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

The chronic fatigue syndrome (CFS) was formally defined in 1988 to describe a syndrome of severe and disabling fatigue of uncertain aetiology associated with a variable number of somatic and/or psychological symptoms. CFS has been reported in most industrialised countries and is most prevalent in women aged between 20 and 50 years. Despite occasional claims to the contrary, the aetiology of CFS remains elusive. Although abnormalities in tests of immune function and cerebral imaging have been described in variable numbers of CFS patients, such findings have been inconsistent and cannot be relied upon, either to establish or exclude the diagnosis. Thus, diagnosis rests on fulfillment of the Centers for Disease Control case definition which was revised in 1992. This case definition remains somewhat controversial, largely due to its subjectiveness. The mainstay of treatment is establishing the diagnosis and educating the patient about the illness. An empathetic clinician can stop further consultations elsewhere ('doctor shopping') and subsequent excessive investigations, which frequently occur in such patients. Most patients should undertake a trial of antidepressant therapy, even if major depression is not present. The choice of antidepressant drug should tailor the tolerability profile to relief of particular CFS symptoms, such as insomnia or hypersomnia. Failure to improve within 12 weeks warrants an alternative antidepressant agent of another class. Many other drugs have been reported anecdotally to be beneficial, but no therapy has been demonstrated to be reproducibly useful in double-blind, placebo-controlled clinical trials with an adequate duration of follow-up.
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PMID:Treatment of the chronic fatigue syndrome. A review and practical guide. 750 50

Researchers in the field of chronic fatigue in tertiary care found that patients' somatic (e.g. viral) explanations for their condition may lead to chronicity of symptoms. We studied the influence of a somatic attributional bias on outcome and reported symptoms in primary care patients with fatigue. We compared fatigue scores on a specific scale, and number of presented symptoms, in two groups of primary care patients with 'functional' fatigue: 75 with a high score on the somatic subscale of the Fatigue Attribution Scale (S-FAS), and 95 with a low score on the S-FAS. At the index visit, patients with low and high scores on the S-FAS were not different for age, sex, fatigue scores, and levels of depressive symptoms. Patients with high scores on the S-FAS presented significantly more somatic and psychological symptoms-a total of 36 symptoms for 24 patients (25.3%) in the low-score group, and a total of 52 symptoms for 31 patients (41.3%) in the high-score group. Forty-two days later, at the follow-up visit, the fatigue scores were similar in both groups. In primary care patients with fatigue not due to somatic illness or major depression, the tendency to attribute fatigue to somatic causes is not associated with a worse outcome, but with a higher number of reported symptoms.
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PMID:Correlates of somatic causal attributions in primary care patients with fatigue. 762 63

Questionnaires and clinician rating scales have been used to assess anxious and depressive symptoms among patients with panic disorder, but these methods do not usually evaluate symptoms in the same terms as the standardized criteria of diagnostic interviews. The present study provides data on the prevalence of symptoms of major depressive disorder and generalized anxiety disorder in 64 patients with panic disorder. Symptoms were assessed using DSM-III-R definitional criteria that consider not only the presence and severity of symptoms, but also their duration and pervasiveness. Depressive symptoms that most frequently met definitional criteria for diagnostic significance were fatigue, insomnia, and concentration difficulties. Over 50% of the sample endorsed feelings of tension, irritability, and restlessness. Disturbances in appetite, feelings of worthlessness, and suicidal ideation were found in less than 10% of the nondepressed panic patients. The implications of these findings for conceptualizing the comorbidity among anxiety and depressive disorders are discussed.
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PMID:Depression and generalized anxiety symptoms in panic disorder. Implications for comorbidity. 774 84

