Tag: review

The chronic fatigue syndrome. A multifactorial approach and the treatment possibilities

Abstract:

The chronic fatigue syndrome is a poorly defined symptoms complex characterized primarily by chronic or recurrent debilitating fatigue and various combinations of other symptoms, including psychological symptoms, sore throat, lymph node pain, headache, myalgia, arthralgias. Psychological disturbances, ranging from mild depression or anxiety to severe behavioral abnormalities, are always present. Chronic fatigue syndrome is the name that more accurately describes this symptom complex of unknown cause.

A viral aetiology has long been hypothesized: many viruses are potential candidates, including any of the 23 Coxsackie A or 6 Coxsackie B viruses, herpes viruses, particularly Epstein-Barr virus and varicella. These studies, though interesting, remain unconvincing because of methodological flaws such as a poor case definition and inadequate control groups.

This syndrome may represent an infection by a yet unidentified virus. It is more likely due to an abnormal immune response toward different intracellular pathogens. There is no treatment to ameliorate the chronic fatigue syndrome. Epidemiological studies are essential with explicit operational case definition before progress can be made in the management of this distressing disorder.

 

Source: Pinardi G, Scarlato G. The chronic fatigue syndrome. A multifactorial approach and the treatment possibilities. Recenti Prog Med. 1990 Dec;81(12):773-7. [Article in Italian] http://www.ncbi.nlm.nih.gov/pubmed/2075278

 

Chronic fatigue syndrome and the psychiatrist

Abstract:

The number of patients who are identified as having chronic fatigue syndrome (CFS) has increased, and as a result, chronic fatigue syndrome has received widespread attention. Research has demonstrated that cognitive, affective and behavioural symptoms are prominent in CFS. Psychiatrists are therefore being asked to participate in the assessment and management of patients with this syndrome. This paper will provide an overview of the clinical characteristics of CFS and the current empirical findings related to its pathology, and will conclude with a discussion of the management of these patients.

 

Source:  Abbey SE, Garfinkel PE. Chronic fatigue syndrome and the psychiatrist. Can J Psychiatry. 1990 Oct;35(7):625-33. http://www.ncbi.nlm.nih.gov/pubmed/2268845

 

Chronic fatigue syndrome

Abstract:

Reports on conditions of chronic fatigue associated with other somatopsychic symptoms after acute viral infections have led to the hypothesis of a “chronic fatigue syndrome” (CFS). Historical disease descriptions, like e.g. “myalgic encephalomyelitits”, were updated by means of modern virological diagnostic techniques and data analysis.

Several viral agents like enteroviruses, Epstein-Barr virus, Human-Herpesvirus 6 and other herpesviruses have been implicated for possible underlying infections. A preliminary disease definition by the Center for Disease Control (CDC) seeks to provide a rational basis for further etiological studies. In fact, there is growing consensus that the syndrome comprises various separate disease entities and causative agents.

Today we can tentatively differentiate a “chronic mononucleosis” after infection with Epstein-Barr virus, an etiologically undetermined “postviral fatigue syndrome” and a fatigue syndrome of the myalgic type after Coxsackie-B virus infection. Furthermore, a valid diagnosis of CFS must be based on the exclusion of defined other diseases and the awareness of dealing with a hypothetical concept. As a result, current knowledge does not yet allow specific therapeutic recommendations.

 

Source: Ewig S, Dengler HJ. Chronic fatigue syndrome. Klin Wochenschr. 1990 Aug 17;68(16):789-96. [Article in German] http://www.ncbi.nlm.nih.gov/pubmed/2170741

 

The chronic fatigue syndrome: a return to common sense

The chronic fatigue syndrome has become one of the past decade’s causes celebres, vying with ecological issues for a place in the public perception of real and imagined threats to society and the individual. Perhaps this interest is a manifestation of the malaise of fin de siecle which in other ages has led to outbursts of anarchy’ or increased eschatological preoccupation. Fortunately, the passing of time-and the cathartic benefits of publication have restored a more reasoned view of chronic fatigue and its attendant problems. Chronic fatigue first became prominent as one of the features of myalgic encephalomyelitis or the ‘ME syndrome’ and has subsequently been the subject of intense debate. (2’5) In truth, fatigue is a symptom with many causes and is thus comparable with dyspnoea or dyspepsia. However, in some patients it is the dominant complaint, thereby defining chronic fatigue as a syndrome sui generis in the minds of some observers.

