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Query: UMLS:C0015674 (chronic fatigue syndrome)
 2,978 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To clarify the role of Epstein-Barr virus (EBV) infection and the value of EBV antibody testing in evaluating patients with chronic fatigue, we studied 200 consecutive patients with chronic fatigue (mean duration, 9 years). Complete EBV serologic panels were obtained for 154 patients, 35 (23%) of whom met serologic or clinical criteria for chronic or reactivated EBV infection. We compared these patients with chronic EBV infection (CEBV cases) to 35 age- and sex-matched patients who were selected from the same cohort of fatigued patients but who did not meet the criteria (CEBV control subjects). We found few differences between groups in demographic characteristics, clinical features, and symptoms; CEBV cases were more likely to meet criteria for the proposed chronic fatigue syndrome (14% vs 0%), and to report that they suffered from an influenza-like illness at the onset of their fatigue syndrome (34% vs 12%), that they lost their job because of their fatigue (37% vs 11%), and that their fatigue was improved by recreational activity (26% vs 3%). Physical examination and laboratory testing showed few abnormalities in either group. Psychiatric morbidity was common in both groups, including mood disorders (63% of CEBV cases vs 54% of CEBV controls), anxiety (11% vs 9%) and somatization disorder (9% in each group). We conclude that EBV serologic patterns have little clinical usefulness in evaluating patients with chronic fatigue.
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PMID:Antibodies to Epstein-Barr virus in patients with chronic fatigue. 164 95

To determine the medical and psychiatric diagnoses that have an aetiological role in chronic fatigue we conducted a prospective study of 405 (65% women) patients who presented for evaluation with this chief complaint to an academic medical centre. The average age was 38.1 years and the average duration of fatigue at entry in the study was 6.9 years. All patients were given comprehensive physical and laboratory evaluations and were administered a highly structured psychiatric interview. Psychiatric diagnoses explaining the chronic fatigue were identified in 74% of patients and physical disorders were diagnosed in 7% of patients. The most common psychiatric conditions in this series were major depression, diagnosed in 58% of patients, panic disorder, diagnosed in 14% of patients, and somatization disorder, diagnosed in 10% of patients. Primary sleep disorders, diagnosed in 2% patients, and chronic infections, confirmed in 1.6% patients, explained the majority of cases whose chronic fatigue was attributed to a physical disorder. Thirty per cent of patients met the criteria used to define the chronic fatigue syndrome (CFS). Compared with age- and gender-matched control subjects with chronic fatigue, CFS patients had a similarly high prevalence of current psychiatric disorders (78% versus 82%), but were significantly more likely to have somatization disorder (28% versus 5%) and to attribute their illness to a viral infection (70% versus 33%). We conclude that most patients with a chief complaint of chronic fatigue, including those exhibiting the features of CFS, suffer from standard mood, anxiety and/or somatoform disorders. Careful research is still needed to determine whether CFS is a distinct entity or a variant of these psychiatric illness.
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PMID:Chronic fatigue and chronic fatigue syndrome: clinical epidemiology and aetiological classification. 849 Nov

This study was conducted to examine the rates of somatization disorder (SD) in the chronic fatigue syndrome (CFS) relative to other fatiguing illness groups. It further addressed the arbitrary nature of the judgments made in assigning psychiatric vs. physical etiology to symptoms in controversial illnesses such as CFS. Patients with CFS (N = 42), multiple sclerosis (MS) (N = 18), and depression (N = 21) were compared with healthy individuals (N = 32) on a structured psychiatric interview. The SD section of the Diagnostic Interview Schedule (DIS) III-R was reanalyzed using different criteria sets to diagnose SD. All subjects received a thorough medical history, physical examination, and DIS interview. CFS patients received diagnostic laboratory testing to rule out other causes of fatigue. This study revealed that changing the attribution of SD symptoms from psychiatric to physical dramatically affected the rates of diagnosing SD in the CFS group. Both the CFS and depressed subjects endorsed a higher percentage of SD symptoms than either the MS or healthy groups, but very few met the strict DSM-III-R criteria for SD. The present study illustrates that the terminology used to interpret the symptoms (ie, psychiatric or physical) will determine which category CFS falls into. The diagnosis of SD is of limited use in populations in which the etiology of the illness has not been established.
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PMID:Assessing somatization disorder in the chronic fatigue syndrome. 867 89

