Tag: review

Controversies in neurological infectious diseases

Abstract:

The past several years have seen major advances in our understanding of neurological infectious diseases, their diagnosis, and their treatment. Along with these advances, however, new information about infectious agents and new therapeutic options have also introduced both uncertainty and controversy in the approach and management of patients with diseases of the central nervous system. Here, we discuss six such areas: the long-term efficacy of HAART therapy in treatment of HIV infection; the role of viral infection in chronic fatigue syndrome; Rasmussen’s encephalitis as an infectious or autoimmune disease; the spectrum of neurological diseases caused by rickettsial infection; the role of Mycoplasma pneumoniae in human central nervous system disease; and the possible association of Chlamydia pneumoniae and human herpesvirus 6 with multiple sclerosis.

 

Source: Greenlee JE, Rose JW. Controversies in neurological infectious diseases. Semin Neurol. 2000;20(3):375-86. http://www.ncbi.nlm.nih.gov/pubmed/11051301

 

Chronic fatigue syndrome and Australian psychiatry: lessons from the UK experience

Abstract:

OBJECTIVE: The aim of this paper is to outline the opportunities and dangers the chronic fatigue syndrome (CFS) issue presents to Australian psychiatry.

METHOD: The scientific literature of the last 50 years on CFS in adults was reviewed and samples of recent media portrayals of CFS in the UK and Australia were collected. The author has worked in both the UK and Australia managing adult CFS patients in specialist outpatient consultation-liaison (C-L) psychiatry settings.

RESULTS: Chronic fatigue syndrome has been at the heart of an acrimonious debate in the UK, both within the medical profession and in the wider community. UK psychiatry has been drawn into the debate, at times being the target of strong and potentially damaging criticism, yet UK psychiatry, especially the C-L subspecialty, has played a crucial role in clarifying appropriate research questions and in devising management strategies. The issue has served to enhance and broaden psychiatry’s perceived research and clinical role at the important medicine-psychiatry interface in that country.

CONCLUSIONS: Handled properly, the CFS issue offers Australian psychiatry, especially C-L psychiatry, an opportunity to make a useful contribution to patient care in a clinically difficult and contentious area, while at the same time serving to help broaden psychiatry’s scope in the Australian medical landscape.

 

Source: Couper J. Chronic fatigue syndrome and Australian psychiatry: lessons from the UK experience. Aust N Z J Psychiatry. 2000 Oct;34(5):762-9. http://www.ncbi.nlm.nih.gov/pubmed/11037362

 

Aspects of occupational disability in psychosomatic disorders

Abstract:

In 1997, 30% of the persons going into early retirement because of occupational disability and received pensions were psychosomatically ill. An additional large number of retirees suffered from untreatable pain such as chronic low back pain, some of them might as well have a chronic somatoform pain disorder. The article describes frequent psychosomatic diseases like somatization disorder, fibromyalgia and chronic fatigue syndrome with respect to their pathophysiology and psychological aspects as well as therapeutic advancements. It is postulated that an interdisciplinary access to these patients early in the course of their illness involving both somatic medical and psychiatric competence is the most promising means to tackle this enormous medical and health protection problem.

 

Source: Huber M. Aspects of occupational disability in psychosomatic disorders. Versicherungsmedizin. 2000 Jun 1;52(2):66-75. [Article in German] http://www.ncbi.nlm.nih.gov/pubmed/10853374

 

Nutritional strategies for treating chronic fatigue syndrome

Abstract:

Despite considerable worldwide efforts, no single etiology has been identified to explain the development of chronic fatigue syndrome (CFS). It is likely that multiple factors promote its development, sometimes with the same factors both causing and being caused by the syndrome.

A detailed review of the literature suggests a number of marginal nutritional deficiencies may have etiologic relevance. These include deficiencies of various B vitamins, vitamin C, magnesium, sodium, zinc, L-tryptophan, L-carnitine, coenzyme Q10, and essential fatty acids. Any of these nutrients could be marginally deficient in CFS patients, a finding that appears to be primarily due to the illness process rather than to inadequate diets. It is likely that marginal deficiencies not only contribute to the clinical manifestations of the syndrome, but also are detrimental to the healing processes.

Therefore, when feasible, objective testing should identify them and their resolution should be assured by repeat testing following initiation of treatment. Moreover, because of the rarity of serious adverse reactions, the difficulty in ruling out marginal deficiencies, and because some of the therapeutic benefits of nutritional supplements appear to be due to pharmacologic effects, it seems rational to consider supplementing CFS patients with the nutrients discussed above, along with a general high-potency vitamin/mineral supplement, at least for a trial period.

