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olde Hartman TC, Scheepers TP, Lucassen P, van Boven K. Do Women With Severe Persistent Fatigue Present With Fatigue at the Primary Care Consultation? ZEITSCHRIFT FUR PSYCHOLOGIE-JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1027/2151-2604/a000402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Recent studies have shown underdiagnosis of severe persistent fatigue in primary care. To study how patients with severe persistent fatigue present in primary care and whether they differ from patients with less severe fatigue and patients with no fatigue. A 4-year retrospective database study combined with a questionnaire, including all female patients 25–50 years ( n = 917) who are registered in one primary care group practice. Based on the results of a validated self-administered questionnaire, patients were divided into three groups: patients with severe persistent fatigue ( n = 42), patients with fatigue ( n = 174), and patients with no fatigue ( n = 246). Data on frequency of consulting, reason for encounter, and diagnoses from 2009 to 2013 were obtained from the electronic medical health record. Data were analyzed using odds ratios. Women with severe persistent fatigue more often were unemployed and had lower education. They visited the general practitioners (GP) more often than other women. However, more than half of the women with severe persistent fatigue did not visit their GP with fatigue as reason for encounter at all during the 4 years of study. A minority of the women with severe persistent fatigue received a psychological diagnosis or social diagnosis (36% and 19%, respectively) during these 4 years. Underdiagnosis of severe persistent fatigue is partly a consequence of patients not presenting or reporting this to their GP. The reasons for this behavior are not clear.
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Affiliation(s)
- Tim C. olde Hartman
- Department of Primary and Community Care, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Tomas P. Scheepers
- Department of Primary and Community Care, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Peter Lucassen
- Department of Primary and Community Care, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Kees van Boven
- Department of Primary and Community Care, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
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Duyck SD, Petrie KJ, Dalbeth N. “You Don't Have to Be a Drinker to Get Gout, But It Helps”: A Content Analysis of the Depiction of Gout in Popular Newspapers. Arthritis Care Res (Hoboken) 2016; 68:1721-1725. [DOI: 10.1002/acr.22879] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 01/22/2016] [Accepted: 03/01/2016] [Indexed: 12/18/2022]
Affiliation(s)
- Stefanie D. Duyck
- Stefanie D. Duyck, BPsych: University of Leuven, Leuven, Belgium; and University of Auckland; Auckland New Zealand
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Mallet M, King E, White PD. A UK based review of recommendations regarding the management of chronic fatigue syndrome. J Psychosom Res 2016; 88:33-5. [PMID: 27521650 DOI: 10.1016/j.jpsychores.2016.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 07/12/2016] [Accepted: 07/15/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Chronic fatigue syndrome (CFS) is a controversial illness, with apparent disagreements between medical authorities and patient support organisations regarding safe and effective treatments. The aim of this study was to measure the extent of different views regarding treatments, comparing patient support organisations and medical authorities in the UK. METHODS Two independent raters analysed two groups of resources: UK patient support websites and both medical websites and textbooks. A 5-point Likert scale was developed with the question 'With what strength does the source recommend these treatments?' The various treatments were divided into the following four groups: complementary and alternative medicine (CAM), pharmacological, rehabilitative, and pacing therapies. RESULTS There were significant differences between the scores for patient support organisations and medical sources for all 4 treatment groups. The results for supporting CAM were 74% (patient group) vs 16% (medical source) (p<0.001), 71% vs 42% for pharmacological (p=0.01), 28% vs 94% for rehabilitative (p<0.001) and 91% vs 50% for pacing treatments (p=0.001). CONCLUSIONS There were substantially different treatment recommendations between patient support organisations and medical sources. Since expectations can determine response to treatment, these different views may reduce the engagement in and effectiveness of rehabilitative therapies recommended by national guidelines and supported by systematic reviews.
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Affiliation(s)
- Miriam Mallet
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Eleanor King
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Peter D White
- Wolfson Institute of Preventive Medicine, Barts and the London School of medicine and Dentistry, Queen Mary University of London, London, UK.