A structured psychiatric interview, forming part of a global psychopathological approach, revealed higher prevalence rates of current and lifetime psychiatric disorders and a higher degree of psychiatric comorbidity in patients with chronic fatigue syndrome (CFS) than in a medical control group. In contrast to previous studies, a very high prevalence of generalized anxiety disorder (GAD) was found in CFS, characterized by an early onset and a high rate of psychiatric comorbidity. It is postulated that GAD represents a susceptibility factor for the development of CFS. A significantly higher prevalence was also observed for the somatization disorder (SD) in the CFS group. Apart from a higher female-to-male ratio in fibromyalgia, no marked differences were observed in sociodemographic or illness-related features, or in psychiatric morbidity, between CFS patients with and without fibromyalgia. CFS patients with SD have a longer illness duration and a higher rate of psychiatric comorbidity. These findings are consistent with the suggestion of Hickie et al. (1) that chronic fatigued subjects with SD should be distinguished from subjects with CFS.
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PMID:Generalized anxiety disorder in chronic fatigue syndrome. 919 5

The relationship of sleep complaints to mood, fatigue, disability, and lifestyle was examined in 69 chronic fatigue syndrome (CFS) patients without psychiatric disorder, 58 CFS patients with psychiatric disorder, 38 psychiatric out-patients with chronic depressive disorders, and 45 healthy controls. The groups were matched for age and gender. There were few differences between the prevalence or nature of sleep complaints of CFS patients with or without current DSM-IIIR depression, anxiety or somatization disorder. CFS patients reported significantly more naps and waking by pain, a similar prevalence of difficulties in maintaining sleep, and significantly less difficulty getting off to sleep compared to depressed patients. Sleep continuity complaints preceded fatigue in only 20% of CFS patients, but there was a strong association between relapse and sleep disturbance. Certain types of sleep disorder were associated with increased disability or fatigue in CFS patients. Disrupted sleep appears to complicate the course of CFS. For the most part, sleep complaints are either attributable to the lifestyle of CFS patients or seem inherent to the underlying condition of CFS. They are generally unrelated to depression or anxiety in CFS.
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PMID:The relation of sleep difficulties to fatigue, mood and disability in chronic fatigue syndrome. 922 7

This study (ntotal = 35) compared early life stress ratings, parental relationships, and health status, notably orthostatic blood pressures, of middle-aged women with low-level chemical intolerance (CI group) and depression, depressives without CI (DEP group), and normals. Environmental chemical intolerance is a symptom of several controversial conditions in which women are overrepresented, that is, sick building syndrome, multiple chemical sensitivity, chronic fatigue syndrome, and fibromyalgia. Previous investigators have postulated that people with CI have variants of somatization disorder, depression, posttraumatic stress disorder (PTSD) initiated by childhood abuse or a toxic exposure event. One neurobehavioral model for CI, somatization disorder, recurrent depression, and PTSD is neural sensitization, that is, the progressive amplification of host responses (e.g., behavioral, neurochemical) to repeated intermittent stimuli (e.g., drugs, chemicals, endogenous mediators, stressors). Females are more vulnerable to sensitization than are males. Limbic and mesolimbic pathways mediate central nervous system sensitization. Although both CI and DEP groups had high levels of life stress and past abuse, the CI group had the most distant and weak paternal relationships and highest limbic somatic dysfunction subscale scores. Only the CI group showed sensitization of sitting blood pressures over sessions. Together with prior evidence, these data are consistent with a neural sensitization model for CI in certain women. The findings may have implications for poorer long-term medical as well as neuropsychiatric health outcomes of a subset of women with CI. Subsequent research should test this model in specific clinical diagnostic groups with CI.
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PMID:Early life stress, negative paternal relationships, and chemical intolerance in middle-aged women: support for a neural sensitization model. 986 91

