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The primary health effect of Chernobyl has been widespread psychological distress in liquidators (workers brought in for cleanup), evacuees, residents of contaminated areas, and residents of adjacent noncontaminated areas. Several psychoneurological syndromes characterized by multiple unexplained physical symptoms including fatigue, sleep and mood disturbances, impaired memory and concentration, and muscle and/or joint pain have been reported in the Russian literature. These syndromes, which resemble chronic fatigue syndrome and fibromyalgia, are probably not due to direct effects of radiation because they do not appear to be dose related to radiation exposure and because they occur in areas of both high and low contamination.
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PMID:Radiophobia: long-term psychological consequences of Chernobyl. 1187 98

Cross-sectional studies have consistently shown a relationship between chronic widespread pain, the clinical hallmark of fibromyalgia, and psychological distress. These studies cannot distinguish the direction of any causal relationship. Recent population based studies have reported that such pain is predictive of future distress. However, chronic pain is often associated with physical and psychological co-morbid features which may confound this relationship. The aim of this study was to examine the hypothesis that chronic widespread pain increases the risk of future distress after adjusting for the effects of possible confounding factors. A population based survey of 1953 individuals identified subjects' psychological status and whether they satisfied criteria for chronic widespread pain. At baseline co-morbid features of chronic widespread pain, including reporting other somatic symptoms, abnormal illness behaviour, health anxiety, fatigue and low levels of self-care, were measured. All subjects were followed up after 12 months to determine levels of psychological distress. Subjects with chronic widespread pain at baseline were much more likely to be distressed at follow up (OR=4.0, 95% CI (2.5,6.3)). As levels of distress at follow up may simply reflect those at baseline the association was adjusted for baseline levels of distress. Chronic widespread pain was, however, still associated with future distress although the relationship was slightly attenuated (odds ratio, OR=3.0, 95% CI (1.8,5.1)). To examine our main hypothesis a final analysis was undertaken adjusting this association for those co-morbid features assessed at baseline. Following these adjustments chronic widespread pain was no longer significantly associated with future distress (OR=1.5, 95% CI (0.8,2.9)). Chronic widespread pain was associated with increased levels of psychological distress at follow up. However, a more rigorous analysis indicated that the association between baseline pain status with future distress was explained by concomitant features of chronic pain rather than pain per se. These findings indicate that it is those persons with chronic widespread pain in the presence of other physical and psychosocial factors who will become distressed.
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PMID:Does chronic pain predict future psychological distress? 1197 95

In this study, exercise self-efficacy was manipulated in a laboratory setting and its effects on feeling state responses were examined. A sample consisting largely of Non-Latina White and Latina women (N = 59) were randomly assigned to a low- or high-efficacy condition, and efficacy was manipulated by provision of false feedback and computer data. Feeling state responses were assessed before and after exercise. Efficacy was successfully manipulated, and participants in the high-efficacy condition reported more positive well-being and energy and less psychological distress and fatigue than those in the low-efficacy condition. There were no significant differences between the two ethnic groups for self-efficacy and feeling state responses. In addition, no clear pattern of relations emerged between efficacy and feeling state responses. The results support structuring exercise treatments in such a way that mastery experiences and positive feedback are maximized to enhance self-efficacy and improve subjective experiences.
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PMID:Self-efficacy effects on feeling states in women. 1217 32

Hospital clinics for patients with chronic unexplained fatigue are held in departments of various disciplines. This causes difficulties for referrers in choosing the appropriate clinic and for researchers in generalizing findings from one type of clinic to others. We randomly selected 37 outpatients attending an immunology fatigue clinic and 36 outpatients attending a psychiatry fatigue clinic, all of whom had chronic fatigue syndrome. We compared demographic factors, symptoms, disability, quality of life, psychological distress and illness attributions. The patients from the two clinics were closely similar in their specific symptoms, disability, quality of life, psychological distress and previous attendance to mental health professionals. Psychological distress was high and equal in the two samples. The proportion of men was greater among patients attending the immunology clinic. In a post-hoc analysis, 64% of immunology attenders attributed their fatigue to physical factors, compared with 31% of psychiatry clinic attenders (chi(2)=6.35, 1 d.f., P=0.01). These findings suggest that research data from one type of chronic fatigue clinic can be generalized to others. Clinically similar patients are referred to different clinics, and the choice of clinic may be influenced by the patients' illness beliefs. The high levels of emotional distress suggest that psychosocial management is as important as physical management in hospital outpatients with chronic fatigue syndrome, irrespective of its aetiology.
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PMID:A comparison of patients with chronic fatigue syndrome attending separate fatigue clinics based in immunology and psychiatry. 1220 7

This article examines the relationships between chemotherapy-induced anemia, fatigue, and psychological distress among anemic cancer patients with solid tumors. Patients participating in two randomized clinical trials evaluating the efficacy of darbepoetin alfa (Aranesp) completed a questionnaire at baseline, at the beginning of each chemotherapy cycle, and at the end of the 12-week treatment period. The questionnaire included four psychological distress outcomes: Brief Symptom Inventory (BSI) Depression and Anxiety, Functional Assessment of Cancer Therapy (FACT)-Emotional Well-Being, numeric rating scale of Overall Health, and the FACT-Fatigue subscale. Patients with a hemoglobin response of at least a 2 g/dL increase were more likely to experience meaningful improvements (at least 3 points) in FACT-Fatigue scores than nonresponders (55.0% vs 39.8%; P = .0004). Patients with meaningful improvements in FACT-Fatigue scores reported significantly greater improvements in each of the psychological outcomes relative to those without improved fatigue (P <.0001). For BSI Depression and Anxiety, the differences in mean change scores between patients with and without improved fatigue were 8.2 and 7.7, respectively. Improving the hemoglobin levels of patients undergoing chemotherapy and suffering from anemia-related fatigue has the potential to produce significant positive effects on patients' fatigue, depressive symptoms, anxiety, feelings of helplessness, and overall health.
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PMID:Psychological outcomes associated with anemia-related fatigue in cancer patients. 1238 Sep 61

