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

Tertiary care patients with chronic fatigue were followed for 2.5 years to determine if changes in physical and psychological status were associated with improvements in chronic fatigue, physical functioning, and return to work. Results indicated that improvement in psychological symptoms, DSM-III-R disorders, physical examination signs, and changes in whether the patient continued to meet criteria for chronic fatigue syndrome (CFS) were associated with recovery from fatigue, improved functioning, and return to work. Patients who never met CFS criteria or only met criteria at the initial assessment, reported improved physical functioning. Patients whose psychiatric disorders and physical examination signs were still present at a mean follow-up time of 2.5 years were more likely to have persistent fatigue and work disability. Loss of physical examination signs was a significant independent predictor of improved functioning and return to work. These results suggest that psychiatric status, as well as physical status, are associated with recovery from chronic fatigue.
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PMID:Longitudinal changes associated with improvement in chronic fatigue patients. 972 Aug 56

Depression strikes twice as many women as men. The dramatic changes in psychoactive hormones like estrogen and progesterone that occur during menstrual cycles and during pregnancy are believed to be key factors. According to the 4th Edition of the Diagnostic and Statistical Manual (DSM-IV), the diagnosis of depression requires that specific criteria be met: depressed mood or loss of interest or pleasure of at least 2 weeks' duration plus at least 4 of the following additional symptoms: change in weight, altered sleep pattern, psychomotor agitation or retardation, fatigue, difficulty concentrating, feelings of worthlessness or guilt, and suicidal ideation. Several new drug therapies are available for treating major depressive illness.
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PMID:Recognizing the Range of Mood Disorders in Women. 974 37

Nature and frequency of somatic complaints, severity of anxiety and depression, and nature of psychiatric symptoms and disorders were evaluated in 81 adequately treated cancer patients, disease-free or with residual disease, using a controlled, prospective follow-up design. Patients were included in the index group (n=60) if they had persistent somatic complaints or unexplained nature or severity of somatic complaints, or the control group (n=21), if they did not report somatic complaints. Instruments used for evaluation were the Scale for Assessment of Somatic Symptoms, Hospital Anxiety and Depression Scale, Psychiatric Assessment Schedule, and DSM-III-R. Common somatic complaints in the index group were pain (19%), fatigue (17%), sensory symptoms (30%), and mixed symptoms (27%). Subjects in the index group significantly (p<0.001) more often had depressive or anxiety disorder (19%) and atypical somatoform disorder (15%). Patients were treated appropriately with psychotropic medications and counseling. Follow-up at 4-6 months revealed a significant reduction in the number of somatic symptoms (p<0.001) and anxiety (p<0.001) and depression (p<0.05) scores. The observations confirm that somatic symptoms may persist in cancer patients, which are related to concomitant psychopathology, and require psychiatric intervention.
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PMID:Persistent somatization in cancer: a controlled follow-up study. 977 70

Premenstrual dysphoric disorder was included in an appendix of DSM-III-R (revised third edition of the Diagnostic and Statistical Manual of Mental Disorders) and DSM-IV to facilitate systematic research. Items contained in its set of research criteria were considered tentative. Only one previous study of premenstrual symptoms specifically addressed symptoms of premenstrual dysphoric disorder, and it did not use DSM-IV criteria. In the present study, prospectively measured symptoms of 99 women were analyzed using exploratory principal components analysis with orthogonal rotation on all 24 items derived from the 11 symptoms listed in DSM-IV. Variation was found across phases of cycle and groups, with five factors predominating: (1) anger/irritability, (2) depressed mood, (3) anxiety/tension, (4) decreased energy and interest with physical symptoms, and (5) eating problems.
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PMID:Symptom patterns of premenstrual dysphoric disorder as defined in the Diagnostic and Statistical Manual of Mental Disorders-IV. 1009 84

