WASHINGTON - Studies confirm that Gulf War veterans suffer disproportionately from post-traumatic stress disorder and other psychiatric illnesses as well as vague symptoms often classified as Gulf War Syndrome, a panel of experts reported on Friday.
The Institute of Medicine panel said better studies are needed to characterize a clear pattern of distress and other symptoms among veterans of the conflicts in the Gulf region that started in 1990 and continue today.
"It is clear that a significant portion of the soldiers deployed to the Gulf War have experienced troubling constellations of symptoms that are difficult to categorize," said Stephen Hauser, chairman of the department of neurology at the University of California, San Francisco.
The committee declined to say that there was any such thing as Gulf War Syndrome but did note many veterans had "multisymptom illness."
"Unfortunately, symptoms that cannot be easily quantified are sometimes incorrectly dismissed as insignificant and receive inadequate attention and funding by the medical and scientific establishment," Hauser added in a statement.
"Veterans who continue to suffer from these symptoms deserve the very best that modern science and medicine can offer to speed the development of effective treatments, cures and - we hope – prevention."
Hauser and the rest of the panel reviewed 400 studies in-depth for their report and concluded that in many cases there was tantalizing evidence, but just not enough data to back it up.
Bowel, sleep disturbances
They found many reports of "seemingly related symptoms, including persistent fatigue, chronic fatigue syndrome, irritable bowel syndrome, memory problems, headache, bodily pains, disturbances of sleep, as well as other physical and emotional problems."
But doctors struggle to categorize as they have no known cause, no diagnostic biomarkers and no way to find traces in tissue.
Studies showed sufficient evidence that veterans suffer from Post-Traumatic Stress Disorder, generalized anxiety disorder and substance abuse, particularly alcohol abuse and gastrointestinal disorders such as irritable bowel syndrome.
There is also clear evidence of "multisymptom illness" among U.S., British and Australian veterans but not enough evidence to show what may have caused it.
"It is beyond dispute, however, that the prevalence of symptoms such as headaches, joint pain and difficulty concentrating, is higher in veterans deployed to the Gulf War theater than the others," the report reads.
The experts, including epidemiologists who study patterns of disease, neurologists and psychiatrists, found limited but suggestive evidence that Gulf War veterans have higher rates of amyotrophic lateral sclerosis, also called ALS or Lou Gehrig's disease - a crippling, progressive and fatal nerve disease.
Veterans also appear to risk fibromyalgia and chronic widespread pain, sexual difficulties and deaths from car accidents.
Inadequate evidence could be found of links to cancer, blood disease, hormone imbalances, multiple sclerosis, heart disease, birth defects, pregnancy or fertility problems.
Better studies are needed to follow veterans long-term and catalog their illnesses. "A second branch of inquiry is also important," the report added.
"It consists of a renewed research effort to identify and treat multisymptom illness in Gulf War veterans."
M.E. (cvs) - Richtlijnen voor psychiaters - Deel I
M.E. (cvs) – Richtlijnen voor psychiaters
M.E. (cvs) – Richtlijnen voor psychiaters
Zuiderzon – ME/CVS.Net, Interactieve website over de ziekte ME/CVS, 18-04-2009
Eleanor Stein is psychiater met een private praktijk in Calgary (Alberta) Canada. Haar kennis aangaande M.E./CVS is mede het gevolg van het jarenlang zorgen voor en helpen van FM- & M.E./CVS-patiënten. Ze is welbekend voor het NIET onderschrijven van de mening die vele psychiaters er op na houden, nl. dat M.E./CVS een gedragsgerelateerde aandoening zou zijn. Ze getuigt ook als experte in gerechtszaken.
Dr Stein beschreef ooit het ‘Stanford Model of Chronic Disease Self Management’ (cfr. : http://patienteducation.stanford.edu/programs/cdsmp.html -) – wereldwijd een veel gebruikt model – dat tegengesteld is aan met het van bovenaf opgelegde, op CGT gebaseerde gedragsmodel dat domineert in het V.K. Het gaat er van uit dat patiënten zich continu moeten engageren voor een heilzame gezondheidszorg, dat patiënten en professionals kennis en bevoegdheid moeten delen en dat patient-‘empowerment’ de sleutel tot succes is. Er worden klinische voordelen gerapporteerd voor diabetes en hypertensie (aandoeningen waarbij levensstijl een grote rol spelen) gebruikmakend van dit model maar er werd geen duidelijke voordeel gevonden voor arthritis. Dr Stein besloot dat gedragsinterventies kunnen leiden tot een schijnbare, subjectieve verbetering op korte termijn maar dat deze alleen niet leiden tot meetbare, objectieve wijzigingen of blijvende symptomatische veranderingen. Daarenboven is er geen bewijs dat dergelijke interventies de pathofysiologie van M.E./CVS aanpakken.
Ze heeft ook het ‘E Team’ opgericht – het eerste multidisciplinair team in Canada – dat cognitieve, sensorische en geïntegreerde geneeskundige bepalingen uitvoert bij mensen met M.E./CVS, FM, MCS en blootselling aan toxische stoffen. Dit team bestaat uit twee artsen, twee psychologen, een optometrist en een audioloog.
Het onderstaande komt uit haar document ‘Assessment and Treatment of Patients with M.E./CFS: Clinical Guidelines for Psychiatrists’ van 2005 (cfr. : http://sacfs.asn.au/download/guidelines_psychiatrists.pdf -) en is bedoeld om psychiaters die het biopsychosociaal model aanhangen andere inzichten bij te brengen…
Myalgische Encefalomyelitis (M.E.) werd voor het eerst gedefinieerd door Acheson in 1959, gebaseerd op 14 gedocumenteerde uitbraken in verschillende landen en honderden sporadische ziekte-gevallen gekarakteriseerd door : hoofdpijn, spierpijn, parese, mentale symptomen, lage of geen koorts en geen mortaliteit (Acheson 1959). Dit was in contrast met polio en andere verlammende aandoeningen die toen prevalent waren. De aandoening werd later geoperationaliseerd door Ramsay met het opnemen van : spier-zwakte en vermoeibaarheid, betrokkenheid van het CZS en fluctuatie van symptomen. In vroege rapporten was emotionele labiliteit – gaande van lichte irritatie tot gewelddadige manifestaties – een bijna constante eigenschap.
In 1988, na een uitbraak in Incline Village (Nevada), vormde het CDC een committee dat de aandoening ‘Chronische Vermoeidheid Syndroom” noemde en criteria suggereerde voor een research-definitie (Holmes et al. 1988 – cfr. 'Chronic Fatigue Syndrome - A working case definition' op : http://www.annals.org/cgi/content/abstract/108/3/387 -).
Deze criteria werden klinisch problematisch bevonden en in 1994 herzag het CDC hun definitie en publiceerde wat nu genoegzaam bekend staat als de ‘Fukuda criteria’ (cfr. : http://www.cvscontactgroep.be/jml/medisch/41-criteria-voor-cvsme/62-1994-de-cdc-criteria-fukuda-et-al - (Fukuda et al. 1994 – cfr. 'The Chronic Fatigue Syndrome: A Comprehensive Approach to Its Definition and Study' op : http://www.annals.org/cgi/content/full/121/12/953 -). Deze definitie uit 1994 vereist minder fysieke tekenen dan de definitie uit 1988 en daarom selekteert ze minder ernstig zieke patiënten (De Becker et al. 2001 – cfr. : 'A definition-based analysis of symptoms in a large cohort of patients with chronic fatigue syndrome' op : http://www.ingentaconnect.com/content/bsc/jint/2001/00000250/00000003/art00890 -). De criteria van Fukuda vereisen slechts één verplicht symptoom : invaliderende vermoeidheid die langer dan 6 maanden aanhoudt. Daarnaast moeten er ten minste 4 van de volgende symptomen zijn : gestoord geheugen/ concentratie, pijnlijke keel, gevoelige lymfeknopen, spier-pijn, pijn aan meerdere gewrichten, nieuwe hoofdpijn, niet-verfrissende slaap en post-exertionele vermoeidheid. Deze definitie mist specificiteit omdat gebruikelijke symptomen zoals autonome en endocriene symptomen niet werden opgenomen. De Fukuda criteria warden ook bekritiseerd omdat spier-vermoeibaarheid niet is vereist. Spier-moeheid is [wel] noodzakelijk voor de diagnose van M.E.
Patiënten die lijden aan symptomen die consistent zijn met CVS hebben een afkeer van de naam omdat het de ernstige incapaciterende mentale en spier-moeheid die wordt ervaren, trivialiseert. Hoewel M.E. en and CVS verschillen qua definitie, refereren verscheidene groepen – inclusief de internationale groep researchers die de ‘Canadian Guidelines’ publiceerden – naar de aandoening als : Myalgische Encefalomyelitis/ Chronische Vermoeidheid Syndroom (M.E./CVS); wat patiënten met én epidemische én sporadische start en patiënten met milde tot extreem ernstige symptomen omvat. De term 'M.E./CVS' zal in dit artikel worden gebruikt.
Het klinisch profiel van M.E./CVS is dat van een onophoudelijke en schommelende mentale en fysieke vermoeidheid, niet-verfrissende slaap, cognitieve dysfunktie en andere symptomen. De ernst kan variëren :
mild – waarbij men nog in staat is voltijds te werken/studeren maar niettemin met inspanning en rust tijdens de weekends:
matig – in staat is deeltijds te werken/studeren met inspanning;
ernstig – niet in staat te werken/studeren en assistentie om een onafhankelijk leven te leiden is vereist;
extreem - niet in staat een onafhankelijk leven te leiden, virtueel aan huis en soms aan bed gekluisterd.
Het verloop van M.E./CVS is variabel. De karakteristieke eigenschap van de ziekte is invaliderende fysieke en cognitieve malaise en/of vermoeidheid en verergering van andere symptomen volgend op inspanning met langdurige reaktieve verslechteringen na aktivititeit.
In de grootste epidemiologische studie tot op heden, werd door Jason en collega’s in Chicago aangetoond dat slechts 40% van een CVS-gemeenshapscohort echt CVS had (Jason et al. 1999). 15,6% van dit cohort had ook het fibromyalgie-syndroom (FM), een aandoening van chronische veralgemeende spier-pijn en gewricht-stijfheid met aanwezigheid van ten minste 11/18 aangewezen ‘tender points’ bij fysisch onderzoek. 41 percent had ‘Multiple Chemical Sensitivity’ (MCS), een aandoening gedefinieerd als een chronische toestand met symptomen die reproduceerbaar terugkomen in respons op lage niveaus van blootstelling aan chemicaliën. De symptomen verbeteren of gaan weg wanneer de aanstokers worden verwijderd. De symptomen van of M.E./CVS komen voor bij meerdere orgaan-systemen en geen enkele andere aandoening kan verantwoordelijk worden geacht voor de symptomen. De invaliditeit die bij M.E./CVS-patiënten wordt gezien, wordt dikwijls verergerd door de co-morbiditeit van M.E./CVS met FM en MCS alsook met andere medische en psychiatrische aandoeningen, indien aanwezig. Een volledige anamnese moet worden afgenomen om alle symptomen die een impact hebben op funktie en gezondheid te identificeren.
De prevalentie van CVS in epidemiologische studies gebaseerd op de totale bevolking, gebruikmakend van de Fukuda criteria, is 0,24 – 0,42% (Reeves et al. 2003, Jason et al. 1999). Dit betekent dat in Canada er ongeveer 125.000 mensen zijn die voldoen aan de CDC criteria voor CVS. Gebaseerd op Amerikaanse schattingen is het jaarlijks verlies aan produktiviteit $ 20.000 per persoon. In Canada wordt de jaarlijks verloren produktiviteit geschat op $ 2,5 miljard (Reynolds et al. 2004). Dit is een reusachtige belasting voor de economie en suggereert dat meer onderzoeksfondsen zouden moeten worden aangewend voor het begrijpen van de preventie, diagnose en aanpak van M.E./CVS.
Ondanks 20 jaar research en meer dan 3.000 gepubliceerde ‘peer-reviewed’ artikels, blijft de etiologie van M.E./CVS onduidelijk. Het wordt nu algemeen aanvaard dat M.E./CVS een paraplu-term is voor een heterogene groep aandoeningen en dat één enkele etiologie of mechanisme wellicht niet zal worden gevonden. Dit heeft geleid tot een oproep voor zorgvuldig sub-typeren door het gebruik van gekende co-relaten bij toekomstig onderzoek (Jason et al. 2005).
Niettemin worden sommige abnormaliteiten consistent gerapporteerd. Deze omvatten : dysfunktie van het autonoom zenuwstelsel, gebruikmakend van de objectieve meting van hartslag-variabiliteit (Cordero et al. 1996) of ‘tilt table’-test (Rowe & Calkins 1998). Meerder studies hebben deficiëntie in ‘natural killer’-cel funktie getoond (Whiteside & Friberg 1998;Ogawa et al. 1998) bij M.E./CVS. Studies van cytokine-profielen suggereren een Th1 naar Th2 verschuiving. Th1 is het aspekt van het immuunsysteem dat intracellulaire infektie controleert. […] Vele intracellulaire infekties bleken meer prevalent bij M.E./CVS vergeleken met controles. […] Dit suggereert dat de infekties secundair zijn aan immuun-dysfunktie. Cognitieve funktie (DeLuca et al. 1997, Michiels et al. 1999, Tiersky et al. 2003), hersen-doorbloeding bij SPECT (Ichise et al. 1992, Costa et al. 1995, Fischler et al. 1996) en kwantitatieve EEG zijn allemaal abnormaal (Flor-Henry et al. 2003). Hormonale studies tonen hypo-funktie ter hoogte van de hypothalamus. Recent werd gesuggereerd dat dit wellicht gevolg is van chronische ziekte eerder dan een oorzaak (Cleare 2004).
De research toont steeds duidelijker dat M.E./CVS GEEN primaire psychiatrische aandoening is hoewel psychiatrische symptomen soms prominent kunnen zijn. De ‘World Health Organization’ heeft M.E./CVS als een neurologische aandoening geklassificeerd. Vroeger hypothesen van psychologische oorzaken zoals de quote van Abbey en Garfinkel uit 1991 (“De meerderheid van zij die lijden [aan of M.E./CVS] ervaren primaire psychiatrische aandoeningen of psychofysiologische reakties en de aandoening is dikwijls een cultureel gesanctioneerde vorm van ziekte-gedrag.”) werd weerlegd door steeds meer onderzoeksresultaten die biologische co-relaten voor M.E./CVS tonen die niet bij depressie of enig andere psychiatrische aandoening worden gevonden.
Voorkomen van psychiatrische aandoening bij CVS is gelijk aan die bij andere chronische medische aandoeningen
Als M.E./CVS een psychiatrische aandoening zou zijn, zouden psychiatrische symptomen universeel moeten zijn. Als de striktere Fukuda criteria echter worden gebruikt voor de selektie van patiënten, is de prevalentie van gekende psychiatrische aandoeningen onder patiënten met M.E./CVS gelijkaardig met die van patiënten met andere chronische, invaliderende medische aandoeningen zoals reumatoïde arthritis; ongeveer 30 – 40% (Thieme et al. 2004, Hickie et al. 1990, Fiedler et al. 1996). Jason’s vergelijkende studie van de Canadse en Fukuda criteria voor M.E./CVS toonden dat de Canadese criteria patiënten selekteerden die fysiek zieker waren, meer fysieke funktionele stoornissen, meer vermoeidheid/ zwakte en meer neuro-cognitieve, neurologische en cardiopulmoniare abnormaliteiten hadden en minder huidige of levenslange psychiatrische stoornissen (Jason et al. 2004) [cfr. ook : ‘Evaluatie van de CDC Empirische Definitie’ op : http://mecvswetenschap.wordpress.com/2009/02/23/431/ -]. Dit draagt bij tot het bewijsmateriaal dat diagnostische criteria de selektie van patiënten beïnvloedt. Studies die een hogere prevalentie van psychiatrische aandoeningen rapporteerden, vertoonden vooroordelen qua recrutering, b.v. het selekteren van degenen die voor behandeling naar een specialistisch centrum gaan of het gebruiken van ongeschikte onderzoeksinstrumenten (Thieme et al. 2004). Jason heeft aangetoond dat het type vragenlijst die wordt gebruikt in een studie significant de prevalentie van psychiatrische aandoeningen, gerapporteerd bij M.E./CVS-populaties, kan beïnvloeden (50% gebruikmakend van de DIS [‘Dissociation Questionnaire’; dissociatieve stoornis = persoonlijkheidsstoornis – cfr. : http://www.tijdschriftvoorpsychiatrie.nl/meetinstrumenten/info.php?id=45 -] vs. 25% bij de SCID [‘Structured Clinical Interview for DSM-IV - Dissociative Disorders’; veelvuldig gebruikt diagnostisch instrument voor het vaststellen van persoonlijkheidsstoornissen – cfr. : http://www.tijdschriftvoorpsychiatrie.nl/meetinstrumenten/info.php?id=105 -]) (Jason et al. 2003). Voor research-doeleinden wordt de ‘Structured Clincial Interview for DSM-IV’ ontwikkeld door Spitzer et al. - cfr. : http://www.tijdschriftvoorpsychiatrie.nl/meetinstrumenten/ -, aanbevolen bij M.E./CVS-studies (Spitzer et al. 1992, Williams et al. 1992).
Aantallen van persoonlijkheidsstoornissen bij M.E./CVS zijn NIET verhoogd
Als M.E./CVS een psychiatrische aandoening zou zijn, zou men verwachten dat het aantal persoonlijkheidsstoornissen verhoogd zou zijn zoals dat bij psychiatrische groepen het geval is. Nochtans hebben mensen met M.E./CVS gelijkaardige percentages persoonlijkheidsstoornissen (ca. 10%) als de algemene bevolking en lagere percentages dan deze die worden gevonden bij depressie (Thieme et al. 2004, Pepper et al. 1993, Saltzstein et al. 1998, Chubb et al.1999). Er zijn studies die hogere percentages psychologisch leed rapporteren gebruikmakend van de MMPI [Minnesota Multiphasic Personality Inventory; één van de meest frequent gebruikte persoonlijkheidstesten – cfr. : http://www.bol.com/nl/p/boeken-engels/mmpi-2/1001004002582122/index.html -] (Blakely et al. 1991) bij M.E./CVS vergeleken met gezonde controles maar er werd echter geargumenteerd dat de MMPI geen accurate bepaling is bij mensen met chronische medische aandoeningen omdat de items werden afgeleid en genormeerd gebaseerd op fysiek gezonde individuen. Wanneer ze wordt gebruikt bij groepen met chronische ziekte, dragen de fysieke symptomen bij tot de ‘hypohondriase’ [bezorgheid over lichamelijk symptomen] en ‘hysterie’ [bewustzijn van problemen en kwetsbaarheden] schalen, wat resulteert in vals-positieven (Pincus et al. 1986, Goldenberg 1989).
Ondanks het overwicht van research voor het tegengestelde, blijft een groep van hoofdzakelijk Britse psychiaters publiceren dat M.E./CVS wordt veroorzaakt en verergerd door verkeerde zelf-perceptie en vermijdend gedrag. De foute overtuigingen worden omschreven als : “het geloof dat men een ernstige ziekte heeft; de verwachting dat haar/zijn toestand wellicht zal verslechten; de ‘ziekte-rol’ – met inbegrip van de effekten van processen en compensatie; en de alarmerende portretering van de aandoening als katastrofisch en invaliderend” (Barsky & Borus 1999). Het moet worden opgemerkt dat noch dit artikel van Barsky noch enig ander met gelijkaardige opinies ‘evidence-based’ is; het zijn de persoonlijke meningen van de auteurs.
Genetica van depressie en M.E./CVS zijn onafhankelijk
De genetica van M.E./CVS is onafhankelijk van deze van depressie; wat suggereert dat de twee aandoeningen GEEN gelijkaardig genetisch risico dragen (Thieme et al. 2004, Hickie et al. 1999).
Fysiologische metingen verschillen tussen M.E./CVS en depressie
Bij depressie is de hypothalamus-hypofyse-bijnier [HPA] as gestimuleerd en moeilijk te onderdrukken met dexamethasone [synthetisch glucocorticoid, geeft negatieve feedback aan de hypofyse om de secretie van ACTH te onderdrukken; kan niet doorheen de bloed-hersen-barrière zodat het toelaat een specifiek deel van de HPA-as te testen], terwijl het tegenovergestelde waar is bij M.E./CVS. Cortisol-waarden in de urine zijn laag, serum-cortisol stijgt scherp en voor langere perioden na oraal dexamethasone (Scott & Dinan 1998). Het is onduidelijk of deze veranderingen in HPA-as funktie primair of secundair zijn (Cleare 2004). Elektrodermale huid-respons en huid-temperatuur aan de vinger zijn verschillend bij M.E./CVS en bij depressie (Pazderka-Robinson et al. 2004 : ‘Quantitative EEG profiles discriminate between ME/CFS, depression and healthy controls’ [cfr. ‘Onderscheid CVS & depressie via Huid-geleiding’ op : http://mecvswetenschap.wordpress.com/2009/02/28/onderscheid-cvs-depressie-via-huid-geleiding/ -], Flor-Henry et al. 2003).
Ernst van de ziekte en NIET psychologische factoren voorspellen uitkomst
Als M.E./CVS een psychiatrische aandoening zou zijn, zou men verwachten dat psychologische symptomen de uitkomst zouden voorspellen. Dit is echter niet het geval. Studies tonen consistent dat de ernst van de symptomen bij aanvang en of iemand voldoet aan de volledige criteria voor M.E./CVS de prognose bij M.E./CVS voorspelt (Darbishire et al. 2005) maar psychologische symptomen en cognitieve overtuigingen NIET (Deale et al. 1998, Jones et al. 2004, Darbishire et al. 2005, White et al. 1998).
Gezien de steeds groeiende hoeveelheid research-data dat M.E./CVS in feite een ernstige, dikwijls invaliderende aandoening is, is het achterlaten van het psychologisch model begrijpelijk. Psychiatrische stoornissen bij M.E./CVS zijn meestal secundair aan het verlies van gezondheid, levensstijl, sociale rol en financiële middelen zowel als het sociaal stigma van het hebben van een ernstige invaliderende maar zeer slecht begrepen ziekte. […]
3. - Behandelingskwesties
Medicijn-dosage en -gevoeligheid
Het wordt algemeen aanvaard dat sommige patiënten met M.E./CVS gevoeliger zijn voor de ongunstige gevolgen van medicatie dan de meeste gezonde mensen. Ze delen deze eigenschap met patiënten met chronische pijn en fibromyalgie. Tricyclische antidepressiva mogen dan misschien bv. nuttig zijn bij het onderhouden van de slaap en het verminderen van centrale pijn-gevoeligheid maar veel patiënten met M.E./CVS hebben slechts voordeel van en tolereren slechts heel lage dosissen. […] SSRIs, die over het algemeen goed worden getolereerd bij de behandeling van depressie en angst, worden niet getolereerd door een sub-groep van M.E./CVS- patiënten. Het mechanisme van deze reakties is onbekend. Het opdrijven van de dosering wetende dat ongunstige gevolgen kunnen optreden bij deze patiënten is echter flirten met rampspoed en verzwakt de therapeutische relatie. […] In sommige gevallen kan medicijn-gevoeligheid de behandeling van de subset van deze patiënten ernstig hinderen.
Bruikbaarheid van CGT/graduele training bij M.E./CVS
Hoewel Cognitieve Gedrag Therapie (CGT) algemeen aanbevolen wordt voor patiënten met M.E./CVS, is het helemaal niet duidelijk of het nuttig is voor de meeste patiënten. De rationale voor het gebruik van CGT bij M.E./CVS is dat onterechte overtuigingen (dat de etiologie fysisch is) en ineffektieve ‘coping’ (vermijden van aktiviteit) M.E./CVS morbiditeit in stand houden en bestendigen (Deale et al. 1997, Sharpe et al. 1996). Het werd echter nooit bewezen dat deze overtuigingen bijdragen tot de morbiditeit bij M.E./CVS. […] Van de 6 gerapporteerde studies die CGT gebruiken bij [wat zij noemen] “M.E./CVS”, zijn er twee die patiënten selekteerden met de Oxford criteria (Deale et al. 1997, Sharpe et al. 1996), één waar de Australische criteria werden gebruikt (Lloyd et al. 1993) en één die de Fukuda criteria gebruikte “met uitzondering van het criterium dat vier van de acht bijkomende symptomen vereist” (Prins et al. 2001). Deze methoden van patient-selektie laten aanzienlijke heterogeniteit en inclusie van psychiatrisch zieke patiënten met vermoeidheid toe. Daarom zijn de resultaten niet toepasbaar op de gemiddelde, door Fukuda of Canadese criteria gedefinieerde patiënten. Van de overblijvende twee studies die valabele selektie-criteria gebruikten, was er één die geen nut voor CGT vond (Friedberg & Krupp 1994). De enige studie die voordelen meldde (verbeterde funktionele capaciteit en verminderde vermoeidheid) werd uitgevoerd bij adolescenten (Stulemeijer et al. 2005).
Het is belangrijk te noteren dat geen enkele CGT-studie heeft gerapporteerd dat patiënten genoeg verbeterd waren om terug aan het werk te gaan; noch veranderingen qua fysieke M.E./CVS-symptomen zoals bv. spier-pijn, koorts, lymfadenopathie, hoofdpijn of orthostatische intolerantie. Verder suggereert klinische ervaring dat het proberen overtuigen van een M.E./CVS-patient dat zij/hij geen fysieke aandoening heeft en niet zou mogen rusten wanneer men vermoeid is, leidt tot conflicten in de arts-patient relatie en slechte uitkomsten voor de patiënten. […]
Ondanks het feit dat verergering van symptomen na inspanning een verplicht criterium voor diagnose van of M.E./CVS is, wordt graduele training dikwijls voorgeschreven voor dergelijke patiënten. Vermoedelijk worden deze aanbevelingen gemaakt in de veronderstelling dat inspanning vergezeld zal gaan van een verbeterde aërobe capaciteit, een verhoogde anaërobe drempel en verbeterde inspanningstolerantie. Bij patiënten met M.E./CVS verbeterde echter noch de inspanningstolerantie noch de fitness bij trainingsprogrammas. Dit kan gelinkt zijn met abnormale responsen op inspanning bij mensen met M.E./CVS. De hartslag bij rust van patiënten is verhoogd en de maximum zuurstof-opname is gereduceerd vergeleken met gezonde sedentaire controles (Riley et al. 1990, Farquhar et al. 2002, Fulcher & White 1997, De Becker et al. 2000). Hersen-analyses via SPECT-scan wijzen op verergering van hypo-perfusie (Goldstein 1993) en verminderde cerebrale doorbloeding (Peterson et al. 1994) na inspanning. Gedaalde cognitie (Blackwood et al. 1998a, LaManca et al. 1998), gedaalde pijn-drempels (Whiteside et al. 2004) en verminderde maximale spier-contractie (Paul et al. 1999) werden ook gemeld.
Volgens een ‘Cochrane Collaboration’ meta-analyse (Edmonds et al. 2004) zijn er vijf studies over training en M.E./CVS die methodologisch deugdelijk zijn. Drie van deze studies gebruikten echter de Oxford criteria (vereisen slechts vermoeidheid gedurende 6 maand voor een diagnose) voor patient-selektie. Eén ervan sloot patiënten met een verstoorde slaap uit (Fulcher & White 1997); wat betekent dat virtueel alle patiënten die gezien worden in de klinische praktijk zouden zijn uitgesloten. Er zijn twee studies die valabele diagnostische criteria gebruiken en beide melden minder zelf-gerapporteerde vermoeidheid (via de ‘Chalder Fatigue Scale’ [cfr. ‘Vermoeidheid bij Myalgische Encefalomyelitis’ op : http://mecvswetenschap.wordpress.com/2008/10/18/vermoeidheid-bij-myalgische-encefalomyelitis/ - voor kritiek]) (Wallman et al. 2004, Moss-Morris et al. 2005). Geen van deze melden follow-up langer dan 12 weken, noch over de fysieke kern-symptomen van M.E./CVS zoals pijn, niet-verfrissende slaap, infektueuze, autonome, neurologische of endocriene symptomen. Het is onduidelijk of deze bevindingen toepasbaar zijn op ernstig zieke patiënten aangezien geen enkele van deze patiënten in staat is deel te nemen aan studies. Het zal veel meer studie vergen bij een bredere groep patiënten, met rapportering over alle symptomen om ooit te uit te maken of graduele training de kern-symptomen van M.E./CVS beïnvloedt.