In 1997, 30% of the persons going into early retirement because of occupational disability and received pensions were psychosomatically ill. An additional large number of retirees suffered from untreatable pain such as chronic low back pain, some of them might as well have a chronic somatoform pain disorder. The article describes frequent psychosomatic diseases like somatization disorder, fibromyalgia and chronic fatigue syndrome with respect to their pathophysiology and psychological aspects as well as therapeutic advancements. It is postulated that an interdisciplinary access to these patients early in the course of their illness involving both somatic medical and psychiatric competence is the most promising means to tackle this enormous medical and health protection problem.
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PMID:[Aspects of occupational disability in psychosomatic disorders]. 1085 74

This article reviews the research evidence for the efficacy of cognitive-behavioral therapy (CBT) for somatoform disorders. Randomized controlled studies support the efficacy of individual CBT for the treatment of hypochondriasis, body dysmorphic disorder (BDD), and undifferentiated somatoform disorders including medically unexplained symptoms, chronic fatigue syndrome, and noncardiac chest pain, and group CBT for the treatment of BDD and somatization disorder. On the basis of this review of the existing research and a theoretical model of the processes involved in somatoform disorders, the authors offer suggestions for future research and effective treatment.
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PMID:Behavioral medicine approaches to somatoform disorders. 1209 Mar 85

In recent years, research-methods literature mainly addressing controlled clinical trials has arisen regarding explanatory and pragmatic treatment trials. Explanatory trials tend to examine causal mechanisms and questions of efficacy and value internal validity (creating optimal study conditions) over generalizability (using study results to understand treatment effects in real-life patient populations). In contrast, pragmatic trials value "external relevance" (generalizability) of study results over "internal elegance" so that clinicians and health policymakers can better understand how treatments might impact their patients and policies. This review draws inspiration from these contrasting explanatory and pragmatic perspectives and develops them for clinical and research pertaining to idiopathic physical symptoms and related syndromes (eg, somatization disorder, chronic fatigue syndrome, multiple chemical sensitivities, irritable bowel syndrome). Explanatory and pragmatic perspectives are used to examine these idiopathies with regard to causation, case definition, labels, and treatment. It is concluded that idiopathic symptom syndromes are fundamentally pragmatic clinical and research challenges. For epidemiologic and methodologic reasons, the complex explanations for these syndromes remain largely elusive. Even so, scientific and clinical pragmatism offers the opportunity to reduce disagreement between competing medical disciplines and between clinicians and affected patients with regard to irreconcilable etiologic questions and to remain evidence-based in the care of patients.
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PMID:Explanatory and pragmatic perspectives regarding idiopathic physical symptoms and related syndromes. 1657 79