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Huiberts A, Hjørnevik M, Mykletun A, Skogen JC. Electromagnetic hypersensitivity (EHS) in the media - a qualitative content analysis of Norwegian newspapers. JRSM SHORT REPORTS 2013; 4:2042533313487332. [PMID: 24319582 PMCID: PMC3831852 DOI: 10.1177/2042533313487332] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives Electromagnetic hypersensitivity (EHS) is a condition characterized by experiencing symptoms after perceived exposure to weak electromagnetic fields (EMFs). There is substantial debate concerning the aetiology of EHS, but experimental data indicate no association between EHS and actual presence of EMFs. Newspapers play a key role in shaping peoples’ understanding of health-related issues. The aim of this study was to describe the content of newspaper articles concerning aetiology and treatment of EHS. Design Qualitative content analysis of newspaper articles. Setting Norwegian newspaper articles were identified using a comprehensive electronic media archive. Participants Norwegian newspaper articles published between 1 February 2006 and 11 August 2010. Main outcome measures Statements coded according to source of information, whether it was pro or con scientific evidence on EHS aetiology, and type of intervention presented as treatment option for EHS. Results Of the statements concerning EHS aetiology (n = 196), 35% (n = 69) were categorized as pro evidence, 65% (n = 127) as con evidence. Of the statements about EHS interventions assessed, 78% (n = 99) were categorized as ‘radiance reduction’, 4% (n = 5) as ‘complementary medicine’, and 18% (n = 23) as ‘other’. Cognitive behavioural therapy (CBT) and psychotropic drugs were never presented as possible treatment options for EHS. Conclusions The newspaper media discourse of EHS aetiology and recommended treatment interventions is much in conflict with the current evidence in the field. The majority of statements concerning aetiology convey that EHS is related to the presence of weak EMFs, and radiance reduction as the most frequently conveyed measure to reduce EHS-related symptoms.
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Affiliation(s)
- Ashild Huiberts
- Research Centre for Health Promotion and Development, Faculty of Psychology, University of Bergen, 5015 Bergen, Norway
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Hossenbaccus Z, White PD. Views on the nature of chronic fatigue syndrome: content analysis. JRSM SHORT REPORTS 2013; 4:4. [PMID: 23413406 PMCID: PMC3572659 DOI: 10.1258/shorts.2012.012051] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives Chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME), has provoked much controversy and led to arguments between the medical profession and patient organizations. A particular focus for debate is the categorization of the condition as physical or psychological in its nature. The aim of this study was to compare how the written media, patient organizations and medical authorities regard the illness. Design Content analysis of newspaper articles, ME patient organization websites, and medical websites and textbooks were assessed by two independent assessors. Setting Three national UK newspapers, UK ME websites, and UK medical websites and textbooks, were accessed during 2010. Participants 146 source files were scored from 36 patients' organizations, 72 media articles and 38 medical authorities. Main outcome measured The overall opinion of an article or website was rated using a five point Likert scale, from ‘extremely psychological’ (scored as 1), ‘moderately psychological’ (2), ‘both psychological and physical’ (3), ‘moderately physical’ (4) or ‘extremely physical’ (5). Results Eighty-nine percent (32 of 36) of ME patient organizations considered the illness to be physical, compared with 58% (42/72) of newspaper articles, and 24% (9/38) of medical authorities. Sixty-three percent (24/38) of medical authorities regarded the illness as both physical and psychological. The inter-group differences of the Likert scores were statistically significant (χ2 = 27.37, 2 df, P < 0.001). Conclusion The considerable disagreement, particularly between ME patient organizations and medical authorities, may help to explain the gulf in understanding between doctors and patients and the consequent reluctance of some patients to engage in behavioural treatments.