A chronic illness characterized by fatigue, neurologic and immunologic disorders and active human herpesvirus type 6 infection Buchwald D, Cheney PR, Peterson DL, Henry B, Wormsley SB, Geiger A, Ablashi DV, Salahuddin SZ, Saxinger C, Biddle R et al. - Ann Intern Med. 1992 Jan 15;116(2):103–113 Cfr. : http://www.annals.org/cgi/content/abstract/116/2/103
A community-based study of chronic fatigue syndrome Jason LA, Richman JA, Rademaker AW, Jordan KM, Plioplys AV, Taylor RR, McCready W, Huang CF, Plioplys S, Department of Psychology, DePaul University, Chicago, IL 60614, USA : firstname.lastname@example.org - Arch Intern Med. 1999 Oct 11;159(18):2129-37 - PMID: 10527290 Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/10527290
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A controlled comparison of multiple chemical sensitivities and chronic fatigue syndrome Fiedler N, Kipen HM, DeLuca J, Kelly-McNeil K, Natelson B, Department of Environmental and Community Medicine, UMDNJ-Robert Wood Johnson Medical School, Piscataway, New Jersey 08855, USA - Psychosom Med. 1996 Jan-Feb;58(1):38-49 - PMID: 8677287 Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/8677287
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A definition-based analysis of symptoms in a large cohort of patients with chronic fatigue syndrome De Becker P, McGregor N, De Meirleir K - J Intern Med 2001; 520: 234-240
A definition-based analysis of symptoms in a large cohort of patients with chronic fatigue syndrome De Becker P, McGregor N, De Meirleir K - J Intern Med 2001; 520: 234-240
A definition-based analysis of symptoms in a large cohort of patients with chronic fatigue syndrome De Becker P, McGregor N, De Meirleir K, VUB, Vakgroep Interne Geneeskunde, KRO gebouw niv.-1, Laarbeeklaan 101, 1090 Brussels, Belgium : email@example.com - J Intern Med. 2001 Sep;250(3):234-40 - PMID: 11555128 Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/11555128
A doctor's dilemma - Is a diagnosis disabling or enabling ? Finestone AJ - Arch Intern Med 1997; 157: 491-492
A matched case control study of orthostatic intolerance in children/adolescents with chronic fatigue syndrome Galland BC, Jackson PM, Sayers RM, Taylor BJ, Department of Women's & Children's Health, University of Otago, Dunedin 9015, New Zealand : firstname.lastname@example.org - Pediatr Res. 2008 Feb;63(2):196-202 - PMID: 18091356 This study aimed to define cardiovascular and heart rate variability (HRV) changes following head-up tilt (HUT) in children/adolescents with chronic fatigue syndrome (CFS) in comparison to age- and gender-matched controls. Twenty-six children/adolescents with CFS (11-19 y) and controls underwent 70-degree HUT for a maximum of 30 min, but returned to horizontal earlier at the participant's request with symptoms of orthostatic intolerance (OI) that included lightheadedness. Using electrocardiography and beat-beat finger blood pressure, a positive tilt was defined as OI with 1) neurally mediated hypotension (NMH); bradycardia (HR <75% of baseline) and hypotension [systolic pressure (SysP) drops >25 mm Hg)] or 2) postural orthostatic tachycardia syndrome (POTS); HR increase >30 bpm or HR >120 bpm (with/without hypotension). Thirteen CFS and five controls exhibited OI generating a sensitivity and specificity for HUT of 50.0% and 80.8%, respectively. POTS without hypotension occurred in seven CFS subjects but no controls. POTS with hypotension and NMH occurred in both. Predominant sympathetic components to HRV on HUT were measured in CFS tilt-positive subjects. In conclusion, CFS subjects were more susceptible to OI than controls, the cardiovascular response predominantly manifest as POTS without hypotension, a response unique to CFS suggesting further investigation is warranted with respect to the pathophysiologic mechanisms involved. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/18091356?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_Single ItemSupl.Pubmed_Discovery_RA&linkpos=3&log$=relatedarticles&logdbfrom=pubmed
A population-based incidence study of chronic fatigue Lawrie SM, Manders DN, Geddes JR, Pelosi AJ - Psychol Med 1997; 27: 343-353
A preliminary assessment of the association of SCL-90-R psychological inventory responses with changes in urinary metabolites in patients with chronic fatigue syndrome McGregor NR, Dunstan RH, Butt HL et al. - J Chronic Fatigue Syndr 1997; 3: 17-37
A preliminary investigation of chlorinated hydrocarbons and chronic fatigue syndrome Dunstan RH, Donohoe M, Taylor W et al. - Med J Aust 1995; 163: 294-297
A randomized controlled graded exercise trial for chronic fatigue syndrome - Outcomes and mechanisms of change Moss-Morris, R., Sharon, C., Tobin, R. & Baldi, J.C. (2005), University of Auckland, New Zealand - J.Health Psychol., 10, 245-259 Cfr. : http://hpq.sagepub.com/cgi/content/abstract/10/2/245
A randomized double-blind placebo-controlled trial of moclobemide in patients with chronic fatigue syndrome Hickie IB, Wilson AJ, Wright JM et al. - J Clin Psychiatry 2000; 61: 643-648
A report - Chronic fatigue syndrome - Guidelines for research Sharpe,M.C., Archard,L.C., Banatvala,J.E., Borysiewicz,L.K., Clare,A.W., David,A., Edwards,R.H., Hawton,K.E., Lambert,H.P., Lane,R.J., McDonald,E.M., Mowbray,J.F., Pearson,D.J., Peto,T.E., Preedy,V.R., Smith,A.P., Smith,D.G., Taylor,D.J., Tyrrell,D.A., Wessely,S. & White,P.D. (1991) - Journal of the Royal Society of Medicine, 84, 118-121 Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/1999813
A review of the evidence for overlap among unexplained clinical conditions Aaron LA, Buchwald D - Ann Intern Med 2001; 134: 868-881
A study of the immunology of the chronic fatigue syndrome - Correlation of immunologic parameters to health dysfunction Hassan IS, Bannister BA, Akbar A et al. - Clin Immunol Immunopathol 1998; 87: 60-67
Abnormal neuropsychological findings are not necessarily a sign of cerebral impairment - A matched comparison between chronic fatigue syndrome and multiple sclerosis Van der Werf SP, Prins JB, Jongen PJ et al. - Neuropsychiatr Neuropsychol Behav Neurol 2000; 13: 199-203
Amplified amplitudes of circadian rhythms and nighttime hypotension in patients with chronic fatigue syndrome - Improvement by inopamil but not by melatonin Leonie van de Luit, MD, Jan van der Meulen, MD, PhD, Ton J. M. Cleophas, MD, PhD, FACA & Aeilko H. Zwinderman, MathD, PhD - Angiology, Vol. 49, No. 11, 903-908 (1998) Cfr. : http://ang.sagepub.com/cgi/content/abstract/49/11/903
An assessment of cognitive function and mood in chronic fatigue syndrome Marshall PS, Watson D, Steinberg P et al. - Biol Psychiatry 1996; 39: 199-206
An evaluation of multidisciplinary intervention for chronic fatigue syndrome with long-term follow-up and a comparison with untreated controls Marlin RG, Anchel H, Gibson JC et al. - Am J Med 1998; 105: 110S-114S
An examination of the working case definition of chronic fatigue syndrome Komaroff AL, Fagioli LR, Geiger AM et al. - Am J Med 1996; 100: 56-64
An investigation of sympathetic hypersensitivity in chronic fatigue syndrome Sendrowski DP, Buker EA, Gee SS - Optom Vis Sci 1997; 74: 660-663
An open study of the efficacy and adverse effects of moclobemide in patients with the chronic fatigue syndrome White, P.D. & Cleary, K.J. (1997), Department of Psychological Medicine, St Bartholomew's and the Royal London Medical School, London - International Clinical Psychopharmacology, 12, 47-52 Cfr. : http://cat.inist.fr/?aModele=afficheN&cpsidt=2661461
Antidepressant-like activity of a Kampo (Japanese herbal) medicine, Koso-san (Xiang-Su-San) and its mode of action via the hypothalamic-pituitary-adrenal axis Ito N, Nagai T, Yabe T, Nunome S, Hanawa T, Yamada H - Phytomedicine ( 2006;) 13:: 658–67
Antimuscle and anti-CNS circulating antibodies in chronic fatigue syndrome Plioplys AV - Neurology 1997; 48: 1717-1719
Antioxidant status and lipoprotein peroxidation in chronic fatigue syndrome Manuel y Keenoy B, Moorkens G, Vertommen J, De Leeuw I - Life Sci ( 2001;) 68:: 2037–49
Anxiety and depression among the epileptics in general population in Benin (Western Africa) Nubukpo P, Houinato D, Preux PM, Avodé G, Clément JP, Doctorat de Santé Publique, Institut d'Epidémiologie Neurologique et de Neurologie Tropicale, Equipe EA 3174, Faculté de Médecine, 2, rue du Dr Marcland, 87025 Limoges - Encephale. 2004 May-Jun;30(3):214-19 Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/15235518
Assessing somatization disorder in the chronic fatigue syndrome Johnson SK, DeLuca J, Natelson BH - Psychosom Med 1996; 58: 50-57
Assessment of anxiety and depression in primary care Ellen SR, Norman TR, Burrows GD - Med J Aust 1997; 167: 328-333
Assessment of regional cerebral perfusion by 99Tcm-HMPAO SPECT in chronic fatigue syndrome Ichise M, Salit IE, Abbey SE, Chung DG, Gray B, Kirsh JC, Freedman M, Department of Radiology (Division of Nuclear Medicine), University of Toronto, Canada - Nucl Med Commun. 1992 Oct;13(10):767-72 - PMID: 1491843 Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/1491843
Association between chronic fatigue syndrome and the corticosteroid-binding globulin gene ALA SER224 polymorphism Torpy DF, Bachmann AW, Gartside M et al. - Endocr Res. 2004;30 :417 –429 Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/15554358
Association of chronic fatigue syndrome with human leucocyte antigen class II alleles J Smith, E L Fritz, J R Kerr, A J Cleare, S Wessely and D L Mattey - J. Clin. Pathol., August 1, 2005; 58(8): 860 – 863 Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/16049290
Associations between perfectionism, mood and fatigue in chronic fatigue syndrome - A pilot study Blenkiron PMA, Edwards R, Lynch S - J Nerv Ment Dis 1999; 187: 566-570
Attributions in chronic fatigue syndrome and fibromyalgia syndrome in tertiary care Neerinckx E, Van Houdenhove B, Lysens R et al. - J Rheumatol 2000; 27: 1051-1055
Australia's mental health - An overview of the general population survey Henderson S, Andrews G, Hall W - Aust N Z J Psychiatry 2000; 34: 197-205
Autoantibodies to a 68/48 kDa protein in chronic fatigue syndrome and primary fibromyalgia - A possible marker for hypersomnia and cognitive disorders Nishikai M, Tomomatsu S, Hankins RW et al. - Rheumatology (Oxford) 2001; 40: 806-810
Autoantibodies to nuclear envelope antigens in chronic fatigue syndrome Konstantinov K, von Mikecz A, Buchwald D et al. - J Clin Invest 1996; 98: 1888-1896
Autonomic nervous system dysfunction in adolescents with postural orthostatic tachycardia syndrome and chronic fatigue syndrome is characterized by attenuated vagal baroreflex and potentiated sympathetic vasomotion Stewart JM - Pediatr Res 2000; 48: 218-226
Autonomic nervous system dysfunction in adolescents with postural orthostatic tachycardia syndrome and chronic fatigue syndrome is characterized by attenuated vagal baroreflex and potentiated sympathetic vasomotion Stewart JM - Pediatr Res 2000; 48: 218-226.
Autonomic testing in patients with chronic fatigue syndrome De Becker P, Dendale P, De Meirleir K et al. - Am J Med 1998; 105: 22S-26S
Barriers to healthcare utilization in fatiguing illness - A population-based study in Georgia Lin JM, Brimmer DJ, Boneva RS, Jones JF, Reeves WC, Chronic Viral Diseases Branch, National Center for Zoonotic, Vector-Borne and Enteric Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA : email@example.com - BMC Health Serv Res. 2009 Jan 20;9:13 - PMID: 19154587 Background - The purpose of this study was to determine the prevalence of barriers to healthcare utilization in persons with fatiguing illness and describe its association with socio-demographics, the number of health conditions, and frequency of healthcare utilization. Furthermore, we sought to identify what types of barriers interfered with healthcare utilization and why they occurred. Methods - In a cross-sectional population-based survey, 780 subjects, 112 of them with chronic fatigue syndrome (CFS), completed a healthcare utilization questionnaire. Text analysis was used to create the emerging themes from verbatim responses regarding barriers to healthcare utilization. Multiple logistic regression was performed to examine the association between barriers to healthcare utilization and other factors. Results - Forty percent of subjects reported at least one barrier to healthcare utilization. Of 112 subjects with CFS, 55% reported at least one barrier to healthcare utilization. Fatiguing status, reported duration of fatigue, insurance and BMI were significant risk factors for barriers to healthcare utilization. After adjusting for socio-demographics, medication use, the number of health problems and frequency of healthcare utilization, fatiguing status remained significantly associated with barriers to healthcare utilization. Subjects with CFS were nearly 4 times more likely to forego needed healthcare during the preceding year than non-fatigued subjects while those with insufficient fatigue (ISF) were nearly 3 times more likely. Three domains emerged from text analysis on barriers to healthcare utilization : 1) accessibility; 2) knowledge-attitudes-beliefs (KABs); and, 3) healthcare system. CFS and reported duration of fatigue were significantly associated with each of these domains. Persons with CFS reported high levels of healthcare utilization barriers for each domain : accessibility (34%), healthcare system (25%) and KABs (19%). In further examination of barrier domains to healthcare utilization, compared to non-fatigued persons adjusted ORs for CFS having "accessibility", "KAB" and "Healthcare System" barrier domains decreased by 40%, 30% and 19%, respectively. Conclusion - Barriers to healthcare utilization pose a significant problem in persons with fatiguing illnesses. Study results suggested two-fold implications: a symptom-targeted model focusing on symptoms associated with fatigue; and an interactive model requiring efforts from patients and providers to improve interactions between them by reducing barriers in accessibility, KABs and healthcare system. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/19154587?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_Single ItemSupl.Pubmed_Discovery_RA&linkpos=2&log$=relatedarticles&logdbfrom=pubmed
Basal activity of the hypothalamic-pituitary-adrenal axis in patients with the chronic fatigue syndrome (neurasthenia) Young AH, Sharpe M, Clements A et al. - Biol Psychiatry 1998; 43: 236-237
Bed rest - A potentially harmful treatment needing more careful evaluation Allen C, Glasziou P, Del Mar C - Lancet 1999; 354: 1229-1233
Bioaccumulated chlorinated hydrocarbons and red/white blood cell parameters Dunstan RH, Roberts TK, Donohoe M et al. - Biochem Mol Med 1996; 58: 77-84
Biochemical evidence for a novel low molecular weight 2-5A-dependent RNase L in chronic fatigue syndrome Suhadolnik RJ, Peterson DL, O'Brien K et al. - J Interferon Cytokine Res 1997; 17: 377-385
Blood volume and its relation to peak O(2) consumption and physical activity in patients with chronic fatigue Farquhar WB, Hunt BE, Taylor JA, Darling SE, Freeman R, Center for Autonomic and Peripheral Nerve Disorders, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA - Am J Physiol Heart Circ Physiol. 2002 Jan;282(1):H66-71 - PMID: 11748048 Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/11748048
Can sustained arousal explain the Chronic Fatigue Syndrome ? Wyller VB, Eriksen HR, Malterud K, Division of Paediatrics, Rikshospitalet University Hospital, Oslo, Norway : firstname.lastname@example.org - Behav Brain Funct. 2009 Feb 23;5:10 - PMID: 19236717 We present an integrative model of disease mechanisms in the Chronic Fatigue Syndrome (CFS), unifying empirical findings from different research traditions. Based upon the Cognitive activation theory of stress (CATS), we argue that new data on cardiovascular and thermoregulatory regulation indicate a state of permanent arousal responses - sustained arousal - in this condition. We suggest that sustained arousal can originate from different precipitating factors (infections, psychosocial challenges) interacting with predisposing factors (genetic traits, personality) and learned expectancies (classical and operant conditioning). Furthermore, sustained arousal may explain documented alterations by establishing vicious circles within immunology (Th2 (humoral) vs Th1 (cellular) predominance), endocrinology (attenuated HPA axis), skeletal muscle function (attenuated cortical activation, increased oxidative stress) and cognition (impaired memory and information processing). Finally, we propose a causal link between sustained arousal and the experience of fatigue. The model of sustained arousal embraces all main findings concerning CFS disease mechanisms within one theoretical framework. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/19236717?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_Single ItemSupl.Pubmed_Discovery_PMC&linkpos=2&log$=citedinpmcarticles&logdbfrom=pub med
Can the chronic fatigue syndrome be defined by distinct clinical features ? Hickie I, Lloyd A, Hadzi-Pavlovic D et al. - Psychol Med 1995; 25: 925-935
Cardiac involvement in patients with chronic fatigue syndrome as documented with holter and biopsy data in Birmingham, Michigan, 1991-1993 Lerner AM, Goldstein J, Chang C et al. - Infect Dis Clin Pract 1997; 6: 327-333
Cardiac rehabilitation and secondary prevention Hare DL, Bunker SJ - Med J Aust 1999; 171: 433-439
Case control study of chronic fatigue in pediatric patients Carter BD, Edwards JF, Kronenberger WG et al. - Pediatrics 1995; 95: 179-186
Case-control study of GP attendance rates by suicide cases with or without a psychiatric history Power K, Davies C, Swanson V et al. - Br J Gen Pract 1997; 47: 211-215
CD4 T lymphocytes from patients with chronic fatigue syndrome have decreased interferon-gamma production and increased sensitivity to dexamethasone Visser J, Blauw B, Hinloopen B et al. - J Infect Dis 1998; 177: 451-454
Changes in Australia's Mental Health Services under the First National Mental Health Plan of the National Mental Health Strategy 1993–98 - Sixth Annual Report of the Commonwealth Department of Health and Aged Care Commonwealth Department of Health and Aged Care - National Mental Health Report 2000 – Canberra : Mental Health and Special Programs Branch, Department of Health and Ageing, 2000
Changes in growth hormone, insulin, insulinlike growth factors (IGFs) and IGF-binding protein-1 in chronic fatigue syndrome Allain TJ, Bearn JA, Coskeran P et al. - Biol Psychiatry 1997; 41: 567-573
Changes in immune parameters seen in Gulf War veterans but not in civilians with chronic fatigue syndrome Zhang Q, Zhou XD, Denny T et al. - Clin Diagn Lab Immunol 1999; 6: 6-13
Changing epidemiology of Ross River virus disease in South Australia Selden SM, Cameron AS - Med J Aust 1996; 165: 313-317
Chronic ciguatera - One cause of the chronic fatigue syndrome Pearn JH - J Chronic Fatigue Syndr 1996; 2: 29-34
Chronic disease self-management program - 2-Year health status and health care utilization outcomes Lorig KR, Ritter P, Stewart AL, Sobel DS, Brown BW Jr, Bandura A, Gonzalez VM, Laurent DD, Holman HR, Stanford University School of Medicine, Stanford, California, USA - Med Care. 2001 Nov;39(11):1217-23 - PMID: 11606875 Objectives - To assess the 1- and 2-year health status, health care utilization and self-efficacy outcomes for the Chronic Disease Self-Management Program (CDSMP). The major hypothesis is that during the 2-year period CDSMP participants will experience improvements or less deterioration than expected in health status and reductions in health care utilization. Design - Longitudinal design as follow-up to a randomized trial. Setting : Community. Participants - Eight hundred thirty-one participants 40 years and older with heart disease, lung disease, stroke or arthritis participated in the CDSMP. At 1- and 2-year intervals respectively 82% and 76% of eligible participants completed data. Main autcome measures - Health status (self-rated health, disability, social/role activities limitations, energy/fatigue and health distress), health care utilization (ER/outpatient visits, times hospitalized and days in hospital) and perceived self-efficacy were measured. Main results - Compared with baseline for each of the 2 years, ER/outpatient visits and health distress were reduced (P <0.05). Self-efficacy improved (P <0.05). The rate of increase is that which is expected in 1 year. There were no other significant changes. Conclusions - A low-cost program for promoting health self-management can improve elements of health status while reducing health care costs in populations with diverse chronic diseases. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/11606875
Chronic fatigue - Symptom and syndrome Wessely S - Ann Intern Med 2001; 134 Suppl: 838-843
Chronic fatigue and chronic fatigue syndrome - Shifting boundaries and attributions [review] Lloyd AR - Am J Med 1998; 105: 7S-10S
Chronic fatigue and its syndromes Wessely S, Hotopf M, Sharpe M - New York : Oxford University Press, 1998
Chronic fatigue and the chronic fatigue syndrome - Prevalence in a Pacific Northwest health care system Buchwald D, Umali P, Umali J et al. - Ann Intern Med 1995; 123: 81-88
Chronic fatigue syndrome - A 20th century illness ? Wessely S - Scand J Work Environ Health 1997; 23: 17-34
Chronic Fatigue Syndrome - A Biological Approach Patrick Englebienne & Kenny De Meirleir – CRC, February 27, 2002 (1 edition) – ISBN-10 : 0849310466 – ISBN-13 : 978-0849310461 Chronic Fatigue Syndrome (CFS) is a complex, debilitating disorder, yet few current scientific biomedical books are available on the subject. The nonspecific symptoms, lack of diagnostic tests and uncertainty as to the cause or causes of CFS make the disease that much more baffling. 'Chronic Fatigue Syndrome - A Biological Approach' represents a monumental step in the journey to a unified understanding of CFS and establishes a scientific basis for treatment. The book provides a rare treatise on current state of the art with respect to the worldwide scientifically documented basis of CFS and acknowledges the many as yet undiscovered or undefined pathogenic mechanisms involved in the production of symptoms. The authors, reflecting their clinical and basic research backgrounds, outline future research imperatives and direct clinicians toward appropriate diagnostic and therapeutic strategies. Because of the multifactorial aspects of the disease, the book addresses various fields of the biomedical sciences, such as protein biochemistry, virology and pharmacology. Many recent, biological discoveries help us better understand the physiology of this disease and improve the specificity of its diagnosis by laboratory tests. This book summarizes these advances and discusses insights that support CFS as a distinct and specific physical disease. Overall, 'Chronic Fatigue Syndrome - A Biological Approach' provides a firm foundation understanding of CFS, opening the way for better diagnosis and design of new therapies Cfr. : http://www.amazon.com/Chronic-Fatigue-Syndrome-Biological-Approach/dp/0849310466
Chronic fatigue syndrome - A clinical and laboratory study with a well matched control group Swanink CM, Vercoulen JH, Bleijenberg G et al. - J Intern Med 1995; 237: 499-506
Chronic fatigue syndrome - A disorder of central cholinergic transmission Chaudhuri A, Majeed T, Dinan T, Behan PO - J Chronic Fatigue Syndr 1997; 3: 3-16
Chronic fatigue syndrome - A working case definition Holmes GP, Kaplan JE, Gantz NM, Komaroff AL, Schonberger LB, Straus SE, Jones JF, Dubois RE, Cunningham-Rundles C, Pahwa S et al., Division of Viral Diseases, Centers for Disease Control, Atlanta, Georgia - Ann Intern Med. 1988 Mar;108(3):387-9 - PMID: 2829679 The chronic Epstein-Barr virus syndrome is a poorly defined symptom complex characterized primarily by chronic or recurrent debilitating fatigue and various combinations of other symptoms, including sore throat, lymph node pain and tenderness, headache, myalgia and arthralgias. Although the syndrome has received recent attention and has been diagnosed in many patients, the chronic Epstein-Barr virus syndrome has not been defined consistently. Despite the name of the syndrome, both the diagnostic value of Epstein-Barr virus serologic tests and the proposed causal relationship between Epstein-Barr virus infection and patients who have been diagnosed with the chronic Epstein-Barr virus syndrome remain doubtful. We propose a new name for the chronic Epstein-Barr virus syndrome--the chronic fatigue syndrome--that more accurately describes this symptom complex as a syndrome of unknown cause characterized primarily by chronic fatigue. We also present a working definition for the chronic fatigue syndrome designed to improve the comparability and reproducibility of clinical research and epidemiologic studies and to provide a rational basis for evaluating patients who have chronic fatigue of undetermined cause. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/2829679
Chronic fatigue syndrome - Aetiology, diagnosis and treatment Avellaneda Fernández A, Pérez Martín A, Izquierdo Martínez M, Arruti Bustillo M, Barbado Hernández FJ, de la Cruz Labrado J, Díaz-Delgado Peñas R, Gutiérrez Rivas E, Palacín Delgado C, Rivera Redondo J, Ramón Giménez JR, Carlos III Health Institute, Sinesio Delgado, n degrees 6, 28029, Madrid, Spanish Society of Primary Care Physicians, Narváez, 15 1 degrees Izda, 28009, Madrid, Spain : email@example.com - BMC Psychiatry. 2009 Oct 23;9 Suppl 1:S1 - PMID: 19857242 Chronic fatigue syndrome is characterised by intense fatigue, with duration of over six months and associated to other related symptoms. The latter include asthenia and easily induced tiredness that is not recovered after a night's sleep. The fatigue becomes so severe that it forces a 50% reduction in daily activities. Given its unknown aetiology, different hypotheses have been considered to explain the origin of the condition (from immunological disorders to the presence of post-traumatic oxidative stress), although there are no conclusive diagnostic tests. Diagnosis is established through the exclusion of other diseases causing fatigue. This syndrome is rare in childhood and adolescence, although the fatigue symptom per se is quite common in paediatric patients. Currently, no curative treatment exists for patients with chronic fatigue syndrome. The therapeutic approach to this syndrome requires a combination of different therapeutic modalities. The specific characteristics of the symptomatology of patients with chronic fatigue require a rapid adaptation of the educational, healthcare and social systems to prevent the problems derived from current systems. Such patients require multidisciplinary management due to the multiple and different issues affecting them. This document was realized by one of the Interdisciplinary Work Groups from the Institute for Rare Diseases and its aim is to point out the main social and care needs for people affected with Chronic Fatigue Syndrome. For this, it includes not only the view of representatives for different scientific societies, but also the patient associations view, because they know the true history of their social and sanitary needs. In an interdisciplinary approach, this work also reviews the principal scientific, medical, socio-sanitary and psychological aspects of Chronic Fatigue Syndrome. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/19857242?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_Single ItemSupl.Pubmed_Discovery_PMC&linkpos=1&log$=citedinpmcreviews&logdbfrom=pub med
Chronic fatigue syndrome - An immunological perspective Vollmer-Conna U, Lloyd A, Hickie I et al. - Aust N Z J Psychiatry 1998; 32: 523-527
Chronic fatigue syndrome - An update Komaroff AL, Buchwald DS - Ann Rev Med 1998; 49: 1-13
Chronic fatigue syndrome - Chronic ciguatera poisoning as a differential diagnosis Pearn JH - Med J Aust 1997; 166: 309-310
Chronic fatigue syndrome - Clinical practice guidelines – Psychological factors - Chronic fatigue syndrome - Clinical practice guidelines – Psychological factors (letters) Ian B Hickie - Med J Aust 2002; 177 (9): 526 To the editor - The process of destigmatising chronic fatigue syndrome (CFS) is not advanced by either limiting enquiry to "acceptable" sciences or increasing the stigma already experienced by people with other neuropsychiatric disorders. Contrary to its intent and in contrast to the recently published Royal Australasian College of Physicians (RACP) guidelines (cfr. 'Chronic fatigue syndrome - Clinical practice guidelines – 2002' - Med J Aust 2002; 176 Suppl May 6: S17-S56 at : http://www.mja.com.au/public/guides/cfs/cfs2.html -) the recent statement by the immediate past president of the RACP and the Chairman of the ME/Chronic Fatigue Syndrome Association of Australia (cfr. 'Chronic fatigue syndrome clinical practice guidelines [letter]' - Larkins RG, Molesworth SR - Med J Aust 2002; 177: 51-52 at : http://www.mja.com.au/public/issues/177_01_010702/larkins_010702.html -) is in danger of increasing the stigma for both people with CFS and people with other common mental disorders. Unfortunately, key propositions in their letter ("There is no evidence that the illness is primarily psychological in origin") are clearly at variance with the tone of the guidelines (see Box 1.5, p.S31; Box 1.7, p.S32; and, "Management" summary, p.S38). Their letter reinforces the classical "dualistic" and rather simplistic "biological" approach (eg, "There is significant evidence of a range of biological abnormalities occurring in people with CFS"). Unwittingly, it colludes with community-based beliefs that mental health problems are "not health" (cfr. 'Monitoring awareness of and attitudes to depression in Australia' - Highet NJ, Hickie IB, Davenport TA - Med J Aust 2002; 176 Suppl May 20: S63-S68 at : http://www.mja.com.au/public/issues/176_10_200502/hig10079_fm.html -) and often imaginary or under the voluntary control of the patient (cfr. 'Exploring the perspectives of people whose lives have been affected by depression' - McNair BG, Highet NJ, Hickie IB, Davenport TA - Med J Aust 2002; 176 Suppl May 20: S69-S76 at : http://www.mja.com.au/public/issues/176_10_200502/mcn10080_fm.html -). There is no doubt that people with CFS share many experiences with people with other neuropsychiatric disorders. They both have daily experiences where their credibility is challenged, their disability is minimised and their needs for appropriate medical management are not met. Australian research and best practice have been recognised internationally for emphasising the integration of psychological, psychiatric and biological factors and respect for the experiences of persons with these debilitating disorders (cfr. 'Illness or disease ? The case of chronic fatigue syndrome' - Lloyd AR, Hickie IB, Loblay RH - Med J Aust 2000; 172: 471-472 at : http://www.mja.com.au/public/issues/172_10_150500/lloyd/lloyd.html -). Unfortunately, the major advances captured in the guidelines may now be undermined if the RACP is perceived to be backing away from supporting appropriate psychological assessment and provision of effective "psychological" treatments (such as cognitive–behavioural therapy and physical rehabilitation approaches). Similar equivocation has left clinical guideline processes in the United Kingdom in disarray (cfr. 'Chronic fatigue report delayed as row breaks out over content' - Eaton L - BMJ 2002; 324: 7 at : http://www.ncbi.nlm.nih.gov/pubmed/11777786?dopt=Abstract -). As demonstrated recently, prolonged fatigue syndromes are common in the Australian community and the vast majority of those who seek healthcare services have concurrent depression or anxiety (cfr. 'Neurasthenia revisited' - Hickie I, Davenport T, Issakidis C, Andrews G - Br J Psychiatry 2002; 181: 56-61 at : http://www.ncbi.nlm.nih.gov/pubmed/12091264?dopt=Abstract -). Real progress towards destigmatisation, meaningful research progress and improved health services for people with CFS will only occur when the field is mature enough to deal with the clear relevance of psychological factors. Instead of rejecting "psychological factors" and associated treatments, relevant professional and consumer bodies should now join with the broader community movement towards increased community awareness of common neuropsychiatric disorders, genuine understanding of their (genetic, "biological", psychosocial and personal) causes and provision of effective (pharmacological and psychological) treatments (cfr. 'Responding to the Australian experience of depression - Promotion of the direct voice of consumers is critical for reducing stigma' - Hickie IB - Med J Aust 2002; 176 Suppl May 20: S61-S62 at : http://www.ncbi.nlm.nih.gov/pubmed/12064999?dopt=Abstract.8 Cfr. : http://www.mja.com.au/public/issues/177_09_041102/hickie_041102.html - Chronic fatigue syndrome - Clinical practice guidelines – Psychological factors (letters) James D Hundertmark - Med J Aust 2002; 177 (9): 525-527 Cfr. : http://www.mja.com.au/public/issues/177_09_041102/hundertmark_041102.html - Chronic fatigue syndrome - Clinical practice guidelines – Psychological factors Donald D Beard - Med J Aust 2002; 177 (9): 526 Cfr. : http://www.mja.com.au/public/issues/177_09_041102/beard_041102.html - Chronic fatigue syndrome - Clinical practice guidelines – Psychological factors (in reply) Richard G Larkins & Simon R Molesworth - Med J Aust 2002; 177 (9): 526-527 Cfr. : http://www.mja.com.au/public/issues/177_09_041102/larkins_041102.html -&- http://www.mja.com.au/public/issues/177_01_010702/larkins_010702.html
