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Query: UMLS:C0015672 (fatigue)
 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Chronic fatigue syndrome is a poorly understood disease characterized by debilitating fatigue and neuromuscular and neuropsychological symptoms. Despite numerous studies on the subject, the epidemiology of the syndrome in the community remains largely unexplored. An estimate of the prevalence in the population is presented, approximating the Centers for Disease Control criteria as well as the prevalence estimates of the fatigue symptom complex that include fatigue, disability, and neuromuscular and neuropsychological symptoms. The study population consisted of a very large, multicenter, stratified, and random sample of a general population health survey known as the Epidemiologic Catchment Area Program. Data used for this study were gathered between 1981 and 1984. The Diagnostic Interview Schedule, a highly structured mental health interview, was used to assess the lifetime prevalence of medical and psychological symptoms. Chronic fatigue was common. A total of 23 percent of the subjects reported having experienced the symptom of persistent fatigue sometime during their lives. Chronic fatigue syndrome, however, as defined by the Centers for Disease Control, appeared to be quite rare in the general population. Only 1 of 13,538 people examined was found to meet a diagnosis of the syndrome with an approximation of the CDC criteria. Fatigue symptom complex was frequently related to medical or psychiatric illness or substance abuse; thus, persons meeting partial criteria of chronic fatigue syndrome were also found to be rare when psychiatric or medical exclusions were applied.
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PMID:Estimating the prevalence of chronic fatigue syndrome and associated symptoms in the community. 843 91

A high prevalence of mood disorders has been found among persons with chronic fatigue. The comorbidity of mood disorders and substance use disorders has long been recognized. In this study, the prevalence of substance use disorders among 100 patients with chronic fatigue was examined. Twenty-eight patients met DSM-III-R criteria for a lifetime diagnosis of substance abuse or dependence; ten of these patients had a current diagnosis. Forty-nine patients had no history of substance abuse or dependence but had other lifetime psychiatric diagnoses. Twenty-three patients had no history of substance abuse or psychiatric illness. No differences in demographic characteristics or in the features of chronic fatigue were found among the three groups. Patients with chronic fatigue who had a lifetime history of a substance use disorder reported more lifetime depressive symptoms and were more likely to have had suicidal ideation or attempts.
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PMID:Substance use disorders in patients with chronic fatigue. 174 63

Depressed patients and suicidal patients are common Emergency Department patrons with the potential for serious morbidity or death. Dysphoric mood, vegetative symptoms, and negative perceptions of oneself, the environment, and the future are characteristic of depression. Often, the patient is unaware of the depression and presents with a variety of somatic complaints, chronic fatigue, or pain syndromes. In these instances, the physician must consider the diagnosis of depression and ask the patient about any history of depressive symptoms. In all depressed patients, a careful history and physical examination are needed to identify any drugs or concurrent medical illnesses which might cause or exacerbate the depression. If depression is suspected or if the patient presents after a suicide attempt, then a thorough evaluation of suicide potential is mandatory. Several risk factors for completed suicide exist. Male sex, age under 19 or over 45, few social supports, and a history of previous suicide attempts are all factors associated with increased suicide rates. Concurrent chronic or severe medical illnesses and certain psychiatric illnesses, notably depression, schizophrenia, and substance abuse, also increase an individual's risk for suicide. The method of suicide attempt and the chance for rescue must also be considered when determining risk as well as the presence of an organized plan. Acute psychosis in the suicidal patient is an ominous finding and these patients should be admitted to the hospital. The physician must adopt an empathetic and nonjudgmental attitude when caring for potentially suicidal patients. Disposition can be determined after careful evaluation of risk factors, circumstances surrounding the attempt, and the patient's current feelings. Consultation with a psychiatrist or another mental health professional is desirable for any potentially suicidal patient. Many such patients can be safely treated as outpatients with proper referral; certain high-risk individuals will need to be admitted to the hospital. The decision to either hospitalize or discharge can be difficult and the emergency physician should admit the patient if doubt exists.
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PMID:Depression and suicide assessment. 200 61

Interviewers questioned 496 low-income black and Hispanic women postpartum in New York City on attitudinal, motivational and financial barriers to prenatal care. Women who had little or no prenatal care were oversampled, so this study is not representative of the New York City population. Oversampling also fixes the distribution of the dependent variable which can bias the regression coefficients unless logistic regression is used. In this study, 54% of the women had received timely prenatal care, while 46% received late or no care. A questionnaire was used with both open-ended and closed questions to determine which barriers to prenatal care were most important. Age was a categorical variable for the descriptive analysis, and a continuous variable for the regression analyses. Health insurance was used as a series of dummy variables. The timely care group ranked depression, lack of energy, travel distance, and transportation problems among the top barriers to prenatal care. The late or no care group ranked lack of energy, depression, cost of care, travel distance, transportation problems, and lack of child care among the top barriers. Those who were most likely to receive timely care were those women with health insurance. Those women with regular doctors were also more likely to receive good prenatal care. Logistic regression according to 2 models showed that late or no prenatal care could be predicted. Lack of health insurance is a major predictor of timely prenatal care. Substance abuse also played an important role in the timeliness of prenatal care. Recommendations are made to reform maternity service financing, and to alleviate substance abuse among pregnant women.
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PMID:Barriers to prenatal care among low-income women in New York City. 227 80

Posttraumatic stress disorder, formally known as battle fatigue, is a real entity in those offices where investigators and pathologists perform the role of death certifiers. Failure to acknowledge this problem may predispose the unsuspecting agency employees to frequent job changes, disruptive behavior, and substance abuse.
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PMID:Posttraumatic stress disorder. A real entity in death investigation. 335 30

