Clinical Differences Exist Between Patients Fulfilling the 1988 and 1994 Case Definitions of Chronic Fatigue Syndrome

Despite the existence of 2 different case definitions for chronic fatigue syndrome, little data exist to evaluate how each performs. We evaluated the symptom patterns of patients fulfilling either the more demanding 1988 or the less demanding 1994 case definitions of Chronic Fatigue Syndrome over an 11-year period from 1991 to 2001. Factor analysis identified 3 factors: muscular–skeletal, viral, and sleep:memory symptom factors accounting for significant variation in the data. Further discriminant analysis showed that the first 2 factors and a self-reported measure of decrease in activity alone gave 91% accuracy in the placement of patients into their respective case definitions. This analysis did indicate that both case definitions were capturing the same broad group of patients. However, the patients in the 1994 group do not endorse infectious-type symptoms as often or to the same degree of severity as those in the 1988 group. This may mean that infection as a cause of CFS is more likely in patients fulfilling the earlier, more demanding case definition.     

Appraised psychological workload, musculoskeletal symptoms, and the mediating effect of fatigue: a structural equation modeling approach

The aim of the present study was to test two structural models of the relationship between appraised psychological workload and musculoskeletal symptoms from the neck, shoulder, and upper and lower back with different aspects of perceived fatigue as mediating variables. In this cross-sectional study a questionnaire survey was conducted among employees at three Swedish assembly plants (n= 305). The proposed models were tested for one general fatigue dimension--lack of energy--and four specific fatigue dimensions--physical discomfort, physical exertion, lack of motivation, and sleepiness--using structural equation modeling. The results indicate that the role of perceived fatigue in the relationship between appraised workload and musculoskeletal symptoms is different for different aspects of fatigue. The general fatigue dimension, lack of energy, does not mediate the relationship. As regards the specific fatigue dimensions, the relationship is partially mediated by physical discomfort and lack of motivation but not by physical exertion or sleepiness. Appraised psychological workload has a unique effect on musculoskeletal symptoms not mediated by fatigue.     

A biochemical analysis of people with chronic fatigue who have Irlen Syndrome: speculation concerning immune system dysfunction.

This study investigated the biological basis of visual processing disabilities in adults with Chronic Fatigue Syndrome. The study involved 61 adults with symptoms of Chronic Fatigue Syndrome who were screened for visual processing problems (Irlen Syndrome) and divided into two groups according to the severity of symptoms of Irlen Syndrome. Significant variations were identified in blood lipids and urine amino and organic acids of the two groups, which may be indicative of activation of the immune system due to some infective agent. It was suggested that metabolic profiling may help the development of more valid diagnostic categories and allow more investigation of immune system dysfunction as a possible causal factor in a range of learning and behaviour disorders.     

A Comparison of the 1988 and 1994 Diagnostic Criteria for Chronic Fatigue Syndrome

Chronic Fatigue Syndrome (CFS) is an illness that involves severe, prolonged fatigue as well as neurological, immunological, and endocrinological system pathology. Because the pathogenesis of CFS has yet to be determined, case definitions have relied on clinical observation in classifying signs and symptoms for diagnosis. In an attempt to address various criticisms and inconsistencies in diagnostic criteria, there have been several revisions of the CFS case definition. The current investigation examined the differences between 1988 and 1994 definitions as well as participants who had a psychiatric explanation for their fatigue. Dependent measures included psychiatric comorbidity, symptom frequency, and functional impairment. The 1988 criteria, compared to the 1994 criteria, appeared to select a group of participants with more symptomatology and functional impairment, but these groups did not significantly differ in psychiatric comorbidity. Implications of these findings are discussed.     

