Clinical Update: Chronic Fatigue Syndrome

2002 ◽  
Vol 7 (1) ◽  
pp. 6-9
Author(s):  
Leon H. Ensalada ◽  
Christopher R. Brigham
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Rating Scale ◽  
Specific Treatment ◽  
Depression Scale ◽  
Chronic Fatigue ◽  
Multiple Chemical Sensitivity ◽  
Physical Symptoms ◽  
Convincing Evidence ◽  
Illness Behavior ◽  
Fatigue Syndrome

Abstract Chronic fatigue syndrome (CFS) is a term applied to individuals who report severe chronic fatigue out of proportion to their efforts, but the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fourth and Fifth Editions, are clear that no ratable impairment is linked to CFS. Chronic fatigue is not synonymous with CFS; only a small fraction of persons who present with chronic fatigue symptoms meet the criteria for CFS; and CFS, like fibromyalgia and multiple chemical sensitivity, is poorly understood. CFS may be associated with disability but primarily is based on psychological rather than physical symptoms. No tests confirm the diagnosis of CFS, and routine laboratory testing is reserved for excluding other medical conditions. CFS is an illness without a disease and often is characterized by illness behavior expressed as somatization. To date, no convincing evidence supports the notion that CFS is an infectious, neuroendocrine, or immunologic disorder. Thus, sophisticated behavioral assessment is critical and may include a fatigue rating scale, a depression scale, and psychological and personality inventories. No specific treatment has been recommended for CFS treatment, but cognitive and behavioral interventions may be useful to address psychological symptoms; medication is reserved for specific symptoms indicative of depression or anxiety.

scholarly journals Treatment outcome in adults with chronic fatigue syndrome: a prospective study in England based on the CFS/ME National Outcomes Database

QJM ◽  
2013 ◽  
Vol 106 (6) ◽  
pp. 555-565 ◽  
Author(s):  
E Crawley ◽  
S M Collin ◽  
P D White ◽  
K Rimes ◽  
J A C Sterne ◽  
...  
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Physical Function ◽  
Clinical Assessment ◽  
Rating Scale ◽  
Depression Scale ◽  
Chronic Fatigue ◽  
Anxiety And Depression ◽  
Fatigue Syndrome ◽  
Graded Exercise Therapy

Abstract Background Chronic fatigue syndrome (CFS) is relatively common and disabling. Over 8000 patients attend adult services each year, yet little is known about the outcome of patients attending NHS services. Aim Investigate the outcome of patients with CFS and what factors predict outcome. Design Longitudinal patient cohort. Methods We used data from six CFS/ME (myalgic encephalomyelitis) specialist services to measure changes in fatigue (Chalder Fatigue Scale), physical function (SF-36), anxiety and depression (Hospital Anxiety and Depression Scale) and pain (visual analogue pain rating scale) between clinical assessment and 8–20 months of follow-up. We used multivariable linear regression to investigate baseline factors associated with outcomes at follow-up. Results Baseline data obtained at clinical assessment were available for 1643 patients, of whom 834 (51%) had complete follow-up data. There were improvements in fatigue [mean difference from assessment to outcome: −6.8; 95% confidence interval (CI) −7.4 to −6.2; P < 0.001]; physical function (4.4; 95% CI 3.0–5.8; P < 0.001), anxiety (−0.6; 95% CI −0.9 to −0.3; P < 0.001), depression (−1.6; 95% CI −1.9 to −1.4; P < 0.001) and pain (−5.3; 95% CI −7.0 to −3.6; P < 0.001). Worse fatigue, physical function and pain at clinical assessment predicted a worse outcome for fatigue at follow-up. Older age, increased pain and physical function at assessment were associated with poorer physical function at follow-up. Conclusions Patients who attend NHS specialist CFS/ME services can expect similar improvements in fatigue, anxiety and depression to participants receiving cognitive behavioural therapy and graded exercise therapy in a recent trial, but are likely to experience less improvement in physical function. Outcomes were predicted by fatigue, disability and pain at assessment.