The impact of alcohol and marijuana abuse on the physical health and nutritional status of adolescents has not been well documented. The health consequences of alcoholism and chemical abuse in adults may not relate to the pediatric population. Forty-nine adolescent boys (mean age 15.8 years) with varying degrees of alcohol and marijuana use by self-report were evaluated as to their general health, pubertal development and nutritional status using health and dietary history, physical examination, anthropometrics, and biochemical assays of liver function and tissue nutrients. Thirteen (27%) were alcohol and marijuana abusers, 20 (41%) marijuana abusers, and 16 (32%) nonusers. There were significant differences between alcohol and marijuana abusers and marijuana abusers compared to nonusers with respect to endorsing symptoms of nutritional deficiency (muscle weakness, bleeding gums, tiredness, etc) (P less than .001). There were no significant differences between subgroups in other nutritional measures except plasma zinc concentration which was low in marijuana abusers (mean 85 micrograms/dL). All adolescents reported consuming adequate nutrients, although alcohol and marijuana abusers reported eating more snack foods and less fruit, vegetables, and milk than other groups. There were no significant differences in hematologic status (complete blood cell count, transferrin, folate), liver function (gamma-glutamyltranspeptidase), or anthropometric and sexual maturational indices of growth. There were no chronic signs of chemical abuse by physical examinations. It appears that health and nutritional disability from chemical abuse in adolescents relates more to poor dietary habits and symptomatic deterioration in general health than to specific effects on growth or nutritional status. Studies with larger numbers of subjects need to document these findings.
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PMID:Health, developmental, and nutritional status of adolescent alcohol and marijuana abusers. 349 3

Adolescent depression occurs within various developmental, social, and biologic contexts, and is manifested by traditional depressive symptoms such as fatigue, loss of interest in daily activities, weight changes, sleep disturbances, sad moods, difficulty with concentration, behavioral agitation or lethargy, feelings of worthlessness, and recurrent thoughts of death. Depressed adolescents may combine these symptoms with certain additional behaviors such as academic deterioration, substance abuse, sexual activity, somatic complaints, eating disorders, conduct disorders, and other risk-taking behaviors. School nurses can play a central role in the prevention, assessment, referral, and follow-up care of this significant adolescent health problem.
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PMID:A review for school nursing professionals: adolescent depression. 828 6

In this retrospective study, the charts of 100 consecutive cancer patients who had been referred to a palliative care consult team within a tertiary acute care hospital were reviewed. Demographic characteristics, including reason for admission and disease status upon admission, length of stay, and discharge and admission location, were recorded. Symptom acuity, cognitive status, and risk for substance abuse were evaluated. Medications before and after the consult were tabulated and compared to recommended medications; compliance with the recommendations was assessed. Five patients were not palliative at the time of the consult. Only 46/95 (48%) were known to have untreatable cancer at the time of their admission. The CAGE questionnaire for alcoholism and the Mini-Mental State Questionnaire (MMSQ) were abnormal in 19/78 (24%) and 40/91 (44%), respectively. The most intense symptoms, as measured by the 100-mm scales of the Edmonton Symptom Assessment Scale (ESAS) were fatigue (72 +/- 24), appetite (60 +/- 32), and well-being (50 +/- 29). Eighty-nine of the 95 patients were living at home prior to admission and 34/95 were able to return home. Twenty died during hospitalization, 23 were transferred to a palliative care unit, and the remaining 18 were discharged to another hospital or long-term care. The patient's physician complied with the palliative care consult team's recommendation in 122/137 cases (89%).
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PMID:Demographic, symptom, and medication profiles of cancer patients seen by a palliative care consult team in a tertiary referral hospital. 1076 Jun 22

Medical students, who deal routinely with difficult studies and with patients, are not always prepared for this challenge. This may produce a specific and important source of stress. As a consequence, medical students may sometimes develop maladaptive responses, such as substance abuse. This study aimed to evaluate performance-enhancing drug use among medical students at the University Hospital of Nancy, France. A self-administered anonymous questionnaire was given to all 104 eighth-year residents. The 93 responding students (37 female and 56 male), were aged 28.0 +/- 2.2 years (mean +/- SD); 53 per cent of the subjects reported enhancing-substance use in their first year of medical studies (72 per cent during preparation for their difficult examinations and 28 per cent throughout the year). The main substances were vitamins, anti-fatigue capsules, betablockers, marijuana (illicit drug) and benzodiazepines; 46 per cent of them were still using these drugs during the second to sixth years of their medical course. The main sources of drugs were retail pharmacists, with or without medical prescriptions. Could this use persist and lead to doctors with substance problems?
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PMID:[Consumption of performance-enhancing drugs by medical students in Nancy]. 1096 17

This article reports on the feasibility of using a contingency management intervention with adolescent smokers that has proven efficacious in adult substance abuse treatment. The study used 8 adolescent participants in an A (1 week)-B (1 week)-A (1 week) reversal design. During the 2 baseline phases, no contingencies were placed on cigarette smoking, and adolescents received money noncontingently. During the experimental intervention week, adolescents received payment contingent on not smoking. The magnitude of reimbursement available during the baseline and intervention phases was equated. Results indicated that the contingency management intervention was effective in reducing smoking, both in terms of increasing the total number of abstinences and consecutive abstinences. In addition, changes in adolescents' affective states during smoking cessation were found. Anxiety, depression, anger, and fatigue were reported, and these negative states ceased once smoking resumed.
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PMID:Contingency management interventions for treating the substance abuse of adolescents: a feasibility study. 1097 28


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