Effects of fatigue on ability to process visual information by experienced orienteers

6 experienced orienteers were subject to a VO2max treadmill test, two days prior to undertaking two tests of visual perception. One test was conducted while the subjects were in a rested state while the other was conducted while they were under a state of fatigue. Fatigue was defined as a state in which the subjects were working at or above their anaerobic threshold which had been determined previously from their VO2max test. The tests in both the fatigue and rest condition were of a similar nature, that is, the subjects were presented slides of orienteering checkpoints at regular intervals followed by a slide showing a set of questions which the subjects had to answer verbally. Two sets of slides were employed and these were approximately counterbalanced between both subjects and conditions. Points were awarded for the correct answers and the two conditions were then compared. The Wilcoxon test for two correlated samples was used and showed a significant difference between the fatigue and rest scores at p less than 0.05. The data suggest that under the influence of fatigue, an orienteer's ability to perceive visual information is greatly impaired.     

Editorial

Fatigue is among the most common and disabling symptoms in multiple sclerosis (MS). However, the relationship of perfectionism to fatigue in MS patients remains poorly understood. One hundred and twenty MS patients (79 women, 41 men) were compared with 120 healthy individuals (79 women, 41 men) to explore whether differences exist between the two groups with respect to perfectionistic characteristics and to investigate whether dimensions of positive and negative perfectionism are related to the symptomatology of fatigue. All participants were asked to complete the positive and negative perfectionism scale (PANPS), the modified fatigue impact scale (MFIS), the fatigue severity scale (FSS) and the Beck depression inventory (BDI). The results revealed that the MS group reported lower levels of positive perfectionism and higher levels of negative perfectionism as well as depressive symptoms than the control group. Perfectionism was also significantly related to fatigue symptoms in both groups. These findings suggest that the fatigue symptoms are strongly associated with perfectionistic characteristics. The negative (maladaptive) dimension of perfectionism may play a predisposing role in the development and/or perpetuation of fatigue in MS patients. The findings are discussed within the scope of current literature and implications for clinical applications are suggested.     

The effect of Multi Convergent Therapy on the psychopathology,mood and performance of Chronic Fatigue Syndrome patients: A preliminary study

Objectives: Multi Convergent Therapy combines approaches such as Cognitive Behaviour Therapy and Graded Exercise Therapy in an holistic treatment of Chronic Fatigue Syndrome. Initial follow‐up data showed that patients were benefiting from this individualised form of therapy. The objective of the present study was to evaluate this Multi Convergent approach, developed at a specialised Chronic Fatigue Syndrome Outpatient clinic in Cardiff, and compare it to Relaxation Therapy and control groups using multiple outcome measures. Design: Thirty‐five participants fitting the Centre for Disease Control criteria for Chronic Fatigue Syndrome were recruited from two outpatient clinics and members of our existing patient panel. Patients were assigned to Multi Convergent Therapy (N=12), Relaxation Therapy (N=14) or recruited as controls (N=9). Methods: Each patient completed a battery of mood and performance tasks along with comprehensive set of questionnaires at baseline, post‐treatment and at six‐month follow‐up. These measures had been validated in previous studies on untreated patients and matched healthy controls. Results: Patients attending the Multi Convergent Therapy clinic showed statistically significant improvements in many of our measures. Most importantly we have produced data indicating that Multi Convergent Therapy provides improvements in objective measures of psychomotor performance and cognition. Discussion: The outcomes of this small study are encouraging. Multi Convergent Therapy has not only produced results indicating significant improvements in standardised questionnaire based measures but also in objective cognitive performance tasks. The next step would be to assess Multi Convergent Therapy at the primary medical care level, with a greater number of patients to further evaluate its efficacy as a treatment for Chronic Fatigue Syndrome.     

Das Ausmaß von Müdigkeit und Erschöpfbarkeit in der über 60-jährigen Normalbevölkerung in Deutschland

In a community-based random sample of 622 elderly persons over 60 years of age, fatigue was assessed by means of the multidimensional fatigue inventory (MFI; a self-assessment measure). Higher fatigue values were found with increasing age, particularly physical feelings of fatigue, reduced activity and reduced motivation. Fatigue was associated with depression, with a low health-related quality of life and with subjective physical complaints. Distinct fatigue symptoms in the elderly should therefore be regarded as possible indicators for somatic and/or psychological burdens and should receive diagnostic and therapeutic attention. In the present paper, mean values and percentiles for different age groups over 60 years are given as norm values for the normal population over 60 years of age.     