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Affiliation(s)
- Zahra Hossenbaccus
- Barts and The London School of Medicine and Dentistry, Queen Mary University London , London , UK
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Knudsen AK, Omenås AN, Harvey SB, Løvvik CMS, Lervik LV, Mykletun A. Chronic fatigue syndrome in the media: a content analysis of newspaper articles. JRSM SHORT REPORTS 2011; 2:42. [PMID: 21637403 PMCID: PMC3105457 DOI: 10.1258/shorts.2011.011016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Although cognitive behavioural therapy and graded exercise treatment are recognized evidence-based treatments for chronic fatigue syndrome/myalgic encephalomyelitis (ME), their use is still considered controversial by some patient groups. This debate has been reflected in the media, where many patients gather health information. The aim of this study was to examine how treatment for chronic fatigue syndrome/ME is described in the newspaper media. DESIGN Content analysis of newspaper articles. SETTING The digitalized media archive Atekst was used to identify Norwegian newspaper articles where chronic fatigue syndrome/ME was mentioned. PARTICIPANTS Norwegian newspaper articles published over a 20-month period, from 1 January 2008 to 31 August 2009. MAIN OUTCOME MEASURES Statements regarding efficiency of various types of treatment for chronic fatigue syndrome/ME and the related source of the treatment advice. Statements were categorized as being either positive or negative towards evidence-based or alternative treatment. RESULTS One hundred and twenty-two statements regarding treatment of chronic fatigue syndrome/ME were identified among 123 newspaper articles. The most frequent statements were positive statements towards alternative treatment Lightning Process (26.2%), negative statements towards evidence-based treatments (22.1%), and positive statements towards other alternative treatment interventions (22.1%). Only 14.8% of the statements were positive towards evidence-based treatment. Case-subjects were the most frequently cited sources, accounting for 35.2% of the statements, followed by physicians and the Norwegian ME association. CONCLUSIONS Statements regarding treatment for chronic fatigue syndrome/ME in newspapers are mainly pro-alternative treatment and against evidence-based treatment. The media has great potential to influence individual choices. The unbalanced reporting of treatment options for chronic fatigue syndrome/ME in the media is potentially harmful.
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Affiliation(s)
- Ann Kristen Knudsen
- Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Anne Nagelgaard Omenås
- Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Samuel B Harvey
- King's College London, Institute of Psychiatry, Department of Psychological Medicine, Weston Education Centre, London, UK
| | - Camilla MS Løvvik
- Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Linn V Lervik
- Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Arnstein Mykletun
- Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen, Norway
- Norwegian Institute of Public Health, Division of Mental Health, Oslo, Norway
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Abstract
This paper discusses factors associated with low rates of help-seeking and poorer quality of physical healthcare among people with mental illnesses. Evidence is reviewed on the associations between low rates of mental health literacy, negative attitudes towards people with mental illness, and reluctance to seek help by people who consider that they may have a mental disorder. People with mental illness often report encountering negative attitudes among mental health staff about their prognosis, associated in part with 'physician bias'. 'Diagnostic overshadowing' appears to be common in general health care settings, meaning the misattribution of physical illness signs and symptoms to concurrent mental disorders, leading to underdiagnosis and mistreatment of the physical conditions.
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Affiliation(s)
- Graham Thornicroft
- Section of Community Psychiatry, Health Services and Population Research Department, Institute of Psychiatry, King's College London. De Crespigny Park, London SE5 8AF. UK.
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Page LA, Petrie KJ, Wessely SC. Psychosocial responses to environmental incidents: a review and a proposed typology. J Psychosom Res 2006; 60:413-22. [PMID: 16581367 DOI: 10.1016/j.jpsychores.2005.11.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/10/2005] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective of this review was to propose a typology for understanding the diversity of psychosocial reactions to environmental incidents. METHODOLOGY The first section provides an introduction and background to the topic; we then attempt to provide a typology of psychosocial responses to environmental incidents. RESULTS Response to an environmental incident can be usefully considered in terms of the exposure, the response of the individual, the action of professionals, the response of the community, and the influence of the society in which the incident occurs. We reviewed each of these factors. CONCLUSIONS By examining incidents in an ordered framework, we suggest that a more comprehensive understanding is possible. We also suggest some basic ways in which the psychosocial management of such difficult and diverse incidents could be improved.
