Biopsychosocial aspects of chronic fatigue syndrome (myalgic encephalomyelitis)

Housebound versus nonhousebound patients with myalgic encephalomyelitis and chronic fatigue syndrome

OBJECTIVES

The objective of this study was to examine individuals with myalgic encephalomyelitis and chronic fatigue syndrome who are confined to their homes due to severe symptomatology. The existing literature fails to address differences between this group, and less severe, nonhousebound patient populations.

METHODS

Participants completed the DePaul Symptom Questionnaire, a measure of myalgic encephalomyelitis and chronic fatigue syndrome symptomology, and the SF-36, a measure of health impact on physical/mental functioning. ANOVAs and, where appropriate, MANCOVAS were used to compare housebound and nonhousebound patients with myalgic encephalomyelitis and chronic fatigue syndrome across areas of functioning, symptomatology, and illness onset characteristics.

RESULTS

Findings indicated that the housebound group represented one quarter of the sample, and were significantly more impaired with regards to physical functioning, bodily pain, vitality, social functioning, fatigue, postexertional malaise, sleep, pain, neurocognitive, autonomic, neuroendocrine, and immune functioning compared to individuals who were not housebound.

DISCUSSION

Findings indicated that housebound patients have more impairment on functional and symptom outcomes compared to those who were not housebound. Understanding the differences between housebound and not housebound groups holds implications for physicians and researchers as they develop interventions intended for patients who are most severely affected by this chronic illness.

Screening for psychological distress using internet administration of the Hospital Anxiety and Depression Scale (HADS) in individuals with chronic fatigue syndrome

OBJECTIVES

To investigate the factor structure and internal consistency of the Hospital Anxiety and Depression Scale (HADS) in individuals with Chronic Fatigue Syndrome (CFS) using an Internet administered version of the instrument.

DESIGN

Between subjects.

METHOD

Confirmatory factor analysis (CFA) and internal consistency analysis of the HADS was used to determine the psychometric characteristics of the instrument in individuals with CFS and a control group with data captured via an Internet data collection protocol.

RESULTS

CFA revealed that a 3-factor solution offered the most parsimonious account of the data. Internal consistency estimations of the anxiety and depression subscales were found to be acceptable for both groups. The CFS group was found to have significantly higher HADS-assessed anxiety and depression scores compared with controls, however, there was also evidence found that Internet administration of the instrument may inflate HADS subscale scores as an artifact of testing medium.

CONCLUSIONS

The HADS is suitable for use for screening individuals with CFS in terms of the factor structure of the instrument, however, clinicians should be aware that this instrument assesses 3 domains of affective disturbance rather than 2 as is interpreted within the current HADS anxiety and depression subscale scoring system. Researchers need also be aware that Internet administration of negative affective state measures such as the HADS is likely to inflate scores and need to ensure that comparisons between clinical groups are made with control group data gathered using the same collection methodology.

Illness Intrusiveness in Myalgic Encephalomyelitis

This study assessed the relationship between illness intrusiveness, symptoms, disability and depression in patients with myalgic encephalomyelitis (ME). Participants were 16 patients with ME and eight patients with ME plus co-morbid disorders. The patients with co-morbid disorders reported greater illness intrusiveness than the patients with ME alone, but there were no differences between the groups on the other variables. Significant correlations were found between illness intrusiveness on the one hand, and fatigue, cognitive dysfunction, disability and depression, on the other. We conclude that ME is a disabling illness, which has a major impact on various life domains.