Fatigue is common in patients with cancer. Fatigue is very distressing to patients, who often view it as an indication that their disease is progressing or that treatment is ineffective. Patients with a cancer diagnosis frequently have psychological distress. Communication and information help patients cope with the diagnosis of cancer and with the management of side effects. Presenting clear, concise, and well-timed communication to patients regarding fatigue management is an important role for health care providers. This article gives an overview of cancer-related fatigue, the various attitudes that prevail among cancer patients seeking information, and interventions patients can use to help manage their fatigue. Armed with this knowledge, oncology nurses and physicians can better meet the need to provide appropriate information about fatigue to patients and families, and at most appropriate points in the illness.
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PMID:Patient communication and strategies for managing fatigue. 1238 Sep 64

This study examined the concept of need for recovery, that is the need to recuperate from work-induced fatigue, experienced after a day of work. The study explored the relationship between need for recovery from work, prolonged fatigue, and psychological distress in the working population. A cross-sectional study was carried out. Data of the Maastricht Cohort Study on fatigue at work were used (n = 12,095). Some degree of need for recovery was found in nearly all employees. Need for recovery from work was associated with demographic, work-related, and health factors. Principal Components Analysis revealed obvious separation between need for recovery items and both fatigue items and psychological distress items, supporting the notion that need for recovery, fatigue, and psychological distress represent different underlying concepts. Although need for recovery, fatigue, and psychological distress were frequently comorbid, they also clearly occurred as separate entities.
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PMID:Need for recovery in the working population: description and associations with fatigue and psychological distress. 1251 72

Noxious stimuli and painful disorders interfere with sleep, but disturbances in sleep also contribute to the experience of pain.Chronic paroxysmal hemicrania and possibly cluster headaches are related to REM sleep. Whereas headache is associated with snoring and sleep apnea, morning headaches are not specific for any primary sleep disorder. Nevertheless, the management of the sleep disorder ameliorates both morning headache and migraine.Noxious stimuli administered into muscles during slow-wave sleep (SWS) result in decreases in delta and sigma but an increase in alpha and beta EEG frequencies during sleep. Noise stimuli that disrupt SWS result in unrefreshing sleep, diffuse musculoskeletal pain, tenderness, and fatigue in normal healthy subjects. Such symptoms accompany alpha EEG sleep patterns that often occur in patients with fibromyalgia. The alpha EEG patterns include phasic and tonic alpha EEG sleep as well as periodic K alpha EEG sleep or frequent periodic cyclical alternating pattern. Moreover, alpha EEG sleep, as well as sleep-related breathing disorder and periodic limb movement disorder, occur in some patients with fibromyalgia, rheumatoid arthritis and osteoarthritis. Depression and not alpha EEG sleep are features of somatoform pain disorder. Disturbances in sleep, pain behaviour and psychological distress influence return to work in workers who have suffered a soft tissue injury, e.g. low back pain. Patients with irritable bowel disorder have disturbed sleep and have increased REM sleep. In conclusion, there is a reciprocal relationship between sleep quality and pain. The recognition of disturbed or unrefreshing sleep influences the management of painful medical disorders.
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PMID:Sleep and pain. 1253 Oct 4

Fatigue is a common disabling symptom of multiple sclerosis (MS). It is often considered a state of exhaustion distinct from depressed mood or physical weakness. Fatigue can be assessed by either self-report scales or performance-based measures; however, neither method captures all features of fatigue. Fatigue in MS frequently leads to unemployment. It is associated with a sense of loss of control over one's environment, low positive affect, psychological distress and neurological impairment. To date there is no reproducible neuroimaging marker or biological correlate that has been identified. Proposed pathological mechanisms of fatigue in MS include neuronal factors such as dysfunction of premotor, limbic, basal ganglia or hypothalamic areas; disruption of the neuroendrocrine axis leading to low arousal; alteration in serotoninergic pathways; changes in neurotransmitter levels; and altered CNS functioning caused by a disruption of the immune response. Treatment of fatigue is best approached in a multidisciplinary fashion that incorporates nonpharmacological interventions as well as medication. Amantadine and modafinil are among the most commonly used medications for fatigue associated with MS. Both medications have been studied with positive results in controlled clinical trials. Additional research towards measurement and pathogenesis of fatigue will hopefully lead to improved therapies.
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PMID:Fatigue in multiple sclerosis: definition, pathophysiology and treatment. 1266 96

In 1998, a large scale prospective cohort study of prolonged fatigue in the working population was started in the Netherlands. The ultimate goal of this Maastricht Cohort Study was to identify risk factors involved in the aetiology and natural course of prolonged fatigue in the working population and to develop preventive measures and treatments that can be used in occupational health settings. In this paper, a conceptual model for epidemiological research on prolonged fatigue is presented. This model is the basis for the Maastricht Cohort Study. Alongside the model and design, the characteristics of the study population, the prevalence and one year cumulative incidence of prolonged fatigue, as well as its relation with secondary health outcomes (psychological distress, need for recovery, and burnout) are presented. Furthermore, model, design, and the presented results are discussed.
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PMID:An epidemiological approach to study fatigue in the working population: the Maastricht Cohort Study. 1278 45


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