Chronic fatigue syndrome - Current perspectives on evaluation and management Hickie IB, Lloyd AR, Wakefield D - Med J Aust 1995; 163: 314-318
Chronic fatigue syndrome - Is total body potassium important ? Burnet RB, Yeap BB, Chatterton BE, Gaffney RD - Med J Aust 1996; 164: 384
Chronic fatigue syndrome - Oxidative stress and dietary modifications Logan AC, Wong C - Altern Med Rev ( 2001;) 6:: 450–9
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Chronic fatigue syndrome – The need for subtypes Jason LA, Corradi K, Torres-Harding S, Taylor RR, King C - DePaul University, Chicago, Illinois 60614, USA : firstname.lastname@example.org - Neuropsychol Rev. 2005 Mar;15(1):29-58 - PMID: 15929497 Chronic fatigue syndrome (CFS) is an important condition confronting patients, clinicians and researchers. This article provides information concerning the need for appropriate diagnosis of CFS subtypes. We first review findings suggesting that CFS is best conceptualized as a separate diagnostic entity rather than as part of a unitary model of functional somatic distress. Next, research involving the case definitions of CFS is reviewed. Findings suggest that whether a broad or more conservative case definition is employed and whether clinic or community samples are recruited, these decisions will have a major influence in the types of patients selected. Review of further findings suggests that subtyping individuals with CFS on sociodemographic, functional disability, viral, immune, neuroendocrine, neurology, autonomic and genetic biomarkers can provide clarification for researchers and clinicians who encounter CFS' characteristically confusing heterogeneous symptom profiles. Treatment studies that incorporate subtypes might be particularly helpful in better understanding the pathophysiology of CFS. This review suggests that there is a need for greater diagnostic clarity and this might be accomplished by subgroups that integrate multiple variables including those in cognitive, emotional, and biological domains. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/15929497
Chronic fatigue syndrome and other fatiguing illnesses in adolescents - A population-based study Jones JF, Nisenbaum R, Solomon L, Reyes M, Reeves WC, National Jewish Medical and Research Center, Denver, Colorado, USA - J Adolesc Health. 2004 Jul;35(1):34-40 - PMID: 15193572 Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/15193572
Chronic fatigue syndrome as a delayed reaction to chronic low-dose organophosphate exposure Behan PO - J Nutr Med 1996; 6: 341-350
Chronic fatigue syndrome comes of age Levine PH - Am J Med 1998; 105(3A): 2S-6S
Chronic fatigue syndrome progression and self-defined recovery - Evidence from the CDC surveillance system Reyes M, Dobbins JG, Nisenbaum R et al. - J Chronic Fatigue Syndr 1999; 5: 7-17
Chronic fatigue syndrome research - Definition and medical outcome assessment (NIH conference) Schluederberg A, Straus SE, Peterson P, Blumenthal S, Komaroff AL, Spring SB, Landay A, Buchwald D, National Institute of Allergy and Infectious Diseases, Bethesda, MD - Ann Intern Med. 1992 Aug 15;117(4):325-31 - PMID: 1322076 Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/1322076
Chronic fatigue syndrome, fibromyalgia and multiple chemical sensitivities in a community-based sample of persons with chronic fatigue syndrome-like symptoms Jason LA, Taylor RR, Kennedy CL - Psychosom Med 2000; 62: 655-663
Chronic fatigue syndrome - Circadian rhythm and hypothalamic-pituitary-adrenal axis impairment Racciatti D, Guagnano MT, Vecchiet J, De Remigis PL, Pizzigallo E, Della Vecchia R et al. - Int J Immunopathol Pharmacol ( 2001;) 14:: 11–5
Chronic fatigue syndrome - Identification of distinct subgroups on the basis of allergy and psychologic variables Borish L, Schmaling K, DiClementi JD et al. - J Allergy Clin Immunol 1998; 102: 222-230
Chronic fatigue syndromes in clinical practice Manu P, Lane TJ, Matthews DA, Department of Medicine, School of Medicine, University of Connecticut Health Center, Farmington - Psychother Psychosom. 1992;58(2):60-8 Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/1484921
Chronic fatigue, chronic fatigue syndrome and fibromyalgia - Disability and health-care use Bombardier CH, Buchwald D - Med Care 1996; 34: 924-930
Chronic fatigue, fibromyalgia and chemical sensitivity - Overlapping disorders Ziem G, Donnay A - Arch Intern Med 1995; 155: 1913
Chronic multisymptom illness affecting Air Force veterans of the Gulf War Keiji Fukuda, MD, MPH; Rosane Nisenbaum, PhD; Geraldine Stewart, MA; William W. Thompson, PhD; Laura Robin, DO, MPH; Rita M. Washko, MD; Donald L. Noah, DVM, MPH; Drue H. Barrett, PhD, MS; Bonnie Randall, MCP; Barbara L. Herwaldt, MD, MPH; Alison C. Mawle, PhD; William C. Reeves, MD, MSPH – JAMA. 1998;280:981-988 Cfr. : http://jama.ama-assn.org/cgi/content/full/280/11/981
Chronic multisymptom illness complex in Gulf War I veterans 10 years later M. S. Blanchard, S. A. Eisen, R. Alpern, J. Karlinsky, R. Toomey, D. J. Reda, F. M. Murphy, L. W. Jackson and H. K. Kang - Am. J. Epidemiol., January 1, 2006; 163(1): 66 - 75 Cfr. : http://aje.oxfordjournals.org/cgi/content/abstract/163/1/66 Read also thje replu to this article : Chronic multisymptom illness complex in Gulf War I Veterans 10 years later – Reply S. C. Hunt, M. Jakupcak, M. McFall, M. Orsborn, B. Felker, S. Larson and M. Klevens - Am. J. Epidemiol., October 1, 2006; 164(7): 708 - 709 Cfr. : http://aje.oxfordjournals.org/cgi/content/full/164/7/708-a
Clinical observation of the treatment of chronic fatigue syndrome by using Bu-Zhong-Yi-Qi decoction in combination with Xiao-Chai-Hu decoction Yang SH, Gao M, Yang XW, Chen DQ - J Beijing Univ TCM ( 2004;) 2:: 87–9
Cognitive behavior therapy for chronic fatigue syndrome - A randomized controlled trial Deale A, Chalder T, Marks I, Wessely S, Academic Department of Psychological Medicine, King's College Hospital, London, United Kingdom - Am J Psychiatry. 1997 Mar;154(3):408-14 - PMID: 9054791 Objective - Cognitive behavior therapy for chronic fatigue syndrome was compared with relaxation in a randomized controlled trial. Methods - Sixty patients with chronic fatigue syndrome were randomly assigned to 13 sessions of either cognitive behavior therapy (graded activity and cognitive restructuring) or relaxation. Outcome was evaluated by using measures of functional impairment, fatigue, mood and global improvement. Results - Treatment was completed by 53 patients. Functional impairment and fatigue improved more in the group that received cognitive behavior therapy. At final follow-up, 70% of the completers in the cognitive behavior therapy group achieved good outcomes (substantial improvement in physical functioning) compared with 19% of those in the relaxation group who completed treatment. Conclusions - Cognitive behavior therapy was more effective than a relaxation control in the management of patients with chronic fatigue syndrome. Improvements were sustained over 6 months of follow-up. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/9054791 Also read the comment on this article : Cognitive behavior therapy for chronic fatigue syndrome Sharpe M - Am J Psychiatry. 1998 Oct;155(10):1461-2 - PMID: 9766788 Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/9766788?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_Disco veryPanel.Pubmed_RVAbstractPlus
Cognitive behavior therapy for chronic fatigue syndrome - Efficacy and implications Sharpe M - Am J Med 1998; 105: 104S-109S
Cognitive behaviour therapy for adolescents with chronic fatigue syndrome - Randomised controlled trial Stulemeijer M, de Jong LW, Fiselier TJ, Hoogveld SW, Bleijenberg G, Expert Centre Chronic Fatigue, University Medical Centre Nijmegen, PO Box 9101, 6500 HB, Netherlands - BMJ. 2005 Jan 1;330(7481):14. Epub 2004 Dec 7 - PMID: 15585538 (Erratum in : BMJ. 2005 Apr 9;330(7495):820) Objective - To evaluate the efficacy of cognitive behaviour therapy for adolescents aged 10-17 years with chronic fatigue syndrome. Design - Randomised controlled trial. Setting - Department of child psychology. Participants - 71 consecutively referred patients with chronic fatigue syndrome; 36 were randomly assigned to immediate cognitive behaviour therapy and 35 to the waiting list for therapy. Intervention - 10 sessions of therapy over five months. Treatment protocols depended on the type of activity pattern (relatively active or passive). All participants were assessed again after five months. Main outcome measures - Fatigue severity (checklist individual strength), functional impairment (SF-36 physical functioning) and school attendance. Results - 62 patients had complete data at five months (29 in the immediate therapy group and 33 on the waiting list). Patients in the therapy group reported significantly greater decrease in fatigue severity (difference in decrease on checklist individual strength was 14.5, 95% confidence interval 7.4 to 21.6) and functional impairment (difference in increase on SF-36 physical functioning was 17.3, 6.2 to 28.4) and their attendance at school increased significantly (difference in increase in percentage school attendance was 18.2, 0.8 to 35.5). They also reported a significant reduction in several accompanying symptoms. Self reported improvement was largest in the therapy group. Conclusion - Cognitive behaviour therapy is an effective treatment for chronic fatigue syndrome in adolescents. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/15585538 Also read the comment ons this article : Cognitive behaviour therapy for adolescents with chronic fatigue syndrome - Data are insufficient and conclusion inappropriate Chaudhuri A - BMJ. 2005 Apr 2;330(7494):789-90; author reply 790 - PMID: 15802727 Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/15802727?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_Disco veryPanel.Pubmed_RVAbstractPlus
Cognitive behaviour therapy for chronic fatigue syndrome in adults Price JR, Mitchell E, Tidy E, Hunot V, Department of Psychiatry, University of Oxford, Warneford Hospital, Headington, Oxford, UK, OX3 7JX : email@example.com - Cochrane Database Syst Rev. 2008 Jul 16;(3):CD001027 - PMID: 18646067 This article is an update of 'Cognitive behaviour therapy for adults with chronic fatigue syndrome' (Price JR, Couper J, Department of Psychiatry, University of Oxford, The Warneford Hospital, Oxford, UK, OX3 7JX : firstname.lastname@example.org - Cochrane Database Syst Rev. 2000;(2):CD001027) at : http://www.ncbi.nlm.nih.gov/pubmed/10796733?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract Background - Chronic fatigue syndrome (CFS) is a common, debilitating and serious health problem. Cognitive behaviour therapy (CBT) may help to alleviate the symptoms of CFS. Objectives - To examine the effectiveness and acceptability of CBT for CFS, alone and in combination with other interventions, compared with usual care and other interventions. Search strategy - CCDANCTR-Studies and CCDANCTR-References were searched on 28/3/2008. We conducted supplementary searches of other bibliographic databases. We searched reference lists of retrieved articles and contacted trial authors and experts in the field for information on ongoing/completed trials. Selection criteria - Randomised controlled trials involving adults with a primary diagnosis of CFS, assigned to a CBT condition compared with usual care or another intervention, alone or in combination. Data collection and analysis - Data on patients, interventions and outcomes were extracted by two review authors independently and risk of bias was assessed for each study. The primary outcome was reduction in fatigue severity, based on a continuous measure of symptom reduction, using the standardised mean difference (SMD) or a dichotomous measure of clinical response, using odds ratios (OR), with 95% confidence intervals (CI). Main results - Fifteen studies (1043 CFS participants) were included in the review. When comparing CBT with usual care (six studies, 373 participants), the difference in fatigue mean scores at post-treatment was highly significant in favour of CBT (SMD -0.39, 95% CI -0.60 to -0.19), with 40% of CBT participants (four studies, 371 participants) showing clinical response in contrast with 26% in usual care (OR 0.47, 95% CI 0.29 to 0.76). Findings at follow-up were inconsistent. For CBT versus other psychological therapies, comprising relaxation, counselling and education/support (four studies, 313 participants), the difference in fatigue mean scores at post-treatment favoured CBT (SMD -0.43, 95% CI -0.65 to -0.20). Findings at follow-up were heterogeneous and inconsistent. Only two studies compared CBT against other interventions and one study compared CBT in combination with other interventions against usual care. Authors' conclusions - CBT is effective in reducing the symptoms of fatigue at post-treatment compared with usual care and may be more effective in reducing fatigue symptoms compared with other psychological therapies. The evidence base at follow-up is limited to a small group of studies with inconsistent findings. There is a lack of evidence on the comparative effectiveness of CBT alone or in combination with other treatments and further studies are required to inform the development of effective treatment programmes for people with CFS. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/18646067?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_Single ItemSupl.Pubmed_Discovery_RA&linkpos=4&log$=relatedreviews&logdbfrom=pubmed Also read the comment on this article : CBT reduces fatigue in adults with chronic fatigue syndrome but effects at follow-up unclear (review) Santhouse AM, South London and Maudsley NHS Foundation Trust, London, UK - Evid Based Ment Health. 2009 Feb;12(1):16 - PMID: 19176775 Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/19176775?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract
Cognitive behaviour therapy for the chronic fatigue syndrome - A randomised controlled trial Sharpe M, Hawton K, Simkin S et al. - BMJ 1996; 312: 22-26
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Cognitive behavioural therapy in chronic fatigue syndrome - A randomised controlled trial of an outpatient group programme O'Dowd H, Gladwell P, Rogers CA, Hollinghurst S, Gregory A, Pain Management Centre, Frenchay Hospital, Bristol, UK - Health Technol Assess. 2006 Oct;10(37):iii-iv, ix-x, 1-121 - PMID: 17014748 Objectives - To test the hypothesis that group cognitive behavioural therapy (CBT) will produce an effective and cost-effective management strategy for patients in primary care with chronic fatigue syndrome/myalgic encephalopathy (CFS/ME). Design - A double-blind, randomised controlled trial was adopted with three arms. Outcomes were assessed at baseline and 6 and 12 months after first assessment and results were analysed on an intention-to-treat basis. Setting - A health psychology department for the management of chronic illness in a general hospital in Bristol, UK. Participants - Adults with a diagnosis of CFS/ME referred by their GP. Interventions - The three interventions were group CBT incorporating graded activity scheduling, education and support group (EAS) and standard medical care (SMC). Outcome measures - The primary outcome measure was the Short Form with 36 Items (SF-36) physical and mental health summary scales. Other outcome measures included the Chalder fatigue scale, Hospital Anxiety and Depression Scale, General Health Questionnaire, physical function (shuttles walked, walking speed and perceived fatigue), health utilities index and cognitive function (mood, recall and reaction times). Results - A total of 153 patients were recruited to the trial and 52 were randomised to receive CBT, 50 to EAS and 51 to SMC. Twelve patients failed to attend for the 12-month follow-up and 19 patients attended one follow-up, but not both. The sample was found to be representative of the patient group and the characteristics of the three groups were similar at baseline. Three outcome measures, SF-36 mental health score, Chalder fatigue scale and walking speed, showed statistically significant differences between the groups. Patients in the CBT group had significantly higher mental health scores [difference +4.35, 95% confidence interval (CI) +0.72 to +7.97, p = 0.019], less fatigue (difference -2.61, 95% CI -4.92 to -0.30, p = 0.027) and were able to walk faster (difference +2.83 shuttles, 95% CI +1.12 to +5.53, p = 0.0013) than patients in the SMC group. CBT patients also walked faster and were less fatigued than those randomised to EAS (walking speed : difference +1.77, 95% CI +0.025 to +3.51, p = 0.047; fatigue : difference -3.16, 95% CI -5.59 to -0.74, p = 0.011). Overall, no other statistically significant difference across the groups was found, although for many measures a trend towards an improved outcome with CBT was seen. Except for walking speed, which, on average, increased by +0.87 shuttles (95% CI +0.09 to +1.65, p = 0.029) between the 6- and 12-month follow-ups, the scores were similar at 6 and 12 months. At baseline, 30% of patients had an SF-36 physical score within the normal range and 52% had an SF-36 mental health score in the normal range. At 12 months, the physical score was in the normal range for 46% of the CBT group, 26% of the EAS group and 44% of SMC patients. For mental health score the percentages were CBT 74%, EAS 67% and SMC 70%. Of the CBT group, 32% showed at least a 15% increase in physical function and 64% achieved a similar improvement in their mental health. For the EAS and SMC groups, this improvement in physical and mental health was achieved for 40 and 60% (EAS) and 49 and 53% (SMC), respectively. The cost-effectiveness of the intervention proved very difficult to assess and did not yield reliable conclusions. Conclusions - Group CBT did not achieve the expected change in the primary outcome measure as a significant number did not achieve scores within the normal range post-intervention. The treatment did not return a significant number of subjects to within the normal range on this domain; however, significant improvements were evident in some areas. Group CBT was effective in treating symptoms of fatigue, mood and physical fitness in CFS/ME. It was found to be as effective as trials using individual therapy in these domains. However, it did not bring about improvement in cognitive function or quality of life. There was also evidence of improvement in the EAS group, which indicates that there is limited value in the non-specific effects of therapy. Further research is needed to develop better outcome measures, assessments of the broader costs of the illness and a clearer picture of the characteristics best fitted to this type of intervention. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/17014748?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_Single ItemSupl.Pubmed_Discovery_RA&linkpos=3&log$=relatedarticles&logdbfrom=pubmed
Cognitive deficits in patients suffering from chronic fatigue syndrome, acute infective illness or depression Vollmer-Conna U, Wakefield D, Lloyd A et al. - Br J Psychiatry 1997; 171: 377-381
Cognitive deficits in patients with chronic fatigue syndrome Marcel B, Komaroff AL, Fagioli LR et al. - Biol Psychiatry 1996; 40: 535-541
Comorbidity of common mental disorders and alcohol or other substance misuse in Australian general practice Hickie IB, Koschera A, Davenport TA et al. - Med J Aust 2001; 175 Suppl Jul 16: S31-S36
Comorbidity of fibromyalgia and psychiatric disorders Arnold LM, Hudson JI, Keck PE, Auchenbach MB, Javaras KN, Hess EV, Women's Health Research Program, Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, Ohio 45219, USA : Lesley.Arnold@uc.edu - J Clin Psychiatry. 2006 Aug;67(8):1219-25 Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/16965199
Comorbidity of fibromyalgia and psychiatric disorders Buskila D, Cohen H, Department of Medicine H, Soroka Medical Center, POB 151, Beer Sheva 84101, Israel : email@example.com - Curr Pain Headache Rep. 2007 Oct;11(5):333-8 - PMID: 17894922 There are mounting data supporting comorbidity of fibromyalgia syndrome (FMS) and psychiatric conditions. These include depression, panic disorders, anxiety and post-traumatic stress disorder (PTSD). The nature of the relationship between depression and FMS is not fully understood and it was hypothesized that chronic pain causes depression or vice versa and that chronic pain syndromes are variants of depression. A link between PTSD symptoms and FMS has been reported and both conditions share similar symptomatology and pathogenetic mechanisms. Assessment of comorbid psychiatric disorders in FMS patients has clinical implications because treatment in these patients should focus both on physical and emotional dimensions of dysfunction. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/17894922
Comparison of 99m Tc HMPAO SPECT scan between chronic fatigue syndrome, major depression and healthy controls - An exploratory study of clinical correlates of regional cerebral blood flow Fischler, B., D'Haenen, H., Cluydts, R., Michiels, V., Demets, K., Bossuyt, A., Kaufman, L. & De Meirleir, K. (1996) - Neuropsychobiology, 34, 175-183 Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/9121617
Comparison of heart rate variability in patients with chronic fatigue syndrome and controls Yataco A, Talo H, Rowe P et al. - Clin Autonom Res 1997; 7: 293-297
Comparison of oral nicotinamide adenine dinucleotide (NADH) versus conventional therapy for chronic fatigue syndrome Santaella ML, Font I, Disdier OM - P R Health Sci J ( 2004;) 23:: 89–93
Comparison of SPET brain perfusion and 18F-FDG brain metabolism in patients with chronic fatigue syndrome Abu-Judeh HH, Levine S, Kumar M et al. - Nucl Med Commun 1998; 19: 1056-1071
Complementary and alternative medical therapy utilization by people with chronic fatiguing illnesses in the United States Jones JF, Maloney EM, Boneva RS, Jones AB, Reeves WC - Division of Viral and Rickettsial Diseases, Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA : firstname.lastname@example.org - BMC Complement Altern Med. 2007 Apr 25;7:12 - PMID: 17459162 Background - Chronic fatiguing illnesses, including chronic fatigue syndrome (CFS), pose a diagnostic and therapeutic challenge. Previous clinical reports addressed the utilization of health care provided to patients with CFS by a variety of practitioners with other than allopathic training, but did not examine the spectrum of complementary and alternative medicine (CAM) therapies used. This study was designed to measure CAM therapy use by persons with fatiguing illnesses in the United States population. Methods - During a random-digit dialing survey to estimate the prevalence of CFS-like illness in urban and rural populations from different geographic regions of the United States, we queried the utilization of CAM including manipulation or body-based therapies, alternative medical systems, mind-body, biologically-based and energy modalities. Results - Four hundred forty fatigued and 444 non-fatigued persons from 2,728 households completed screening. Fatigued subjects included 53 persons with prolonged fatigue, 338 with chronic fatigue and 49 with CFS-like illness. Mind-body therapy (primarily personal prayer and prayer by others) was the most frequently used CAM across all groups. Among women, there was a significant trend of increasing overall CAM use across all subgroups (p-trend = 0.003). All categories of CAM use were associated with significantly poorer physical health scores and all but one (alternative medicine systems) were associated with significantly poorer mental health scores. People with CFS-like illness were significantly more likely to use body-based therapy (chiropractic and massage) than non-fatigued participants (OR = 2.52, CI = 1.32, 4.82). Use of body-based therapies increased significantly in a linear trend across subgroups of non-fatigued, prolonged fatigued, chronic fatigued and CFS-like subjects (p-trend = 0.002). People with chronic fatigue were also significantly more likely to use body-based therapy (OR = 1.52, CI = 1.07, 2.16) and mind-body (excluding prayer) therapy than non-fatigued participants (OR = 1.73, CI = 1.20 - 2.48). Conclusion - Utilization of CAM was common in fatiguing illnesses and was largely accounted for by the presence of underlying conditions and poor physical and mental health. Compared to non-fatigued persons, those with CFS-like illness or chronic fatigue were most likely to use body-based and mind-body therapies. These observations have important implications for provider education programs and development of intervention strategies for CFS. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/17459162?dopt=Abstract
Complex genetic and environmental relationships between psychological distress, fatigue and immune functioning - A twin study Hickie I, Bennett B, Lloyd A et al. - Psychol Med 1999; 29: 269-277
Conclusions about the assessment and management of common mental disorders in Australian general practice Hickie IB, Davenport TA, Naismith SL, Scott EM on behalf of the SPHERE National Secretariat - Med J Aust 2001; 175 Suppl Jul 16: S52-S55
Contrasting neuroendocrine responses in depression and chronic fatigue syndrome Cleare AJ, Bearn J, McGregor A et al. - J Affect Disord 1995; 35: 283-289
Coping and other predictors of outcome in chronic fatigue syndrome - A 1-year follow-up Ray C, Jefferies S, Weir WRC - J Psychosom Res 1997; 43: 405-415
Coping strategies in twins with chronic fatigue and chronic fatigue syndrome Afari N, Schmaling KB, Herrell R et al. - J Psychosom Res 2000; 48: 547-554
Coping with chronic fatigue syndrome – Illness responses and their relationship with fatigue, functional impairment and emotional status Ray, C., Jefferies, S. & Weir, W.R. (1995) - Psychological Medicine, 25, 937-945 Cfr. : http://cat.inist.fr/?aModele=afficheN&cpsidt=3688724
Cortical motor potential alterations in chronic fatigue syndrome Gordon R, Michalewski HJ, Nguyen T et al. - Int J Molec Med 1999; 4: 493-499
Couples' perceptions of wives' CFS symptoms, symptom change and impact on the marital relationship Goodwin SS - Issues Mental Health Nursing 2000; 21: 347-363
Critical life events, infections and symptoms during the year preceding chronic fatigue syndrome (CFS) - An examination of CFS patients and subjects with a nonspecific life crisis Theorell T, Blomkvist V, Lindh G, Evengard B - Psychosom Med 1999; 61: 304-310
Cytokine and other immunologic markers in chronic fatigue syndrome and their relation to neuropsychological factors Patarca-Montero R, Antoni M, Fletcher MA et al. - Appl Neuropsychol 2001; 8: 51-64
Death of a lifestyle – The effects of social support and healthcare support on the quality of life of persons with fibromyalgia and/or chronic fatigue syndrome Schoofs, N., Bambini, D., Ronning, P., Bielak, E. & Woehl, J. (2004) - Orthop.Nurs., 23, 364-374 Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/15682879
Decreased bone mineral density during low dose glucocorticoid administration in a randomized, placebo controlled trial McKenzie R, Reynolds JC, O'Fallon A et al. - J Rheumatol 2000; 27: 2222-2226
Defining exercise capacity, exercise performance and a sedentary lifestyle Sargent C, Scroop GC - Med Sci Sports Exerc 2002; 34: 1692-1693
Demonstration of borna disease virus RNA in peripheral blood mononuclear cells derived from Japanese patients with chronic fatigue syndrome Nakaya T, Takahashi H, Nakamura Y et al. - FEBS Lett 1996; 378: 145-149
Demonstration of delayed recovery from fatiguing exercise in chronic fatigue syndrome Paul, L., Wood, L., Behan, W.M. & Maclaren, W.M. (1999) - European Journal of Neurology, 6, 63-69 Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/10209352
Depressed Australians - Should we worry ? (letter) Hickie IB - Med J Aust 2001; 174: 425-426
Detection of borna disease virus-reactive antibodies from patients with psychiatric disorders and from horses by electrochemiluminescence immunoassay Yamaguchi K, Sawada T, Naraki T et al. - Clin Diagn Lab Immunol 1999; 6: 696-700
Detection of enterovirus-specific RNA in serum - The relationship to chronic fatigue Clements GB, McGarry F, Nairn C, Galbraith DN - J Med Virol 1995; 45: 156-161
Detection of immunologically significant factors for chronic fatigue syndrome using neural-network classifiers Hanson SJ, Gause W, Natelson B - Clin Diag Lab Immunol 2001; 8: 658-662
Detection of intracranial abnormalities in patients with chronic fatigue syndrome - Comparison of MR imaging and SPECT Schwartz RB, Garada BM, Komaroff AL, Tice HM, Gleit M, Jolesz FA, Holman BL - AJR Am J Roentgenol. 1994 Apr;162(4):935–941 Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/8141020
Detection of Mycoplasma genus and Mycoplasma fermentans by PCR in patients with chronic fatigue syndrome Vojdani A, Choppa PC, Tagle C et al. - FEMS Immunol Med Microbiol 1998; 22: 355-365
Developing case definitions for symptom-based conditions - The problem of specificity Hyams KC - Epidemiol Rev 1998; 20: 148-156
Development of a simple screening tool for common mental disorders in general practice Hickie IB, Davenport TA, Hadzi-Pavlovic D, Koschera A, Naismith SL, Scott EM, Wilhelm KA, School of Psychiatry, University of New South Wales, Sydney : email@example.com - Med J Aust. 2001 Jul 16;175 Suppl:S10-7 - PMID: 11556430 Objective - To develop and validate a self-report screening tool for common mental disorders. Design and setting - Sequential development and validation studies in three cohorts of patients in general practice and one cohort of patients in a specialist psychiatry clinic. Participants - 1585 patients in general practice examined cross-sectionally and longitudinally; 46515 patients attending 386 general practitioners nationwide; 364 patients participating in a longitudinal study of psychiatric disorders in general practice; and 522 patients attending a specialist psychiatry clinic. Main outcome measures - Performance of the 12 items from the 34-item SPHERE questionnaire against DSM-III-R and DSM-IV diagnoses of psychiatric disorder, self-reported Brief Disability Questionnaire findings, GPs' ratings of patients' needs for psychological care and degree of risk resulting from mental disorder and patients' and GPs' reports of reasons for presentation. Results - Six somatic and six psychological questions identify two levels (and three types) of mental disorder: patients reporting both characteristic psychological and somatic symptoms (Level 1, Type 1) and patients reporting either psychological symptoms (Level 2, Type 2) or somatic symptoms (Level 2, Type 3). This classification system predicts disability ratings (Level 1, 8.2 "days out of role in the last month" and Level 2, 4.1 and 5.4 "days out of role in the last month" for Types 2 and 3, respectively), rates of lifetime psychiatric diagnoses (Level 1, 63% and Level 2, 59% and 48%, respectively), both patients' and GPs' report of reasons for presentation and doctors' ratings of risk as a result of mental disorder. There are important and differing sociodemographic correlates for the three types of mental disorders. Conclusion - A classification system based on the 12 items from the 34-item SPHERE questionnaire can be used to identify common mental disorders. This system has acceptable validity and reliability and is suited specifically for general practice settings. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/11556430?dopt=Abstract Also read the comment on this article : Mental distress or disorder ? Harris MF, Penrose-Wall J, School of Community Medicine, University of New South Wales, Sydney - Med J Aust. 2001 Jul 16;175 Suppl:S6-7 - PMID: 11556439 Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/11556439?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract
Diagnose and be damned - Management of CFS in children is not contentious [letter] Wessely S - BMJ 2000; 320: 1004
Diagnosis and management of chronic fatigue syndrome Loblay RH, for the Clinical and Laboratory Practices Committee, Australasian Society of Clinical Immunology and Allergy - R Australas Coll Physicians Fellowship Affairs 1994; 13: 27-31
Diagnosis in chronic illness - Enabling or disabling - The case of chronic fatigue syndrome Woodward RV, Broom DH, Legge DG - J R Soc Med 1995; 88: 325-329
Diagnosis of chronic fatigue syndrome in children and adolescents - Special considerations Bell DS - J Chronic Fatigue Syndr 1995; 1: 9-33
Diagnosis, disease and illness Mayou R, Sharpe M - QJM 1995; 88: 827-831
Dissociation of body-temperature and melatonin secretion circadian rhythms in patients with chronic fatigue syndrome Williams G, Pirmohamed J, Minors D et al. - Clin Physiol 1996; 16: 327-337
Disturbed neuroendocrine-immune interactions in chronic fatigue syndrome Kavelaars A, Kuis W, Knook L et al. - J Clin Endocrinol Metab 2000; 85: 692-696
Diurnal variation of adrenocortical activity in chronic fatigue syndrome MacHale SM, Cavanagh JTO, Bennie J et al. - Neuropsychobiology 1998; 38: 213-217
Divided attention deficits in patients with chronic fatigue syndrome Ross S, Fantie B, Straus SF et al. - Applied Neuropsychology 2001; 8: 4-11
Does high "action-proneness" make people more vulnerable to chronic fatigue syndrome ? - A controlled psychometric study Van Houdenhove B, Onghena P, Neerinckx E, Hellin J - J Psychosom Res 1995; 39: 633-640
Does the chronic fatigue syndrome involve the autonomic nervous system ? Freeman R, Komaroff AL - Am J Med 1997; 102: 357-364
Double-blind randomized controlled trial to assess the efficacy of intravenous gammaglobulin for the management of chronic fatigue syndrome in adolescents Rowe KS - J Psychiatr Res 1997; 133-147
Dysfunction of natural killer activity in a family with chronic fatigue syndrome Levine PH, Whiteside TL, Friberg D et al. - Clin Immunol Immunopathol 1998; 88: 96-104
Educational strategies for chronically ill students - Chronic fatigue syndrome Rowe KS, Fitzgerald P - Aust Educat Developmental Psychologist 1999; 16: 5-21
Effect of a self-management program on patients with chronic disease Lorig KR, Sobel DS, Ritter PL, Laurent D, Hobbs M, Stanford University School of Medicine, Calif, USA : firstname.lastname@example.org - Eff Clin Pract. 2001 Nov-Dec;4(6):256-62 - PMID: 11769298 Context : For patients with chronic disease, there is growing interest in "self-management" programs that emphasize the patients' central role in managing their illness. A recent randomized clinical trial demonstrated the potential of self-management to improve health status and reduce health care utilization in patients with chronic diseases. Objective - To evaluate outcomes of a chronic disease self-management program in a real-world" setting. Study design - Before-after cohort study. Patients and setting - Of the 613 patients from various Kaiser Permanente hospitals and clinics recruited for the study, 489 had complete baseline and follow-up data. Intervention - The Chronic Disease Self-Management Program is a 7-week, small-group intervention attended by people with different chronic conditions. It is taught largely by peer instructors from a highly structured manual. The program is based on self-efficacy theory and emphasizes problem solving, decision making and confidence building. Main outcome measures - Health behavior, self-efficacy (confidence in ability to deal with health problems), health status and health care utilization, assessed at baseline and at 12 months by self-administered questionnaires. Results - At 1 year, participants in the program experienced statistically significant improvements in health behaviors (exercise, cognitive symptom management and communication with physicians), self-efficacy and health status (fatigue, shortness of breath, pain, role function, depression and health distress) and had fewer visits to the emergency department (ED) (0.4 visits in the 6 months prior to baseline, compared with 0.3 in the 6 months prior to follow-up; P = 0.05). There were slightly fewer outpatient visits to physicians and fewer days in hospital, but the differences were not statistically significant. Results were of about the same magnitude as those observed in a previous randomized, controlled trial. Program costs were estimated to be about $200 per participant. Conclusions - We replicated the results of our previous clinical trial of a chronic disease self-management program in a "real-world" setting. One year after exposure to the program, most patients experienced statistically significant improvements in a variety of health outcomes and had fewer ED visits. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/11769298
Effect of bojungikki-tang on lipopolysaccharide-induced cytokine production from peripheral blood mononuclear cells of chronic fatigue syndrome patients Shin HY, Shin CH, Shin TY, Lee EJ, Kim HM - Immunopharmacol Immunotoxicol ( 2003;) 25:: 491–501
Effect of Hochu-ekki-to (TJ-41), a Japanese herbal medicine, on daily activity in a Murine model of chronic fatigue syndrome Wang XQ, Takahashi T, Zhu SJ, Moriya J, Saegusa S, Yamakawa J et al. - Evid Based Complement Altern Med ( 2004;) 1:: 203–6
Effect of Kuibitang on lipopolysaccharide-induced cytokine production in peripheral blood mononuclear cells of chronic fatigue syndrome patients Shin HY, An NH, Cha YJ, Shin EJ, Shin TY, Baek SH et al. - J Ethnopharmacol ( 2004;) 90:: 253–9
Effect of natural and synthetic antioxidants in a mouse model of chronic fatigue syndrome Singh A, Naidu PS, Gupta S, Kulkarni SK - J Med Food ( 2002;) 5:: 211–20
Effectiveness of complementary and self-help treatments for depression Jorm AF, Christensen H, Griffiths KM, Rodgers B - Med J Aust 2002; 176 Suppl May 20: S97-S104
Effects of exercise on cognitive and motor function in chronic fatigue syndrome and depression Blackwood, S.K., MacHale, S.M., Power, M.J., Goodwin, G.M. & Lawrie, S.M. (1998a) - Journal of Neurology, Neurosurgery & Psychiatry, 65, 541-546 Cfr. : http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2170292/
Effects of mental health training and clinical audit on general practitioners' management of common mental disorders Naismith SL, Hickie IB, Scott EM, Davenport TA - Med J Aust 2001; 175 Suppl Jul 16: S42-S47
Effects of mild exercise on cytokines and cerebral blood flow in chronic fatigue syndrome patients Peterson, P.K., Sirr, S.A., Grammith, F.C., Schenck, C.H., Pheley, A.M., Hu, S., Chao & CC. (1994) - Clinical & Diagnostic Laboratory Immunology, 1, 222-226 Cfr. : http://www.ncbi.nlm.nih.gov/pmc/articles/PMC368231/
Effects of Panax ginseng, consumed with and without glucose, on blood glucose levels and cognitive performance during sustained ‘mentally demanding’ tasks Reay JL, Kennedy DO, Scholey AB - J Psychopharmacol ( 2006;) 20:: 771–81
Effects of unilateral repetitive transcranial magnetic stimulation of the motor cortex on chronic widespread pain in fibromyalgia Passard A, Attal N, Benadhira R, Brasseur L, Saba G, Sichere P, Perrot S, Januel D, Bouhassira D - INSERM U-792, Boulogne-Billancourt F-92100 France - Brain. 2007 Oct;130(Pt 10):2661-70. Epub 2007 Sep 14 Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/17872930
Efficacy of cognitive behavioral therapy for adolescents with chronic fatigue syndrome - Long-term follow-up of a randomized, controlled trial Hans Knoop, MSca, Maja Stulemeijer, MSca, Lieke W. A. M. de Jong, MScb, Theo J. W. Fiselier, MD, PhDc and Gijs Bleijenberg, PhDa - a Expert Centre Chronic Fatigue b Department of Medical Psychology - c Department of Pediatrics, Radboud University, Nijmegen Medical Centre, Nijmegen, Netherlands - PEDIATRICS Vol. 121 No. 3 March 2008, pp. e619-e625 Cfr. : http://pediatrics.aappublications.org/cgi/content/abstract/121/3/e619
Elevated apoptotic cell population in patients with chronic fatigue syndrome - The pivotal role of protein kinase RNA Vojdani M, Ghoneum M, Choppa PC et al. - J Intern Med 1997; 242: 465-478
Elevated MMPI scores for hypochondriasis, depression and hysteria in patients with rheumatoid arthritis reflect disease rather than psychological status Pincus, T., Callahan, L.F., Bradley, L.A., Vaughn, W.K. & Wolfe, F. (1986) - Arthritis Rheum., 29, 1456-1466 Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/3801070
Elevation of bioactive transforming growth factor-B in serum from patients with chronic fatigue syndrome Bennett AL, Chao CC, Hu S et al. - J Clin Immunol 1997; 17: 160-166
Enteroviral RNA sequences detected by polymerase chain reaction in muscle of patients with postviral fatigue syndrome Gow JW, Behan WMH, Clements GB et al. - BMJ 1991; 302: 692-696
Epidemiology of unexplained fatigue and major depression in the community - The Baltimore ECA follow-up 1981-1994 Addington AM, Gallo JJ, Ford DE, Eaton WW - Psychol Med 2001; 31: 1037-1044
Estimating rates of chronic fatigue syndrome from a community-based sample - A pilot study Jason LA, Taylor R, Wagner L et al. - Am J Community Psychol 1995; 23: 557-568
Estimating the prevalence of chronic fatigue syndrome among nurses Jason LA, Wagner L, Rosenthal S et al. - Am J Med 1998; 105: 91S-93S
Evaluating cognitive impairment in depression with the Luria-Nebraska Neuropsychological Battery - Severity correlates and comparisons with nonpsychiatric controls Miller LS, Faustman WO, Moses JA, Jr, Csernansky JG - Psychiatry Res. 1991 Jun;37(3):219–227 Cfr. : http://cat.inist.fr/?aModele=afficheN&cpsidt=5597127
Evidence for and pathophysiologic implications of hypothalamic-pituitary-adrenal axis dysregulation in fibromyalgia and chronic fatigue syndrome Demitrack MA, Crofford LJ, Lilly Research Laboratories, Lilly Corporate Center, Indianapolis, Indiana 46285, USA - Ann N Y Acad Sci. 1998 May 1;840:684-97 - PMID: 9629295 Chronic fatigue syndrome (CFS) is characterized by profound fatigue and an array of diffuse somatic symptoms. Our group has established that impaired activation of the hypothalamic-pituitary-adrenal (HPA) axis is an essential neuroendocrine feature of this condition. The relevance of this finding to the pathophysiology of CFS is supported by the observation that the onset and course of this illness is excerbated by physical and emotional stressors. It is also notable that this HPA dysregulation differs from that seen in melancholic depression, but shares features with other clinical syndromes (e.g., fibromyalgia). How the HPA axis dysfunction develops is unclear, though recent work suggests disturbances in serotonergic neurotransmission and alterations in the activity of AVP, an important co-secretagogue that, along with CRH, influences HPA axis function. In order to provide a more refined view of the nature of the HPA dusturbance in patients with CFS, we have studied the detailed, pulsatile characteristics of the HPA axis in a group of patients meeting the 1994 CDC case criteria for CFS. Results of that work are consistent with the view that patients with CFS have a reduction of HPA axis activity due, in part, to impaired central nervous system drive. These observations provide an important clue to the development of more effective treatment to this disabling condition. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/9629295?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_Single ItemSupl.Pubmed_Discovery_RA&linkpos=2&log$=relatedreviews&logdbfrom=pubmed
Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization - A randomized trial Lorig KR, Sobel DS, Stewart AL, Brown BW Jr, Bandura A, Ritter P, Gonzalez VM, Laurent DD, Holman HR, Stanford University School of Medicine, California, USA : lorig@leland.Stanford.edu - Med Care. 1999 Jan;37(1):5-14 - PMID: 10413387 Objectives - This study evaluated the effectiveness (changes in health behaviors, health status and health service utilization) of a self-management program for chronic disease designed for use with a heterogeneous group of chronic disease patients. It also explored the differential effectiveness of the intervention for subjects with specific diseases and comorbidities. Methods - The study was a six-month randomized, controlled trial at community-based sites comparing treatment subjects with wait-list control subjects. Participants were 952 patients 40 years of age or older with a physician-confirmed diagnosis of heart disease, lung disease, stroke or arthritis. Health behaviors, health status and health service utilization, as determined by mailed, self-administered questionnaires, were measured. Results - Treatment subjects, when compared with control subjects, demonstrated improvements at 6 months in weekly minutes of exercise, frequency of cognitive symptom management, communication with physicians, self-reported health, health distress, fatigue, disability and social/role activities limitations. They also had fewer hospitalizations and days in the hospital. No differences were found in pain/physical discomfort, shortness of breath or psychological well-being. Conclusions - An intervention designed specifically to meet the needs of a heterogeneous group of chronic disease patients, including those with comorbid conditions, was feasible and beneficial beyond usual care in terms of improved health behaviors and health status. It also resulted in fewer hospitalizations and days of hospitalization. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/10413387
Examining the temporal stability of prolonged fatigue - A 12 month longitudinal study Hickie I, Koschera A, Bennett B, Hadzi-Pavlovic D - Australasian Society for Psychiatric Research : Annual Scientific Meeting 1996. Program and Abstracts. Melbourne: ASPR, 1996
Exploring the perspectives of people whose lives have been affected by depression McNair BG, Highet NJ, Hickie IB, Davenport TA – Beyondblue - The national depression initiative, Melbourne, VIC, Australia - Med J Aust. 2002 May 20;176 Suppl:S69-76 - PMID: 12065001 Objectives - To describe the experiences of people whose lives have been affected by depression. Design, setting and particiapants - Thematic review of data collected from 21 community meetings (1529 people, providing 911 evaluation forms) and nine focus groups (69 individuals) held nationally and written feedback and website-based interactions with 'Beyondblue (the national depression initiative)' between April and December 2001. Main oucome measures - Barriers to social participation experienced by people whose lives have been affected by depression and their interactions with the healthcare system. Results - The key theme was the experience of stigma, which was evident in healthcare settings and in barriers to social participation, particularly regarding employment. Inadequacies of primary care and specialist treatment systems were highlighted. Particular emphasis was placed on limited access to high-quality primary care and non-pharmacological care. The stigmatising attitudes of many healthcare providers were notable. Within society, lack of access to knowledge and self-care or mutual support services was evident. Lack of support both from and for people in caring roles was also emphasised. Conclusions - People with depression are subject to many of the same attitudes, inadequate healthcare and social barriers reported by people with psychotic disorders. Consumers and carers prioritise certain notions of illness, recovery and quality of healthcare and expect healthcare providers to respond to these concerns. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/12065001?dopt=Abstract -&- http://www.mja.com.au/public/issues/176_10_200502/mcn10080_fm.html
Familial aggregation of fainting in a case-control study of neurally mediated hypotension patients who present with unexplained chronic fatigue Lucas et al. - Europace 2006;8:846-851 Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/16920765
Fibromyalgia is common and adversely affects pain and fatigue perception in North Indian patients with rheumatoid arthritis V. Dhir, A. Lawrence, A. Aggarwal and R. Misra - J Rheumatol, November 1, 2009; 36(11): 2443 – 2448 Cfr. : http://www.jrheum.org/content/36/11/2443.abstract
Follicular phase hypothalamic-pituitary-gonadal axis function in women with fibromyalgia and chronic fatigue syndrome Korszun A, Young EA, Engleberg NC et al. - J Rheumatol 2000; 27: 1526-1530
Follow up of 200 young people with CFS - Relationship of functional outcomes to symptom patterns and psychological features Rowe KS, Rowe KJ - Proceedings of the 5th International Conference of the American Association of Chronic Fatigue Syndrome, Seattle Washington Jan 24-26, 2001: A92
Form and frequency of mental disorders across centres Goldberg, DP, Lecrubier Y – In : 'Mental illness in general health care: an international study' - Ustun TB, Sartorius N (editors) – Chicester : John Wiley and Sons, 1995: 323-334
General practitioners and young suicide - A preventative role for primary care Appleby L, Amos T, Doyle U et al. - Br J Psychiatry 1996; 168: 330-333
Generalized anxiety disorder in chronic fatigue syndrome Fischler B, Cluydts R, De Gucht V et al. - Acta Psychiatr Scand 1997; 95: 405-413
Generation of classification criteria for chronic fatigue syndrome using an artificial neural network and traditional criteria set Linder R, Dinser R, Wagner M et al. - In vivo 2002; 16: 37-44 Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/11980359
M.E. (cvs) - Richtlijnen voor psychiaters - Deel VII
M.E. (cvs) – Richtlijnen voor psychiaters
Growth hormone as concomitant treatment in severe fibromyalgia associated with low IGF-1 serum levels - A pilot study Cuatrecasas G, Riudavets C, Güell MA, Nadal A, Servicio de Endocrinología y Nutrición, Centro Médico Teknon, Vilana 12, E-08022 Barcelona, Spain : email@example.com - BMC Musculoskelet Disord. 2007 Nov 30;8:119 - PMID: 18053120 – Trial registration : NCT00497562 (ClinicalTrials.gov) Background - There is evidence of functional growth hormone (GH) deficiency, expressed by means of low insulin-like growth factor 1 (IGF-1) serum levels, in a subset of fibromyalgia patients. The efficacy of GH versus placebo has been previously suggested in this population. We investigated the efficacy and safety of low dose GH as an adjunct to standard therapy in the treatment of severe, prolonged and well-treated fibromyalgia patients with low IGF-1 levels. Methods - Twenty-four patients were enrolled in a randomized, open-label, best available care-controlled study. Patients were randomly assigned to receive either 0.0125 mg/kg/d of GH subcutaneously (titrated depending on IGF-1) added to standard therapy or standard therapy alone during one year. The number of tender points, the Fibromyalgia Impact Questionnaire (FIQ) and the EuroQol 5D (EQ-5D), including a Quality of Life visual analogic scale (EQ-VAS) were assessed at different time-points. Results - At the end of the study, the GH group showed a 60% reduction in the mean number of tender points (pairs) compared to the control group (p < 0.05; 3.25 +/- 0.8 vs. 8.25 +/- 0.9). Similar improvements were observed in FIQ score (p < 0.05) and EQ-VAS scale (p < 0.001). There was a prompt response to GH administration, with most patients showing improvement within the first months in most of the outcomes. The concomitant administration of GH and standard therapy was well tolerated and no patients discontinued the study due to adverse events. Conclusion - The present findings indicate the advantage of adding a daily GH dose to the standard therapy in a subset of severe fibromyalgia patients with low IGF-1 serum levels. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/18053120?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_Single ItemSupl.Pubmed_Discovery_PMC&linkpos=3&log$=citedinpmcarticles&logdbfrom=pubmed
Guidelines for the development and implementation of clinical practice guidelines National Health and Medical Research Council - Canberra: NHMRC, Oct 1995
Gulf War syndrome, chronic fatigue syndrome and the multiple chemical sensitivity syndrome - Stirring the cauldron of confusion Meggs WJ - Arch Environ Health 1999; 54: 309-311
Gulf War veterans' health - Medical evaluation of a U.S. cohort S. A. Eisen, H. K. Kang, F. M. Murphy, M. S. Blanchard, D. J. Reda, W. G. Henderson, R. Toomey, L. W. Jackson, R. Alpern, B. J. Parks et al. - Ann Intern Med, June 7, 2005; 142(11): 881 - 890 Cfr. : http://www.annals.org/cgi/content/abstract/142/11/881
Health status in patients with chronic fatigue syndrome and in general population and disease comparison groups Komaroff AL, Fagioli LR, Doolittle TH et al. - Am J Med 1996; 101: 281-290
Helpfulness of interventions for mental disorders - Beliefs of health professionals compared with the general public Jorm AF, Korten AE, Jacomb PA et al. - Br J Psychiatry 1997; 171: 233-237
High frequency of autoantibodies to insoluble cellular antigens in patients with chronic fatigue syndrome von Mikecz A, Konstantinov K, Buchwald DS et al. - Arthritis Rheum 1997; 40: 295-305
Hormonal influences on stress-induced neutrophil mobilization in health and chronic fatigue syndrome Cannon JG, Angel JB, Abad LW et al. - J Clin Immunol 1998; 18: 291-298
Hormonal responses to exercise in chronic fatigue syndrome- Defining melancholia - Properties of a refined sign-based measure Ottenweller JE, Sisto SA, McCarty RC et al. - Neuropsychobiology 2001; 43: 34-41
How many functional somatic syndromes ? Nimnuan C, Rabe-Hesketh S, Wessely S, Hotopf M - J Psychosom Res 2001; 51: 549-557
How significant are primary sleep disorders and sleepiness in the chronic fatigue syndrome ? Le Bon O, Hoffmann G, Murphy J et al. - Sleep Res Online 2000; 3: 43-48
Human herpesvirus 6 and human herpesvirus 7 in chronic fatigue syndrome DiLuca D, Zorzenon M, Mirandola P et al. - J Clin Microbiol 1995; 33: 1660-1661
Human herpesviruses 6 and 7 in chronic fatigue syndrome - A case-control study Reeves WC, Stamey FR, Black JB et al. - Clin Infect Dis 2000; 31: 48-52
Human herpesviruses in chronic fatigue syndrome Wallace HL 2nd, Natelson B, Gause W et al. - Clin Diagn Lab Immunol 1999; 6: 216-223
Hypothalamic-pituitary-adrenal axis reactivity in chronic fatigue syndrome and health under psychological, physiological and pharmacological stimulation Gaab J, Hüster D, Peisen R, Engert V, Heitz V, Schad T, Schürmeyer TH, Ehlert U, Center for Psychobiological and Psychosomatic Research, University of Trier, Trier, Germany : firstname.lastname@example.org - Psychosom Med. 2002 Nov-Dec;64(6):951-62 - PMID: 12461200 Objectives - Subtle alterations of the hypothalamic-pituitary-adrenal (HPA) axis in chronic fatigue syndrome (CFS) have been proposed as a shared pathway linking numerous etiological and perpetuating processes with symptoms and observed physiological abnormalities. Because the HPA axis is involved in the adaptive responses to stress and CFS patients experience a worsening of symptoms after physical and psychological stress, we tested HPA axis functioning with three centrally acting stress tests. Methods - We used two procedures mimicking real-life stressors and compared them with a standardized pharmacological neuroendocrine challenge test. CFS patients were compared with healthy control subjects regarding their cardiovascular and endocrine reactivity in a psychosocial stress test and a standardized exercise test and their endocrine response in the insulin tolerance test (ITT). Results - Controlling for possible confounding variables, we found significantly lower ACTH response levels in the psychosocial stress test and the exercise test and significantly lower ACTH responses in the ITT, with no differences in plasma total cortisol responses. Also, salivary-free cortisol responses did not differ between the groups in the psychosocial stress test and the exercise test but were significantly higher for the CFS patients in the ITT. In all tests CFS patients had significantly reduced baseline ACTH levels. Conclusions - These results suggest that CFS patients are capable of mounting a sufficient cortisol response under different types of stress but that on a central level subtle dysregulations of the HPA axis exist. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/12461200?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_Single ItemSupl.Pubmed_Discovery_RA&linkpos=4&log$=relatedarticles&logdbfrom=pubmed
Hypothalamic-pituitary-gonadal axis hormones and cortisol in both menstrual phases of women with chronic fatigue syndrome and effect of depressive mood on these hormones Cevik R, Gur A, Acar S, Nas K, Sarac AJ - BMC Musculoskelet Disord ( 2004;) 5:: 47–53
Hypothalamo-pituitary-adrenal axis dysfunction in chronic fatigue syndrome and the effects of low-dose hydrocortisone therapy Cleare AJ, Miell J, Heap E et al. - J Clin Endocrinol Metab 2001; 86: 3545-3554
Identification of ambiguities in the 1994 chronic fatigue syndrome research case definition and recommendations for resolution Reeves WC, Lloyd A, Vernon SD, Klimas N, Jason LA, Bleijenberg G et al. (International Chronic Fatigue Syndrome Study Group) - BMC Health Serv Res ( 2003;) 3:: 25–34
Identification of suicide risk factors using epidemiologic studies Moscicki EK - Psychiatr Clin North Am 1997; 20: 499-518
Identification of the ambiguities in the 1994 chronic fatigue syndrome research case definition and recommendations for resolution Reeves WC, Lloyd A, Vernon SD for the International Chronic Fatigue Syndrome Study Group - BMC Health Serv Res 2003; 3: 25
IgE levels are the same in chronic fatigue syndrome (CFS) and control subjects when stratified by allergy skin test results and rhinitis types Repka-Ramirez MS, Naranch K, Park YJ et al. - Ann Allergy Asthma Immunol 2001; 87: 218-221
IgM serum antibodies to Epstein-Barr virus are uniquely present in a subset of patients with the chronic fatigue syndrome Lerner, A.M., Beqaj, S.H., Deeter, R.G. & Fitzgerald, J.T. (2004) - In Vivo, 18, 101-106 Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/15113035
Immunologic and psychologic therapy for patients with chronic fatigue syndrome - A double blind, placebo controlled trial Lloyd, A., Hickie, I., Brockman, A., Hickie, C., Wilson, A., Dryer, J. & Wakefield, D. (1993) - American Journal of Medicine, 94, 197-203 Cfr. : http://linkinghub.elsevier.com/retrieve/pii/000293439390183P
Immunologic aspects of chronic fatigue syndrome Gerrity TR, Papanicolaou DA, Amsterdam JD, Bingham S, Grossman A, Hedrick T et al. - Neuroimmunomodulation ( 2004;) 11:: 351–57
Immunologic parameters in chronic fatigue syndrome, major depression and multiple sclerosis Natelson BH, LaManca JJ, Denny TN et al. - Am J Med 1998; 105: 43S-49S
Immunological response in chronic fatigue syndrome following a graded exercise test to exhaustion LaManca JJ, Sisto SA, Zhou XD et al. - J Clin Immunol 1999; 19: 135-142
Impaired effortful cognition in depression Tancer ME, Brown TM, Evans DL, Ekstrom D, Haggerty JJ, Jr, Pedersen C, Golden RN - Psychiatry Res. 1990 Feb;31(2):161–168 Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/2326395
Improved clinical status in fibromyalgia patients treated with individualized homeopathic remedies versus placebo I. R. Bell1,2,3,4,6,8, D. A. Lewis, II9, A. J. Brooks3, G. E. Schwartz3,5,6, S. E. Lewis9, B. T. Walsh4 and C. M. Baldwin3,4,7,8 - 1Program in Integrative Medicine - 2Departments of Psychiatry – 3Psychology – 4Medicine – 5Neurology - 6Surgery, the - 7Arizona Respiratory Center and the - 8Mel and Enid Zuckerman Arizona College of Public Health at the University of Arizona, Tucson, Arizona and - 9Saybrook Graduate School and Research Institute, San Francisco, California, USA - Correspondence to : I. R. Bell, Program in Integrative Medicine, The University of Arizona Health Sciences Center, 1249 N. Mountain Avenue, Tucson, AZ 85719, USA : IBELL@U.ARIZONA.EDU - Rheumatology 2004; 43: 577-582 - Rheumatology Vol. 43 No. 5 (c) British Society for Rheumatology 2004 Cfr. : http://rheumatology.oxfordjournals.org/cgi/content/abstract/43/5/577
Improving the quality of reporting of randomized controlled trials Begg C, Cho M, Eastwood S, Horton R et al. - JAMA 1996; 276: 637-639
In vitro effects of echinacea and ginseng on natural killer and antibody-dependent cell cytotoxicity in healthy subjects and chronic fatigue syndrome or acquired immunodeficiency syndrome patients See DM, Broumand N, Sahl L, Tilles JG. - Immunopharmacology ( 1997;) 35:: 229–35
Incidence, prognosis and risk factors for fatigue and chronic fatigue syndrome in adolescents – A prospective community study K. A. Rimes, R. Goodman, M. Hotopf, S. Wessely, H. Meltzer and T. Chalder - Pediatrics, March 1, 2007; 119(3): e603 – e609 Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/17332180
Incidence, risk and prognosis of acute and chronic fatigue syndromes and psychiatric disorders after glandular fever White PD, Thomas JM, Amess J et al. - Br J Psychiatry 1998; 173: 475-481
Incidence, risk and prognosis of acute and chronic fatigue syndromes and psychiatric disorders after glandular fever White, P.D., Thomas, J.M., Amess ,J., Crawford, D.H., Grover, S.A., Kangro, H.O. & Clare, A.W. (1998) - British Journal of Psychiatry, 173, 475-481 Cfr. : http://bjp.rcpsych.org/cgi/content/abstract/173/6/475
Increase in prefrontal cortical volume following cognitive behavioural therapy in patients with chronic fatigue syndrome F. P. de Lange, A. Koers, J. S. Kalkman, G. Bleijenberg, P. Hagoort, J. W. M. van der Meer and I. Toni - Brain, August 1, 2008; 131(8): 2172 – 2180 Cfr. : http://brain.oxfordjournals.org/cgi/content/abstract/131/8/2172
Increased brain serotonin function in men with chronic fatigue syndrome Sharpe M, Hawton K, Clements A et al. - BMJ 1997; 315: 164-165
Increased prolactin response to buspirone in chronic fatigue syndrome Sharpe M, Clements A, Hawton K et al. - J Affect Disord 1996; 41: 71-76
Influence of exhaustive treadmill exercise on cognitive functioning in chronic fatigue syndrome LaManca, J.J., Sisto, S.A., DeLuca, J., Johnson, S.K., Lange, G., Pareja,J ., Cook, S. & Natelson, B.H. (1998) - American Journal of Medicine, 105, 59S-65S Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/9790484
Information processing efficiency in chronic fatigue syndrome and multiple sclerosis DeLuca J, Johnson SK, Natelson BH - Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark - Arch Neurol. 1993 Mar;50(3):301-4 Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/8442710
Information processing in chronic fatigue syndrome - A preliminary investigation of suggestibility DiClementi JD, Schmaling KB, Jones JF - J Psychosom Res 2001; 51: 679-686
Insulin-like growth factor-I (somatomedin C) levels in chronic fatigue syndrome and fibromyalgia Buchwald D, Umali J, Stene M - J Rheumatol 1996; 23: 739-742
Interferon-induced proteins are elevated in blood samples of patients with chemically or virally induced chronic fatigue syndrome Vojdani A, Lapp CW - Immunopharmacol Immunotoxicol 1999; 21: 175-202
Interleukin-1 beta, Interleukin-1 receptor antagonist and soluble Interleukin-1 receptor type II secretion in chronic fatigue syndrome Cannon JG, Angel JB, Abad LW et al. - J Clin Immunol 1997; 17: 253-261
International Mid-Term Review of the Second National Mental Health Plan for Australia. Canberra Thornicroft G, Betts V - Mental Health and Special Programs Branch, Department of Health and Ageing, 2002
Intravenous immunoglobulin is ineffective in the treatment of patients with chronic fatigue syndrome Vollmer-Conna U, Hickie I, Hadzi-Pavlovic D et al. - Am J Med 1997; 103: 38-43
Intravenous immunoglobulin is ineffective in the treatment of patients with chronic fatigue syndrome Vollmer-Conna U, Hickie I, Hadzi-Pavlovic D, Tymms K, Wakefield D, Dwyer J et al. - Am J Med ( 1997;) 103:: 38–43
Investigation by polymerase chain reaction of enteroviral infection in patients with chronic fatigue syndrome McArdle A, McArdle M, Jackson MJ et al. - Clin Sci 1996; 90: 295-300
Iron supplementation improves progressive fatigue resistance during dynamic knee extensor exercise in iron-depleted, nonanemic women Brutsaert TD, Hernandez-Cordero S, Rivera J, Viola T, Hughes G, Haas JD - Am J Clin Nutr ( 2003;) 77:: 441–8