Comment in: Nutritional strategies for treating chronic fatigue syndrome. [Altern Med Rev. 2001]

 

Source: Werbach MR. Nutritional strategies for treating chronic fatigue syndrome. Altern Med Rev. 2000 Apr;5(2):93-108. http://www.altmedrev.com/publications/5/2/93.pdf (Full article)

 

Fibromyalgia, chronic fatigue syndrome, and myofascial pain syndrome

Abstract:

Fibromyalgia and widespread pain were common in Gulf War veterans with unexplained illness referred to a rheumatology clinic. Increased tenderness was demonstrated in the postmenstrual phase of the cycle compared with the intermenstrual phase in normally cycling women but not in users of oral contraceptives. Patients with fibromyalgia had high levels of symptoms that have been used to define silicone implant-associated syndrome. Tender points were found to be a common transient finding associated with acute infectious mononucleosis, but fibromyalgia was an unusual long-term outcome. The common association of fibromyalgia with other rheumatic and systemic illnesses was further explored. A preliminary study revealed a possible linkage of fibromyalgia to the HLA region. Patients with fibromyalgia were found to have an impaired ability to activate the hypothalamic pituitary portion of the hypothalamic pituitary adrenal axis as well as the sympathoadrenal system, leading to reduced corticotropin and epinephrine response to hypoglycemia. Much interest has been expressed in the literature on the possible role of autonomic dysfunction in the development or exacerbation of fatigue and other symptoms in chronic fatigue syndrome. Mycoplasma genus and mycoplasma fermentans were detected by polymerase chain reaction in patients with chronic fatigue syndrome. It was reported that myofascial temporomandibular disorder does not run in families. No major therapeutic trials in fibromyalgia, chronic fatigue syndrome, or myofascial pain syndrome were reported over the past year. The effectiveness of cognitive behavioral therapy and behavior therapy for chronic pain in adults was emphasized. A favorable outcome of fibromyalgia and chronic fatigue syndrome in children and adolescents was reported.

 

Source: Buskila D. Fibromyalgia, chronic fatigue syndrome, and myofascial pain syndrome. Curr Opin Rheumatol. 2000 Mar;12(2):113-23. http://www.ncbi.nlm.nih.gov/pubmed/10751014

 

Chronic fatigue syndrome

Definition: Chronic fatigue syndrome is characterised by severe, disabling fatigue and other symptoms, including musculoskeletal pain, sleep disturbance, impaired concentration, and headaches. Two widely used definitions of chronic fatigue syndrome (from the US Centers for Disease Control and Prevention 1 and from Oxford 2—see table) were developed as operational criteria for research. There are two important differences between these definitions. The British criteria insist on the presence of mental fatigue; the American criteria include a requirement for several physical symptoms, reflecting the belief that chronic fatigue syndrome has an underlying immunological or infective pathology.

Incidence/prevalence: Community and primary care based studies have reported the prevalence of chronic fatigue syndrome to be 0.2-2.6%, depending on the criteria used.3 4 Systematic population surveys have found similar rates of the syndrome in people of different socioeconomic status, and in all ethnic groups.4 5 Female sex is the only demographic risk factor (relative risk 1.3 to 1.7 depending on diagnostic criteria used).6

Aetiology: The cause of chronic fatigue syndrome is poorly understood.

Prognosis: Studies of prognosis in chronic fatigue syndrome have focused on people attending specialist clinics, who are likely to have had the condition for longer and to have a poorer outlook. Children with the syndrome seem to have a notably better outcome: 54-94% of children show definite improvement (after up to six years’ follow up); 20-50% of adults show some improvement in the medium term and only 6% return to premorbid levels of functioning.7 Despite the considerable burden of morbidity associated with chronic fatigue syndrome, there is no evidence of increased mortality. Outcome is influenced by the presence of psychiatric disorders and beliefs about causation and treatment.7

Aims: To reduce levels of fatigue and associated symptoms; to increase levels of activity; to improve quality of life.

Outcomes: Severity of symptoms; effects on physical function and quality of life measured in several different ways by: the medical outcomes survey short form general health survey (SF-36), a rating scale measuring limitation of physical functioning caused by ill health 8; the Karnofsky scale, a modified questionnaire originally developed for the rating of quality of life in people undergoing chemotherapy for malignancy 9; the Beck depression inventory 10; the sickness impact profile, a measure of the influence of symptoms on social and physical functioning 11; and self reported severity of symptoms and levels of activity.

