and the tendency to amplify symptoms also increased linearly with the number of medically unexplained physical symptoms.

CONCLUSION: The patients with the highest numbers of medically unexplained physical symptoms had extraordinarily high rates of current and lifetime psychiatric disorders. These data suggest that the current case definition for chronic fatigue syndrome inadvertently selects for patients with the highest prevalence of lifetime psychiatric diagnoses. A recommendation based on these results is to modify the case criteria for chronic fatigue syndrome to include patients with fatigue and few physical symptoms and to identify and consider excluding patients with high numbers of physical complaints.

Comment in: Defining the chronic fatigue syndrome. [Arch Intern Med. 1992]

 

Source: Katon W, Russo J. Chronic fatigue syndrome criteria. A critique of the requirement for multiple physical complaints. Arch Intern Med. 1992 Aug;152(8):1604-9. http://www.ncbi.nlm.nih.gov/pubmed/1497394

 

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/

 

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

 

Biopsychosocial aspects of chronic fatigue syndrome (myalgic encephalomyelitis)

Abstract:

Fifteen patients, with a primary complaint of chronic fatigue, were referred to a physician by their general practitioners. Psychological distress, measured by simple psychiatric rating scales was common, but specific psychiatric diagnoses, derived from a comprehensive diagnostic interview, occurred less frequently.

One questionnaire (Montgomery-Asberg depression rating scale) found emotional distress in 93%, but the diagnostic instrument (Present State Examination) suggested depressive syndromes in only two patients (13%). There were significant occupational difficulties in 87%. No consistently abnormal indices of biochemical or immunological function were found, nor evidence of acute or chronic infection.

Chronic fatigue syndrome (CFS) is associated with physical, psychological and social distress. The illness cannot be defined using just one of these dimensions. Such a unilateral approach has resulted in unnecessary controversy over the nature of the ‘real’ core of CFS. A problem-oriented approach, recognising the multi-factorial and overlapping cause and effect issues in CFS, may be of more benefit to patients.

 

Source: Yeomans JD, Conway SP. Biopsychosocial aspects of chronic fatigue syndrome (myalgic encephalomyelitis). J Infect. 1991 Nov;23(3):263-9. http://www.ncbi.nlm.nih.gov/pubmed/1753134

 

Tired, weak, or in need of rest: fatigue among general practice attenders

Abstract:

OBJECTIVES: To determine the prevalence and associations of symptoms of fatigue.

DESIGN: Questionnaire survey.

SETTING: London general practice.

PARTICIPANTS: 611 General practice attenders.

MAIN OUTCOME MEASURES: Scores on a fatigue questionnaire and reasons given for fatigue.

RESULTS: 10.2% Of men (17/167) and 10.6% of women (47/444) had substantial fatigue for one month or more. Age, occupation, and marital status exerted minor effects. Subjects attributed fatigue equally to physical and non-physical causes. Physical ill health, including viral infection, was associated with more severe fatigue. Women rather than men blamed family responsibilities for their fatigue. The profile of persistent fatigue did not differ from that of short duration. Only one person met criteria for the chronic fatigue syndrome.

CONCLUSIONS: Fatigue is a common complaint among general practice attenders and can be severe. Patients may attribute this to physical, psychological, and social stress.

Comment in

Chronic fatigue syndrome. [BMJ. 1991]

Fatigue among general practice attenders. [BMJ. 1991]

 

Source: David A, Pelosi A, McDonald E, Stephens D, Ledger D, Rathbone R, Mann A. Tired, weak, or in need of rest: fatigue among general practice attenders. BMJ. 1990 Nov 24;301(6762):1199-202. http://www.ncbi.nlm.nih.gov/pubmed/2261560

Note: You can read the full article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1664364/

 

Postviral syndrome

Note: This letter appeared in the Journal of the Royal Society of Medicine, Volume 83, July 1990.

 

We read with interest the paper by Bowman (December 1989 JRSM, p 712) which suggests that the positive monospot test may only be present within the first four weeks of the illness. They also questioned the specificity of V P-I antigen, a view recently supported by Lynch and Seth. (1)

We are, however, interested in their comment that the General Health Questionnaire (GHQ) is having a limited usefulness in the context, of postviral syndrome. They have used an older version of the GHQ which includes 60 questions. There is a 30 item GHQ which was derived from the GHQ-60 by excluding symptoms that were commonly present in subjects with entirely physical illness thus the GHQ-30 could be regarded as a measure of more purely psychological or psychosocial symptoms (2). Another difficulty with postviral syndrome patients is that by definition they suffer from chronic symptoms. By using the GHQ as a screening instrument, it is likely that there will be a number of cases that will not be detected by GHQ (false negatives). It has been suggested that false negatives largely result from the relative insensitivity of the GHQ for chronic disorders (3,4). To overcome this problem Goodchild and Duncan-Jones have proposed a new scoring procedure (C-GHQ) to eliminate the insensitivity of the GHQ for chronic complaints (5).

Further investigation on this showed that the new scoring method was better with regard to both the GHQ at the measure of severity and GHQ with the screening instrument (6,7). We therefore suggest that in future investigation of the psychological well being of patients with postviral syndrome the shorter version of the GHQ with the revised scoring methods is to be used.

~B T FARID Consultant Psychiatrist

~A CHANDRA Registrar in Psychiatry New Cross Hospital Wolverhampton WV10 0QP

References

1 Lynch S, Seth R. Postviral fatigue syndrome and the V P-I antigen. Lancet 1989;ii.1160-1

2 Huppert FA, et al. The factor structure of the General Health Questionnaire (GHQ-30). Br J Psychiatry 1989; 155:178-85

3 BenJamin S, elm P, Haran D. Community screening for mental illness: A validity study of the General Health Questionnaire. Br J Psychiatry 1982;140:174-80

4 Finlay-Jones RA, Murphy E. Severity of psychiatric disorder and the 30-item GHQ. Br J Psychiatry 1979; 134:609-16

5 Goodchild ME, Duncan-Jones P. Chronicity and the General Health Questionnaire. Br J Psychiatry 1985; 146:55-62

6 Koetar MWJ, Van Den Brink W, Ormel J. Chronic psychiatric complaints and the General Health Questionnaire. Br J Psychiary 1989;155:186-90.

7 Surtees PG. Psychiatric disorder in the community and the General Health Questionnaire. Br J Psychiatry 1987;150:828-35

 

Source:  B T Farid and A Chandra. Postviral syndrome. J R Soc Med. 1990 Jul; 83(7): 476. PMCID: PMC1292747 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1292747/