We have created a mindfulness approach to treat patients who experience multiple, persistent, and disabling physical symptoms that cannot be explained by a well-defined medical or surgical condition. Randomized controlled trials in this area are few, and research is hampered by the lack of clear definitions. Bodily distress syndrome (BDS) or bodily stress is an empirically defined definition unifying various conditions such as fibromyalgia, chronic fatigue syndrome, and somatization disorder. In the present PhD, we explored whether patients suffering from BDS may be committed to mental training in the form of mindfulness therapy, which is a mindfulness program specifically targeted patients suffering from BDS. The theoretical model for including mindfulness training in the treatment of BDS is based on identified neurobiological impairments in these patients and the neurobiological improvements that mindfulness training may offer. BDS is a major public health issue possibly associated with the pathology of the immuno-endocrine and autonomic nervous system. BDS patients are often stigmatized, and effective treatment is rarely delivered, which leaves these patients isolated, left by themselves, vulnerable to potentially harming medical and/or alternative treatments. Accordingly, there is a need for non-harming practical tools that patients can learn to master so that they can improve the ability to take responsibility for their own health and wellbeing. Mindfulness-Based Stress Reduction (MBSR) is a group program that employs mindfulness practice to alleviate suffering associated with physical, psychosomatic, and psychiatric disorders. Mindfulness-Based Cognitive Therapy (MBCT) is designed to prevent depressive relapse. Paper I and II present systematic literature reviews only of randomized controlled trials on MBSR and MBCT. The effect of MBSR has been explored on fibromyalgia in three studies, none of them showed convincing results, but gave some indications as to improvement. The reviews recommended MBSR as a useful method for improving mental health; however, lack of long-term follow-up and active control groups are limitations in most studies. MBCT was recommended as a tool for preventing depressive relapse in recovered, recurrently depressed patients, but the implication of MBSR and MBCT is problematic, especially due to the lack of well educated mindfulness teachers. We combined MBSR with cognitive behavioral therapy, CBT, specifically targeted BDS. Paper III provides original data from 119 patients enrolled in a randomized clinical trial, mindfulness therapy for BDS. The randomized controlled trial indicates that BDS patients are capable of and willing to engage in mindfulness therapy. This thesis showed that mindfulness therapy can safely and successfully engage BDS patients in mindfulness practice. Since individual CBT and psychiatric consultation have previously been found to have positive outcomes for BDS patients, we compared mindfulness therapy to an active control group entitled specialized treatment in which an individual treatment was planned in collaboration between the patient and an MD specialized in BDS, CBT, and psychiatry. Mindfulness therapy was comparable to specialized treatment in improving the quality of life and the symptoms of the patients with BDS at 15-month follow-up. For primary outcome physical health (PCS) at 15-month follow-up, different developments over time for the two treatment groups could not be established (F(3,2674) = 1.51, p = 0.21). However, in the mindfulness therapy group, PCS significant changed at the end of treatment and this change remained at 15-month follow-up, whereas no significantly change was seen in the specialized treatment group until at the 15-month follow-up. In the mindfulness therapy group, 26%; CI: 14-38 reported a marked improvement (> 1 SD) at the end of treatment compared with 10%; CI: 2-18 in the specialized treatment group. This amounts to a statistically significant difference between the groups (OR = 3.21; CI 1.05-9.78, p = 0.04). The results are indicating that mindfulness therapy produced greater and more rapid improvements than specialized treatment. Mindfulness therapy appears to produce improvements within the range of those reported in the STreSS-1 trial, where CBT was compared with enhanced usual care, and no improvements on the SF-36 scale were observed in the enhanced usual care group. This indicates that the changes accomplished with the two treatments mindfulness therapy and specialized treatment reflect real changes attributable to the interventions. The economic effects of mindfulness therapy are evaluated in paper IV by the use of original register data from the 119 enrolled patients and a matched control group of 5,950 individuals. Mindfulness therapy had substantial socioeconomic benefits over specialized treatment. The costs incurred to cover permanent health-related benefits, especially disability pension, were significantly lower in the mindfulness therapy group than in the specialized treatment group over a 15-month follow-up period; 25% from the mindfulness therapy group received disability pension compared with 45% from the specialized treatment group (p = 0.025). The total health care utilization was reduced over time in both groups from the year before inclusion (mean $ 5,325, median $ 2,971) to the year after inclusion (mean $ 3,644, median $ 1,593) (p = 0.0001). There was no difference between the two groups. Five and ten years before their inclusion, the BDS patients were less self-supporting than an age-, gender- and ethnicity-matched population control group; the BDS patients accumulated more weeks of sickness benefit and unemployment. Thus, the included BDS patients may have been ill and in high risk for a social decline five and ten years before they received a proper diagnosis and treatment. In conclusion, the social and economic consequences of BDS are significant and mindfulness therapy may have a potential to significantly improve function, quality of life and symptoms, prevent a social decline, and reduce societal costs.
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PMID:Mindfulness and bodily distress. 2317 54


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