There is some evidence that the neurotransmitter serotonin (5-hydroxytryptamine; 5-HT) may be involved in the pathogenesis of seasonal affective disorder (SAD). Short-term tryptophan (TRP) depletion was carried out in 18 drug-free remitted patients who met DSM-IV criteria for SAD. Behavioral effects were measured with the Hamilton Depression Rating Scale (HDRS) both 24 h before and 24 h after TRP depletion. Some of the patients showed behavioral responses such as lowered mood, feelings of guilt, loss of interest, agitation, loss of energy, fatigue, social withdrawal, increased appetite, and carbohydrate craving. It was the aim of our study to investigate whether the genotypes of the serotonin transporter gene were associated with symptoms of transient depressive relapse after TRP depletion. In addition, we matched the SAD patients with healthy control subjects to see if alleles and genotypes of the serotonin transporter gene were associated with SAD. High molecular weight DNA was isolated from peripheral blood leukocytes using standard methods. For the 5-HTT receptor gene, a 17-bp repetitive element of intron 2 was genotyped (variable number tandem repeat, VNTR). Alterations in HDRS scores after TRP depletion showed no significant association with alleles or genotypes of the 5-HTT gene, although heterozygotes showed a trend toward increased HDRS scores. The serotonin transporter is known to play a critical role in the termination of serotonergic neurotransmission by sodium-dependent uptake of 5-HT into the presynaptic neuron. The present study in a small group of SAD patients was unable to demonstrate that the 5-HTT gene plays a role in the pathogenesis of SAD or in short-term depressive relapse after TRP depletion.
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PMID:Behavioral effects of tryptophan depletion in seasonal affective disorder associated with the serotonin transporter gene? 1033 77

Examination of mood and behaviour changes after frontal damage may contribute to understanding the functional role of distinct prefrontal areas in depression and anxiety. Depression and anxiety disorders, symptoms, and behaviour were compared in eight patients with single lateral and eight patients with single medial frontal lesions matched for age, sex, race, education, socioeconomic status, side, and aetiology of lesion 2 weeks and 3 months after brain injury. DSM IV major depressive and generalised anxiety disorders were more frequent in patients with lateral compared with medial lesions at 2 weeks but not at 3 months. At 3 months, however, patients with lateral damage showed greater severity of depressive symptoms, and greater impairment in both activities of daily living and social functioning. At initial evaluation depressed mood and slowness were more frequent, whereas at 3 months slowness, lack of energy, and social unease were more frequent in the lateral than the medial group. Patients with lateral lesions showed greater reduction of emotion and motivation (apathy) during both examinations. Medial frontal injury may fail to produce emotional dysregulation or may inhibit experience of mood changes, anxiety, or apathy. Lateral prefrontal damage may disrupt mood regulation and drive while leaving intact the ability to experience (negative) emotions.
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PMID:Frontal lobe syndrome reassessed: comparison of patients with lateral or medial frontal brain damage. 1051 77

The purpose of this study is to determine the individual contribution, or importance number, of the symptoms to an analysis of depression, utilizing a neural network model. In addition, the presence of hopelessness and somatic complaints was examined, to determine their relevance to depression. Using Wave 1 data from Duke University's contribution in the Epidemiological Catchment Area (ECA) study, we created a mathematical model, a neural network, to map the relationship of nine symptoms of major depression, hopelessness and somatic complaints to the presence or absence of the formal diagnosis of depression, and performed a contribution analysis. The contribution analysis using the neural network revealed that the symptoms with the greatest impact on the occurrence of depression, or with the largest importance number for depression, were sadness, loss of interest, tiredness and sleeping trouble, in that order. The most frequently reported symptoms, though, were sadness, sleeping trouble, suicidal ideation, tiredness and poor concentration, in that order. Hopelessness and somatic symptoms were the lowest in their contribution to the diagnosis of depression. The study thus provides the hierarchy of the symptoms of depression and supports the DSM classification of major depression.
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PMID:Analysis of the symptoms of depression--a neural network approach 1057 52

