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.     

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.     

The Role of Religious Beliefs in Coping With Chronic Illness

The authors examined the ways in which 40 women with chronic illnesses (rheumatoid arthritis, osteoporosis, multiple sclerosis, systemic lupus erythematosus, or a combination of these disorders) used religious beliefs as a means of coping with their illnesses, The participants, all between the ages of 28 and 79 years, were interviewed about the role religious beliefs played in their experiences and the ways in which they made meaning in their lives or coped with their illnesses. The majority of the women reported that religious beliefs were important in living with a chronic illness. In addition, more women who were identified as coping well with their illness reported strong religious beliefs, whereas the majority of women identified as poor copers reported that religion was unimportant or that they had no religious beliefs.     

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…     

Religious Moral Beliefs Inversely Related to Trauma Experiences Severity and Depression Severity among War Veterans in Bosnia and Herzegovina

The aim of this study is to determine the association of religious moral beliefs and depression severity of war veterans in Bosnia and Herzegovina. The sample consists of male war veterans who were inpatients with clinically presented depression and those who were observed as healthy, regarding results of previous psychological testing (n = 65 both). The Bosnia–Herzegovina versions of Hopkins Symptom Checklist and Harvard Trauma Questionnaire with questionnaire for religious moral beliefs were applied. The religious moral belief index was inversely correlated to depression severity. The religious moral beliefs may help protection of the war veterans’ mental health stability after surviving multiple war traumas.     

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.     

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.     

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.     

Effects of Child Psychopathology on Maternal Depression: The Mediating Role of Child-Related Acute and Chronic Stressors

In light of recent research highlighting the potential effects of children’s behavior on mothers’ mental health, the current study examined 679 mothers and their adolescent children from a community-based sample to determine the effects of youth psychopathology on maternal depression and levels of child-related stress in mothers’ lives. It was hypothesized that the number of past clinical diagnoses in 15-year-old adolescents would predict the presence of maternal depression at youth age 15 and 5 years later, as well as more episodes of maternal depression during the follow-up period. Furthermore, it was hypothesized that increased levels of child-related stress in mothers’ lives would mediate these relationships. Regression analyses indicated that past youth diagnoses do confer risk for the presence of current and future maternal depression, as well as more episodes of maternal depression, and mediation analyses revealed that child-related acute and chronic stress were mediators of the relationship between youth diagnoses and the presence of maternal depression at follow-up. Findings suggest that increased levels of child-related objective stress in mothers’ lives are one mechanism by which children’s psychopathology affects mothers’ future risk for depression.     

Relationship of Illness Severity with Health and Life Satisfaction in Patients with Cardiovascular Disease: The Mediating Role of Self-efficacy Beliefs and Illness Perceptions

Guidelines for cardiovascular rehabilitation from different countries underline the importance of psychological factors in the achievement of improved clinical conditions and quality of life in patients with cardiovascular disease (CVD). Nevertheless, little research has been performed to identify the specific factors that greatly affect or foster patients’ quality of life. The aim of the current study was to investigate the contribution of illness perceptions (IP) and self-efficacy beliefs (SE) on the impact exerted by illness severity on health and life satisfaction in patients with CVD undergoing a rehabilitation program. The study had a cross-sectional design and involved 116 patients (mean age = 65.6 years; SD = 10.0 years; 79.3 % men). Illness severity was measured in terms of left ventricular ejection fraction (LVEF) at the discharge from the cardiology department, whereas psychological factors were assessed one week later. The results showed no relationships among LVEF and the two indicators of health and life satisfaction; moreover, these two variables are differently influenced by IP and cardiac risk factors SE (χ²(1) = 0.96, p = n.s.). Findings provide important suggestions for the implementation of interventions aimed at bettering patients’ quality of life, underlying the importance of working on IP and SE to improve levels of health and life satisfaction in patients with CVD.     

Coping Style and Depression in Early Adolescence: Relationships to Gender,Gender Role,and Implicit Beliefs

Three studies were designed to investigate the interrelationships among coping styles, gender roles, and level of depression for early adolescents. Girls displayed more depression than boys, and more highly depressed girls demonstrated coping patterns similar to those of depressed adolescent and adult women. Individuals who identified with the feminine gender role showed increases in depression with age. Participants' implicit beliefs about what constituted appropriate coping behavior were also linked to gender. Both genders believed that men should not ruminate but that they should distract themselves from problems. The implications of these findings are discussed.     

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.     

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.     

神经质人格对中小学生抑郁的影响：班级环境的跨层调节作用

基于素质-应激理论考察神经质人格及班级环境对中小学生抑郁的作用机制,对30个班级共933名中小学生进行问卷调查。多层分析结果显示：（1）中小学生抑郁存在显著的班级聚集效应;（2）神经质人格正向预测中小学生抑郁,班级人际环境、班级学习环境均负向预测中小学生抑郁;（3）班级学习环境跨层调节神经质人格与中小学生抑郁之间的关系,即积极的班级学习环境削弱了神经质人格对中小学生抑郁的影响。结果表明,我国教学制度下的班级学习环境在中小学生抑郁预防过程中可发挥重要作用。     

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.     

The Effect of War Stressors and Life Events on Gulf War Veterans With Chronic Fatigue Syndrome Symptoms

This study examines the association of life stressors and the period when they occur, with the development of chronic fatigue syndrome (CFS) symptoms in Gulf War veterans. Of data collected from Gulf War Health Registry veterans, 113 met CFS criteria and 441were controls. After hierarchical multiple regression, several negative life stressors were associated with CFS group membership: being wounded, experiencing a traumatic war experience, frequent battle experiences, demotion, and unable to work within 2 years of returning from the Gulf. The positive life stressor of buying a house more than 2 years after returning protected against being in the CFS group. The findings are consistent with etiological hypotheses of CFS incorporating a psychosocial component and are useful in developing programs for veterans returning from war.     

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.