You can read the rest of this article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2429649/pdf/postmedj00163-0004.pdf

 

Source: Denman AM. The chronic fatigue syndrome: a return to common sense. Postgrad Med J. 1990 Jul;66(777):499-501. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2429649/

 

Nonrestorative sleep and symptoms after a febrile illness in patients with fibrositis and chronic fatigue syndromes

Abstract:

This review summarizes the physiologic and clinical evidence that shows nonrestorative sleep to be associated with chronic fatigue and diffuse myalgia after a flulike illness. Such a febrile illness may trigger alteration in sleep-wake brain and immune functions in patients with fibrositis or chronic fatigue syndromes.

 

Source: Moldofsky H. Nonrestorative sleep and symptoms after a febrile illness in patients with fibrositis and chronic fatigue syndromes. J Rheumatol Suppl. 1989 Nov;19:150-3. http://www.ncbi.nlm.nih.gov/pubmed/2691676

 

Chronic fatigue syndrome: review of the literature

Abstract:

Chronic fatigue syndrome, previously known as chronic mononucleosis or post-infectious fatigue, is a poorly understood illness characterized by chronic debilitating fatigue, recurrent flu-like symptoms, and few clinical or laboratory abnormalities. Attention was briefly focused on the Epstein-Barr virus (EBV) as a causal agent, but that hypothesis is now in serious doubt. While a significant incidence of psychiatric illness has been demonstrated among patients with the chronic fatigue syndrome, there is also evidence of subtle immune system abnormalities, leading some researchers to postulate a multi-factorial psycho-immune cause.

 

Source: Turgeon SA. Chronic fatigue syndrome: review of the literature. Can Fam Physician. 1989 Oct;35:2061-5. http://www.ncbi.nlm.nih.gov/pubmed/21249084

Note: You can read the full article here:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2280912/

 

Epstein-Barr virus and the chronic fatigue syndrome: a short review

Abstract:

Chronic Fatigue Syndrome (CFS), previously known as neuroasthenia is often considered to be due to psychiatric causes. Evidence for a possible role for the Epstein-Barr virus in CFS is summarized. A plea is made for physicians to accept CFS as a non-psychiatric chronic illness to encourage further research into a clear definition of the syndrome.

 

Source: Jones JF. Epstein-Barr virus and the chronic fatigue syndrome: a short review. Microbiol Sci. 1988 Dec;5(12):366-9.  http://www.ncbi.nlm.nih.gov/pubmed/2856301

 

The chronic fatigue syndrome (myalgic encephalomyelitis)–myth or mystery?

Abstract:

The chronic fatigue syndrome (CFS) or myalgic encephalomyelitis has caused great confusion, misunderstanding and perhaps even mismanagement of many persons presenting with a variety of combinations of ill-defined complaints. The history, possible pathogenesis and clinical features, of what is probably in most instances a post-viral infection syndrome, are reviewed. The recent Centers for Disease Control case definition is summarised and simplified. The need for such uniformity of definition, acceptable to most workers in the field, is emphasised in order to facilitate further studies into the cause, diagnosis, course and treatment of CFS. The difficulty in treating this condition and the currently recommended management are described. Double-blind controlled studies are essential in assessing any proposed new treatment.

 

Source: Spracklen FH. The chronic fatigue syndrome (myalgic encephalomyelitis)–myth or mystery? S Afr Med J. 1988 Nov 5;74(9):448-52. http://www.ncbi.nlm.nih.gov/pubmed/3055363