A rating scale for fibromyalgia and chronic fatigue syndrome (the FibroFatigue scale)

2002 ◽  
Vol 52 (6) ◽  
pp. 501-509 ◽  
Author(s):  
Olof Zachrisson ◽  
Björn Regland ◽  
Marianne Jahreskog ◽  
Margareta Kron ◽  
Carl G Gottfries
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Rating Scale ◽  
Chronic Fatigue ◽  
Fatigue Syndrome

scholarly journals Systematic review of multi-symptom conditions in Gulf War veterans

2006 ◽  
Vol 36 (6) ◽  
pp. 735-747 ◽  
Author(s):  
HOLLIE V. THOMAS ◽  
NICOLA J. STIMPSON ◽  
ALISON L. WEIGHTMAN ◽  
FRANK DUNSTAN ◽  
GLYN LEWIS
Keyword(s):  
Systematic Review ◽  
Chronic Fatigue Syndrome ◽  
Chronic Fatigue ◽  
Multiple Chemical Sensitivity ◽  
Gulf War ◽  
Chemical Sensitivity ◽  
War Veterans ◽  
Gulf War Veterans ◽  
Fatigue Syndrome ◽  
Multiple Chemical

Background. Gulf War veterans have a number of health complaints. We therefore decided to carry out a systematic review to identify and summarize the findings from studies that have assessed multi-symptom conditions in Gulf War veterans and in an unexposed comparison group.Method. Studies published between January 1990 and May 2004 were identified by searching a large number of electronic databases. Reference lists and websites were also searched and key researchers were contacted. Studies were included if they compared the prevalence of chronic fatigue syndrome, multiple chemical sensitivity, CDC-defined chronic multi-symptom illness, fibromyalgia, or symptoms of either fatigue or numbness and tingling in Gulf War veterans and non-Gulf veterans. A total of 2401 abstracts were independently reviewed by two authors.Results. Twenty-three publications fulfilled the inclusion criteria. Gulf deployment was most strongly associated with chronic fatigue syndrome (OR 3·8, 95% CI 2·2–6·7). Gulf War veterans were also approximately three and a half times more likely than non-Gulf veterans to report multiple chemical sensitivity or chronic multi-symptom illness as defined by CDC. The methodological quality of the studies varied but the later and larger studies were of a high methodological standard with robust sampling strategies, adequate response rates and good adjustment for confounders.Conclusions. The results support the hypothesis that deployment to the Gulf War is associated with greater reporting of multi-symptom conditions.

Prevalence of ADHD in chronic fatigue syndrome

2011 ◽  
Vol 26 (S2) ◽  
pp. 1574-1574
Author(s):  
N. Sáez Francàs ◽  
J. Alegre ◽  
N. Calvo Piñero ◽  
J.A. Ramos Quiroga ◽  
E. Ruiz ◽  
...  
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Rating Scale ◽  
Chronic Fatigue ◽  
Diagnostic Interview ◽  
Initial Sample ◽  
Hyperactivity Disorder ◽  
Fatigue Syndrome ◽  
Severe Fatigue ◽  
Severe Psychopathology ◽  
The Relationship

IntroductionChronic Fatigue Syndrome (CFS) is characterized by severe fatigue associated with pain, sleep disturbance, attentional impairment and headaches. Evidence points towards a prominent role for Central Nervous System in its pathogenesis, and alterations in serotoninergic and dopaminergic neurotransmission have been described.Attention-deficit Hyperactivity Disorder (ADHD) courses with inattention, impulsivity, and hyperactivity. It affects children and persists into adulthood in 50% of patients. Dopamine transporter abnormalities lead to impaired neurotransmission of catecholaminergic frontal-subcortical-cerebellar circuits.ObjectivesTo describe the prevalence of ADHD in a sample of CFS patients, and the clinical implications of the association.AimsTo study the relationship between CFS and ADHD.MethodsThe initial sample consisted of 142 patients, of whom 9 were excluded because of severe psychopathology or incomplete evaluation. All the patients (age 49 ± 87; 94,7 women) received CFS diagnoses according to Fukuda criteria. ADHD was assessed with a diagnostic interview (CAADID), ADHD Rating Scale and the scale WURS, for childhood diagnose. The scales FIS-40, HAD, STAI and Pluthik Risk of Suicide (RS) were administrated.Results38 patients (28,8%) were diagnosed of childhood ADHD (4 combined, 22 hyperactive-impulsive, 12 inattentive) and persisted into adulthood in 28 (21,1%; 5 combined, 4 hyperactive-impulsive, 19 inattentive). There were no differences in Fukuda criteria profile and FIS-40 between groups. ADHD patients scored higher in HAD-Anxiety (9,88 ± 4,82 vs. 12,57 ± 3,49; p = 0,007), HAD-Depression (9,69 ± 4,84 vs. 12,04 ± 4,53; p = 0,023), STAI-E (30,55 ± 14,53 vs. 38,41 ± 11,35; p = 0,012), and RS (6,13 ± 3,48 vs. 8,49 ± 3,07; p = 0,002).ConclusionsADHD is frequent in CFS patients and it is associated with more severe clinical profile.