Lack of association between HLA genotype and chronic fatigue syndrome Underhill JA, Mahalingam M, Peakman M, Wessely S - Eur J Immunogen 2001; 28: 425-428
Life-events and the course of chronic fatigue syndrome Ray C, Jefferies S, Weir WRC - Br J Med Psychol 1995; 68: 323-331
Living a healthy life with chronic conditions Lorig, K., Halsted, H., Sobel, D., Laurent, D., Gonzalez, V. & Minor, M. (2000) - Bull Publishing, Boulder CO Cfr. : http://www.bullpub.com/chronic.html
Living a healthy life with chronic conditions - Self-management of heart disease, arthritis, diabetes, asthma, bronchitis, emphysema & others Halsted, M.D. Holman, David Sobel, Diana Laurent, Virginia Gonzalez, Marian, Ph.D. Minor, Kate Lorig - Publishers Group West (2 edition), August 15, 2000 – ISBN-10 : 0923521534 – ISBN-13 : 978-0923521530 Drawing on input from people with long-term ailments, this book points the way to achieving the best possible life under the circumstances. Cfr. : http://www.amazon.com/Living-Healthy-Life-Chronic-Conditions/dp/0923521534
Long-and short-term blood pressure and RR-interval variability and psychosomatic distress in chronic fatigue syndrome Duprez DA, De Buyzere ML, Drieghe B et al. - Clin Sci 1998; 94: 57-63
Longitudinal analysis of symptoms reported by patients with chronic fatigue syndrome Nisenbaum R, Jones A, Jones J et al. - Ann Epidemiol 2000; 10: 458
Longitudinal assessment of neuropsychological functioning, psychiatric status, functional disability and employment status in chronic fatigue syndrome Tiersky LA, DeLuca J, Hill N et al. - Appl Neuropsych 2001; 8: 41-50
Low-dose hydrocortisone for treatment of chronic fatigue syndrome - A randomized controlled trial McKenzie R, O'Fallen A, Dale J et al. - JAMA 1998; 280: 1061-1066
Low-dose hydrocortisone in chronic fatigue syndrome - A randomised crossover trial Cleare AJ, Heap E, Malhi GS, Wessely S, O’Keane V, Miell J - Lancet ( 1999;) 353:: 455–8
Lower ambulatory blood pressure in chronic fatigue syndrome J. L. Newton, A. Sheth, J. Shin, J. Pairman, K. Wilton, J. A. Burt and D. E. J. Jones - Psychosom Med, April 1, 2009; 71(3): 361 – 365 Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/19297309
Memory functioning in patients with primary fibromyalgia and major depression and healthy controls Landro NI, Stiles TC, Sletvold H - J Psychosom Res 1997; 42: 297-306
Mental disorders in a population sample with musculoskeletal disorders Patten SB, Williams JV, Wang J. BMC Musculoskelet Disord. 2006 Apr 25; 7:37. Epub 2006 Apr 25 Cfr. : http://www.biomedcentral.com/1471-2474/7/37
Mental health - Statement of rights and responsibilities Mental Health Consumer Outcomes Task Force - Canberra: AGPS, 1991
Mental health literacy - An impediment to the optimum treatment of major depression in the community Goldney RD, Fisher LJ, Wilson DH - J Affect Disord 2001: 64; 277-284
Mental health literacy - Public knowledge and beliefs about mental disorders Jorm AF - Br J Psychiatry 2000; 177: 396-401
Mental health literacy - An impediment to the optimum treatment of major depression in the community Goldney RD, Fisher LJ, Wilson DH - J Affect Disord 2001; 64: 277-284
Mental health literacy" - A survey of the public's ability to recognise mental disorders and their beliefs about the effectiveness of treatment Jorm AF, Korten AE, Jacomb PA, Christensen H, Rodgers B, Pollitt P, NHMRC Social Psychiatry Research Unit, Australian National University, Canberra, ACT : Anthony.Jorm@anu.edu.au - Med J Aust. 1997 Feb 17;166(4):182-6 - PMID: 9066546 Objectives - To assess the public's recognition of mental disorders and their beliefs about the effectiveness of various treatments ("mental health literacy"). Design - A cross-sectional survey, in 1995, with structured interviews using vignettes of a person with either depression or schizophrenia. Participants - A representative national sample of 2031 individuals aged 18-74 years; 1010 participants were questioned about the depression vignette and 1021 about the schizophrenia vignette. Results - Most of the participants recognised the presence of some sort of mental disorder : 72% for the depression vignette (correctly labelled as depression by 39%) and 84% for the schizophrenia vignette (correctly labelled by 27%). When various people were rated as likely to be helpful or harmful for the person described in the vignette for depression, general practitioners (83%) and counsellors (74%) were most often rated as helpful, with psychiatrists (51%) and psychologists (49%) less so. Corresponding data for the schizophrenia vignette were : counsellors (81%), GPs (74%), psychiatrists (71%) and psychologists (62%). Many standard psychiatric treatments (antidepressants, antipsychotics, electroconvulsive therapy, admission to a psychiatric ward) were more often rated as harmful than helpful and some nonstandard treatments were rated highly (increased physical or social activity, relaxation and stress management, reading about people with similar problems). Vitamins and special diets were more often rated as helpful than were antidepressants and antipsychotics. Conclusion - If mental disorders are to be recognised early in the community and appropriate intervention sought, the level of mental health literacy needs to be raised. Further, public understanding of psychiatric treatments can be considerably improved. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/9066546?dopt=Abstract
M.E. (cvs) - Richtlijnen voor psychiaters - Deel VIII
M.E. (cvs) – Richtlijnen voor psychiaters
Multiplex PCR for the detection of Mycoplasma fermentans, M. hominis and M. penetrans in cell cultures and blood samples of patients with chronic fatigue syndrome Choppa, P.C., Vojdani, A., Tagle, C., Andrin, R. & Magtoto, L. (1998) - Molecular & Cellular Probes, 12, 301-308 Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/9778455
Muscle endurance, twitch properties, voluntary activation and perceived exertion in normal subjects and patients with chronic fatigue syndrome Lloyd AR, Gandevia SC, Hales JP - Brain 1991; 114: 85-98
Muscle fibre characteristics and lactate responses to exercise in chronic fatigue syndrome Lane RJM, Barrett MC, Woodrow D et al. - J Neurol Neurosurg Psychiatry 1998; 64: 362-367
Neurasthenia - Prevalence, disability and health care characteristics in the Australian community Hickie I, Davenport T, Issakidis C, Andrews G, School of Psychiatry, University of New South Wales, Sydney, Australia : email@example.com - Br J Psychiatry. 2002 Jul;181:56-61 - PMID: 12091264 Background - Neurasthenia imposes a high burden on primary medical health care systems in all societies. Aims - To determine the prevalence of ICD-10 neurasthenia and associated comorbidity, disability and health care utilisation. Method - Utilisation of a national sample of Australian households previously surveyed using the Composite International Diagnostic Interview and other measures. Results - Prolonged and excessive fatigue was reported by 1465 people (13.29% of the sample). Of these, one in nine people meet current ICD-10 criteria for neurasthenia. Comorbidity was associated with affective, anxiety and physical disorders. People with neurasthenia alone (<0.5% of the population) were less disabled and used less services than those with comorbid disorders. Conclusions - Fatigue is frequent in the Australian community and is common in people attending general practice. Neurasthenia is disabling and demanding of services largely because of its comorbidity with other mental and physical disorders. Until a remedy for persistent fatigue is provided, doctors should take an active psychological approach to treatment. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/12091264?dopt=Abstract Also read the comment on this article : Chronic fatigue syndrome or neurasthenia ? Bailly L - Br J Psychiatry. 2002 Oct;181:350-1 - PMID: 12356666 Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/12356666?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract
Neurobehavioral properties of chemical sensitivity syndromes Weiss B - Neurotoxicology 1998; 19: 259-268
Neurocognitive abilities for a clinically depressed sample versus a matched control group of normal individuals Grossman I, Kaufman AS, Mednitsky S, Scharff L, Dennis B - Psychiatry Res. 1994 Mar;51(3):231–244 Cfr. : http://cat.inist.fr/?aModele=afficheN&cpsidt=3977145
Neuroedocrine aspects of chronic fatigue syndrome - A commentary Demitrack MA - Am J Med 1998; 105: 11S-14S
Neuroendocrine perturbations in fibromyalgia and chronic fatigue syndrome Neeck G, Crofford LJ, Department of Rheumatology, University of Giessen, Bad Nauheim, Germany : firstname.lastname@example.org - Rheum Dis Clin North Am. 2000 Nov;26(4):989-1002 - PMID: 11084955 A large body of data from a number of different laboratories worldwide has demonstrated a general tendency for reduced adrenocortical responsiveness in CFS. It is still not clear if this is secondary to CNS abnormalities leading to decreased activity of CRH- or AVP-producing hypothalamic neurons. Primary hypofunction of the CRH neurons has been described on the basis of genetic and environmental influences. Other pathways could secondarily influence HPA axis activity, however. For example, serotonergic and noradrenergic input acts to stimulate HPA axis activity. Deficient serotonergic activity in CFS has been suggested by some of the studies as reviewed here. In addition, hypofunction of sympathetic nervous system function has been described and could contribute to abnormalities of central components of the HPA axis. One could interpret the clinical trial of glucocorticoid replacement in patients with CFS as confirmation of adrenal insufficiency if one were convinced of a positive therapeutic effect. If patient symptoms were related to impaired activation of central components of the axis, replacing glucocorticoids would merely exacerbate symptoms caused by enhanced negative feedback. Further study of specific components of the HPA axis should ultimately clarify the reproducible abnormalities associated with a clinical picture of CFS. In contrast to CFS, the results of the different hormonal axes in FMS support the assumption that the distortion of the hormonal pattern observed can be attributed to hyperactivity of CRH neurons. This hyperactivity may be driven and sustained by stress exerted by chronic pain originating in the musculoskeletal system or by an alteration of the CNS mechanism of nociception. The elevated activity of CRH neurons also seems to cause alteration of the set point of other hormonal axes. In addition to its control of the adrenal hormones, CRH stimulates somatostatin secretion at the hypothalamic level, which, in turn, causes inhibition of growth hormone and thyroid-stimulating hormone at the pituitary level. The suppression of gonadal function may also be attributed to elevated CRH because of its ability to inhibit hypothalamic luteinizing hormone-releasing hormone release; however, a remote effect on the ovary by the inhibition of follicle-stimulating hormone-stimulated estrogen production must also be considered. Serotonin (5-HT) precursors such as tryptophan (5-HTP), drugs that release 5-HT or drugs that act directly on 5-HT receptors stimulate the HPA axis, indicating a stimulatory effect of serotonergic input on HPA axis function. Hyperfunction of the HPA axis could also reflect an elevated serotonergic tonus in the CNS of FMS patients. The authors conclude that the observed pattern of hormonal deviations in patients with FMS is a CNS adjustment to chronic pain and stress, constitutes a specific entity of FMS and is primarily evoked by activated CRH neurons. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/11084955?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_Single ItemSupl.Pubmed_Discovery_RA&linkpos=3&log$=relatedreviews&logdbfrom=pubmed
Neuroendocrine responses to d-fenfluramine and insulin-induced hypoglycemia in chronic fatigue syndrome Bearn J, Allain T, Coskeran P et al. - Biol Psychiatry 1995; 37: 245-252
NIH conference - Chronic fatigue syndrome research - Definition and medical outcome assessment Schluederberg A, Straus SE, Peterson P, Blumenthal S, Komaroff AL, Spring SB, Landay A, Buchwald D - Ann Intern Med. 1992 Aug 15;117(4):325–331 Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/1322076
No evidence of active infection with human herpesvirus 6 (HHV-6) or HHV-8 in chronic fatigue syndrome Enbom M, Linde A, Evengard B - J Clin Microbiol 2000; 38: 2457
No findings of enteroviruses in Swedish patients with chronic fatigue syndrome Lindh G, Samuelson A, Hedlund K et al. - Scan J infect Dis 1996; 28: 305-307
Nutritional strategies for treating chronic fatigue syndrome Werbach MR - Altern Med Rev ( 2000;) 5:: 93–108
Odor perception - Multiple chemical sensitivities, chronic fatigue and asthma Caccappolo E, Kipen H, Kelly-McNeil K et al. - J Occup Environ Med 2000; 42: 629-638
Oriental medicine - An introduction Ehling D - Altern Ther Health Med ( 2001;) 7:: 71–82
Outcome and prognosis of patients with chronic fatigue vs chronic fatigue syndrome Bombardier CH, Buchwald D - Arch Intern Med 1995; 155: 2105-2110
Outcome measures for health education and other health care interventions Dr. Kate Lorig, Dr. Anita Stewart, Philip Ritter, Dr. Virginia M. Gonzalez, Dr. Diana Laurent, Dr. John Lynch - Sage Publications, Inc. (1 edition), January 15, 1996 – ISBN-10 : 0761900675 – ISBN-13 : 978-0761900672 'Although Outcome Measurement' has become an important tool in the evaluation of health promotion patient education and other health services interventions, problems remain in locating reliable measurements and scales. This book provides a unique compilation of more than 50 self-administered scales for measuring health behaviors, health status, self-efficacy and health-care utilization. Cfr. : http://www.amazon.com/Outcome-Measures-Health-Education-Interventions/dp/0761900675
Outcomes focussed service delivery - Developing an academic-management partnership Tobin MJ, Hickie I - Aust N Z J Psychiatry 1998; 32: 327-336
Over-the-counter sleeping pills - A survey of use in Hong Kong and a review of their constituents Yang SH, Gao M, Yang XW, Chen DQ - Gen Hosp Psychiatry ( 2002;) 24:: 430–5
Overlapping conditions among patients with chronic fatigue syndrome, fibromyalgia and temporomandibular disorder Aaron L, Burke M, Buchwald D - Arch Int Med 2000; 160: 221-227
Patterns of utilization of medical care and perceptions of the relationship between doctor and patient with chronic illness including chronic fatigue syndrome Twemlow SW, Bradshaw SL, Coyne L, Lerma BH - Psychol Rep 1997; 80: 643-658
Perceived need for mental health care - Influences of diagnosis, demography and disability Meadows G, Burgess P, Bobevski I et al. - Psychol Med 2002; 32: 299-309
Personality, mental distress and subjective health complaints among persons with environmental annoyance K Österberg, Department of Laboratory Medicine, Division of Occupational and Environmental Medicine, Lund University, Sweden; Department of Occupational and Environmental Medicine, Lund University Hospital, SE-22185 Lund, Sweden : email@example.com - R Persson, National Institute of Occupational Health, Copenhagen, Denmark - B Karlson & F Carlsson Eek, Department of Laboratory Medicine, Division of Occupational and Environmental Medicine, Lund University, Sweden - P Ørbæk, National Institute of Occupational Health, Copenhagen, Denmark Cfr. : http://het.sagepub.com/cgi/content/abstract/26/3/231
Phylogenic analysis of short enteroviral sequences from patients with chronic fatigue syndrome Galbraith DN, Nairn C, Clements GB. - J Gen Virol 1995; 76: 1701-1707
Physical performance and prediction of 2-5A synthetase/RNase L antiviral pathway activity in patients with chronic fatigue syndrome Snell, C.R., Vanness,J .M., Strayer, D.R. & Stevens, S.R. (2002) - In Vivo, 16, 107-109 Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/12073768
Physical, psychological and functional comorbidities of multisymptom illness in australian male veterans of the 1991 Gulf War H. L. Kelsall, D. P. McKenzie, M. R. Sim, K. Leder, A. B. Forbes and T. Dwyer - Am. J. Epidemiol., October 15, 2009; 170(8): 1048 – 1056 Cfr. : http://aje.oxfordjournals.org/cgi/content/abstract/170/8/1048
Population-based care of depression - Effective disease management strategies to decrease prevalence Katon W, Von Korff M, Lin E et al. - Gen Hosp Psychiatry 1997; 19: 169-178
Predictors of persistent and new-onset fatigue in adolescent girls Maike ter Wolbeek, PhDa,b, Lorenz J. P. van Doornen, PhDb, Annemieke Kavelaars, PhDa and Cobi J. Heijnen, PhDa - a Laboratory of Psychoneuroimmunology, University Medical Center Utrecht, Utrecht, Netherlands - b Department of Health Psychology, Utrecht University, Utrecht, Netherlands - PEDIATRICS Vol. 121 No. 3 March 2008, pp. e449-e457 Cfr. : http://pediatrics.aappublications.org/cgi/content/abstract/121/3/e449
Preliminary determination of a molecular basis to chronic fatigue syndrome McGregor NR, Dunstan RH, Zerbes M et al. - Biochem Mol Med 1996; 57: 73-80
Preliminary determination of the association between symptom expression and urinary metabolites in subjects with chronic fatigue syndrome McGregor NR, Dunstan RH, Zerbes M et al. - Biochem Mol Med 1996; 58: 85-92
Premorbid "overactive" lifestyle in chronic fatigue syndrome and fibromyalgia - An etiological factor of proof of good citizenship ? Van Houdenhove B, Neerinckx E, Onghena P et al. - J Psychosom Res 2001; 51: 571-576
Prevalence and incidence of chronic fatigue syndrome in Wichita, Kansas Reyes, M., Nisenbaum, R., Hoaglin, D.C., Unger, E.R., Emmons, C., Randall, B., Stewart, J.A., Abbey, S., Jones, J.F., Gantz, N., Minden, S. & Reeves, W.C. (2003) - Arch.Intern.Med., 163, 1530-1536 Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/12860574
Prevalence of chronic fatigue and chemical sensitivities in Gulf Registry Veterans Kipen HM, Hallman W, Kang H et al. - Arch Environ Health 1999; 54: 313-318
Prevalence of chronic fatigue syndrome in a community population in Japan Kawakami N, Iwata N, Fujihara S et al. - Tohoku J Exp Med 1998; 186: 33-41
Prevalence of IgM antibodies to human herpesvirus 6 (HHV-6) early antigen (P41/38) in patients with chronic fatigue syndrome Patnaik M, Komaroff AL, Conley E et al. - J Infect Dis 1995; 172: 1364-1367 (published erratum appears in J Infect Dis 1995; 172: 1643)
Prevalence of irritable bowel syndrome in chronic fatigue Gomborone JE, Gorard DA, Dewsnap PA et al. - J R Coll Physicians Lond 1996; 30: 512-513
Prevalence, comorbidity, disability and service utilisation - Overview of the Australian National Mental Health Survey Andrews G, Henderson S, Hall W - Br J Psychiatry 2001; 178: 145-153
Prognosis in chronic fatigue syndrome - A prospective study on the natural course Vercoulen JHMM, Swanink CMA, Fennis JFM et al. - J Neurol Neurosurg Psychiatry 1996; 60: 489-494
Promoting evidence-based non-drug interventions - Time for a non-pharmacopoeia ? Paul P Glasziou - Med J Aust 2009; 191 (2): 52-53 In 2004, the Journal published a randomised controlled trial of graded exercise for chronic fatigue syndrome (CFS). As with several similar trials, this trial found that graded exercise was an effective intervention. But what is graded exercise ? In response to numerous emails from both doctors and CFS patients who wanted further details of the exercise program, the authors of the study published a second article that provided the additional “how to” details and addressed different scenarios. I now keep the pdf file of this second article on my general practice computer to give to and discuss with, CFS patients. The difficulties in accessing information on this simple, non-drug intervention are in stark contrast to the helpful tools available for prescribing pharmaceuticals : formularies, prescription pads and pharmacies. Cfr. : http://www.mja.com.au/public/issues/191_02_200709/gla10407_fm.html
Psychiatric diagnosis, sexual and physical victimization and disability in patients with irritable bowel syndrome or inflammatory bowel disease Walker EA, Gelfand AN, Gelfand MD, Katon WJ - Psychol Med 1995; 25: 1259-1267
Psychiatric illness in patients with chronic fatigue and those with rheumatoid arthritis Katon WJ, Buchwald DS, Simon GE et al. - J Gen Int Med 1991; 6: 277-285 Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/1890495
Psychiatric morbidity and illness experience of primary care patients with chronic fatigue in Hong Kong Lee S, Yu H, Wing YK et al. - Am J Psychiatry 2000; 157: 380-384
Psychoneuroendocrinological contributions to the etiology of depression, posttraumatic stress disorder and stress-related bodily disorders - The role of the hypothalamus-pituitary-adrenal axis Ehlert U, Gaab J, Heinrichs M, Department of Clinical Psychology, University of Zurich, Zurichbergstrasse 43, CH-8044, Zurich, Switzerland : firstname.lastname@example.org - Biol Psychol. 2001 Jul-Aug;57(1-3):141-52 - PMID: 11454437 Following the assumption that stressors play an important part in the etiology and maintenance of psychiatric disorders, it is necessary to evaluate parameters reflecting stress-related physiological reactions. Results from these examinations may help to deepen the insight into the etiology of psychiatric disorders and to elucidate diagnostic uncertainties. One of the best-known stress-related endocrine reactions is the hormonal release of the hypothalamic-pituitary-adrenal (HPA) axis. Dysregulations of this axis are associated with several psychiatric disorders. Profound hyperactivity of the HPA-axis has been found in melancholic depression, alcoholism and eating disorders. In contrast, posttraumatic stress disorder, stress-related bodily disorders like idiopathic pain syndromes and chronic fatigue syndrome seem to be associated with diminished HPA activity (lowered activity of the adrenal gland). Hypotheses referring to (a) the psychophysiological meaning and (b) the development of these alterations are discussed. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/11454437?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_Single ItemSupl.Pubmed_Discovery_RA&linkpos=5&log$=relatedreviews&logdbfrom=pubmed
Public beliefs about the helpfulness of interventions for depression - Effects on actions taken when experiencing anxiety and depression symptoms Jorm AF, Medway J, Christensen H, Korten AE, Jacomb PA, Rodgers B, Centre for Mental Health Research, Australian National University, Canberra : Anthony.Jorm@anu.edu.au - Aust N Z J Psychiatry. 2000 Aug;34(4):619-26 - PMID: 10954393 Objective - Previous research has shown that the public have different beliefs to mental health professionals about the helpfulness of interventions for mental disorders. However, it is not known whether the public's beliefs actually influence their behaviour when they develop psychiatric symptoms. Method - A postal survey of 3,109 Australian adults was used to assess beliefs about the helpfulness of a broad range of interventions for depression, as well as respondents' current level of anxiety and depression symptoms and any history of treated depression. A follow-up survey of 422 persons who had a high level of symptoms at baseline was conducted 6 months later. These people were asked which interventions they had used to reduce their symptoms. An analysis was carried out to see whether beliefs and other factors at baseline predicted subsequent use of interventions. Results - There were some major discrepancies between the ranking of interventions as likely to be helpful and the ranking of how frequently they were actually used. Interventions involving mental health professionals were often rated as likely to be helpful, but were rarely used in practice. Other simple, cheap and readily available interventions were used the most frequently, but were not the most likely to be rated as helpful. The most consistent predictors across all interventions used were gender, history of treatment, current symptoms and belief in a particular intervention. Of particular interest was the finding that beliefs in the helpfulness of antidepressants predicted their use. However, beliefs were not predictors of use for all interventions. Conclusions - Beliefs about the helpfulness of an intervention did not always predict actual use of that intervention, although beliefs did predict use of antidepressants. Therefore, campaigns that change public beliefs about effective treatments may also influence actual use of treatments. Interventions preferred by professionals are not frequently used at present. Most people with anxiety and depression symptoms rely primarily on simple self-help interventions, the effectiveness of which has been little researched. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/10954393?dopt=Abstract
Putting the rest cure to rest – again - Rest has no place in treating chronic fatigue Sharpe M, Wessely S - BMJ 1998; 316: 796
Quality of attention in chronic fatigue syndrome - Subjective reports of everyday attention and cognitive difficulty and performance on tasks of focused attention Ray C, Phillips L, Weir WR - Br J Clin Psychol. 1993 Sep;32 (:357–364 Patients with chronic fatigue syndrome (also known as post-viral fatigue syndrome or myalgic encephalomyelitis) commonly report cognitive difficulties concerning attention, concentration and memory. In this study, patients were compared with matched controls on two questionnaires which assess subjective difficulties with attention and general cognitive functioning and on two tasks requiring focused attention. Patients reported significantly greater difficulty with attention on the Everyday Attention Questionnaire and more cognitive symptoms on the Profile of Fatigue-Related Symptoms. The objective tests did not clearly indicate a deficit in patients' focused attention; patients tended to perform less well on the Embedded Figures Test and the Stroop Colour-Word Interference Test, but these differences were not significant. There was, however, evidence of psychomotor retardation, with patients having longer response times for word reading and colour naming in the Stroop test. Difficulties in interpreting findings for both subjective and objective cognitive measures are discussed. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/8251968
Randomised controlled trial of graded exercise in chronic fatigue syndrome Wallman KE, Morton AR, Goodman C, Grove R, Guilfoyle AM, School of Human Movement and Exercise Science, University of Western Australia, Stirling Highway, Nedlands, WA 6009, Australia : email@example.com - Med J Aust. 2004 May 3;180(9):444-8 - PMID: 15115421 Objective - To investigate whether 12 weeks of graded exercise with pacing would improve specific physiological, psychological and cognitive functions in people with chronic fatigue syndrome (CFS). Design - Randomised controlled trial. Setting - Human performance laboratory at the University of Western Australia. Participants - 61 patients aged between 16 and 74 years diagnosed with CFS. Interventions - Either graded exercise with pacing (32 patients) or relaxation/flexibility therapy (29 patients) performed twice a day over 12 weeks. Main outcome measures - Changes in any of the physiological, psychological or cognitive variables assessed. Results - Following the graded exercise intervention, scores were improved for resting systolic blood pressure (P = 0.018), work capacity (W.kg(-1)) (P = 0.019), net blood lactate production (P = 0.036), depression (P = 0.027) and performance on a modified Stroop Colour Word test (P = 0.029). Rating of perceived exertion scores, associated with an exercise test, was lower after graded exercise (P = 0.013). No such changes were observed in the relaxation/flexibility condition, which served as an attention-placebo control. Conclusions - Graded exercise was associated with improvements in physical work capacity, as well as in specific psychological and cognitive variables. Improvements may be associated with the abandonment of avoidance behaviours. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/15115421 Also read the comments on this article : - To exercise or not to exercise in chronic fatigue syndrome ? - No longer a question Lloyd AR - Med J Aust. 2004 May 3;180(9):437-8 - PMID: 15115418 Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/15115418?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract - To exercise or not to exercise in chronic fatigue syndrome ? Scroop GC, Burnet RB - Med J Aust. 2004 Nov 15;181(10):578-9; author reply 579-80 - PMID: 15540976 Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/15540976?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract
Randomised controlled trial of patient education to encourage graded exercise in chronic fatigue syndrome Powell P, Bentall RP, Nye FJ, Edwards RHT - BMJ 2001; 322: 1-5 Objective - To assess the efficacy of an educational intervention explaining symptoms to encourage graded exercise in patients with chronic fatigue syndrome. Design - Randomised controlled trial. Setting - Chronic fatigue clinic and infectious diseases outpatient clinic. Subject - 148 consecutively referred patients fulfilling Oxford criteria for chronic fatigue syndrome. Interventions - Patients randomised to the control group received standardised medical care. Patients randomised to intervention received two individual treatment sessions and two telephone follow up calls, supported by a comprehensive educational pack, describing the role of disrupted physiological regulation in fatigue symptoms and encouraging home based graded exercise. The minimum intervention group had no further treatment, but the telephone intervention group received an additional seven follow up calls and the maximum intervention group an additional seven face to face sessions over four months. Main outcome measure - A score of >/=25 or an increase of >/=10 on the SF-36 physical functioning subscale (range 10 to 30) 12 months after randomisation. Results - 21 patients dropped out, mainly from the intervention groups. Intention to treat analysis showed 79 (69%) of patients in the intervention groups achieved a satisfactory outcome in physical functioning compared with two (6%) of controls, who received standardised medical care (P<0.0001). Similar improvements were observed in fatigue, sleep, disability and mood. No significant differences were found between the three intervention groups. Conclusions - Treatment incorporating evidence based physiologicalexplanations for symptoms was effective in encouraging self managed graded exercise. This resulted in substantial improvement compared with standardised medical care. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/11179154 Also read the comment on this article : Patient education to encourage graded exercise in chronic fatigue syndrome - Trial has too many shortcomings Chaudhuri A - BMJ. 2001 Jun 23;322(7301):1545-6 - PMID: 11439997 Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/11439997?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract
Randomised, double-blind, placebo-controlled study of fluoxetine in chronic fatigue syndrome Vercoulen JH, Swanink CM, Zitman FG, Vreden SG, Hoofs MP, Fennis JF et al. - Lancet ( 1996;) 347:: 858–61
Randomised, doubleblind, placebo-controlled study of fluoxetine in chronic fatigue syndrome Vercoulen, J.H., Swanink, C.M., Zitman, F.G., Vreden, S.G., Hoofs, M.P., Fennis, J.F., Galama, J.M., van der Meer, J.W. & Bleijenberg, G. (1996) – Lancet, 347, 858-861 Cfr. : http://linkinghub.elsevier.com/retrieve/pii/S0140673696913458
Randomized controlled trial of Siberian ginseng for chronic fatigue Hartz AJ, Bentler S, Noyes R, Hoehns J, Logemann C, Sinift S et al. - Psychol Med ( 2004;) 34:: 51–61
Recent developments in chronic fatigue syndrome (symposium supplement) Levine PH (editor) - Am J Med 1998; 105 (3A)
Recent trends in the use of antidepressant drugs in Australia, 1990-1998 McManus P, Mant A, Mitchell PB et al. - Med J Aust 2000; 173: 458-461
Reduced oxidative muscle metabolism in chronic fatigue syndrome McCully KK, Natelson BH, Lotti S et al. - Muscle Nerve 1996; 19: 621-625
Reducing heterogeneity in chronic fatigue syndrome - A comparison with depression and multiple sclerosis Natelson BH, Johnson SK, DeLuca J, Sisto S, Ellis SP, Hill N, Bergen MT - Clin Infect Dis. 1995 Nov;21(5):1204–1210 Cfr. : http://www.jstor.org/pss/4459037