The Role of Attachment Style and Depression in Patients with Hepatitis C

Patients infected with chronic hepatitis C virus (HCV) commonly suffer from the triad of depression, pain and fatigue. This symptom triad in HCV is likely influenced by additional psychological and interpersonal factors, although the relationship is not clearly understood. This retrospective study aimed to characterize the relationship between attachment style and depressive and physical symptoms in the HCV-infected population. Over 18 months, 99 consecutively referred HCV infected patients were assessed with the Hamilton Depression Rating Scale (HDRS), Fatigue Severity Scale, Patient Health Questionnaire-15 for physical symptoms and the Relationship Questionnaire for attachment style. An ANOVA was used to identify differences between attachment styles and Pearson correlations were used to evaluate the association between depression, fatigue and physical symptoms. Approximately 15 % of patients in the sample had a fearful attachment style. Patients with fearful attachment style had significantly higher depressive symptoms compared to a secure attachment style (p = .025). No differences in physical and fatigue symptoms were observed between attachment styles. Further, HDRS scores were significantly associated with fatigue scores (p < .001) and physical symptoms (p < .001), reinforcing the relationship between these symptom domains in HCV-infected patients. Although depressive, physical and fatigue symptoms are inter-related in HCV-infected patients, our study results suggest that only depressive symptoms were influenced by the extremes of attachment style. Screening of relationship styles may identify at-risk HCV-infected individuals for depression who may have difficulty engaging in care and managing physical symptoms.     

The Complex Interplay Between Trait Fatigue and Cognition in Multiple Sclerosis

Cognitive impairments are frequent in patients with Multiple Sclerosis (MS). Yet, the influence of MS-related symptoms on cognitive status is not clear. Studies investigating the impact of trait fatigue along with anxio-depressive symptoms on cognition are seldom, and even less considered fatigue as multidimensional. Moreover, these studies provided conflicting results.Twenty-nine MS patients and 28 healthy controls, matched on age, gender and education underwent a full comprehensive neuropsychological assessment. Anxio-depressive and fatigue symptoms were assessed using the HAD scale and the MFIS, respectively. Six composite scores were derived from the neuropsychological assessment, reflecting the cognitive domains of working memory, verbal and visual learning, executive functions, attention and processing speed. Stepwise regression analyses were conducted in each group to investigate if trait cognitive and physical fatigue, depression and anxiety are relevant predictors of performance in each cognitive domain. In order to control for disease progression, patient’s EDSS score was also entered as predictor variable.In the MS group, trait physical fatigue was the only significant predictor of working memory score. Cognitive fatigue was a predictor for executive functioning performance and for processing speed (as well as EDSS score for processing speed). In the healthy controls group, only an association between executive functioning and depression was observed.Fatigue predicted cognition in MS patients only, beyond anxio-depressive symptoms and disease progression. Considering fatigue as a multidimensional symptom is paramount to better understand its association with cognition, as physical and cognitive fatigue are predictors of different cognitive processes.     

Prevalence and treatment of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis and co-morbid severe health anxiety

Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) is a debilitating condition that affects 0.2–0.4% of the population. Health focussed anxiety is common across medical conditions, and may be relevant in CFS/ME. This study sought to identify the prevalence and impact of health anxiety (HA) in CFS/ME and evaluate the effectiveness of Cognitive Behavioural Therapy for HA in CFS/ME. Cross-sectional questionnaire methods and case-series design were used to achieve study aims. Analysis indicated that 41.9% of the CFS/ME clinic sample experienced threshold levels of health anxiety, which was associated with elevated symptom severity across several dimensions. Stepwise multiple regression indicated physical functioning and depression accounted for 23.8% of variance in fatigue; depression, fatigue and HA, accounted for 32.9% of variance in physical functioning. Large effect sizes and clinically significant changes were generated in the treatment study. HA is common in CFS/ME and likely to exacerbate fatigue and physical functioning. This study identifies HA as an important target for treatment, trial findings should be further replicated on a larger scale.     