You can read the rest of this article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1117488/

 

Source: Reid S, Chalder T, Cleare A, Hotopf M, Wessely S. Chronic fatigue syndrome. BMJ : British Medical Journal. 2000;320(7230):292-296. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1117488/ (Full article)

 

Chronic fatigue syndrome

Abstract:

The chronic fatigue syndrome is an illness of unknown etiology characterized by severe fatigue, myalgias, lymphadenopathy, arthralgias, chills, fevers, and postexertional malaise. Recognizing chronic fatigue syndrome is primarily a method of exclusion with no definitive diagnostic test or physical findings. As research continues to delve into the many possible etiologic agents for chronic fatigue syndrome–infectious, immunologic, neurologic, or psychiatric alone or in combination–the answer remains elusive. What is known is that chronic fatigue syndrome is a heterogeneous disorder very possibly involving an interaction of biological systems. Therefore, chronic fatigue syndrome may describe a large subset of patients, each exhibiting unique symptoms and serologic profiles dependent on the nature of the onset of illness and the genetic profile of individual patients.

 

Source: Kakumanu S, Yeager M, Craig TJ. Chronic fatigue syndrome. J Am Osteopath Assoc. 1999 Oct;99(10 Su Pt 1):S1-5. http://www.ncbi.nlm.nih.gov/pubmed/10624375

 

Chronic fatigue syndrome: new insights and old ignorance

Abstract:

Chronic fatigue syndrome (CFS) is a condition characterized by impairment of neurocognitive functions and quality of sleep and of somatic symptoms such as recurrent sore throat, muscle aches, arthralgias, headache, and postexertional malaise. A majority of patients describe an infectious onset but the link between infections and CFS remains uncertain. Findings show an activation of the immune system, abberations in several hypothalamic-pituitary axes and involvement of other parts of the central nervous system. The origin is bound to be complex and it may well be that the solution will come together with a more generally altered view about mind-body dualism, and the concept of illness and disease.

 

Source: Evengård B, Schacterle RS, Komaroff AL. Chronic fatigue syndrome: new insights and old ignorance. J Intern Med. 1999 Nov;246(5):455-69. http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2796.1999.00513.x/full (Full article)

 

Toward a model of social course in chronic illness: the example of chronic fatigue syndrome

Abstract:

Retrospective, narrative accounts of illness experience in chronic fatigue syndrome provide the empirical basis for a preliminary conceptual model of social course in chronic illness. Qualities of distress interact with culturally specific expectations for social life and personal conduct to trigger microsocial processes of marginalization: role constriction, delegitimation, impoverishment, and social isolation.

Marginalizing processes are opposed by acts of resistance initiated by ill individuals and directed toward integration in social worlds. Social distance from the perceived centers of CFS sufferers’ interpersonal worlds expands and contracts with the changing predominance of marginalizing and resisting influences over time. Social course thus consists of successive, bi-directional movements along a ‘continuum of marginality’ by persons living lives with chronic illness.

 

Source: Ware NC. Toward a model of social course in chronic illness: the example of chronic fatigue syndrome. Cult Med Psychiatry. 1999 Sep;23(3):303-31. http://www.ncbi.nlm.nih.gov/pubmed/10572737

 

Review of juvenile primary fibromyalgia and chronic fatigue syndrome

Abstract:

This article reviews the current literature on childhood fibromyalgia and chronic fatigue syndrome. In doing so, it questions assumptions about the presumed nature of the disorders-that they are distinct from each other and are duplicates of their adult counterparts. It also attempts to synthesize the available data to reach some preliminary judgments about these disorders: that fibromyalgia and chronic fatigue syndrome may be related in children and may not be duplicates of the adult disorders; that psychological and psychosocial factors are unlikely contributors to the etiology of these disorders; and that the evidence is increasingly pointing to a role for genetic factors in their etiology. A discussion of the research into treatments for childhood fibromyalgia and chronic fatigue syndrome highlights the lack of well-designed, controlled studies. Finally, directions for future research are offered where results of the current literature are unclear.

 

Source: Breau LM, McGrath PJ, Ju LH. Review of juvenile primary fibromyalgia and chronic fatigue syndrome. J Dev Behav Pediatr. 1999 Aug;20(4):278-88. http://www.ncbi.nlm.nih.gov/pubmed/10475602