Relationship of brain MRI abnormalities and physical functional status in chronic fatigue syndrome Cook DB, Lange G, DeLuca J et al. - Int J Neuroscience 2001; 107: 1-6
Relationship of physical symptoms to posttraumatic stress disorder among veterans seeking care for Gulf War related health concerns Engel CC Jr, Liu X, McCarthy BD et al., Deployment Health Clinical Center, Walter Reed Army Medical Center, Washington, DC, USA : firstname.lastname@example.org - Psychosom Med 2000;62:739–45 Objectives - Studies of the relationship of posttraumatic stress disorder (PTSD) to physical symptoms in war veterans consistently show a positive relationship. However, traumatic experiences causing PTSD may correlate with other war exposures and medical illnesses potentially accounting for those symptoms. Methods - We analyzed data obtained from 21,244 Gulf War veterans seeking care for war-related health concerns to assess the relationship of PTSD to physical symptoms independent of environmental exposure reports and medical illness. At assessment, veterans provided demographic information and checklists of 15 common physical symptoms and 20 wartime environmental exposures. Up to seven ICD-9 provider diagnoses were ranked in order of estimated clinical significance. The relationship of provider-diagnosed PTSD to various physical symptoms and to the total symptom count was then determined in bivariate and multivariate analyses. Results - Veterans diagnosed with PTSD endorsed an average of 6.7 (SD = 3.9) physical symptoms, those with a non-PTSD psychological condition endorsed 5.3 (3.5), those with medical illness endorsed 4.3 (3.4) and a group diagnosed as "healthy" endorsed 1.2 (2.2). For every symptom, the proportion of veterans reporting the symptom was highest in those with PTSD, second highest in those with any psychological condition, third highest in those with any medical illness and lowest in those labeled as healthy. The PTSD-symptom count relationship was independent of demographic characteristics, veteran-reported environmental exposures and comorbid medical conditions, even when symptoms overlapping with those of PTSD were excluded. Conclusions - PTSD diminishes the general health perceptions of care-seeking Gulf War veterans. Clinicians should carefully consider PTSD when evaluating Gulf War veterans with vague, multiple or medically unexplained physical symptoms. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/11138991
Report of a workshop on the epidemiology, natural history and pathogenesis of chronic fatigue syndrome in adolescents Marshall GS - J Pediatr 1999; 134: 395-405
Responses to controlled diesel vapor exposure among chemically sensitive Gulf War veterans Fiedler N, Giardino N, Natelson B, Ottenweller JE, Weisel C, Lioy P, Lehrer P, Ohman-Strickland P, Kelly-McNeil K, Kipen H, Department of Environmental and Community Medicine of UMDNJ-RWJ Medical School, Piscataway, NJ 08854, USA : email@example.com - Psychosom Med. 2004 Jul-Aug;66(4):588-98 - PMID: 15272108 Objective - A significant proportion of Gulf War veterans (GWVs) report chemical sensitivity, fatigue and unexplained symptoms resulting in ongoing disability. GWVs frequently recall an association between diesel and petrochemical fume exposure and symptoms during service. The purpose of the present study among GWVs was to evaluate the immediate health effects of acute exposure to chemicals (diesel vapors with acetaldehyde) with and without stress. Methods - In a single, controlled exposure to 5 parts per million (ppm) diesel vapors, symptoms, odor ratings, neurobehavioral performance and psychophysiologic responses of 12 ill GWVs (GWV-I) were compared with 19 age- and gender-matched healthy GWVs (GWV-H). Results - Relative to baseline and to GWV-H, GWV-I reported significantly increased symptoms such as disorientation and dizziness and displayed significantly reduced end-tidal CO(2) just after the onset of exposure. As exposure increased over time, GWV-I relative to GWV-H reported significantly increased symptoms of respiratory discomfort and general malaise. GWV-I were also physiologically hyporeactive in response to behavioral tasks administered during but not before exposure. Conclusions - Current symptoms among GWV-I may be exacerbated by ongoing environmental chemical exposures reminiscent of the Gulf War. Both psychologic and physiologic mechanisms contribute to current symptomatic responses of GWV-I. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/15272108
Reviving the diagnosis of neurasthenia Hickie I, Hadzi-Pavlovic D, Ricci C - Psychol Med 1997; 27: 989-994
Rheumatic disorders in patients with silicone implants - A critical review Bridges AJ - J Biomater Sci Polymer Ed 1995; 7: 147-157
Rheumatic fibromyalgia - Psychiatric features (article in Spanish) Sarró Alvarez S, Centro de Salud Mental. Martí i Julià. Sta. Coloma de Gramanet. Barcelona. Spain - Actas Esp Psiquiatr. 2002 Nov-Dec;30(6):392-6 - PMID: 12487950 Rheumatic fibromyalgia, also known as fibrositis or myofascial pain, is a common syndrome whose diagnoses, founded mainly on physical examination, usually delays due to symptom unspecificity, amount of complementary tests requested and intercourse with psychiatric disorders. Psychyatrists and psychologists get often involved in fibromyalgia treatment. Its proper knowledge prevents not only physicians and patients' psychological discourage but also development of depression and mental health expenses, as well as allows designing a treatment plan according to the main symptoms which may offer improvement chances to fibromyalgia patients. This article intends to offer an up-to-date and complete information about this entity, focused on psychiatric aspects, to better identify and manage such a puzzling disease. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/12487950
Role of impaired lower-limb venous innervation in the pathogenesis of the chronic fatigue syndrome Streeten DH, Department of Medicine, SUNY Upstate Medical University, Syracuse, New York 13210, USA - Am J Med Sci. 2001 Mar;321(3):163-7 - PMID: 11269790 Background - In patients with acute orthostatic hypotension, there is excessive pooling of blood in the legs, which may result from the strikingly subnormal compliance that is demonstrable in the pedal veins during norepinephrine infusion. The common occurrence of delayed orthostatic hypotension and/or tachycardia in the chronic fatigue syndrome (CFS) led to the present studies of foot vein compliance in CFS patients with a linear variable differential transformer. Methods - Seven patients with CFS were compared with 7 age- and gender matched healthy control subjects in their blood pressure, heart-rate and plasma norepinephrine responses to prolonged standing and in measurements of their foot vein contractile responses to intravenous norepinephrine infusions with the linear variable differential transformer. Results - Excessive, delayed (usually after 10 min) orthostatic reductions in systolic and diastolic blood pressure (P < 0.01) and inconsistently excessive increases in heart rate were found in the CFS patients, in whom venous compliance in response to infused norepinephrine was significantly reduced (P < 0.05). Conclusions - In these patients with CFS, delayed orthostatic hypotension was clearly demonstrable and, as in previously reported patients with orthostatic hypotension of acute onset, this was associated with reduced pedal vein compliance during norepinephrine infusion, implying impaired sympathetic innervation of foot veins. The rapid symptomatic improvement demonstrated in previous studies of CFS patients during correction of orthostatic venous pooling by inflation of military antishock trousers (MAST) to 35 mm Hg may suggest that excessive lower body venous pooling, perhaps by reducing cerebral perfusion, is involved in the orthostatic component of fatigue in these patients. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/11269790?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_Single ItemSupl.Pubmed_Discovery_RA&linkpos=1&log$=relatedarticles&logdbfrom=pubmed
Ross River virus infection on the North Coast of New South Wales Westley-Wise VJ, Beard JR et al. - Aust N Z J Public Health 1996; 20: 87-92
Screening for prolonged fatigue syndromes - Validation of the SOFA scale Hadzi-Pavlovic D, Hickie IB, Wilson AJ, Davenport TA, Lloyd AR, Wakefield D, Mood Disorders Unit, Prince of Wales Hospital, Randwick, NSW, Australia : D.Hadzi-Pavlovic@unsw.edu.au - Soc Psychiatry Psychiatr Epidemiol. 2000 Oct;35(10):471-9 - PMID: 11127722 Background - The identification of syndromes characterised by persistent and disabling mental and/or physical fatigue is of renewed interest in psychiatric epidemiology. This report details the development of two specific instruments : the SOFA/CFS for identification of patients with chronic fatigue syndrome (CFS) in specialist clinics and the SOFA/GP for identification of prolonged fatigue syndromes (PFS) in community and primary care settings. Methods - Patients with clinical diagnoses of CFS (n = 770) and consecutive attenders at primary care (n = 1593) completed various self-report questionnaires to assess severity of current fatigue-related symptoms and other common somatic and psychological symptoms. Quality receiver operating characteristic curves were used to derive appropriate cut-off scores for each of the instruments. Comparisons with other self-report measures of anxiety, depression and somatic distress are noted. Various multivariate statistical modelling techniques [latent class analysis (LCA), longitudinal LCA] were utilised to define the key features of PFS and describe its longitudinal characteristics. Results - The SOFA/CFS instrument performs well in specialist samples likely to contain a high proportion of patients with CFS disorders. Cut-off scores of either 1/2 or 2/3 can be used, depending on whether the investigators wish to preferentially emphasise false-negatives or false-positives. Patients from these settings can be thought of as consisting not only of those with a large number of unexplained medical symptoms, but also those with rather specific musculoskeletal and pain syndromes. The SOFA/GP instrument has potential cut-off scores of 1/2 or 2/3, with the latter preferred as it actively excludes all non-PFS cases (sensitivity = 81%, specificity = 100%). Patients with these syndromes in the community represent broader sets of underlying classes, with the emergence of not only musculoskeletal and multisymptomatic disorders, but also persons characterised by significant cognitive subjective impairment. Twelve-month longitudinal analyses of the primary care sample indicated that the underlying class structure was preserved over time. Comparisons with other measures of psychopathology indicated the relative independence of these constructs from conventional notions of anxiety and depression. Conclusions - The SOFA/GP instrument (which is considerably modified from the SOFA/CFS in terms of anchor points for severity and chronicity) is preferred for screening in primary care and community settings. Patients with PFS and CFS present a range of psychopathology that differs in its underlying structure, cross-sectionally and longitudinally, from coventional notions of anxiety and depression. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/11127722
Screening for psychiatric disorders in chronic fatigue and chronic fatigue syndrome Buchwald D, Pearlman T, Kith P et al. - J Psychosom Res 1997; 42: 87-94
Secondary gain concept - A review of the scientific evidence Fishbain DA, Rosomoff HL, Cutler RB, Rosomoff RS - Clin J Pain 1995; 11: 6-21
Selective impairment of auditory processing in chronic fatigue syndrome - A comparison with multiple sclerosis and healthy controls Johnson SK, DeLuca J, Diamond BJ, Natelson BH - Percept Motor Skills 1996; 83: 51-62
Self-reported sensitivity to chemical exposures in five clinical populations and healthy controls Nawab SS, Miller CS, Dale JK et al. - Psychiatry Res 2000; 95: 67-74
Seroepidemiology of chronic fatigue syndrome – A case-control study Mawle AC, Nisenbaum R, Dobbins JG et al. - Clin Infect Dis 1995; 21: 1386-1389
Seronegative' Sjogren's syndrome manifested as a subset of chronic fatigue syndrome Nishikai M, Akiya K, Tojo T et al. - Br J Rheumatol 1996; 35: 471-474
Serum neopterin and somatization in women with chemical intolerance, depressives and normals Bell IR, Patarca R, Baldwin CM et al. - Neuropsychobiology 1998; 38: 13-18
Serum neuropeptides in patients with both fibromyalgia (FM) and chronic fatigue syndrome (CFS) Clauw DJ, Sabol M, Radulovic D et al. - J Musculoskel Pain 1995; 3 Suppl 1: S79
Sexual abuse, physical abuse, chronic fatigue and chronic fatigue syndrome - A community-based study Taylor RR, Jason LA - J Nerv Ment Dis 2001; 189: 709-715
Significant other responses are associated with fatigue and functional status among patients with chronic fatigue syndrome Schmaling KB, Smith WR, Buchwald DS - Psychosom Med 2000; 62: 444-450
Silicone breast implants, where have we been and where are we now ? Gatenby PA - Aust N Z J Med 1996; 26: 341-342
Single-blind, placebo phase-in trial of two escalating doses of selegiline in the chronic fatigue syndrome Natelson BH, Cheu J, Hill N et al. - Neuropsychobiology 1998; 37: 150-154
Sleep abnormalities demonstrated by home polysomnography in teenagers with chronic fatigue syndrome Stores G, Wiggs L - J Psychosom Res 1998; 45: 85-91
Sleep anomalies in the chronic fatigue syndrome - A comorbidity study Fischler B, Le Bon O, Hoffman G et al. - Neuropsychobiology 1997; 35: 115-122
Small adrenal glands in chronic fatigue syndrome - A preliminary computed tomography study Scott LV, Teh J, Reznek R et al. - Psychoneuroendocrinology 1999; 24: 759-768
Social and familial risk factors in suicide behaviour Maris RW - Psychiatr Clin North Am 1997; 20: 519-550
Sociosomatics and illness course in chronic fatigue syndrome Ware NC - Psychosom Med 1998; 60: 394-401
Somatization and depression in fibromyalgia syndrome Kirmayer LJ, Robbins JM, Kapusta MA, Institute of Community and Family Psychiatry, Sir Mortimer B. Davis-Jewish General Hospital, Montreal, Quebec, Canada - Am J Psychiatry. 1988 Aug;145(8):950-4 - PMID: 3164984 Psychiatric diagnoses, self-reports of symptoms and illness behavior of 20 fibromyalgia patients and 23 rheumatoid arthritis patients were compared. The fibromyalgia patients were not significantly more likely than the arthritis patients to report depressive symptoms or to receive a lifetime psychiatric diagnosis of major depression. These results do not support the contention that fibromyalgia is a form of somatized depression. Fibromyalgia patients, however, reported significantly more somatic symptoms of obscure origin and exhibited a pattern of reporting more somatic symptoms, multiple surgical procedures and help seeking that may reflect a process of somatization rather than a discrete psychiatric disorder. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/3164984
Somatomedin C (insulin-like growth factor 1) levels in patients with chronic fatigue syndrome Bennett AL, Mayes DM, Fagioli LR et al. - J Psychiat Res 1997; 31: 91-96
SPECT brain imaging in chronic fatigue syndrome Patterson J, Aitchison F, Wyper DJ et al. - J Immunol Immunopharmacol 1995; XV, 1-2: 53-58
SPHERE - A National Depression Project - Development of a simple screening tool for common mental disorders in general practice Hickie IB, Davenport TA, Hadzi-Pavlovic D et al. - Med J Aust 2001; 175 Suppl: S10-S17
Studying symptoms - Sampling and measurement issues Kroenke K - Ann Intern Med 2001; 134 Suppl: 844-853
Subgrouping of fibromyalgia patients on the basis of pressure-pain thresholds and psychological factors Giesecke T, Williams DA, Harris RE, Cupps TR, Tian X, Tian TX, Gracely RH, Clauw DJ, University of Michigan, Ann Arbor, USA - Arthritis Rheum. 2003 Oct;48(10):2916-22 - PMID: 14558098 Objective - Although the American College of Rheumatology (ACR) criteria for fibromyalgia are used to identify individuals with both widespread pain and tenderness, individuals who meet these criteria are not a homogeneous group. Patients differ in their accompanying clinical symptoms, as well as in the relative contributions of biologic, psychological and cognitive factors to their symptom expression. Therefore, it seems useful to identify subsets of fibromyalgia patients on the basis of which of these factors are present. Previous attempts at identifying subsets have been based solely on psychological and cognitive features. In this study, we attempt to identify patient subsets by incorporating these features as well as the degree of hyperalgesia/tenderness, which is a key neurobiologic feature of this illness. Methods - Ninety-seven individuals meeting the ACR criteria for fibromyalgia finished the same battery of self-report and evoked-pain testing. Analyzed variables were obtained from several domains, consisting of 1) mood (evaluated by the Center for Epidemiologic Studies Depression Scale [for depression] and the State-Trait Personality Inventory [for symptoms of trait-related anxiety]), 2) cognition (by the catastrophizing and control of pain subscales of the Coping Strategies Questionnaire) and 3) hyperalgesia/tenderness (by dolorimetry and random pressure-pain applied at suprathreshold values). Cluster analytic procedures were used to distinguish subgroups of fibromyalgia patients based on these domains. Results - Three clusters best fit the data. Multivariate analysis of variance (ANOVA) confirmed that each variable was differentiated by the cluster solution (Wilks' lambda [degrees of freedom 6,89] = 0.123, P < 0.0001), with univariate ANOVAs also indicating significant differences (all P < 0.05). One subgroup of patients (n = 50) was characterized by moderate mood ratings, moderate levels of catastrophizing and perceived control over pain and low levels of tenderness. A second subgroup (n = 31) displayed significantly elevated values on the mood assessments, the highest values on the catastrophizing subscale, the lowest values for perceived control over pain and high levels of tenderness. The third group (n = 16) had normal mood ratings, very low levels of catastrophizing and the highest level of perceived control over pain, but these subjects showed extreme tenderness on evoked-pain testing. Conclusion - These data help support the clinical impression that there are distinct subgroups of patients with fibromyalgia. There appears to be a group of fibromyalgia patients who exhibit extreme tenderness but lack any associated psychological/cognitive factors, an intermediate group who display moderate tenderness and have normal mood and a group in whom mood and cognitive factors may be significantly influencing the symptom report. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/14558098 Also read the comment on this article : No justification for publication of study on subgrouping of fibromyalgia patients - Comment on the article by Giesecke et al. Ehrlich GE - Arthritis Rheum. 2004 Aug;50(8):2716; author reply 2716-7 - PMID: 15334497 Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/15334497?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract
Successful intravenous immunoglobulin therapy in 3 cases of parvovirus B19-associated chronic fatigue syndrome Kawamura Y, Kihara M, Nishimoto K, Taki M - Clin Infect Dis ( 2003;) 36:: e100–6
Successful use of a primary care practice-specialty collaboration in the care of an adolescent with chronic fatigue syndrome Kuo DZ, Cheng TL, Rowe PC, Maple Avenue Pediatrics, Fair Lawn, New Jersey, USA : firstname.lastname@example.org - Pediatrics. 2007 Dec;120(6):e1536-9 - PMID: 18055669 We report on the successful collaborative care of an adolescent with chronic fatigue syndrome between a primary care pediatrician and an academic chronic fatigue syndrome specialist located in different cities. Regular telephone and e-mail communication and clearly defined patient-care roles allowed for timely management of symptoms and marked clinical improvement. We discuss ways to improve the collaboration of primary care and subspecialty physicians for patients with chronic fatigue syndrome and children with special health care needs. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/18055669
Symptom occurrence in persons with chronic fatigue syndrome Jason LA, Torres-Harding SR, Carrico AW, Taylor RR, DePaul University, Center for Community Research, 990 West Fullerton Road, Chicago, IL 60614, USA : Ljason@depaul.edu - Biol Psychol. 2002 Feb;59(1):15-27 - PMID: 11790441 This investigation compared differences in the occurrence of symptoms in participants with CFS, melancholic depression and no fatigue (controls). The following Fukuda et al. [Ann. Intern. Med. 121 (1994) 953] criteria symptoms differentiated the CFS group from controls, but did not differentiate the melancholic depression group from controls : headaches, lymph node pain, sore throat, joint pain and muscle pain. In addition, participants with CFS uniquely differed from controls in the occurrence of muscle weakness at multiple sites as well as in the occurrence of various cardiopulmonary, neurological and other symptoms not currently included in the current case definition. Implications of these findings are discussed. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/11790441
Symptom patterns in long-duration chronic fatigue syndrome Friedberg F, Dechene L, McKenzie MJI, Fontanetta R - J Psychosom Res 2000; 48: 59-68
Symptom patterns of children and adolescents with chronic fatigue syndrome Rowe KS, Rowe KJ – In : 'International perspectives on child and adolescent mental health' - Singh NN, Ollendick T, Singh AN, editors
Symptoms of autonomic dysfunction in chronic fatigue syndrome Newton JL, Okonkwo O, Sutcliffe K, Seth A, Shin J, Jones DE, Fatigue Interest group and Liver Research Group, Institute for Cellular Medicine, University of Newcastle, Newcastle, UK : email@example.com - QJM. 2007 Aug;100(8):519-26. Epub 2007 Jul 7 - PMID: 17617647 Background - Chronic fatigue syndrome (CFS) is common and its cause is unknown. Aim - To study the prevalence of autonomic dysfunction in CFS and to develop diagnostic criteria. Design - Cross-sectional study with independent derivation and validation phases. Methods - Symptoms of autonomic dysfunction were assessed using the Composite Autonomic Symptom Scale (COMPASS). Fatigue was assessed using the Fatigue Impact Scale (FIS). Subjects were studied in two groups : phase 1 (derivation phase), 40 CFS patients and 40 age- and sex-matched controls; phase 2 (validation phase), 30 CFS patients, 37 normal controls and 60 patients with primary biliary cirrhosis. Results - Symptoms of autonomic dysfunction were strongly and reproducibly associated with the presence of CFS or primary biliary cirrhosis (PBC) and correlated with severity of fatigue. Total COMPASS score >32.5 was identified in phase 1 as a diagnostic criterion for autonomic dysfunction in CFS patients and was shown in phase 2 to have a positive predictive value of 0.96 (95%CI 0.86-0.99) and a negative predictive value of 0.84 (0.70-0.93) for the diagnosis of CFS. Discussion - Autonomic dysfunction is strongly associated with fatigue in some, but not all, CFS and PBC patients. We postulate the existence of a 'cross-cutting' aetiological process of dysautonomia-associated fatigue (DAF). COMPASS >32.5 is a valid diagnostic criterion for autonomic dysfunction in CFS and PBC and can be used to identify patients for targeted intervention studies. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/17617647
Tc99-HMPAO SPECT and magnetic resonance imaging in 30 patients suffering from chronic fatigue syndrome Osmanagaoglu K, Lambrecht L, Van de Wiele C et al. - Neurospect. SPECT in Clinical Neurology and Psychiatry. Acta Neurol Belg 1995; Suppl: 87-88
The assessment of vascular abnormalities in late life chronic fatigue syndrome by brain SPECT - Comparison with late life major depressive disorder Goldstein JA, Mena I, Jouanne E, Lesser I - J Chronic Fatigue Syndr 1995; 1: 55-79
The BEACH study of general practice Britt HC, Miller GC - Med J Aust 2000; 173: 63-64
The biology of chronic fatigue syndrome Komaroff AL - Am J Med 2000; 108: 169-171
The connection between chronic fatigue syndrome and neurally mediated hypotension Wilke WS, Fouad-Tarazi FM, Cash JM, Calabrese LH, Department of Rheumatic and Immunologic Disease, Cleveland Clinic Foundation, OH 44195, USA - Cleve Clin J Med. 1998 May;65(5):261-6 - PMID: 9599909 Research from several groups of investigators indicates that some patients with chronic fatigue syndrome have abnormal vasovagal or vasodepressor responses to upright posture. If confirmed, these findings may explain some of the symptoms of chronic fatigue syndrome. There is also speculation that neurally mediated hypotension may be present in fibromyalgia. This article discusses the original research in this area, the results of follow-up studies and the current approach to treating patients with chronic fatigue syndrome in whom neurally mediated hypotension is suspected. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/9599909
The Dubbo INfgection Outcomes Study - Post-infective Fatigue as a model for CFS Jones, J., Hickie, I., Wakefield, D., Davenport, T.A., Vollmer-Conna, U. & Lloyd, A. (2004a) Cfr. 'Some Interesting Facets of Research Science - AACFS Seventh International Conference' (Alan Cocchetto, 2004) at : http://www.ncf-net.org/forum/InterestingFacets.htm
The economic impact of chronic fatigue syndrome Reynolds KJ, Vernon SD, Bouchery E, Reeves WC, Division of Viral and Rickettsial Diseases, Centers for Disease Control and Prevention, Atlanta, U.S.A. : firstname.lastname@example.org - Cost Eff Resour Alloc. 2004 Jun 21;2(1):4 - PMID: 15210053 Background - Chronic fatigue syndrome (CFS) is a chronic incapacitating illness that affects between 400,000 and 800,000 Americans. Despite the disabling nature of this illness, scant research has addressed the economic impact of CFS either on those affected or on the national economy. Methods - We used microsimulation methods to analyze data from a surveillance study of CFS in Wichita, Kansas and derive estimates of productivity losses due to CFS. Results - We estimated a 37% decline in household productivity and a 54% reduction in labor force productivity among people with CFS. The annual total value of lost productivity in the United States was $9.1 billion, which represents about $20,000 per person with CFS or approximately one-half of the household and labor force productivity of the average person with this syndrome. Conclusion - Lost productivity due to CFS was substantial both on an individual basis and relative to national estimates for other major illnesses. CFS resulted in a national productivity loss comparable to such losses from diseases of the digestive, immune and nervous systems and from skin disorders. The extent of the burden indicates that continued research to determine the cause and potential therapies for CFS could provide substantial benefit both for individual patients and for the nation. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/15210053
The effect of paroxetine and nefazodone on sleep - A placebo controlled trial Sharpley AL, Williamson DJ, Attenburrow MEJ et al. - Psychopharmacology Berl 1996; 126: 50-54
The epidemiology of anxiety disorders - Prevalence and societal costs Lépine JP, Assistance Publique Hôpitaux de Paris, Service de Psychiatrie, Hôpital Fernand Widal, Paris, France : email@example.com - J Clin Psychiatry. 2002;63 Suppl 14:4-8 -PMID: 12562112 Anxiety disorders are the most prevalent of psychiatric disorders, yet less than 30% of individuals who suffer from anxiety disorders seek treatment. Prevalence of anxiety disorders is difficult to pinpoint since even small changes in diagnostic criteria, interview tools or study methodology affect results. Analyses of the largest prevalence studies of psychiatric illnesses in the United States find that anxiety disorders afflict 15.7 million people in the United States each year and 30 million people in the United States at some point in their lives. Currently, the European Study of Epidemiology of Mental Disorders and the World Health Organization World Mental Health 2000 studies are underway. These studies, which share a similar methodology, will facilitate future worldwide comparisons of the prevalence of anxiety disorders. Anxiety disorders impose high individual and social burden, tend to be chronic and can be as disabling as somatic disorders. Compared with those who have other psychiatric disorders, people with anxiety disorders are high care utilizers who present to general practitioners more frequently than to psychiatric professionals, placing a strain upon the health care system. The economic costs of anxiety disorders include psychiatric, nonpsychiatric and emergency care; hospitalization; prescription drugs; reduced productivity; absenteeism from work; and suicide. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/12562112?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_Single ItemSupl.Pubmed_Discovery_RA&linkpos=4&log$=relatedreviews&logdbfrom=pubmed
The epidemiology of chronic fatigue in San Francisco Steele L, Dobbins JG, Fukuda K et al. - Am J Med 1998; 105: 83S-90S
The epidemiology of chronic fatigue syndrome Wessely S - Epidemiol Rev 1995; 17: 139-151
The epidemiology of fatigue and depression - A French primary-care study Fuhrer R, Wessely S - Psychol Med 1995; 25: 895-905
The existence of a fatigue syndrome after glandular fever White PD, Thomas JM, Amess J et al. - Psychol Med 1995; 25: 907-916
The family response questionnaire - A new scale to assess the responses of family members to people with chronic fatigue syndrome Cordingley L, Wearden A, Appleby L, Fisher L - J Psychosom Res 2001; 51: 417-424
The fibromyalgia syndrome as a manifestation of neuroticism ? P. Netter & J. Hennig, Department of Psychology, University of Giessen, Germany : firstname.lastname@example.org - Zeitschrift fur Rheumatologie 1998;57 Suppl 2():105-8 After elucidating the components and theory of neuroticism (N) as well as of psychosomatic complaints and their relationships to personality dimensions and to psychosomatic diseases, comparisons are performed between patients suffering from fibromyalgia syndrome (FMS) or related pain diseases with healthy subjects scoring high on personality dimensions related to neuroticism. FMS and pain patients score high on depression, anxiety and experience of stress although questionnaire scores on depression are higher in subjects not exhibiting somatic features of the disease. High subjective pain sensitivity and low thresholds for pain perception are also common features in high N subjects and FMS patients. On the endocrinological level cortisol responses to challenge tests with CRH as well as prolactin responses to TRH are higher in FMS patients than in high N healthy subjects indicating an endocrinological difference. A common feature, however, is the lack of adaptability in the two groups, since neurotics are in particular characterized by a low capacity to shift their behavior from one state to the other (waking-sleeping, working-relaxing), to re-adapt to baseline levels after endocrinological or physiological stress responses or to adjust to conditions of shift work. This is reflected by chronobiological disturbances in FMS patients and could also explain their maintainance of pain perception, because they are incapable of correcting conditioned pain-producing muscle tension. Cfr. : http://www.websciences.org/cftemplate/NAPS/archives/indiv.cfm?ID=19991043
The global burden of disease - A comprehensive assessment of mortality and disability from diseases, injuries and risk factors in 1990 and projected to 2020 Murray CJL, Lopez AD (editors) - Cambridge, MA : Harvard University Press, 1996