Estimating rates of chronic fatigue syndrome from a community-based sample: A pilot study

Most of the Chronic Fatigue Syndrome (CFS) epidemiological studies have relied on physicians who refer patients having at least 6 months of chronic fatigue and other symptoms. However, there are a number of potential problems when using this method to derive prevalence statistics. For example, some individuals with CFS might not have the economic resources to access medical care. Other individuals with CFS might be reluctant to use medical personnel, particularly if they have encountered physicians skeptical of the authenticity of their illness. In addition, physicians that are skeptical of the existence of CFS might not identify cases. In the present pilot study, a random community sample (N=1,031) was interviewed by telephone in order to identify and comprehensively evaluate individuals with symptoms of CFS and those who self-report having CFS. Different definitions of CFS were employed, and higher rates (0.2%) of CFS were found than in previous studies. Methodological benefits in using more rigorous epidemiological methods when estimating CFS prevalence rates are discussed. The authors appreciate the generous financial support of the CFIDS Association and Minnan, Inc. We also are grateful for many helpful suggestions provided by Judith A. Richman, William McCready, Wendell Richmond, and Stephen E. Goldston. Finally, we are very thankful to the many undergraduate volunteers who helped us complete this study, and they include Cheryl Stenzel, Georgina DeLa Torre, Vickie Chrisos, Don Banik, Hillary Loeb, Leslie Ramesack, Ellen Diamond, Rob Bleeker, Gib Garza III, Mindy Silverstein, Kadip Sen, Meredith Lombrazo, Brian Miller, Caroline Marsden, Lorraine Whitmore, Stan Gayot, Karen Costakis, and Dave Sobotka.     

Influence of music on Wingate Anaerobic Test performance

While several studies have investigated the effects of music on cardiovascular endurance performance and perceived exertion during exercise of moderate intensity, few studies have investigated such effects on supramaximal exercise bouts. The purpose of the present study was to assess whether music affects performance on the Wingate Anaerobic Test. Each of the 12 men and 3 women were required to report to the laboratory on two occasions, once for tests in the music condition and once for tests in the nonmusic condition. Conditions were randomly ordered. All music selections were set at the same tempo. On each test day subjects performed a series of three Wingate Anaerobic Tests with 30-sec. rests in between. On Test 3 subjects were asked to continue pedaling until fatigued. Mean Power Output, Maximum Power Output, Minimum Power Output, and Fatigue Index were compared between conditions for each test using a repeated-measures analysis of variance. Time to fatigue on Trial 3 compared by analysis of variance gave no significant differences between conditions for any measures.     

Task-induced fatigue states and simulated driving performance

States of fatigue are implicated in driver impairment and motor vehicle accidents. This article reports two studies investigating two possible mechanisms for performance impairment: (1) loss of attentional resources; and (2) active regulation of matching effort to task demands. The first hypothesis predicts that fatigue effects will be accentuated by high task demands, but the second hypothesis predicts that fatigue effects will be strongest in "underload" conditions. In two studies, drivers performed a stimulated driving task, in which task demands were manipulated by varying road curvature. In a "fatigue induction" condition, the early part of the drive was occupied by performance of a demanding secondary task concurrently with driving, after which the concurrent task ceased. Post-induction driving performance was compared with a control condition in which drivers were not exposed to the induction. In both studies, the fatigue induction elicited various subjective fatigue and stress symptoms, and also raised reported workload. Fatigue effects on vehicle control and signal detection were assessed during and after the fatigue induction. The fatigue induction increased heading error, reduced steering activity, and, in the second study, reduced perceptual sensitivity on a secondary detection task. These effects were confined to driving on straight rather than on curved road sections, consistent with the effort regulation hypothesis. The second study showed that fatigue effects were moderated by a motivational manipulation. Results are interpreted within a control model, such that task-induced fatigue may reduce awareness of performance impairment, rather than reluctance or inability to mobilize compensatory effort following detection of impairment.     