The role of psychological factors in the fatigue of primary biliary cirrhosis

Fatigue impairs the quality of life of primary biliary cirrhosis (PBC) patients. In this study, we explored the psychological factors and coping strategies in fatigued PBC patients. Patients participated in a semi-structured interview examining thoughts regarding the impact of fatigue and coping strategies. All completed the disease-specific quality-of-life tool, PBC-40, the Penn State Worry Questionnaire (PSWQ) (degree of habitual worry) and Hospital Anxiety and Depression Scale (HADS) (current anxiety and depression). PBC patients were allocated into high (>38, n=10) and low-fatigue (<38, n=14) groups. No differences were seen between high-fatigue and low-fatigue groups regarding age, marital status, employment status, PBC stage, years with diagnosis and years experiencing fatigue. High-fatigue participants were significantly more anxious (P=0.008), more depressed (P<0.001), and more likely to worry (<0.05). High-fatigue participants had more frequent thoughts about the impact of fatigue (P<0.005) and lower self-efficacy scores (P<0.001). In conclusion, PBC patients can experience profound distress associated with fatigue. PBC patients with high levels of fatigue seem to be more vulnerable to emotional distress, more likely to perceive that their quality of life has been negatively affected and are less confident to engage in everyday activities compared with those with low levels of fatigue.

Associations between Fatigue and Medication Use in Chronic Rhinosinusitis

We conducted a prospective study of 586 adults to determine if associations exist between fatigue symptom scores and three classes of medications prescribed for the treatment of chronic rhinosinusitis (CRS): prescription nonsedating antihistamines, topical nasal steroids, and antibiotics. Patients were assessed with the assistance of the Rhinosinusitis Symptom Inventory and Likert-scale fatigue symptom scores. On multivariate analysis and correcting for disease severity, we found that significantly higher fatigue symptom scores were associated with the use of nonsedating antihistamines (mean Likert score: 2.75 vs. 2.27 for patients not taking a nonsedating antihistamine; p = 0.029). Higher fatigue scores were also associated with a greater number of antibiotic courses and more total weeks of antibiotic use (p < 0.001 in both cases). No association was seen between fatigue scores and the use of topical nasal steroids (mean Likert score: 2.65 vs. 2.24; p = 0.658). We recommend that long-term use of a nonsedating antihistamine be scrutinized in CRS patients who report symptoms of fatigue.

Linkages between goal attainment and quality of life for individuals with chronic fatigue syndrome

Goal setting was the cornerstone of a rehabilitation program for people with chronic fatigue syndrome. This study examines the relationship between goal attainment and quality of life. Participants (N = 47) set goals over eight supportive and educational group sessions. Group members reported goal progress and confidence level for goal attainment. Using a forward, stepwise linear regression analysis, goal attainment emerged as the only significant predictor of quality of life improvement (B = 0.234, 95% CI for B: 0.050 to 0.419, SE = 0.091, β = 0.372, p <. 05) independently of fatigue severity, symptom severity, and comorbid psychiatric diagnosis.

Coping and illness cognitions: chronic fatigue syndrome

The chronic fatigue syndrome (CFS) is described, and research on coping with this illness reviewed and analysed. CFS is a severely disabling illness of unknown etiology, which has occurred in epidemic forms all over the world. However, the number of sufferers has dramatically increased over previous years. The heterogeneous symptomatology of CFS was reviewed, and diagnostic criteria were discussed. The difficulty in establishing causality was emphasized. An interaction of factors appears most likely to be associated with illness onset and maintenance. As the mediating factor could be sufferers' coping behavior, the existing coping literature was reviewed. There might be an association between coping and physical and psychological well-being. Finally, recommendations are made for longitudinal research on coping and coping effectiveness, and for the development of therapeutic interventions.

Coping and other predictors of outcome in chronic fatigue syndrome: a 1-year follow-up

In this prospective study, 137 patients with chronic fatigue syndrome were followed-up at a 1-year interval to determine factors relating to outcomes. Nearly two thirds reported an improvement on direct ratings of change. In analyses with fatigue and functional impairment at follow-up as the criteria, and controlling for earlier status, poorer outcomes were predicted by illness duration, subjective cognitive difficulty, and somatic symptoms; there was no influence of anxiety, depression, or general emotional distress. Fatigue was also predicted by information-seeking, and impairment by behavioral disengagement and a low internal locus of control. The belief that one's actions can influence outcomes modified the relationship between illness accommodation and both fatigue and impairment; adverse outcomes were associated with accommodating to illness only in the context of lower levels of perceived control. Thus, it is suggested that interventions that either discourage avoidance of activity or enhance perceived control could benefit the course of the illness.