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Affiliation(s)
- Lisa A Page
- Department of Psychological Medicine, Institute of Psychiatry, King's College, London, UK
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Voss M. Checking the pulse: Midwestern reporters' opinions on their ability to report health care news. Am J Public Health 2002; 92:1158-60. [PMID: 12084701 PMCID: PMC1447207 DOI: 10.2105/ajph.92.7.1158] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Newspapers play a key role in disseminating information and shaping perceptions about health, research, and policies. Inadequate or misleading reporting constitutes a public health threat that can jeopardize individual health and lead to harmful health policies. METHODS Surveys were mailed to 165 reporters at 122 newspapers in 5 Midwest states. The association of training, newspaper size, and experience with reporter's self-perceived reporting ability was assessed. RESULTS The response rate was 69.6% (115/165). Between 66% and 85% of the reporters assessed 4 tasks vital to sound health reporting as "sometimes difficult" to "nearly always difficult." No significant differences in perceived ability were found by training or newspaper size. Respondents with less experience reported higher perceived ability. CONCLUSIONS These findings show that reporters may have difficulty understanding complex health issues and interpreting statistics because they are inadequately trained.
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Abstract
AIM The aim of this study was to explore people's experiences, concerns and beliefs about disclosing minor mental health problems by focusing on the ways in which such disclosures are interpreted. BACKGROUND Approximately half of people with mental health problems do not seek help. The decision to consult represents just one aspect of the process of revealing one's illness to others. People with mental health problems are known to be reluctant to reveal the existence of those problems through fear of how others might then view them. DESIGN A qualitative approach was employed. In-depth interviews were carried out with 47 users and nonusers of community mental health services. Interviews were tape-recorded, transcribed and analysed. RESULTS The data suggest that when people reveal minor mental health problems others interpret these in relation to a number of perceived contextual factors. These include perceptions of the severity and duration of any possible causes, the inner 'strength' of the person, the expected ability of the person to either solve or suppress the experience, and the form and context of the expression itself. The data presented included individuals who were seeking help for relatively 'minor' mental health problems (primarily depression and anxiety) and individuals who had no current mental health problems but routinely managed expressions of their own emotions. Throughout the data there appeared to be no distinct difference between these two groups other than one of the severity of psychological experience. CONCLUSION The key elements involved in the interpretation of people's expressions of sadness were essentially the same as those involved in the interpretation of expressions of depression. An appreciation of these contextual factors influencing the interpretation and disclosure of minor mental health problems may aid the development of more person-centred mental health services and inform the content of health education in the mental health field.
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Affiliation(s)
- B Williams
- Behavioural Science, Department of Epidemiology and Public Health, Ninewells Hospital and Medical School, Dundee, UK.
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Weiss MG, Jadhav S, Raguram R, Vounatsou P, Littlewood R. Psychiatric stigma across cultures: Local validation in Bangalore and London. Anthropol Med 2001. [DOI: 10.1080/13648470120063906] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Johnson SK, DeLuca J, Natelson BH. Chronic fatigue syndrome: reviewing the research findings. Ann Behav Med 2000; 21:258-71. [PMID: 10626034 DOI: 10.1007/bf02884843] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
This article reviews the current state of research in chronic fatigue syndrome (CFS). The evolving definition, prevalence, and prognosis of this controversial illness are presented. We review studies examining psychiatric, personality, and psychosocial etiology for CFS. The evidence for pathophysiology in CFS is also presented, and studies investigating viral, immune, neuroimaging, neuroendocrine, and central and autonomic nervous system abnormalities in CFS are assessed. Current evidence indicates that CFS is multi-determined and heterogeneous and that subgrouping patients according to factors such as psychiatric state and symptom onset may be fruitful. The current state of treatment for CFS is reviewed, and the challenges for research aimed at resolving this prototypical mind/body problem are discussed.
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Affiliation(s)
- S K Johnson
- Department of Psychology, University of North Carolina, Charlotte 28223, USA
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Elliott H. Use of formal and informal care among people with prolonged fatigue: a review of the literature. Br J Gen Pract 1999; 49:131-4. [PMID: 10326269 PMCID: PMC1313351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
Prolonged fatigue is a common symptom in the community and a common complaint in GPs' surgeries. The current consensus is that prolonged fatigue is most appropriately managed within primary care but that quality of care is patchy. Diagnosis is difficult and there is no conclusive evidence about effective treatment. This can lead to confusion and controversy among lay people and health professionals alike. Although the value of a positive doctor-patient relationship is emphasized, general practice consultations are frequently experienced as difficult by both parties. Moreover, little is known about how people access other sources of care and information about prolonged fatigue, such as alternative medicine, self-help groups, lay others, and self care, in conjunction with or as an alternative to care from health professionals. This paper reviews the literature on the nature and extent of the problem prolonged fatigue represents for primary care, and on the use of formal and informal care for prolonged fatigue.
