Symptoms of Meares-Irlen/Visual Stress Syndrome in subjects diagnosed with Chronic Fatigue Syndrome

Several diagnostic symptoms of the visual-processing deficit Meares-Irlen/Visual Stress Syndrome are remarkably similar to symptom manifestations reported by individuals with chronic fatigue syndrome (CFS). We surveyed the specific incidences of nine widely-recognised symptoms of visual stress (VS) in a group of subjects (n = 20) previously diagnosed with CFS. The presence of each symptom of VS in the CFS group was compared to its respective presence in both an age and sex matched healthy comparison group (n = 46), and an age and sex matched group comprised of individuals (n = 14) diagnosed with VS. Results showed the frequencies of all nine VS symptoms in the CFS-diagnosed group to be significantly higher (p = .032 – p < .0005) than in the comparison group, with only two symptoms being statistically less frequent in the CFS group than in the VS-diagnosed group. The average number of VS symptoms reported by the CFS group was also significantly higher than the comparison group, yet not significantly different from the VS group. Thus, the occurrence of VS symptoms in subjects diagnosed with CFS appears to be far greater than previously reported, which in turn may indicate the interplay of some yet to be identified underlying factor(s) common to both conditions.     

Using Rebt and Supportive Psychotherapy with Post-Stroke Patients

This paper discusses the benefits of using Calabro's (1990) three-stage cognitive-behavioral model, to determine when to use supportive Psychotherapy or Rational-Emotive Behavior Therapy (REBT) with post-stroke patients. It also discusses the benefits of using a support group and how to decide when to use a group and/or individual psychotherapy.     

警惕慢性疲劳综合症

“慢性疲劳综合症”是一种新疾病。本病临床表现主要为极度疲劳、微热、咽痛、淋巴结肿大、肌力低下、思考力下降、注意力不易集中、精神抑郁。人的疲劳主要反映在人体的三大系统。一是神经系统的疲劳:二是心血管系统的疲劳,三是骨骼肌肉系统的疲劳。神经系统疲劳分为深度与表层疲劳两种形式。表层疲劳如失重、头晕、睡眠不好、没有精神。如果属于比较深层的精神疲劳,即食欲消失、彻夜不眠、烦躁不安等症状,就要用心理的、物理的、化学方面的方法来进行恢复。心血管系统疲劳症状是心跳杂音,间歇乃至出现心肌炎、胸膜炎等症状,正常的心率间歇…     

Cognitive Behavior Therapy for Relatively Active and for Passive Chronic Fatigue Syndrome Patients

In chronic fatigue syndrome (CFS), facilitating, initiating, and perpetuating factors are distinguished. Although somatic factors might have initiated symptoms in CFS, they do not explain the persistence of fatigue. Cognitive behavior therapy (CBT) for CFS focuses on factors that perpetuate and prolong symptoms. Recently it has been shown that, based on their level of activity, two groups of patients can be distinguished. For so-called “relatively active” CFS patients, the main perpetuating factors are nonaccepting and demanding cognitions leading to bursts of activity. For so-called “passive” CFS patients, their fear that activity might worsen their symptoms (which results in an avoidance of activity) is the most important perpetuating factor. These differences in perpetuating factors result in separate treatment manuals for relatively active and for passive CFS patients. Before describing the treatment manuals, we outline basic assumptions, considerations before starting CBT for CFS, and ways to determine the activity pattern.     

Chronic Fatigue Syndrome: The Need for Subtypes

Chronic fatigue syndrome (CFS) is an important condition confronting patients, clinicians, and researchers. This article provides information concerning the need for appropriate diagnosis of CFS subtypes. We first review findings suggesting that CFS is best conceptualized as a separate diagnostic entity rather than as part of a unitary model of functional somatic distress. Next, research involving the case definitions of CFS is reviewed. Findings suggest that whether a broad or more conservative case definition is employed, and whether clinic or community samples are recruited, these decisions will have a major influence in the types of patients selected. Review of further findings suggests that subtyping individuals with CFS on sociodemographic, functional disability, viral, immune, neuroendocrine, neurology, autonomic, and genetic biomarkers can provide clarification for researchers and clinicians who encounter CFS characteristically confusing heterogeneous symptom profiles. Treatment studies that incorporate subtypes might be particularly helpful in better understanding the pathophysiology of CFS. This review suggests that there is a need for greater diagnostic clarity, and this might be accomplished by subgroups that integrate multiple variables including those in cognitive, emotional, and biological domains.     