The quality of life of persons with chronic fatigue syndrome

This descriptive study used a between-methods triangulation design to analyze the multiple dimensions of quality of life in persons with chronic fatigue syndrome (CFS). This method, which refers to the combination of both quantitative and qualitative methods in the same study, allowed the authors to obtain more comprehensive and robust data than could be obtained by either method alone. A convenience sample of 110 persons with CFS completed the quality of life index and CFS questionnaire, and a subset of 22 persons were interviewed regarding their lived experience with CFS. Overall scores on the quality of life index were significantly lower in CFS than for other chronic illness groups. Subjects reported the lowest quality of life scores in health and functioning domain. Indepth interviews provided a more complete understanding of the quality of life in CFS and further explained the low ratings that were found on the quality of life index. The findings suggest that quality of life is particularly and uniquely disrupted in CFS.

Chronic fatigue syndrome: sufferers' evaluation of medical support

In response to reports of negative cooperation between sufferers of chronic fatigue syndrome (CFS) and their doctors, semi-structured interviews were conducted with sufferers from two different patient samples. Satisfaction with support received and with medical professionals in general was low. Sufferers complained about insufficient informational as well as emotional support from their doctors, and as a consequence most opted for alternative or complementary forms of treatment. In addition, disagreements over illness aetiology and treatment precluded effective cooperation. If satisfaction and compliance are to improve, sufferers will need more information about CFS and more support.

Chronic fatigue syndrome

Chronic fatigue syndrome (CFS) is a medically unexplained illness characterized by chronic, disabling fatigue, impaired concentration, muscle pain, and other somatic symptoms. The conceptual difficulties associated with all medically unexplained illnesses contribute to the controversy surrounding CFS, which has centered around whether it is best regarded as a medical or as a psychiatric condition. Clinically, such an approach is not helpful, and current research suggests that both pathophysiologic changes and psychosocial factors are important. Pragmatic management based on a detailed assessment of the individual is outlined.

Neurocognitive functioning in chronic fatigue syndrome

Although substantial research has been conducted on chronic fatigue syndrome (CFS) over the past decade, the syndrome remains poorly understood. The most recent case definition describes CFS as being characterized both by disabling fatigue and by subjective reports of difficulty with concentration and "short-term" memory. However, research into the neurocognitive and psychological functioning of individuals with CFS has provided mixed objective results. The current paper reviews studies that have examined the neurocognitive and/or psychological functioning of individuals with CFS. Changes in research design and instruments employed to study individuals with CFS are suggested.

Coping with chronic fatigue syndrome: illness responses and their relationship with fatigue, functional impairment and emotional status

The implications of patients' approaches to managing chronic fatigue syndrome were examined in a cross-sectional study. With severity of fatigue controlled, attempting to maintain activity was associated with less functional impairment, while accommodating to the illness was positively related to impairment; behavioural disengagement was related not only to higher levels of impairment but also to greater emotional disturbance. Fatigue itself was positively associated with focusing on symptoms and with behavioural disengagement; it was associated also with illness accommodation, but only for illness of longer duration. The causal direction of relationships between coping and fatigue severity is ambiguous, and a follow-up study will address the effects of coping on changes in the illness over time.

Professional and popular views of chronic fatigue syndrome

OBJECTIVE

To study the coverage of the chronic fatigue syndrome in the popular and professional press.

DESIGN

Search of all original research papers on the chronic fatigue syndrome published in British journals from 1980 onwards and of professional trade papers, national newspapers, and women's magazines. Interviews with six medical journalists.

SETTING

British scientific, medical, and popular press.

RESULTS

37 (49%) articles in research journals did not favour organic causes and 23 (31%) favoured organic causes. By contrast 31 (55%) articles in the medical trade press and 118 (69%) in national newspapers and women's magazines favoured organic causes.

CONCLUSIONS

Press coverage of chronic fatigue syndrome has amplified and distorted divisions in the research community concerning the chronic fatigue syndrome. Articles in the press concentrate on a simple medical model of illness reinforcing the stigma of psychological illness and dissatisfaction with traditional medical authority.