Fatigue, cognitive functioning and psychological distress in Marfan syndrome, a pilot study

Marfan patients report fatigue as a major subjective complaint. We found no studies exploring the subject. The aim of this study was in a strictly defined Marfan population to assess self-reported fatigue, cognitive functions and psychological distress, correlations among them and correlations to visual acuity, joint hypermobility and use of beta-blockers. Sixteen subjects aged 18 - 30 years, fulfilling the Gent criteria, were assessed with the Fatigue Severity Scale, Fatigue Questionnaire, a comprehensive battery of neuropsychological tests and the General Health Questionnaire (GHQ). Self-reported fatigue was comparable with fatigue reported in other severe chronic diseases and disabilities, and was primarily in the mental/psychological domain. Psychological distress was higher than expected compared with the population at large. All neuropsychological test results were within the normal range, except for tests of visuo-motor coordination and speed of information processing. There was a significant inverse correlation between Fatigue Questionnaire ratings and some neuropsychological tests. Fatigue seems to be a serious problem for persons with Marfan syndrome and seems related to some areas of cognitive functioning. We found no overall impairment in cognitive functioning, but slightly reduced speed of information processing. Reduced visuo-motor coordination could be explained by impaired visual acuity.     

Applying Cluster Analysis to Define a Typology of Chronic Fatigue Syndrome in a Medically-Evaluated,Random Community Sample

This study involved a randomly selected, medically-evaluated, community-based sample of 166 individuals with chronic fatigue. Participants diagnosed with chronic fatigue syndrome and medically-explained chronic fatigue reported significantly more severe fatigue following exertion than the idiopathic chronic fatigue group, and participants with medically-explained chronic fatigue also reported significantly more severe fatigue following exertion than the psychiatrically-explained chronic fatigue group. A cluster analysis was performed to define a typology of chronic fatigue symptomatology for participants diagnosed with chronic fatigue syndrome. Three clusters emerged. Cluster 1 contained only one participant with chronic fatigue syndrome and was characterized by relatively low post-exertional fatigue. Cluster 2 contained a small proportion of individuals with chronic fatigue syndrome and was characterized by most severe post-exertional fatigue and most improvement in fatigue following rest. Cluster 3 contained the highest proportion of individuals with chronic fatigue syndrome, and was characterized by high post-exertional fatigue and fatigue not alleviated by rest.     

Symptoms,impairment and illness intrusiveness–their relationship with depression in women with CFS/ME

Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is an illness in which physiological and psychological factors are believed to interact to cause and maintain CFS/ME in an individual predisposed to it. The various symptoms and impairments associated with CFS/ME have a large impact on quality of life. The purpose of the present study was to identify the extent to which the core symptoms and impairments associated with CFS/ME relate to depression in women with CFS/ME, and to discover whether these relationships were mediated by illness intrusiveness. CFS/ME was found to be a highly intrusive illness, intruding into more life domains and to a greater degree than other illnesses. The effects of both symptoms and impairment on depression were, in part, mediated by illness intrusiveness. Although symptoms severity and impairment had both direct and indirect effects on depression, illness intrusiveness was the strongest predictor of depression.     