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Affiliation(s)
- H Elliott
- National Primary Care Research and Development Centre, University of Salford, Manchester.
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Clements A, Sharpe M, Simkin S, Borrill J, Hawton K. Chronic fatigue syndrome: a qualitative investigation of patients' beliefs about the illness. J Psychosom Res 1997; 42:615-24. [PMID: 9226609 DOI: 10.1016/s0022-3999(97)00087-1] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The chronic fatigue syndrome is a disabling chronic condition of uncertain cause. Previous studies have found that patients seen in hospital clinics with the syndrome often strongly believe that their illness is physical in nature and minimize the role of psychological and social factors. There is also evidence that patients cope by avoiding activity. However, almost all of these studies have assessed illness beliefs only by questionnaire. The aim of this study was to explore the nature and origin of illness beliefs in more detail using in-depth interviews and a qualitative analysis of patient responses. Sixty-six consecutive referrals meeting Oxford criteria for chronic fatigue syndrome were recruited. Analysis of responses indicated that, whereas the most commonly described explanation for the illness was a physical one, more than half the patients also believed "stress" had played a role. Patients believed that they could partially control the symptoms by reducing activity but felt helpless to influence the physical disease process and hence the course of the illness. Patients reported that they had arrived at these beliefs about the illness after prolonged reflection on their own experience combined with the reading of media reports, self help books, and patient group literature. The views of health professionals played a relatively small role. There is potentially a considerable opportunity to help patients arrive at a wider and more enabling explanation of their illness when they first present to primary care.
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Affiliation(s)
- A Clements
- Department of Psychiatry, University of Oxford, Warneford Hospital, UK.
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Heyll U, Wachauf P, Senger V, Diewitz M. [Definition of "chronic fatigue syndrome" (CFS)]. MEDIZINISCHE KLINIK (MUNICH, GERMANY : 1983) 1997; 92:221-7. [PMID: 9221305 DOI: 10.1007/bf03043262] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The definition of "Chronic Fatigue Syndrome" (CFS) in 1988 was an attempt to establish a uniform basis for the previously heterogeneous approaches to research of this severe and inexplicable state of fatigue. At the same time, researchers wished to narrow down a pathogenetically founded disease entity a priori by specifying precise disease criteria. The empirical data gathered in accordance with the CFS definition, however, have failed to confirm the assumption that the disease entity is pathogenetically uniform. Furthermore, the originally selected criteria have proven to be impracticable ore theoretically questionable. In the period that followed, modifications that permitted a more comprehensive and yet more differentiated classification of fatigue states of unclear etiology were proposed. The new research approach avoids postulation of causal entities and puts CFS back in a category with other descriptive states of fatigue.
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Affiliation(s)
- U Heyll
- Gesellschaftsärztliche Abteilung der Deutschen Krankenversicherung, Köln
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Simpson M, Bennett A, Holland P. Chronic fatigue syndrome/myalgic encephalomyelitis as a twentieth-century disease: analytic challenges. THE JOURNAL OF ANALYTICAL PSYCHOLOGY 1997; 42:191-9. [PMID: 9161120 DOI: 10.1111/j.1465-5922.1997.00191.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The challenges of chronic fatigue syndrome (often called myalgic encephalomyelitis, especially in the UK) (CFS/ME) to analytical and medical approaches are connected with our inability to understand its distressing somatic symptoms in terms of a single identifiable and understandable disease entity. The evidence for the roles of viral aetiologies remains inconclusive, as does our understanding of the involvement of the immune system. The history and social context of CFS/ME, and its relation to neurasthenia and psychasthenia are sketched. A symbolic attitude to the condition may need to be rooted in an awareness of psychoid levels of operation, and the expression and spread of CFS/ME may sometimes be aided by the ravages of projective identification. Psychic denial, sometimes violent, in sufferers (especially children and adolescents) and their families may be important in the aetiology of CFS/ME. We draw out common threads from psychodynamic work with five cases, four showing some symptomatic improvement, analytic discussions of three cases being presented elsewhere in this issue of JAP.