Family and Partner Facing a Chronic Disease: Chronic Fatigue Syndrome

The purpose of this article is to analyze the growing interest in the influence of the family, particularly the patient's partner, on chronic fatigue syndrome (CFS). Social support is a vital element in many medical conditions. There is growing interest in the influence of the family, particularly the patient's partner, on chronic fatigue syndrome (CFS), but more work is needed in this line. Helping family members to optimize the support they provide may be the key to improving the efficacy of therapeutic interventions in CFS, and have a positive impact on the patient's symptoms.     

Few Gender Differences Exist Between Women and Men with Chronic Fatigue Syndrome

Chronic fatigue syndrome (CFS) is generally considered to be a women's health issue, but the illness occurs also in men. The research objective of this study was to determine if illness patterns and functional status differed between the sexes. Because our own data showed that women with CFS have significantly more comorbid fibromyalgia or multiple chemical sensitivity than men, we eliminated patients with these comorbid conditions from our evaluation. Women with CFS were quite similar to men with CFS in terms of demographics, psychiatric status, functional status, and assessments of disability. Women reported more infectious/flu-like symptoms (represented by a factor derived from factor analysis) than men, but these differences were insignificant after controlling for other variables. Cluster analysis revealed that women were more likely than men to fall in the cluster characterized by symptom severity. Differences found were those of degree rather than of type; strikingly different illness patterns—suggestive of different pathophysiological processes between the sexes—were not found.     

Detecting Chronic Fatigue Syndrome: The Role of Counselors

Chronic fatigue syndrome (CFS) is a physical illness, the cause of which is unknown. Known also as chronic fatigue immune dysfunction syndrome and myalgic encepalomyelitis, the illness has a probable incidence of 2 to 3 per 1,000 among adults and adolescents and is seen also in children. Only a small minority of cases are diagnosed, and only 25% of those suffering from CFS suspect this as the diagnosis. For this reason, counselors often see persons with unsuspected cases and may play an important role in detecting and referring these clients appropriately. Case histories are used to illustrate how suspected cases of CFS can be distinguished from depression and other mental health conditions in counseling practice.     

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.     

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.     

慢性心力衰竭患者临床管理与评估

尽管近年来在慢性心力衰竭(CHF)的治疗方面取得了较大的进展,但CHF患者仍有较高的住院率及病死率.CHF临床实践指南的发布促进了规范化治疗.为了取得良好的医疗效果,临床医生必须对心力衰竭患者提供一系列复杂的药物治疗及严格的自我控制措施.随着医学的不断发展,出现了包括心脏再同步化起搏、左心室辅助装置或心脏移植等治疗,而这些手段常需要在对患者进行危险性评估的基础上进行.严格遵循指南并使CHF患者出院后的教育与各种支持项目相结合才能够在一定程度上减低患者的再住院率及病死率.     

Chronic Fatigue Syndrome Severity and Depression: The Role of Secondary Beliefs

Chronic fatigue syndrome (CFS) is a poorly understood illness that is characterized by profound and prolonged exhaustion and has no clear pathological marker. This study investigated the role of illness severity and secondary beliefs in depression among a CFS cohort, using the A–B–C framework of Rational Emotive Behavioral Therapy. Empirical research has consistently found that CFS patients tend to hold more negative cognitions about their illness, which could be associated with greater severity and emotional deficits. Specifically, secondary beliefs were explored as a mediating factor; as evidence suggests that secondary beliefs can result in dysfunctional emotions and/or behaviors, such as depression. Furthermore, it is estimated that up to 80% of CFS patients concurrently have depression. There were 156 participants with CFS who completed a questionnaire pack, which included the revised version of the Illness Perception Questionnaire, the Secondary Beliefs Scale (SBS), and the Cardiac Depression Scale. Hierarchical regression analysis revealed that secondary beliefs mediated the relationship between illness severity and depression. Specifically, the approval and comfort subscales of the SBS were significantly associated with depression. The current findings indicated that secondary beliefs could be an important focus in treatment of depression in chronic illness. As the mediating role of secondary beliefs is a new research finding, it is advised that further exploratory research is required.     