An evaluation of counselling and rehabilitation courses for Chronic Fatigue Syndrome

The aim of the current study was to evaluate the services offered by Action for ME to sufferers of Chronic Fatigue Syndrome using measures developed and validated in previous research. Preliminary studies had suggested that clients attending rehabilitation residential courses were benefiting from the service. A further, more in‐depth evaluation process with a greater number of health‐related outcome measures was warranted. In addition, assessment was widened to include other services offered to sufferers of the illness. Data relating to the usefulness and success of the services (rated by the clients) were also collected. Data from client volunteers were collected at baseline (that is, before intervention) and approximately six months later. Quantitative comparative analyses were conducted using within‐group comparisons to assess any improvements in scores at six‐month follow‐up from baseline. Fifty‐six participants completed wide‐ranging questionnaires assessing illness history, psychopathology, psychosocial factors and health and well‐being. Data relating to improvements in illness status and acceptability of treatment were also collected by means of global outcome measures. Both the counselling and residential groups showed improvements in many areas assessed at follow‐up. Most importantly, improvements were indicated in areas such as fatigue and the levels of disability suffered by patients. In addition, there were significant improvements in ratings of mood, anxiety, depression and physical symptoms. Overall, clients reported satisfaction with the care received and most found the services useful. All of the participants who completed the evaluation stated that they would recommend Action for ME services to fellow sufferers. The outcome of the current study is encouraging. The data presented provides evidence of the high level of support and advice Action for ME offers to sufferers of this illness. Furthermore, measurable improvements in scores relating to illness status were accompanied by improvements in mental health and psychosocial variables in the patient group.     

Reduction in disability in a randomized controlled trial of telephone-administered cognitive-behavioral therapy.

OBJECTIVE: The authors examined the efficacy of telephone-administered cognitive-behavioral therapy (T-CBT) and telephone-administered supportive emotion-focused therapy (T-SEFT) in reducing disability among disabled patients with multiple sclerosis and depression. Telephone administration of therapy allowed care to be delivered to a more disabled population. This is a secondary analysis of a randomized controlled trial; the primary outcome results for depression are reported in D. C. Mohr, S. L. Hart, L. Julian, C. Catledge, L. Honos-Webb, L. Vella, et al. (2005). DESIGN: A randomized controlled trial, comparing 16 weeks of T-CBT with T-SEFT. MAIN OUTCOME MEASURES: Disability was measured using Guy's Neurological Disability Scale; fatigue was measured using the Fatigue Impact Scale; depression was measured using the Hamilton Depression Rating Scale and the Beck Depression Inventory-II. RESULTS: Patients in both treatments showed significant improvements in disability and fatigue. These improvements were related to reductions in depression. T-CBT produced significantly greater decreases in disability and fatigue, compared with T-SEFT, even after controlling for depression. The greater benefit of T-CBT on disability was mediated by physical fatigue. CONCLUSION: These findings support the hypothesis that significant reductions in disability can be achieved by reducing depression in patients with multiple sclerosis. There was also evidence that further reductions could be achieved through CBT-specific interventions that include a focus on symptoms such as fatigue management.     

A review of definitions of fatigue – And a step towards a whole definition

Despite its importance to health and safety, there is a long history of disagreement about how to operationalize fatigue when studying exertion in human transport operators. The current article reviews existing definitions, and consequently proposes a new definition as a step forward. A consideration of everyday use of the term finds that people often seem to use fatigue to describe a sensation related to exertion. Formal definitions of fatigue can be divided into a few broad definitions, capturing experiential, physiological and performance aspects of the construct, and many narrow definitions, focusing only on one or two of these aspects. Most existing definitions do not account explicitly for the role of sleep drives and sleepiness. They also fail to account for a wide range of factors associated with transport operator exertion, such as motivation and individual, organizational and environmental factors. Each of these points is assimilated in the derivation of a new “whole definition” of fatigue, in which the experience of human operator fatigue is a central aspect of the fatigue process. Although multidimensional and diffuse, the evolved definition does not detract from the measurement and study of limited aspects of fatigue. Rather, by describing the dynamic complexity of fatigue, it may help make explicit what different studies do or do not measure or account for in terms of the different aspects of fatigue. It is claimed that the proposed definition could be used to help harmonise attempts to study and tackle fatigue in transport health and safety contexts.