scholarly journals Predictors of response to treatment for chronic fatigue syndrome

2002 ◽  
Vol 181 (3) ◽  
pp. 248-252 ◽  
Author(s):  
Richard P. Bentall ◽  
Pauline Powell ◽  
Fred J. Nye ◽  
Richard H. T. Edwards
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Psychological Treatment ◽  
Controlled Trial ◽  
Depression Scale ◽  
Chronic Fatigue ◽  
Response To Treatment ◽  
Poor Outcome ◽  
Fatigue Syndrome ◽  
Predictors Of Response ◽  
Randomised Controlled

BackgroundControlled trials have shown that psychological interventions designed to encourage graded exercise can facilitate recovery from chronic fatigue syndrome.AimsTo identify predictors of response to psychological treatment for chronic fatigue syndrome.MethodOf 114 patients assigned to equally effective treatment conditions in a randomised, controlled trial, 95 completed follow-up assessments. Relationships between variables measured prior to randomisation and changes in physical functioning and subjective handicap at 1 year were evaluated by multiple regression.ResultsPoor outcome was predicted by membership of a self-help group, being in receipt of sickness benefit at the start of treatment, and dysphoria as measured by the Hospital Anxiety and Depression scale. Severity of symptoms and duration of illness were not predictors of response.ConclusionsPoor outcome in the psychological treatment of chronic fatigue syndrome is predicted by variables that indicate resistance to accepting the therapeutic rationale, poor motivation to treatment adherence or secondary gains from illness.

Emotional Regulation in Women with Chronic Fatigue Syndrome and Depression: Internal Representations and Adaptive Defenses

2018 ◽  
Vol 66 (4) ◽  
pp. 701-741 ◽  
Author(s):  
Anthony D. Bram ◽  
Kiley A. Gottschalk ◽  
William M. Leeds
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Emotional Regulation ◽  
Chronic Fatigue ◽  
Physical Symptoms ◽  
Depression Treatment ◽  
Internal Representations ◽  
Fatigue Syndrome ◽  
Defensive Functioning ◽  
Individual Assessment ◽  
Early Relationships

Chronic fatigue syndrome (CFS) presents challenges in differential diagnosis and treatment. Complicating diagnosis is that its symptoms overlap with those of depression. This study applies psychoanalytic concepts to understand emotional regulation (ER) in women with CFS and/or depression. One hundred eighty-six women were assigned to four groups and compared: (a) CFS plus high er depression (CFS-HD); (b) CFS plus lower depression (CFS-LD); (c) depressive disorder (DD); and (d) healthy controls (HC). ER was operationalized by measures of capacity to form internal representations and adaptive defenses. The study’s premise was that difficulties metabolizing emotions psychologically would be associated with their greater somatic expression. Some support was found for the hypothesis that CFS participants would exhibit more impairment in representing emotions and in adaptive defenses compared to the DD and HC groups, but this held only for the CFS-HD group. Although CFS-LD participants were expected to be more purely somatizing than the CFS-HD group, they instead showed more sophisticated capacities for ER than that group and recalled less distressing early relationships, revealing more resilience. Still, however, we found support for somatization in some CFS sufferers: Within both the CFS-HD and the CFS-LD groups, weaknesses in representing emotions and in defensive functioning were associated with more severe physical symptoms. Clinically, the heterogeneity of CFS and those who suffer from it indicates the need for individual assessment and depression treatment.

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