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Affiliation(s)
- J H Pearn
- Department of Paediatrics and Child Health, Royal Children's Hospital, Brisbane, QLD
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Abstract
To determine the prevalence of chronic fatigue syndrome (CFS) criteria in other forms of unexplained chronic fatigue, 297 consecutive outpatients under the age of 40 from a general medicine practice were studied. After excluding the three with chronic fatigue syndrome, the remaining 294 individuals were divided into those with unexplained chronic fatigue (64 patients) those without (the remaining 230 patients). Chronic fatigue syndrome criteria noted to be significantly more common in those with unexplained fatigue compared to those without include: fever, painful adenopathy, muscle weakness, myalgia, headache, migratory arthralgia, neuropsychologic symptoms, and sleep disorder. Like chronic fatigue syndrome, unexplained chronic fatigue often started suddenly. I conclude that the CFS criteria are noted more commonly than expected in other forms of unexplained chronic fatigue.
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Affiliation(s)
- A C Chester
- Georgetown University Medical Center, Washington D.C., USA
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Affiliation(s)
- Liz Welsh
- Senior registrar in public health at South and West Devon Health Authority
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Abstract
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.
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Affiliation(s)
- M Sharpe
- Department of Psychiatry, University of Oxford, United Kingdom
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Abstract
This review summarises recent work on somatisation in childhood. Minor physiological dysfunction may play a part in a number of cases and associated psychiatric disorders are commonly though not universally found. Contributory family factors include high rates of health problems and of parental psychological distress and there is some evidence for the role of family modelling and reinforcement of illness behaviour. There is suggestive evidence linking somatisation to emotional closeness in families, to family togetherness around health matters and to anomalies in children's social relationships. Somatisation in children can respond to treatments involving cognitive-behavioural and family techniques as well as to sensitive, psychologically sound advice from paediatricians.
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Affiliation(s)
- M E Garralda
- Academic Unit of Child and Adolescent Psychiatry, St Mary's Hospital Medical School, London, U.K
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Hurel SJ, Abuiasha B, Baylis PH, Harris PE. Patients with a self diagnosis of myalgic encephalomyelitis. BMJ (CLINICAL RESEARCH ED.) 1995; 311:329. [PMID: 7633260 PMCID: PMC2550388 DOI: 10.1136/bmj.311.7000.329] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Abstract
Chronic fatigue syndrome (CFS) is a disorder of unknown etiology characterized by debilitating fatigue and other somatic and neuropsychiatric symptoms. A range of heterogeneous clinical and laboratory findings have been reported in patients with CFS. Various theories have been proposed to explain the underlying pathophysiologic processes but none has been proved. Research findings of immunologic dysfunction and neuroendocrine changes suggest the possible dysregulation of interactions between the nervous system and the immune system. Without a clear understanding of its etiopathogenesis, CFS has no definitive treatment. Management approaches have been necessarily speculative, and they have evolved separately in a number of medical and nonmedical disciplines. The results of several controlled treatment studies have been inconclusive. An accurate case definition identifying homogeneous subtypes of CFS is needed. The integration of medical and psychologic treatment modalities and the use of both biologic and psychologic markers to evaluate treatment response will enhance future treatment strategies.
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Affiliation(s)
- D J Farrar
- Department of Psychiatry, Beth Israel Hospital, Harvard Medical School, Boston, USA
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Lawrie SM, Pelosi AJ. Chronic fatigue syndrome: prevalence and outcome. BMJ (CLINICAL RESEARCH ED.) 1994; 308:732-3. [PMID: 8142823 PMCID: PMC2539646 DOI: 10.1136/bmj.308.6931.732] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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