The purpose of the present 6-week multicenter dose finding study was to compare the efficacy and tolerability of mirtazapine (preferentially presynaptic alpha 2-adrenergic receptor blocker) to placebo in hospitalized patients with major depression. The clinical efficacy was evaluated with the Hamilton Depression Scale (HAM-D), Montgomery-Asberg Depression Rating Scale (MADRS), Beck Self-Rating Depression Scale, Global Assessment Scale (GAS), and Brief Psychiatric Rating Scale (BPRS). The side effects were recorded on a checklist of emergent symptoms (ROSE) and physical examinations, ECG, clinical chemistry, and hematology tests were carried out. The dosages of mirtazapine were gradually raised from 15 mg to 50 mg. One hundred and fourteen patients were included. Twenty-two patients (37%) in mirtazapine group and 24 (44%) in the placebo group were prematurely withdrawn from the study mainly due to inadequate efficacy. The decrease in HAM-D and MADRS was generally more pronounced in the mirtazapine group than in the placebo group. Minor side effects were reported in less than 15% of the patients in both groups. Only fatigue and faintness were slightly more pronounced in the mirtazapine group than in the placebo group. No significant changes were found in laboratory parameters. Because of methodological flaws like combining a dose finding study with a placebo controlled study, further conclusions should not be made on the efficacy of mirtazapine when treating depressive patients.
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PMID:Double-blind study of mirtazapine and placebo in hospitalized patients with major depression. 791 44

The chronic fatigue syndrome consists of a combination of non-specific symptoms. Some believe that the CFS is subcategory of major depression, because the symptoms are similar to those of major depression. We believe that the CFS is quite different from major depression or neurotic depression, since the CFS has no lack of initiative and effort, no inhibition which is seen in endogenous depression, and sharp fluctuations in general fatigue, anxiety, and various persisting somatic symptoms, such as, malaise and mild fever. CFS seems to be similar to the neurasthenia. It is harmful, at least, in aetiology and treatment, to neglect the diagnosis of the CFS.
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PMID:[Chronic fatigue syndrome and psychiatric diseases]. 800 11

The psychobiology of idiopathic fatigue has received renewed interest in the medical literature in recent years. In order to examine the relation between chronic, idiopathic fatigue and specific subtypes of depressive illness, we characterized the pattern and severity of seasonal symptom variation in 73 patients with chronic, idiopathic fatigue, compared to patients with major depression (n = 55), atypical depression (n = 35), and seasonal affective disorder (n = 16) Fifty of the fatigued subjects also met the specific Centers for Disease Control and Prevention case criteria for chronic fatigue syndrome, though this definition was unable to discriminate a distinct subgroup of patients, based on their seasonality scores alone. As a group, the fatigued subjects reported the lowest levels of symptom seasonality of any of the study groups. Further, even in those fatigued subjects with scores in the range of those seen in patients with seasonal affective disorder, seasonality was not reported to be a subjectively distressing problem. These findings lend support to the idea that although chronic fatigue shares some clinical features with certain mood disorders, they are not the same illnesses. These data are also consistent with the emerging view that chronic fatigue represents a heterogeneously determined clinical condition.
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PMID:Seasonal symptom variation in patients with chronic fatigue: comparison with major mood disorders. 806 38

The chronic fatigue syndrome (CFS) including myalgic encephalomyelitis and the postviral syndrome is a term used today to describe a not fully recognized disease characterized primarily by chronic or recurrent debilitating fatigue and various combinations of neuromuscular and neuropsychological symptoms. The term CFS has been introduced and defined by the Centers for Disease Control (CDC) in Atlanta. Fatigue is one of the most common symptoms in medicine, but CFS as defined by CDC has appeared to be quite rare in the general population. Researchers have suggested that the syndrome is a heterogenous immunologic disorder that follows viral infection, but despite numerous studies on the subject the etiologic factor of the syndrome is unknown. CFS is a controversial diagnosis. In a very high percentage of patients with the CFS depression, phobias or anxiety disorders have frequently preceded the onset of the chronic fatigue. There are many overlapping symptoms between CFS and major depression. Some clinicians suggest that it is not obvious that CFS can be distinguished from neurasthenia.
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PMID:[The chronic fatigue syndrome]. 813 94