Generalized Worry in Patients With Chronic Fatigue Syndrome Following Cognitive Behavioral Therapy: A Prospective Cohort Study in Secondary Care

Research has shown that generalized anxiety disorder is commonly associated with Chronic Fatigue Syndrome (CFS). This prospective cohort study aimed to investigate the prevalence of generalized worry in CFS patients and its relationship with fatigue, anxiety and social functioning, before and after Cognitive Behavioral Therapy (CBT). Our cohort consisted of 470 patients diagnosed with CFS who received CBT at a secondary care, specialist clinic. Patients completed self-report measures investigating levels of generalized worry, fatigue, work and social adjustment, anxiety and depression at baseline (pretreatment), discharge from treatment, 3-month and 6-month follow up (posttreatment). Analysis indicated a high prevalence of generalized worry (72.4%) at assessment. A significant reduction in worry following CBT (M = −3.42, p < .001, 95% CIs: 2.26, 4.57) was observed at discharge, which remained stable at follow-up. Severe baseline worriers had greater overall fatigue score (M = 3.74, p = .026, 95% CIs: .33, 7.15) and worse overall work and social adjustment than mild worriers across time-points (M = 5.42, p = .035 95% CIs: .27, 10.58). Avoidance behavior mediated the association between generalized worry and work and social adjustment (95% bootstrap CIs: 013, .080). The majority of patients with CFS had comorbid generalized worry and severe worriers reported greater fatigue, anxiety, and worse work and social adjustment. This suggests that CFS patients may benefit from targeting generalized worry during CBT.     

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.     

干扰素治疗慢性乙型肝炎管理策略初探

在慢性乙肝抗病毒治疗中干扰素作为一线治疗取得了一定的疗效。在治疗过程中通过选择合适的慢性乙肝患者、监测疗效、确立个体化的疗程和剂量、及时监测不良反应和恰当的处理和最大限度的提高患者的依从性可使干扰素的疗效达到最大化。     

干扰素治疗慢性乙型肝炎管理策略初探

在慢性乙肝抗病毒治疗中干扰素作为一线治疗取得了一定的疗效.在治疗过程中通过选择合适的慢性乙肝患者、监测疗效、确立个体化的疗程和剂量、及时监测不良反应和恰当的处理和最大限度的提高患者的依从性可使干扰素的疗效达到最大化.     

Professional support of self-help groups: a support group project for Chronic Fatigue Syndrome patients

Professionals are involved in self-help groups in a variety of roles as advising experts, facilitators and even as group leaders. A few studies focus on attitudes toward professional involvement, but very little is known about the nature of this collaboration. The study follows a collaborative support group project between a team of health professionals at a regional hospital in Norway and a Chronic Fatigue Syndrome patients' group. It is arguably an advantage for professionals to decide upon the aim of a joint intervention in dialogue with the participants, but simply asking the participants what their aims are does not guarantee actual agreement. As this case study demonstrates, participants may have reason to conceal their objectives.     

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.     

Causal Attributions,Perceived Control,and Psychological Adjustment: A Study of Chronic Fatigue Syndrome1

Causal attributions control, beliefs, and helpful and unhelpful support attempts were examined among people experiencing chronic fatigue syndrome (CFS) and their close others. Results revealed that 84% of respondents with CFS believed that their illness was due, at least in part, to physical or external causes, whereas 47% mentioned internal/psychological causes. Reports of internal causal attributions for CFS were positively correlated with indicators of poor psychological adjustment among those with CFS. Having an external locus of control (i.e., to powerful others) was also associated with poorer psychological adjustment among respondents with CFS. Close others' causal attributions to internal factors were related to frequency of self‐reported unhelpful support attempts and to reports of depression and anxiety those respondents with CFS.