The head-up tilt test with haemodynamic instability score in diagnosing chronic fatigue syndrome Naschitz JE, Rosner I, Rozenbaum M, Naschitz S, Musafia-Priselac R, Shaviv N, Fields M, Isseroff H, Zuckerman E, Yeshurun D, Sabo E, Department of Internal Medicine A, Bnai Zion Medical Center, Haifa, Israel : Naschitz@tx.technion.ac.il - QJM. 2003 Feb;96(2):133-42 - PMID: 12589011 Background - Studying patients with chronic fatigue syndrome (CFS), we have developed a method that uses a head-up tilt test (HUTT) to estimate BP and HR instability during tilt, expressed as a 'haemodynamic instability score' (HIS). Aim - To assess HIS sensitivity and specificity in the diagnosis of CFS. Design - Prospective controlled study. Methods - Patients with CFS (n=40), non-CFS chronic fatigue (n=73), fibromyalgia (n=41), neurally mediated syncope (n=58), generalized anxiety disorder (n=28), familial Mediterranean fever (n=50), arterial hypertension (n=28) and healthy subjects (n=59) were evaluated with a standardized head-up tilt test (HUTT). The HIS was calculated from blood pressure (BP) and heart rate (HR) changes during the HUTT. Results - The tilt was prematurely terminated in 22% of CFS patients when postural symptoms occurred and the HIS could not be calculated. In the remainder, the median(IQR) HIS values were : CFS +2.14(4.67), non-CFS fatigue -3.98(5.35), fibromyalgia -2.81(2.62), syncope -3.7(4.36), generalized anxiety disorder -0.21(6.05), healthy controls -2.66(3.14), FMF -5.09(6.41), hypertensives -5.35(2.74) (p<0.0001 vs. CFS in all groups, except for anxiety disorder, p=NS). The sensitivity for CFS at HIS >-0.98 cut-off was 90.3% and the overall specificity was 84.5%. Discussion - There is a particular dysautonomia in CFS that differs from dysautonomia in other disorders, characterized by HIS >-0.98. The HIS can reinforce the clinician's diagnosis by providing objective criteria for the assessment of CFS, which until now, could only be subjectively inferred. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/12589011 Also read the comments on this article : - The head-up tilt test for diagnosing chronic fatigue syndrome Ghosh AK, Ghosh K - QJM. 2003 May;96(5):379-80 - PMID: 12702788 Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/12702788?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract - Assessing chronic fatigue Baschetti R - QJM. 2003 Jun;96(6):454 - PMID: 12788966 Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/12788966?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract
The HPA axis and the genesis of chronic fatigue syndrome Cleare AJ, Section of Neurobiology of Mood Disorders, Division of Psychological Medicine, The Institute of Psychiatry, London, SE5 8AF, UK : email@example.com - Trends Endocrinol Metab. 2004 Mar;15(2):55-9 - PMID: 15036250 Many studies of patients with long-standing chronic fatigue syndrome (CFS) have found alterations to the hypothalamo-pituitary-adrenal (HPA) axis, including mild hypocortisolism, heightened negative feedback and blunted responses to challenge. However, recent prospective studies of high-risk cohorts suggest that there are no HPA axis changes present during the early stages of the genesis of fatiguing illnesses. Moreover, HPA axis changes can be reversed by modifying behavioural features of the illness, such as inactivity, deconditioning and sleep disturbance. Nevertheless, raising levels of cortisol pharmacologically can temporarily alleviate symptoms of fatigue. This article presents the case that there is no specific change to the HPA axis in CFS and that the observed changes are of multifactorial aetiology, with some factors occurring as a consequence of the illness. Nevertheless, the HPA axis might play a role in exacerbating or perpetuating symptoms late on in the course of the illness. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/15036250
The hypothalamic-pituitary-adrenal stress axis in fibromyalgia and chronic fatigue syndrome Crofford LJ, Division of Rheumatology, University of Michigan, Ann Arbor 48109-0680, USA : firstname.lastname@example.org - Z Rheumatol. 1998;57 Suppl 2:67-71 - PMID: 10025087 HPA axis abnormalities in FM, CFS and other stress-related disorders must be placed in a broad clinical context. We know that interventions providing symptomatic improvement in patients with FM and CFS can directly or indirectly affect the HPA axis. These interventions include exercise, tricyclic anti-depressants and serotonin reuptake inhibitors. There is little direct information as to how the specific HPA axis perturbations seen in FM can be related to the major symptomatic manifestations of pain, fatigue, sleep disturbance and psychological distress. Since many of these somatic and psychological symptoms are present in other syndromes that exhibit HPA axis disturbances, it seems reasonable to suggest that there may be some relationship between basal and dynamic function of the HPA axis and clinical manifestations of FM and CFS. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/10025087?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_Single ItemSupl.Pubmed_Discovery_RA&linkpos=1&log$=relatedreviews&logdbfrom=pubmed
The hypothalamo-pituitary-adrenal axis in chronic fatigue syndrome and fibromyalgia syndrome Tanriverdi F, Karaca Z, Unluhizarci K, Kelestimur F, Department of Endocrinology, Medical School, Erciyes University, Kayseri, Turkey - Stress. 2007 Mar;10(1):13-25 - PMID: 17454963 The hypothalamo-pituitary-adrenal (HPA) axis plays a major role in the regulation of responses to stress. Human stress-related disorders such as chronic fatigue syndrome (CFS), fibromyalgia syndrome (FMS), chronic pelvic pain and post-traumatic stress disorder are characterized by alterations in HPA axis activity. However, the role of the HPA axis alterations in these stress-related disorders is not clear. Most studies have shown that the HPA axis is underactive in the stress-related disorders, but contradictory results have also been reported, which may be due to the patients selected for the study, the methods used for the investigation of the HPA axis, the stage of the syndrome when the tests have been done and the interpretation of the results. There is no structural abnormality in the endocrine organs which comprise the HPA axis, thus it seems that hypocortisolemia found in the patients with stress-related disorder is functional. It may be also an adaptive response of the body to chronic stress. In this review, tests used in the assessment of HPA axis function and the HPA axis alterations found in CFS and FMS are discussed in detail. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/17454963
The impact of catastrophic beliefs on functioning in chronic fatigue syndrome Petrie K, Moss-Morriss R, Weinman J - J Psychosom Res 1995; 39: 31-37
The low dose ACTH test in chronic fatigue syndrome and in health Scott LV, Medbak S, Dinan TG - Clin Endocrinol 1998; 48: 733-737
The measurement of fatigue in patients with multiple sclerosis - A multidimensional comparison with patients with chronic fatigue syndrome and healthy subjects Vercoulen JH, Hommes OR, Swanink CM et al. - Arch Neurol 1996; 53: 642-649
The mental health of patients with a chief complaint of chronic fatigue - A prospective evaluation and follow-up Manu P, Matthews DA, Lane TJ, Division of General Medicine, University of Connecticut Health Center, Farmington 06032 - Arch Intern Med. 1988 Oct;148(10):2213-7 - PMID: 3178379 To determine the psychiatric morbidity of patients complaining of chronic fatigue, we undertook a prospective evaluation of 100 adults (65 women and 35 men; mean age, 41 years; and mean duration of chronic fatigue, 13 years). The study was conducted in an internal medicine outpatient clinic. In addition to a comprehensive medical evaluation, the patients were administered the 260-item Diagnostic Interview Schedule, a highly structured instrument that enabled the physician-interviewer to make accurate psychiatric diagnoses. A thorough follow-up examination was given an average of 8.4 months later. Sixty-six patients had one or more psychiatric disorders that were considered a major cause of their chronic fatigue (mood disorder, 47 patients; somatization disorder, 15 patients; and anxiety disorder, nine patients). Five patients had medical conditions that were considered a major cause of their fatigue. The complaint of chronic fatigue remained unexplained in 31 patients. In this prospective study, two thirds of cases of chronic fatigue appeared to be caused by psychiatric disorders. A thorough evaluation of the mental health of patients complaining of chronic fatigue could therefore provide pharmacologic and psychotherapeutic approaches and avoid unnecessary and costly medical investigations and therapies. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/3178379 Also read the comment on this article : Chronic fatigue - Psyche or sleep ? [No authors listed] - Arch Intern Med. 1990 May;150(5):1116, 1118, 1121 - PMID: 2331192 Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/2331192?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_Dis coveryPanel.Pubmed_RVAbstractPlus
The natural history of concurrent sick building syndrome and chronic fatigue syndrome Chester AC, Levine PH - J Psychiat Res 1997; 31: 51-57
The neuroendocrinology of chronic fatigue syndrome Cleare AJ, Section of Neurobiology of Mood Disorders, Division of Psychological Medicine, The Institute of Psychiatry, London SE5 8AZ, United Kingdom : email@example.com - Endocr Rev. 2003 Apr;24(2):236-52 - PMID: 12700181 Chronic fatigue syndrome (CFS) is a common and disabling problem; although most likely of biopsychosocial origin, the nature of the pathophysiological components remains unclear. There has been a wealth of interest in the endocrinology of this condition, which will be reviewed in this article. Most studied has been the hypothalamic-pituitary-adrenal (HPA) axis; although the quality of many studies is poor, the overall balance of evidence points to reduced cortisol output in at least some patients, with some evidence that this is linked to symptom production or persistence. There is evidence for heightened negative feedback and glucocorticoid receptor function and for impaired ACTH and cortisol responses to a variety of challenges. However, there is no evidence for a specific or uniform dysfunction of the HPA axis. Given the many factors that may impinge on the HPA axis in CFS, such as inactivity, sleep disturbance, psychiatric comorbidity, medication and ongoing stress, it seems likely that HPA axis disturbance is heterogeneous and of multifactorial etiology in CFS. Studies assessing GH, dehydroepiandrostenedione and its sulfate, melatonin, leptin and neuroendocrine-monoamine interactions are also reviewed. There is some evidence from these studies to suggest alterations of dehydroepiandrostenedione sulfate function and abnormal serotonin function in CFS, but whether these changes are of functional importance remains unclear. To obtain a clearer assessment of the etiological and pathophysiological relevance of endocrine changes in CFS, it is suggested that more prospective cohort studies be undertaken in groups at high risk for CFS, that patients with CFS are followed up into recovery and that multidimensional assessments are undertaken to unravel the influence of the various confounding factors on the observed endocrine changes in CFS. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/12700181
The neuropsychiatry of chronic fatigue syndrome Wessely S - Ciba Found Symp 1993; 173: 212-229
The prevalence and morbidity of chronic fatigue and chronic fatigue syndrome - A prospective primary care study Wessely S, Chalder T, Hirsch S, Wallace P, Wright D - Am J Public Health 1997; 87: 1449-1455 Cfr. : http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1380968/
The prevalence of chronic fatiguing illnesses among adolescents in the United States Dobbins JG, Randall B, Reyes M et al. - J Chronic Fatigue Syndr 1997; 3: 15-27
The prevalence of psychiatric morbidity - OPCS survey of psychiatric morbidity in Great Britain Mason P, Wilkinson G - Br J Psychiatry 1996; 168: 1-3
The prognosis of chronic fatigue and chronic fatigue syndrome - A systematic review Joyce J, Hotopf M, Wessely S - QJM 1997; 90: 223-233
The psychiatric status of patients with the chronic fatigue syndrome Hickie, I., Lloyd, A., Wakefield, D. & Parker, G. (1990) - British Journal of Psychiatry, 156, 534-540 Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/2386862
The role of essential fatty acids in chronic fatigue syndrome - A case-controlled study of red-cell membrane essential fatty acids (EFA) and a placebo-controlled treatment study with high dose of EFA Warren G, McKendrick M, Peet M - Acta Neurol Scand 1999; 99: 112-116
The role of personality in the development and perpetuating of chronic fatigue syndrome White C, Schweitzer R - J Psychosom Res 2000; 48: 515-524
The role of physical inactivity in the chronic fatigue syndrome White PD - J Psychosom Res 2000; 49: 283-284
The role of psychiatric disorders in fibromyalgia McBeth J, Silman Ajm Arthritis Research Campaign Epidemiology Unit, School of Epidemiology and Health Sciences, University of Manchester, Stopford Building, Oxford Road, Manchester M13 9PT, UK . firstname.lastname@example.org - Curr Rheumatol Rep. 2001 Apr;3(2):157-64 - PMID: 11286672 The cardinal features of fibromyalgia are chronic widespread pain in the presence of widespread tenderness as measured by multiple tender points. Despite extensive investigations, the etiology of this syndrome remains unclear. Increased rates of psychiatric disorders, particularly depressive, anxiety and somatoform disorders, are apparent in clinic populations. Epidemiologic evidence suggests that this is also true for community subjects. Depression, generalized psychological distress and other psychological factors have been shown to be associated with the onset and persistence of fibromyalgia symptoms. However, the bodily processes through which such factors may lead to the onset of fibromyalgia are unclear. Recent investigations have demonstrated altered stress system responsiveness, most notably the hypothalamic-pituitary-adrenal stress axis, in patients with fibromyalgia. These findings and one promising avenue for investigating the interaction between psychological and biological factors in the onset of chronic pain syndromes including fibromyalgia, are discussed. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/11286672
The roles of orthostatic hypotension, orthostatic tachycardia, and subnormal erythrocyte volume in the pathogenesis of the chronic fatigue syndrome Streeten DH, Thomas D, Bell DS, Department of Medicine, State University of New York Health Science Center, Syracuse 13210, USA - Am J Med Sci. 2000 Jul;320(1):1-8 - PMID: 10910366 Background - Orthostatic hypotension during upright tilt is an important physical disorder in patients with chronic fatigue syndrome. We have tested its occurrence during prolonged standing, whether it is correctable and whether reduced circulating erythrocyte volume is present. Methods - Fifteen patients were randomly selected from a large population of patients with chronic fatigue syndrome, studied and observed for several years (by DSB). Blood pressure (BP) and heart rate (HR) measured with Dinamap every minute for 30 minutes supine and 60 minutes standing were compared with these findings in 15 healthy age- and gender-matched control subjects and later during lower body compression with military antishock trousers (MAST). Plasma catecholamines and circulating erythrocyte and plasma volumes were also measured by isotopic dilution methods. Results - Abnormal findings in the patients included excessive orthostatic reductions in systolic (P < 0.001) and diastolic BP (P < 0.001) and excessive orthostatic tachycardia (P < 0.01), together with presyncopal symptoms in 11 of the 15 patients and in none of the control subjects after standing for 60 min. Lower body compression with the MAST restored all orthostatic measurements to normal and overcame presyncopal symptoms within 10 min. Circulating erythrocyte but not plasma volumes were subnormal in the 12 women (P < 0.01) and plasma norepinephrine concentration rose excessively after standing for 10 min. Conclusion - Delayed orthostatic hypotension and/or tachycardia caused by excessive gravitational venous pooling, which is correctable with external lower-body compression, together with subnormal circulating erythrocyte volume, are very frequent, although not invariably demonstrable, findings in moderate to severe chronic fatigue syndrome. When present, they may be involved in its pathogenesis. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/10910366
The Sickness of War Thomas M. Walshe, MD - Published in Journal Watch Neurology October 6, 2005 (covering Ann Intern Med 2005 Jun 7; 142:881-90) Questionnaire studies aimed at identifying causes of illness in military personnel deployed during the 1991 Gulf War have provided no clear evidence of specific causes... Cfr. : http://neurology.jwatch.org/cgi/content/citation/2005/1006/9
The Structured Clinical Interview for DSM-III-R (SCID) – I. - History, rationale and description Spitzer RL, Williams JB, Gibbon M, First MB, Department of Psychiatry, Columbia University, New York, NY - Arch Gen Psychiatry. 1992 Aug;49(8):624-9 - PMID: 1637252 The history, rationale and development of the Structured Clinical Interview for DSM-III-R (SCID) is described. The SCID is a semistructured interview for making the major Axis I DSM-III-R diagnoses. It is administered by a clinician and includes an introductory overview followed by nine modules, seven of which represent the major axis I diagnostic classes. Because of its modular construction, it can be adapted for use in studies in which particular diagnoses are not of interest. Using a decision tree approach, the SCID guides the clinician in testing diagnostic hypotheses as the interview is conducted. The output of the SCID is a record of the presence or absence of each of the disorders being considered, for current episode (past month) and for lifetime occurrence. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/1637252
The Structured Clinical Interview for DSM-III-R (SCID) – II. - Multisite test-retest reliability Williams JB, Gibbon M, First MB, Spitzer RL, Davies M, Borus J, Howes MJ, Kane J, Pope HG Jr, Rounsaville B et al., Department of Psychiatry, Columbia University, New York, NY. - Arch Gen Psychiatry. 1992 Aug;49(8):630-6 - PMID: 1637253 A test-retest reliability study of the Structured Clinical Interview for DSM-III-R was conducted on 592 subjects in four patient and two nonpatient sites in this country as well as one patient site in Germany. For most of the major categories, kappa s for current and lifetime diagnoses in the patient samples were above .60, with an overall weighted kappa of .61 for current and .68 for lifetime diagnoses. For the nonpatients, however, agreement was considerably lower, with a mean kappa of .37 for current and .51 for lifetime diagnoses. These values for the patient and nonpatient samples are roughly comparable to those obtained with other structured diagnostic instruments. Sources of diagnostic disagreement, such as inadequate training of interviewers, information variance and low base rates for many disorders, are discussed. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/1637253?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_Single ItemSupl.Pubmed_Discovery_RA&linkpos=1&log$=relatedarticles&logdbfrom=pubmed
The symptoms and signs of upper airway resistance syndrome - A link to the functional somatic syndromes Gold Avram R. (1) ; Dipalo Francis (1) ; Gold Morris S. (2) ; O'Hearn Daniel (1) - (1) Division of Pulmonary/Critical Care Medicine, SUNY-Stony Brook, School of Medicine, DVA Medical Center, Northport, NY, Etats-Unis - (2) Biostatistics and Data Management, Novartis Consumer Health, Summit, NJ, Etats-Unis - Chest 2003, vol. 123, no1, pp. 87-95 - American College of Chest Physicians, Northbrook, IL, Etats-Unis (1970) Study objectives - The functional somatic syndromes are associated with a variety of symptoms/ signs of uncertain etiology. We determined the prevalence of several of those symptoms/signs in patients with sleep-disordered breathing and examined the relationship between the prevalence of the symptoms/signs and the severity of sleep-disordered breathing. Design - A descriptive study without intervention. Setting - A university sleep-disorders center located in a suburban setting. Patients or participants : three groups of 25 consecutively collected patients with sleep-disordered breathing. Groups varied in their apnea hypopnea indexes (AHIs) as follows : upper airway resistance syndrome (UARS) [AHI < 10/h), mild-to-moderate obstructive sleep apnea/ hypopnea (OSA/H) [AHI ≥ 10 to < 40/h) and moderate-to-severe OSA/H (AHI ≥ 40/h). Measurements and results - Patients underwent comprehensive medical histories, physical examinations and full-night polysomnography. The diagnosis of UARS included quantitative measurement of inspiratory airflow and inspiratory effort with demonstration of inspiratory flow limitation. The percentage of women among the patients with sleep-disordered breathing (p = 0.001) and the prevalence of sleep-onset insomnia (p = 0.04), headaches (p = 0.01), irritable bowel syndrome (p = 0.01) and alpha-delta sleep (p = 0.01) was correlated with decreasing severity of AHI group. Conclusions - We conclude that patients with UARS, mild-to-moderate OSA/H and moderate-to-severe OSA/H differ in their presenting symptoms/signs. The symptoms/signs of UARS closely resemble those of the functional somatic syndromes. Cfr. : http://cat.inist.fr/?aModele=afficheN&cpsidt=14474218
The symptoms of chronic fatigue syndrome are related to abnormal ion channel function Chaudhuri A, Watson WS, Pearn J et al. - Med Hypotheses 2000; 54: 59-63
The temporal stability and co-morbidity of prolonged fatigue - A longitudinal study in primary care Hickie I, Koschera A, Hadzi-Pavlovic D et al. - Psychol Med 1999; 29: 855-861
The use of a symptom "self-report" inventory to evaluate the acceptability and efficacy of a walking program for patients suffering with chronic fatigue syndrome Coutts R, Weatherby R, Davie A - J Psychosom Res 2001; 51: 425-429
The validity and reliability of the fatigue syndrome that follows glandular fever White PD, Grover SA, Kangro HO et al. - Psychol Med 1995; 25: 917-924
Thirteen-year follow-up of children and adolescents with chronic fatigue syndrome Bell DS, Jordan K, Robinson M, Primary Care Pediatrics, Lyndonville, New York, USA - Pediatrics. 2001 May;107(5):994-8 - PMID: 11331676 Objective - To describe the educational, social, and symptomatic outcome of children and adolescents with chronic fatigue syndrome 13 years after illness onset. Methods - Between January 1984 and December 1987, 46 children and adolescents developed an illness suggestive of chronic fatigue syndrome. Follow-up questionnaires were obtained from 35 participants an average of 13 years after illness onset. Data were obtained concerning subsequent medical diagnoses, amount of school missed, presence and severity of current symptoms and subjective assessment of degree of illness resolution. Results - Of the 35 participants, 24 were female (68.6%) and 11 were male (31.4%). Average age at illness onset was 12.1 years. Eight participants (22.9%) had an acute onset of symptoms, 27 (77.1%) had a gradual onset. No participant received an alternative medical diagnosis that could have explained the symptom complex between illness onset and follow-up. Thirteen participants (37.1%) considered themselves resolved of illness at follow-up; 15 participants (42.9%) considered themselves well but not resolved; 4 (11.4%) considered themselves chronically ill; and 3 (8.6%) considered themselves more ill than during the early years of illness. Correlation with the Medical Outcomes Study Short Form Health Survey was good for current level of symptoms and degree of recovery. Eight participants (22.9%) missed >2 years of school and 5 of these were still ill at follow-up. Amount of school missed correlated with both illness severity at follow-up and perceived social impact of the illness. Conclusions - These data demonstrate the presence of an illness consistent with the current definition of chronic fatigue syndrome. Eighty percent of children and adolescents affected had a satisfactory outcome from their fatiguing illness, although the majority of these participants had mild to moderate persisting symptoms. Twenty percent of participants remain ill with significant symptoms and activity limitation 13 years after illness onset. Chronic fatigue syndrome in children and adolescents may result in persistent somatic symptoms and disability in a minority of those affected. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/11331676
Thoroughly modern worries - The relationship of worries about modernity to reported symptoms, health and medical care utlization Petrie KJ, Sivertsen B, Hysing M et al. - J Psychosom Res 2001; 51: 295-401
Time for Healing - Relaxation for mind and body Catherine Regan, Ph.D. - Bull Publishing Catherine Regan, Ph.D., is a clinical psychologist whose work includes a broad range of psychotherapy and behavioral medicine interventions. She lives and works in San Francisco, CA. 'Time for Healing' includes two 30-minute relaxation exercises with soft background music and the voice of Catherine Regan. They are meant to release tension, achieve deep muscular relaxation and guide listeners toward heightened self-awareness. Widely used in conjunction with our chronic conditions books. Now available in CD format. Cfr. : http://www.bullpub.com/healing.html
Traditional Chinese Medicine for Chronic Fatigue Syndrome Rui Chen1,2, Junji Moriya2, Jun-ichi Yamakawa2, Takashi Takahashi2 and Tsugiyasu Kanda2 - 1Department of Traditional Chinese Medicine, Union Hospital Affiliated to Huazhong University of Science and Technology, Wuhan, China and 2Department of General Medicine, Kanazawa Medical University, Ishikawa, Japan - Evid Based Complement Alternat Med 2008 More and more patients have been diagnosed as having chronic fatigue syndrome (CFS) in recent years. Western drug use for this syndrome is often associated with many side-effects and little clinical benefit. As an alternative medicine, traditional Chinese medicine (TCM) has provided some evidences based upon ancient texts and recent studies, not only to offer clinical benefit but also offer insights into their mechanisms of action. It has perceived advantages such as being natural, effective and safe to ameliorate symptoms of CFS such as fatigue, disordered sleep, cognitive handicaps and other complex complaints, although there are some limitations regarding the diagnostic standards and methodology in related clinical or experimental studies. Modern mechanisms of TCM on CFS mainly focus on adjusting immune dysfunction, regulating abnormal activity in the hypothalamic-pituitary-adrenal (HPA) axis and serving as an antioxidant. It is vitally important for the further development to establish standards for ‘zheng’ of CFS, i.e. the different types of CFS pathogenesis in TCM, to perform randomized and controlled trials of TCM on CFS and to make full use of the latest biological, biochemical, molecular and immunological approaches in the experimental design. Cfr. : http://ecam.oxfordjournals.org/cgi/content/full/nen017
Treating depression - The beyondblue guidelines for treating depression in primary care - "Not so much what you do but that you keep doing it" Ellis PM, Smith DA, Beyond blue, the national depression initiative - Department of Psychological Medicine, Wellington School of Medicine and Health Sciences, University of Otago, PO Box 7343, Wellington South, New Zealand : email@example.com - Med J Aust. 2002 May 20;176 Suppl:S77-83 - PMID: 12065002 1/ Most people with depression will be treated in general practice, either by the GP alone or (for more serious depression) in partnership with specialist mental health services. 2/ Treatment plans should always be based on thorough assessment, including the type, severity and duration of the depressive episode and any stressors that contributed to the episode. 3/ For mild and moderate depression, meta-analysis shows there is little difference in relative effectiveness of treatments and continuation of therapy is more important than initial treatment choice. 4/ The best outcomes are likely when a good therapeutic alliance is formed between a healthcare professional and the patient and adequate treatment is provided over a long enough period. For pharmacological interventions, treatment should continue for : at least one year for a first episode of depression and at least two years for repeated episodes or where there are other risk factors for relapse. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/12065002?dopt=Abstract Also read the comment on this article : How long should drug treatment of depression last ? Fava GA, Ruini C, Tossani E - Med J Aust. 2003 May 19;178(10):526; author reply 526-7 - PMID: 12741948 Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/12741948?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract
Treatment of common mental disorders in Australian general practice Hickie IB, Davenport TA, Naismith S et al. - Med J Aust 2001; 175 Suppl Jul 16: S25-S30
Treatment options and patient perspectives in the management of fibromyalgia - Future trends Lawson K, Biomedical Research Centre, Sheffield Hallam University, Faculty of Health and Wellbeing, Sheffield, UK - Neuropsychiatr Dis Treat. 2008 Dec;4(6):1059-71 - PMID: 19337451 Fibromyalgia (FM) is a common, complex and difficult to treat chronic widespread pain disorder, which usually requires a multidisciplinary approach using both pharmacological and non-pharmacological (education and exercise) interventions. It is a condition of heightened generalized sensitization to sensory input presenting as a complex of symptoms including pain, sleep dysfunction and fatigue, where the pathophysiology could include dysfunction of the central nervous system pain modulatory systems, dysfunction of the neuroendocrine system and dysautonomia. A cyclic model of the pathophysiological processes is compatible with the interrelationship of primary symptoms and the array of postulated triggers associated with FM. Many of the molecular targets of current and emerging drugs used to treat FM have been focused to the management of discrete symptoms rather than the condition. Recently, drugs (eg, pregabalin, duloxetine, milnacipran, sodium oxybate) have been identified that demonstrate a multidimensional efficacy in this condition. Although the complexity of FM suggests that monotherapy, non-pharmacological or pharmacological, will not adequately address the condition, the outcomes from recent clinical trials are providing important clues for treatment guidelines, improved diagnosis, and condition-focused therapies. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/19337451?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_Single ItemSupl.Pubmed_Discovery_PMC&linkpos=1&log$=citedinpmcarticles&logdbfrom=pub med
Unexplained suffering in the aftermath of war Anthony L. Komaroff - Annals 2005 142: 938-939 In 1990, military forces from Iraq invaded and occupied Kuwait and massed at the Saudi Arabia border. Early in 1991, an international alliance led by the United States attacked Iraqi forces and rapidly drove them back into Iraq. More than 500 000 U.S. personnel were involved in the Gulf War military action. Approximately 300 were killed and 500 were wounded—remarkably low numbers for a force of that size. But the end of hostilities was not the end of the story. By the end of 1991, many Gulf War veterans felt unwell. They reported various persistent and debilitating symptoms. Both the U.S. Department of Defense and the U.S. Department of Veterans Affairs created registries of ailing combatants from the Gulf War. The most commonly reported symptoms were fatigue, rashes, headache, muscle and joint pain and memory impairment (1, 2). Disability claims mounted. By 2001, nearly 20% of personnel deployed to the Gulf War were receiving some form of disability compensation (3). Was the Gulf War, in fact, associated with an unusual burden of chronic multisymptom reports ? Data from the registries could not answer that question, since the individuals in the registries were self-selected. Therefore, the U.S. Department of Veterans Affairs initiated several large population-based studies. The studies—conducted in the United States (4, 5), the United Kingdom (6, 7), Canada (8), and Denmark (9)—shared certain features .../... Cfr. : http://www.annals.org/content/142/11/938.extract