The purpose of this study was to determine whether Gulf War Illness (GWI) can be explained by the presence of psychiatric disorders as assessed by DSM-III-R. To reduce the heterogeneity amongst Persian Gulf War veterans with GWI (PGV-F), only those were studied who presented with severe fatigue as a major complaint and also fulfilled clinical case definitions for Chronic Fatigue Syndrome, Idiopathic Chronic Fatigue, and/or Multiple Chemical Sensitivity. A total of 95 Registry PGVs were examined; 53 presented with GWI and 42 did not report any post-war health problems (PGV-H). All subjects were assessed for the presence of DSM-III-R Axis I psychiatric disorders. Compared to PGV-Hs, 49% of PGV-Fs had similar post-war psychiatric profiles: either no, or only one, psychiatric disorder was diagnosed. Psychiatric profiles of the remaining 51% of PGV-Fs were significantly different from PGV-Hs in that most of these veterans suffered from multiple post-war psychiatric diagnoses. The presence of psychiatric disorders as assessed by DSM-III-R criteria cannot explain symptoms of Gulf War Illness among all Persian Gulf veterans with severe fatiguing illness.
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PMID:Psychiatric diagnoses in Gulf War veterans with fatiguing illness. 1064 76

Mild cognitive impairment is found in many cases of depression, and it is mostly assumed to improve during the time course of depression remission. Recent data question the reversibility of low cognitive test performance in depression. The aim of this study is to determine the degree of reversibility and the proportion of patients who will not demonstrate reversibility of cognitive dysfunction. Consecutive inpatients suffering from depression (N=102) were investigated and N=82 matched control subjects. N=57 of the patients were diagnosed as major depression according to DSM-IV. A total of N=67 could be retested after remission of depression (N=32 of the patients with major depression) and a matched control group (N=62). Neuropsychological tests were applied in a test session which avoids the effects of fatigue in the patients by the short duration of strenuous tests. For most neuropsychological tests an impaired performance in the depressed patients was found. About one third of the depression subjects performed at an impaired level in tests of averbal memory and verbal fluency (below 5th percentile). In the follow-up investigation, a slight improvement in performance could be assessed for both the depression and the control group, which was, however, attributed to a general test training effect. No normalization of cognitive test performance was found in spite of complete recovery of the affective symptoms. No correlation between the duration of the disease before the index episode or number of episodes and cognitive deficits could be found. The data of the neuropsychological deficits of depressed patients, which are stable in the time course of the affective disorder, may indicate that these patients may suffer from comorbidity of both depression and mild cognitive disorder. The findings are discussed as 1) indicating only a minor impact of the depressed mood on the cognitive performance and 2) they are consistent with a role of brain lesions which have been reported in several studies in a subgroup of depression.
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PMID:Comorbidity of mild cognitive disorder and depression--a neuropsychological analysis. 1100 71

This report examines clinical features of 'pure' dysthymic disorder (DD, without superimposed major depressive disorder, MDD) in a sample of children and adolescents. Profiles of symptomatology and comorbidity as a function of age and gender are described. The sample consisted of 48 subjects (22 males, 26 females, age range 7-18 years, mean age 12.1 years) screened from consecutively referred children and adolescents. All subjects were comprehensively diagnosed with structured diagnostic interviews (Schedule for Affective Disorders and Schizophrenia for School Age, Diagnostic Interview for Children and Adolescents-Revised), according to DSM-IV criteria. Depressed mood, irritability, loss of energy and fatigue, guilt and low self-esteem were present in more than 70% of the subjects. Differences in symptomatic profile between males and females were not significant. Children showed less symptoms than adolescents, but the symptomatic profile was comparable (only anhedonia was significantly more frequent in adolescents). Anxiety disorders were more commonly comorbid with DD, especially separation anxiety disorder in children (33%) and generalised anxiety disorder in adolescents (67%). Externalising disorders were less frequently represented in our sample (14%). An early diagnosis of 'pure' DD before the first episode of MDD is crucial for a timely intervention.
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PMID:Depressive symptoms in children and adolescents with dysthymic disorder. 1115 Sep 28


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