Our prospective, standardized cohort study was designed to assess the presence of alpha wave intrusions during non-rapid eye movement sleep (alpha-delta sleep) and its relationship to fibromyalgia, major depression, and chronic fatigue syndrome (CFS) in patients with a chief complaint of chronic fatigue. The study group comprised 30 consecutive patients seen at a university hospital referral clinic for evaluation of chronic fatigue. All patients had nocturnal polysomnography, dolorimetric tender point assessment for fibromyalgia, a comprehensive history, physical, and laboratory evaluation, and a structured psychiatric interview. Alpha-delta sleep was identified in 8 of the 30 patients (26%), major depression in 20 (67%), CFS in 15 (50%), and fibromyalgia in 4 (13%). Ten of the 30 patients (33%) had a primary sleep disorder (sleep apnea, periodic limb movements, or narcolepsy). Alpha-delta sleep was not significantly correlated with fibromyalgia, CFS, major depression, or primary sleep disorders, but was significantly more common among patients who had chronic fatigue without major depression. We conclude that primary sleep disorders are relatively common among patients with chronic fatigue and must be diligently sought and treated. Alpha-delta sleep is not a marker of fibromyalgia or CFS, but may contribute to the illness of nondepressed patients with these conditions.
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PMID:Alpha-delta sleep in patients with a chief complaint of chronic fatigue. 797 34

The psychopathological status of 25 inpatients suffering from clinically definite multiple sclerosis (MS) according to Poser criteria was assessed by using standardized methods (Structured Clinical Interview for DSM-III-R, Inpatient Multidimensional Psychiatric Scale, Hamilton and Montgomery-Asberg Depression Rating Scales and the Structured Interview for the Diagnosis of Alzheimer Dementia and Dementias of other Aetiology (SIDAM). Magnetic resonance (MRT) (0.5 T; T2-weighted sequence) of the brain was analysed by measuring the ventricular brain ration (VBR), the area of the corpus callosum (CC) and the extension of hyperintense lesions of the brainstem, the temporal lobes and the brain at all. Six of 25 (24%) of these moderately disabled patients (mean Extended Disability Score (EDSS) 3.3) were diagnosed to suffer from depressive mood disorder (major depression or dysthymia); 2 were demented. In correlation analysis, depression was unrelated to age, gender, duration of illness, status of disability (EDSS) or the results of cognitive assessment. No relationship between the depression scores and the different MRT measures could be identified. The presence or absence of gadolinium enhancement was also uncorrelated to depressive symptoms. Fatigue as measured by the Fatigue Severity Scale was unrelated to depression or subcortical brain atrophy (increased VBR) but significantly correlated to the area of hyperintense MRT changes in brainstem and midbrain. Cognitive impairment (decreased SIDAM scores) was correlated to the total area of hyperintense MRT changes of the brain parenchyma. The type of clinical course (relapsing-remitting vs chronic progredient) was not found to influence the affective or cognitive state in our MS patient's sample.
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PMID:Correlates of cognitive impairment and depressive mood disorder in multiple sclerosis. 817 61

The 8 symptoms of Criterion B for major depressive disorder (MDE) in the third edition of the Diagnostic and Statistical Manual of Mental Disorders were studied in 107 cases and 57 noncases of MDE (all had depressed mood or pervasive anhedonia for more than 2 weeks). Sleep change, loss of energy, and appetite change were the most common symptoms, and psychomotor change and feelings of worthlessness the least common, in MDE. Loss of energy and sleep change were the best single symptoms and thoughts of death, feelings of worthlessness, and psychomotor change the worst for both diagnoses. Psychomotor change was the best and thoughts of death the worst indicator of MDE. Absence of sleep change and of loss of energy were the best and absence of thoughts of death, psychomotor change, and feelings of worthlessness the worst indicators of non-MDE. Results suggest that vegetative symptoms are more central to clinical depression than feelings of worthlessness, self-reproach, or guilt.
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PMID:The symptoms of major depression. 831 32


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