Unique genetic and environmental determinants of prolonged fatigue - A twin study Hickie I, Kirk K, Martin N, School of Psychiatry, University of New South Wales, Sydney, Australia - Psychol Med. 1999 Mar;29(2):259-68 - PMID: 10218917 Background - Prolonged fatigue syndromes have been proposed as prevalent and disabling forms of distress that occur independently of conventional notions of anxiety and depression. Methods - To investigate the genetic and environmental antecedents of common forms of psychological and somatic distress, we measured fatigue, anxiety, depression and psychological distress in 1004 normal adult twin pairs (533 monozygotic (MZ), 471 dizygotic (DZ)) over 50 years of age. Results - Familial aggregation of psychological distress, anxiety and fatigue appeared to be due largely to additive genetic factors (MZ:DZ ratios of 2.12-2.69). The phenotypic correlations between the psychological measures (distress, anxiety and depression) were moderate (0.67-0.79) and higher than that between fatigue and psychological distress (0.38). Multivariate genetic modelling revealed a common genetic factor contributing to the development of all the observed phenotypes (though most strongly for the psychological forms), a second independent genetic factor also influenced anxiety and depression and a third independent genetic factor made a major contribution to fatigue alone. In total, 44% (95% CI 25-60%) of the genetic variance for fatigue was not shared by the other forms of distress. Similarly, the environmental factor determining psychological distress made negligible contributions to fatigue, which was underpinned largely by its own independent environmental factor. Conclusion - This study supports the aetiological independence of prolonged fatigue and, therefore, argues strongly for its inclusion in classification systems in psychiatry. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/10218917
Upregulation of the 2-5A synthetase/RNase L antiviral pathway associated with chronic fatigue syndrome Suhadolnik,R.J., Reichenbach,N.L., Hitzges,P., Sobol,R.W., Peterson,D.L., Henry, B, Ablashi,D.V., Muller,W.E., Schroder,H.C. & Carter,W.A. (1994) - Clinical Infectious Diseases, 18 Suppl 1, S96-104
Urinary free cortisol excretion in chronic fatigue syndrome, major depression and in healthy volunteers Scott,L.V. & Dinan,T.G. (1998) - Journal of Affective Disorders, 47, 49-54
US case definition of chronic fatigue syndrome - Diagnostic and theoretical issues Jason LA, King CP, Richman JA et al. - J Chronic Fatigue Synd 1999; 5(3/4): 3-33
Use of medications by people with chronic fatigue syndrome and healthy persons - A population-based study of fatiguing illness in Georgia Boneva RS, Lin JM, Maloney EM, Jones JF, Reeves WC, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA : firstname.lastname@example.org - Health Qual Life Outcomes. 2009 Jul 20;7:67 - PMID: 19619330 Background - Chronic fatigue syndrome (CFS) is a debilitating condition of unknown etiology and no definitive pharmacotherapy. Patients are usually prescribed symptomatic treatment or self-medicate. We evaluated prescription and non-prescription drug use among persons with CFS in Georgia and compared it to that in non-fatigued Well controls and also to chronically Unwell individuals not fully meeting criteria for CFS. Methods - A population-based, case-control study. To identify persons with possible CFS-like illness and controls, we conducted a random-digit dialing telephone screening of 19,807 Georgia residents, followed by a detailed telephone interview of 5,630 to identify subjects with CFS-like illness, other chronically Unwell, and Well subjects. All those with CFS-like illness (n = 469), a random sample of chronically Unwell subjects (n = 505) and Well individuals (n = 641) who were age-, sex-, race- and geographically matched to those with CFS-like illness were invited for a clinical evaluation and 783 participated (48% overall response rate). Clinical evaluation identified 113 persons with CFS, 264 Unwell subjects with insufficient symptoms for CFS (named ISF) and 124 Well controls; the remaining 280 subjects had exclusionary medical or psychiatric conditions and 2 subjects could not be classified. Subjects were asked to bring all medications taken in the past 2 weeks to the clinic where a research nurse viewed and recorded the name and the dose of each medication. Results - More than 90% of persons with CFS used at least one drug or supplement within the preceding two weeks. Among users, people with CFS used an average of 5.8 drugs or supplements, compared to 4.1 by ISF and 3.7 by Well controls. Persons with CFS were significantly more likely to use antidepressants, sedatives, muscle relaxants and anti-acids than either Well controls or the ISF group. In addition, persons with CFS were significantly more likely to use pain-relievers, anti-histamines and cold/sinus medications than were Well controls. Conclusion - Medical care providers of patients with chronic fatigue syndrome should be aware of polypharmacy as a problem in such patients and the related potential iatrogenic effects and drug interactions. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/19619330?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_Single ItemSupl.Pubmed_Discovery_RA&linkpos=3&log$=relatedarticles&logdbfrom=pubmed
Variability in diagnostic criteria for chronic fatigue syndrome may result in substantial differences in patterns of symptoms and disability Leonard A. Jason, Jena Helgerson & Susan R. Torres-Harding, DePaul University - Adam W. Carrico, University of Miami - Renee R. Taylor, University of Illinois - Evaluation & the Health Professions, Vol. 26, No. 1, 3-22 (2003) Chronic fatigue syndrome (CFS) is an illness that involves severe, prolonged exhaustion as well as neurologic, immunologic and endocrine system pathology. Because the pathogenesis of CFS has yet to be determined, case definitions have relied on clinical observation in classifying signs and symptoms for diagnosis. The current investigation examined differences between CFS as defined by Fukuda and colleagues and a set of criteria that has been stipulated for myalgic encephalomyelitis (ME). Dependent measures included psychiatric comorbidity, symptom frequency, symptom severity and functional impairment. The ME and Fukuda et al. (1994) CFS criteria were compared with a group having chronic fatigue due to psychiatric reasons. Significant differences occurred primarily with neurologic, neuropsychiatric, fatigue/weakness and rheumatological symptoms. These findings suggest that it might be inappropriate to synthesize results from studies of this illness that use different definitions to select study populations. Cfr. : http://ehp.sagepub.com/cgi/content/abstract/26/1/3
Vascular perturbations in the chronic orthostatic intolerance of the postural orthostatic tachycardia syndrome Stewart and Weldon J. Appl. Physiol. 2000;89:1505-1512
Viral serologies in patients with chronic fatigue syndrome Buchwald D, Ashley RL, Pearlman T et al. - J Med Virol 1996; 50: 25-30
Vo2peak versus Vo2max ? - An important distinction Sargent C, Scroop GC - Med Sci Sports Exerc 2002; 34: 1215-1216
War syndromes and their evaluation - From the U.S. Civil War to the Persian Gulf War Hyams KC, Wignall FS, Roswell R - Ann Intern Med 1996;125:398–405
What is chronic fatigue syndrome ? - Heterogeneity within an international multicentre study Wilson A, Hickie I, Hadzi-Pavlovic D et al. - Aust N Z J Psych 2001; 35: 520-527
What people say about their general practitioners' treatment of anxiety and depression Andrews G, Carter GL, School of Psychiatry, University of NSW at St Vincent's Hospital, Sydney : email@example.com - Med J Aust. 2001 Jul 16;175 Suppl:S48-51 - PMID: 11556437 (erratum in : Med J Aust 2001 Nov 19;175(10):560 & Med J Aust 2002 Jan 21;176(2):69) Objective - To determine from self-report how often people with anxiety and depressive disorders consult GPs and what treatment they receive. Design - The study was derived from the 1997 Australian National Survey of Mental Health and Wellbeing. A probability sample of adults was interviewed to determine how many had which mental disorders, how disabled they were by those disorders and what treatment they had received. Participants - 10641 adults, a 78% response rate. Main outcome measures - Prevalence of anxiety and depressive disorders and related disability; frequency of consultations for a mental problem; treatment received. Results - 13.6% of the population both met criteria for an anxiety or depressive disorder in the 12 months before the survey and, when they suffered from more than one disorder, nominated this as their principal complaint. They reported some disability in 7 of the previous 28 days, and consulted a GP or other health professional 1.4 times in that period. Over half did not seek a consultation for a mental health problem at any time during the year, many because they thought they had no need. Conclusion - Many people who could benefit from treatment for anxiety and depressive disorders are not being reached. If people were registered with a general practice it would be possible for GPs to take a proactive stance that could result in greater benefit to patients at a lower cost to the health system. Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/11556437?dopt=Abstract Also read the comments on this article : - Mental distress or disorder ? Harris MF, Penrose-Wall J, School of Community Medicine, University of New South Wales, Sydney - Med J Aust. 2001 Jul 16;175 Suppl:S6-7 - PMID: 11556439 Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/11556439?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract - Treating depression - Making it better Ellis PM, Smith DA, Bushnell JA, Wellington School of Medicine and Health Sciences, University of Otago, New Zealand - Med J Aust. 2001 Jul 16;175 Suppl:S8-9 - PMID: 11556440 Cfr. : http://www.ncbi.nlm.nih.gov/pubmed/11556440?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract
When do symptoms become a disease ? Aronowitz RA - Ann Intern Med 2001; 134 Suppl: 803-808 When do symptoms become a disease ? Are there rules or norms, currently or in the past, that tell us when a particular collection of largely symptom-based criteria has enough specificity, utility or plausibility to justify the appellation disease ? The history of numerous symptom-based diagnoses in use today suggests partial answers to these questions. The 19th-century shift to understanding ill health as a result of specific diseases, increasingly defined more by signs than symptoms, led to a loss of status for illnesses that possessed little clinical or laboratory specificity. Nevertheless, clinicians then and now have used symptom-based diagnoses. Some of these diagnoses owe their existence as specific diseases to the norms and practices of an older era much different from our own. Others have not only thrived but have resisted plausible redefinition done by using more “objective” criteria. Many strategies, such as response-to-treatment arguments, quantitative methods (for example : factor analysis) and consensus conferences, have been used to find or confer specificity in symptom-based diagnoses. These strategies are problematic and have generally been used after symptom-based diagnoses have been recognized and defined. These historical observations emphasize that although biological and clinical factors have set boundaries for which symptoms might plausibly be linked in a disease concept, social influences have largely determined which symptom clusters have become diseases. Cfr. : http://www.annals.org/content/134/9_Part_2/803.abstract
In medicine and psychology, a syndrome is the association of several clinically recognizable features, signs (observed by a physician), symptoms (reported by the patient), phenomena or characteristics that often occur together, so that the presence of one feature alerts the physician to the presence of the others. In recent decades, the term has been used outside medicine to refer to a combination of phenomena seen in association.
The term 'syndrome' derives from its Greek roots (σύνδρομος) and means literally "run together", as the features do. It is most often used to refer to the set of detectable characteristics when the reason that they occur together (the pathophysiology of the syndrome) has not yet been discovered. A familiar syndrome name often continues to be used even after an underlying cause has been found or when there are a number of different primary causes that all give rise to the same combination of symptoms and signs. Many syndromes are named after the physicians credited with first reporting the association; these are "eponymous" syndromes (cfr. also the list of eponymous diseases, many of which are referred to as "syndromes"). Otherwise, disease features or presumed causes, as well as references to geography, history or poetry, can lend their names to syndromes.
"Subsyndromal" conditions (or "formes fruste") are those which do not meet full criteria for a diagnosis, for example because the symptoms are fewer or less severe, but which nevertheless can be identified and related to the "full-blown" syndrome.
A culture-bound syndrome is a set of symptoms where there is no evidence of an underlying biological cause and which is only recognized as a "disease" in a particular culture.
When do symptoms become a disease ?
Aronowitz RA - Ann Intern Med 2001; 134 Suppl: 803-808
When do symptoms become a disease ? Are there rules or norms, currently or in the past, that tell us when a particular collection of largely symptom-based criteria has enough specificity, utility or plausibility to justify the appellation disease ?
The history of numerous symptom-based diagnoses in use today suggests partial answers to these questions. The 19th-century shift to understanding ill health as a result of specific diseases, increasingly defined more by signs than symptoms, led to a loss of status for illnesses that possessed little clinical or laboratory specificity.
Nevertheless, clinicians then and now have used symptom-based diagnoses. Some of these diagnoses owe their existence as specific diseases to the norms and practices of an older era much different from our own. Others have not only thrived but have resisted plausible redefinition done by using more “objective” criteria. Many strategies, such as response-to-treatment arguments, quantitative methods (for example factor analysis) and consensus conferences, have been used to find or confer specificity in symptom-based diagnoses. These strategies are problematic and have generally been used after symptom-based diagnoses have been recognized and defined.
These historical observations emphasize that although biological and clinical factors have set boundaries for which symptoms might plausibly be linked in a disease concept, social influences have largely determined which symptom clusters have become diseases.
Burnout is een specifieke stressreactie of toestand van overspannenheid die voornamelijk voorkomt bij mensen in sociale of contactuele beroepen zoals het welzijnswerk, de gezondheidszorg, het onderwijs. Werkende vrouwen en managers hebben er vaker last van dan anderen.
In het algemeen worden bij burnout drie reacties onderscheiden, die niet gelijktijdig hoeven voor te komen : emotionele uitputting, depersonalisatie (het gevoel buiten je eigen lichaam of geest te staan) en verminderde persoonlijke bekwaamheid.
Specifieke symptomen zijn :
Niet meer met plezier naar je werk gaan (als gevolg van vermoeidheid).
Te lang en te veel over het werk piekeren.
Niet meer kunnen genieten van dingen.
Geen zin meer in seks.
Chaotisch denken en handelen (niet meer kunnen organiseren)
Hoofd- en nekpijn.
Verlies van eetlust.
Neurotische klachten zoals schuldgevoelens, angsten, depressies of obsessies manifesteren zich meestal in een latere fase.
De risicofactoren voor burnout zijn : hoge werkdruk, slechte werksfeer, beperkte controlemogelijkheden (zoals beslissen over vrije dagen en pauzes) en lage beloning. Uit onderzoek blijkt dat één op de tien Nederlanders zich 'opgebrand' voelt. Met name werknemers in het onderwijs en de horeca hebben hier last van. Daarnaast komt werkstress in het bijzonder voor bij mensen tussen de 35 en 55 jaar. Er is ook een verband tussen opleiding en werkdruk. Hoe hoger opgeleid, hoe groter de kans op werkstress.
Wie getreiterd wordt op het werk, gaat soms door een hel. Er is een wet die de slachtoffers beschermt, maar er zit een addertje onder het gras : van die bescherming kan je alleen genieten als je je moed bijeenraapt en je klacht op de juiste manier kenbaar maakt.
Dat is gebleken voor het Arbeidshof (arrest van het Arbeidshof van Bergen dd. 28-11-2008 - A.R. nr. 20538). Na een lange voorgeschiedenis had een arbeider op de dag van zijn terugkeer uit ziekte zijn ontslag gekregen. Hij werd uitbetaald en mocht niet meer komen werken.
De man liet het daar niet bij. Hij voerde aan dat zijn problemen het gevolg waren geweest van pesterijen op het werk en eiste voor de rechtbank een morele schadevergoeding van zijn ex-werkgever. Maar hij ving bot – hoewel zijn dokter schriftelijk getuigde dat de zenuwinzinking van zijn patiënt een gevolg was geweest van pesterijen op het werk.
Doktersbriefje is geen bewijs
Om te beginnen aanvaardden de rechters het attest niet als een bewijs. De arts kon wel vaststellen dat zijn patiënt depressief was, maar volgens de magistraten kon hij onmogelijk weten wat zich op de arbeidsplaats had afgespeeld aangezien hij daar nooit was geweest.
Niet meteen naar de rechter…
Een belangrijkere struikelsteen was echter dat de arbeider zich niet kon beroepen op de wet die de slachtoffers beschermt tegen geweld, pesterijen en ongewenst seksueel gedrag op het werk. De arbeider had nl. niet eerst het probleem binnen het bedrijf aangekaart, vooraleer hij naar de rechter was gestapt. Dat is nochtans wat de wet voorschrijft.
Doordat hij niet kon steunen op de pestwet, kon de arbeider niet genieten van de zogenaamde “omkering van bewijslast”. Dit is één van de voordelen van de pestwet. Het betekent dat het de (ex-)werkgever is die moet bewijzen dat er géén pesterijen hebben plaatsgevonden. Om de morele schadevergoeding te kunnen bekomen, had de arbeider in dit geval dus zelf bewijzen op tafel moeten leggen, wat hij niet had gedaan.
… maar naar de preventieadviseur
De les is duidelijk. Voel je je het mikpunt van geweld, pestgedrag of ongewenste seksueel getinte woorden of handelingen op je werk, neem dan contact op met de vertrouwenspersoon of met de preventieadviseur. Uitleg vind je in 'Nieuwe antipestwet is van kracht' (VDAB.be/magezine, juli 2007) (cfr. hierna).
Geweld, pesterijen en ongewenst seksueel gedrag op het werk, we weten dat het gebeurt. Gelukkig bestaat sedert 1996 een wet die de slachtoffers beschermt. Sinds 16 juni 2007 is deze wet op heel wat punten veranderd.
Ziehier in een notendop wat je moet weten als je geen andere uitweg meer ziet dan je te beroepen op de wet.
1. - Waarover gaat het ?
De nieuwe wet verstaat onder geweld :
tijdens de uitvoering van het werk.
De nieuwe wet verstaat onder pesterijen :
herhaalde feiten, buiten of binnen de onderneming, die de werknemer vernederen of zijn job in gevaar brengen,
bedreigingen, handelingen of woorden die een onleefbare werkomgeving creëren (kwetsende opmerkingen over bijv. godsdienst, leeftijd, geslacht, etnische afkomst, handicap of seksuele geaardheid vallen hieronder).
De nieuwe wet verstaat onder ongewenst seksueel gedrag :
ongewenste seksueel getinte woorden of handelingen.
2. - Wat is je eerste stap ?
De nieuwe wet raadt je sterk aan de kwestie te regelen binnen de onderneming. Je werkgever is verplicht twee zaken op te nemen in het arbeidsreglement :
de naam en de gegevens van de vertrouwenspersoon en van de preventieadviseur,
de stappen die je moet zetten om de feiten aan te klagen.
De nieuwe wet geeft de vertrouwenspersoon meer macht, maar je werkgever is niet verplicht er een aan te stellen. In dat geval moet je op de preventieadviseur rekenen.
3. - Wat indien de pesterijen niet stoppen ?
Wat als je een klacht hebt ingediend bij de vertrouwenspersoon of de preventieadviseur, maar de pesterijen blijven ? Dan kan je tijdens de interne procedure toch naar de arbeidsrechtbank stappen en maatregelen vragen. De rechter kan bijv. beslissen dat de collega die jij aanklaagt, verbod krijgt om de lokalen te betreden waar jij werkt.
4. - Wat indien de interne procedure niets oplevert ?
Dan kan je naar de rechtbank. Je zal moeten aantonen dat je eerst vruchteloos geprobeerd hebt een oplossing te bereiken binnen de onderneming. Het kan ook zijn dat jouw werkgever nalatig is en geen interne procedures heeft voorzien. In zo’n geval mag je meteen naar de rechter.
Als er wél interne regels bestaan, maar ze worden niet toegepast, dan dien je best klacht in bij de Dienst Toezicht op het Welzijn op het werk (tel. : 02 233 45 11) : www.werk.belgie.be -.
5. - Riskeer je je job te verliezen ?
Neen, want je geniet van ontslagbescherming vanaf het moment dat de klacht is ingediend. Het is de werkgever verboden de volgende personen te ontslaan of hun arbeidsvoorwaarden te veranderen (tenzij om totaal andere redenen) :
de werknemer die een met redenen omklede klacht heeft ingediend volgens de interne procedures van de onderneming
of die een klacht heeft ingediend bij de Dienst Toezicht op het Welzijn op het werk
of die een klacht heeft ingediend bij de politie of bij het gerecht (openbaar ministerie of onderzoeksrechter)
of die bij de rechtbank een proces is begonnen wegens geweld, pesterijen of ongewenst seksueel gedrag.
De ontslagbescherming geldt ook voor wie optreedt als getuige, zowel in een interne procedure als in een externe.
6. - Wat als je elders wil gaan werken ?
Als de procedure is afgelopen en de feiten zijn bewezen, maar de werkgever wil het slachtoffer niet in dienst houden, dan heeft het slachtoffer recht op een schadevergoeding.
Maar wat indien het slachtoffer zélf geen zin heeft om te blijven, iets wat vaak gebeurt ? De nieuwe wet bepaalt dat de schadevergoeding ook moet betaald worden wanneer het slachtoffer zelf weigert te blijven werken in de onderneming.
7. - Waar vind je de wettekst ?
Aangename lectuur is het beslist niet, maar als je om welke reden ook de tekst van de wet zelf wilt opsporen, dan surf je naar de website van het Belgisch Staatsblad : www.ejustice.just.fgov.be -. Daar zoek je naar het Staatsblad van 6 juni 2007; het datumvak vul je in op zijn Amerikaans, dus als volgt : '2007 – 06 – 06'. Gebruik als zoekterm het woord "geweld". Dat levert dan de drie teksten op die je nodig hebt : een koninklijk besluit van 17 mei 2007, een wet van 6 februari 2007 en een wet van 10 januari 2007.
Automatisering heeft het Nederlandse kantoorwerk de laatste twintig jaar drastisch veranderd. Een groot deel van de Nederlandse beroepsbevolking brengt zijn werkdagen achter het computerbeeldscherm door.
De intrede van de automatisering heeft naast veel lusten ook enkele lasten opgeleverd. Spieren bewegen monotoon gedurende langere tijd, je zit uren achtereen in dezelfde houding achter een bureau in soms niet al te comfortabele bureaustoelen en ogen staren de hele dag naar een beeldscherm.
In 1992 nam Nederland in de ARBO-wet het 'Besluit Beeldschermwerk' op. Hierin staan belangrijke richtlijnen, bestemd voor iedereen die met de ARBO-wet te maken heeft. Dus niet alleen de werknemers zelf, maar ook de werkgevers en automatiseerders zijn eraan gebonden. Werkplekken moeten voldoen aan de regels die in het besluit zijn opgenomen.
Die regels hebben onder meer te maken met de apparatuur die je gebruikt; inrichting van de werkplek en verplichte pauzes zodat je niet te lang achtereen achter de pc zit.
Is jouw werkplek 'ARBO-proof' ? En wat vind je van die regels : goed dat ze er zijn of is het overdreven ? Lees de extra informatie om meer te lezen over de ARBO-wetgeving en geef hier een reactie.
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Chiropractie - Vrijspraak voor Simon Singh in smaadzaak
Chiropractie Vrijspraak voor Simon Singh in smaadzaak
Martijn van Calmthout – de Volskrant, 02-04-2010
AMSTERDAM - De Britse wetenschapsjournalist Simon Singh heeft met zijn felle campagne tegen chiropracters geen smaad gepleegd, maar normale kritische vragen gesteld bij de werkzaamheid van een alternatieve geneeswijze.
Dat heeft het hoogste Britse hof donderdag geoordeeld in een al twee jaar slepende zaak van de vereniging van chiropracters tegen Singh. Eerder had de Hoge Raad geoordeeld dat de zaak van de beroepsvereniging tegen Singh een smaadzaak was.
Het gevolg was dat Singh in dat geval zou moeten aantonen dat chiropractische behandelingen, waarbij het lichaam wordt gemasseerd en gewrichten gerekt, niet werken tegen darmklachten en astma, zoals hij in krantenstukken had verondersteld. Daarmee werd de bewijslast omgedraaid. Singh had in krantenartikelen in The Guardian in 2008 de beroepsgroep gevraagd te bewijzen dat behandelingen wel werken.
De zaak werd onder Britse wetenschappers en journalisten met grote belangstelling gevolgd, omdat het de speelruimte voor kritiek op alternatieve geneeswijzen ernstig zou kunnen inperken. Dat lijkt nu niet het geval.
Singh zei in een reactie op het vonnis gelukkig te zijn met het oordeel van de hogerechters, maar memoreerde dat de kwestie hem hoe dan ook 200 duizend pond aan juridische bijstand heeft gekost : ‘Geen wonder dat critici wel tweemaal nadenken over wat ze zeggen en schrijven.’
De voorzitter van de Britse vereniging van chiropracter toonde zich teleurgesteld over de uitspraak, maar zei nog mogelijkheden te zien voor verdere acties tegen Singh.
De Steungroep ME en Arbeidsongeschiktheid roept ME/CVS patiënten op om mee te werken aan onderzoek van TNO naar de Wet tegemoetkoming chronisch zieken en gehandicapten (WTCG).
Op grond van de WTCG kunnen ouderen, arbeidsongeschikten en mensen die veel zorg gebruiken tegemoetkomingen krijgen die variëren van 150 tot 500 euro per jaar. Dit als compensatie voor hoge meerkosten.
Het onderzoek is bedoeld om na te gaan hoe op een betere manier kan worden bepaald of iemand voor zo'n tegemoetkoming in aanmerking komt en tot welk bedrag.
Door de criteria die hiervoor nu gelden vallen bepaalde groepen buiten de boot. Enkele van die criteria zijn gekoppeld aan medicijngebruik of ziekenhuisbehandeling voor bepaalde aandoeningen. Hierbij vallen ME/CVS-patiënten buiten de boot. Alleen voor kinderen met ME/CVS die in een ziekenhuis behandeld worden ligt er nu een plan om dit aan te passen. Maar ook volwassenen met ME/CVS hebben door hun ziekte vaak forse meerkosten en niet alleen wanneer zij in een ziekehuis behandeld worden.
Op grond van criteria die niets met de behandeling van ME/CVS te maken hebben kunnen ME/CVS-patiënten soms wel in aanmerking komen voor een (gedeeltelijke) tegemoetkoming. Dit is bijvoorbeeld het geval bij het krijgen van een bepaalde hoeveelheid huishoudelijke hulp via de Wet Maatschappelijke Ondersteuning (WMO) of bij een arbeidsongeschiktheid van minstens 35%. Het TNO-onderzoek zou kunnen bijdragen aan voorstellen die meer recht doen aan de positie van ME/CVS-patiënten.
Het invullen van de vragenlijst gaat via internet en duurt volgens de onderzoekers ongeveer een half uur. Het is een algemene vragenlijst, waardoor iemand met ME/CVS zich niet in alle vragen zal herkennen (ergens 'zin' in hebben is bijvoorbeeld heel iets anders dan ergens 'energie' voor hebben). Maar als je je daar overheen zet is er redelijk ruimte om je beperkingen en meerkosten door te geven.
Cfr. voor informatie over het onderzoek en vragenlijst 'TNO-onderzoek naar afbakening Wtcg' op : www.tno.nl/wtcg -.
Magical Medicine - How to make a disease disappear
Magical Medicine : How to make a disease disappear
Press Relaese - Medical Research Council, 12th February 2010 Contact : Professor Malcolm Hooper (tel. : +44 191 528 5536)
A formal complaint has been lodged by Professor Malcolm Hooper with the Rt. Hon The Lord Drayson, Minister of State with responsibility for the Medical Research Council (Science and Innovation) about the “PACE” Clinical Trial of behavioural modification interventions for people with Myalgic Encephalomyelitis (ME) / Chronic Fatigue Syndrome (CFS).
PACE is the acronym for 'Pacing, Activity and Cognitive behavioural therapy', a randomised Evaluation, interventions that, according to one of the Principal Investigators, are without theoretical foundation.
The MRC’s PACE Trial seemingly inhabits a unique and unenviable position in the history of medicine. It is believed to be the first and only clinical trial that patients and the charities that support them have tried to stop before a single patient could be recruited and is the only clinical trial that the Department for Work and Pensions (DWP) has ever funded.
Since 1993, the giant US permanent health insurance company UNUMProvident has been advising the UK DWP about the most effective ways of curtailing sickness benefit payments. The PACE Trial is run by psychiatrists of the Wessely School, most of whom work for the medical and permanent health insurance industry, including UNUMProvident.
These psychiatrists insist – in defiance of both the World Health Organisation and the significant biomedical evidence about the nature of it -- that “CFS/ME” is a behavioural disorder, into which they have subsumed ME, a classified neurological disorder whose separate existence they deny. Their beliefs have been repudiated in writing by the World Health Organisation.
In 1992, the Wessely School gave directions that in cases of ME/CFS, the first duty of the doctor is to avoid legitimisation of symptoms; in 1994, ME was described by Professor Simon Wessely as merely “a belief”; in 1996 recommendations were made that no investigations should be performed to confirm the diagnosis and in 1999 patients with ME/CFS were referred to as “the undeserving sick”.
The complaint is supported by a 442 page Report which addresses areas of major concern about the PACE Trial.
These include apparent coercion and exploitation of patients, flawed methodology, apparent lack of scientific rigour, apparent failure to adhere to the Declaration of Helsinki, the unusual personal financial interest of the Chief Investigator, the vested financial interests of the Principal Investigators and others involved with the trial and the underlying non-clinical purpose of the trial.
The psychiatrists’ unproven beliefs and assumptions are presented as fact and trial therapists have been trained to provide participants with misinformation; therapists have also been trained to advise participants to ignore symptoms, a situation that may in some cases result in death.
There are some extremely disquieting issues surrounding the MRC PACE Trial and documents obtained under the Freedom of Information Act allow the full story to be told for the first time.
People with ME/CFS do not seek any special consideration; they simply wish to be treated equally to those who suffer from other classified neurological disorders.
As shown in the Report that accompanies the complaint, the MRC PACE Trial clearly demonstrates that people with ME/CFS are not treated equally to those with other chronic neurological disorders.
Chronic fatigue syndrome is an illness characterized by a profound, disabling and unexplained sensation of fatigue lasting at least 6months, which severely impairs daily functioning and is accompanied by a combination of non-specific symptoms. Many potential causes of chronic fatigue syndrome have been investigated, including viral infections, immune dysfunctions, abnormal neuroendocrine responses, central nervous system abnormalities, autonomic dysfunctions, impaired exercise capacities, sleep disruptions, genetic backgrounds, psychiatric abnormalities, personality and abnormal psychological processes. However, no etiology, specific physical signs or laboratory test abnormalities have been found. It is essential to establish a conceptual theory of chronic fatigue syndrome that can explain its pathophysiology in order to identify the clinical entity and to develop effective treatment methods. In this article, a new conceptual hypothesis about the pathophysiology of chronic fatigue syndrome, the co-conditioning theory, is presented : after repetitive overwork and/or stress, alarm signal to rest and fatigue sensation may cause in response to an unconditioned stimulus (impaired homeostasis and function) that has been paired with a conditioned stimulus (overwork and/or stress). In the future, a new treatment strategy for patients with chronic fatigue syndrome, re-co-conditioning therapy, may be developed on the basis of the co-conditioning theory. In addition, this theory will likely contribute to a better understanding of the pathophysiology of chronic fatigue syndrome.