An evaluation of exclusionary medical/psychiatric conditions in the definition of chronic fatigue syndrome

Abstract Background Only a few studies have analyzed the effects of physical and psychiatric conditions on the risk of chronic fatigue syndrome (CFS). Therefore, the goal of this exploratory case-control study was to investigate the associations of physical and psychiatric conditions with CFS in almost 19 800 adults from Germany. Methods This study included patients diagnosed for the first time with CFS in one of 1238 general practices in Germany between 2010 and 2017 (index date). Controls without CFS were matched (1:1) to cases with CFS by sex, age, index year, and practice. Physical and psychiatric conditions diagnosed in the year prior to the index date were included if they were present in at least 3% of patients with CFS. Associations between physical and psychiatric conditions (33 potential independent variables) and CFS (dependent variable) were analyzed in an adjusted conditional logistic regression model, and physical and psychiatric disorders were included in the model using forward stepwise selection. Results This study included 9896 cases with CFS and 9896 controls without CFS [65.1% women; mean (standard deviation) age 49.5 (18.3) years]. Seven conditions were associated with CFS in the adjusted regression model. The disorders displaying the strongest relationship with CFS were cancer [odds ratio (OR) = 2.57, 95% confidence interval (CI) = 2.24–2.95], sleep disorders (OR = 1.88, 95% CI = 1.66–2.12) and depression (OR = 1.77, 95% CI = 1.61–1.95). Conclusions Cancer, sleep disorders, and depression were strongly and positively associated with CFS. Additional studies are needed to gain a better understanding of the mechanisms underlying these relationships.

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Definition of the Chronic Fatigue Syndrome

Annals of Internal Medicine ◽

10.7326/0003-4819-109-6-511 ◽

1988 ◽

Vol 109 (6) ◽

pp. 511 ◽

Cited By ~ 10

Author(s):

Dale A. Matthews

Keyword(s):

Chronic Fatigue Syndrome ◽

Chronic Fatigue ◽

Fatigue Syndrome ◽

Definition Of

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Article Commentary: Kynurenine Pathway Pathologies: Do Nicotinamide and Other Pathway Co-Factors have a Therapeutic Role in Reduction of Symptom Severity, Including Chronic Fatigue Syndrome (CFS) and Fibromyalgia (FM)

International Journal of Tryptophan Research ◽

10.4137/ijtr.s11193 ◽

2013 ◽

Vol 6s1 ◽

pp. IJTR.S11193 ◽

Cited By ~ 5

Author(s):

Adele Blankfield

Keyword(s):

Chronic Fatigue Syndrome ◽

Neuropsychiatric Symptoms ◽

Protein Energy Malnutrition ◽

Chronic Fatigue ◽

Kynurenine Pathway ◽

Metabolic Dysfunction ◽

Fatigue Syndrome ◽

Inflammatory Conditions ◽

Protein Energy ◽

Definition Of

Chronic fatigue syndrome (CFS) and fibromyalgia (FM) appear to meet the criteria of a tryptophan-kynurenine pathway disorder with potential neuroimmunological sequelae. Aspects of some of the putative precipitating factors have been previously outlined. 2 , 3 An analysis of the areas of metabolic dysfunction will focus on future directions for research and management. The definition of dual tryptophan pathways has increased the understanding of the mind-body, body-mind dichotomy. The serotonergic pathway highlights the primary (endogenous) psychiatric disorders. The up-regulation of the kynurenine pathway by physical illnesses can cause neuropathic and immunological disorders 1 associated with secondary neuropsychiatric symptoms. Tryptophan and nicotinamide deficiencies fall within the protein energy malnutrition (PEM) spectrum. They can arise if the kynurenine pathway is stressed by primary or secondary inflammatory conditions and the consequent imbalance of available catabolic/anabolic substrates may adversely influence convalescent phase efficiency. The replacement of depleted or reduced NAD+ levels and other cofactors can perhaps improve the clinical management of these disorders.

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Chronic Fatigue Immune Dysfunction Syndrome: An Epidemic?

PEDIATRICS ◽

10.1542/peds.89.4.804 ◽

1992 ◽

Vol 89 (4) ◽

pp. 804-804

Author(s):

MUDR ALEŠ KMINEK ◽

MUDR IVO SIMUNEK

Keyword(s):

Chronic Fatigue Syndrome ◽

Children And Adolescents ◽

Immune Dysfunction ◽

Chronic Fatigue ◽

Case Definition ◽

Fatigue Syndrome ◽

Definition Of ◽

Mild Fever

To the Editor.— We read with great interest the article "Chronic Fatigue in Adolescents" by Smith et al in the August 1991 issue.1 We appreciate the statement by the authors that "the CDC-recommended criteria for case definition of the chronic fatigue syndrome (CFS) were developed mainly from adult populations and may not be appropriate for children and adolescents." We have studied children suffering from unexplained fatigue, mild fever, nonexudative pharyngitis, lymphadenopathia, etc, since 1987, ie, prior to publication of CDC-recommended criteria of CFS.2

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U.S. Case Definition of Chronic Fatigue Syndrome

Journal of Chronic Fatigue Syndrome ◽

10.1300/j092v05n03_02 ◽

1999 ◽

Vol 5 (3-4) ◽

pp. 3-33 ◽

Cited By ~ 24

Author(s):

Leonard A. Jason ◽

Caroline P. King ◽

Judith A. Richman ◽

Renee R. Taylor ◽

Susan R. Torres ◽

...

Keyword(s):

Chronic Fatigue Syndrome ◽

Chronic Fatigue ◽

Case Definition ◽

Fatigue Syndrome ◽

Definition Of

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Post-Acute COVID-19 Symptoms, a Potential Link with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A 6-Month Survey in a Mexican Cohort

Brain Sciences ◽

10.3390/brainsci11060760 ◽

2021 ◽

Vol 11 (6) ◽

pp. 760

Author(s):

J Antonio González-Hermosillo ◽

Jhanea Patricia Martínez-López ◽

Sofía Antonieta Carrillo-Lampón ◽

Dayanara Ruiz-Ojeda ◽

Sharon Herrera-Ramírez ◽

...

Keyword(s):

Chronic Fatigue Syndrome ◽

Clinical Features ◽

Length Of Hospital Stay ◽

Chronic Fatigue ◽

Median Number ◽

Myalgic Encephalomyelitis ◽

Common Symptom ◽

Fatigue Syndrome ◽

Potential Link ◽

Definition Of

The aim of this study was to describe the clinical evolution during 6 months of follow-up of adults recovered from COVID-19. We tried to determine how many met the definition of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). A total of 130 patients (51.0 ± 14 years, 34.6% female) were enrolled. Symptoms were common, participants reported a median number of 9 (IQR 5–14) symptoms. Fatigue was the most common symptom (61/130; 46.9%). Patients with fatigue were older 53.9 ± 13.5 years compared with 48.5 ± 13.3 years in those without fatigue (p = 0.02) and had a longer length of hospital stay, 17 ± 14 days vs. 13 ± 10 days (p = 0.04). There was no difference in other comorbidities between patients with fatigue and those without it, and no association between COVID-19 severity and fatigue. After multivariate adjustment of all baseline clinical features, only age 40 to 50 years old was positively associated with fatigue, OR 2.5 (95% CI 1.05–6.05) p = 0.03. In our survey, only 17 (13%) patients met the Institute of Medicine’s criteria for “systemic exertion intolerance disease,” the new name of ME/CFS. In conclusion, in some patients, the features of post-acute COVID-19 syndrome overlap with the clinical features of ME/CFS.

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