SOME FACTS ABOUT M.E./PVFS/CFS

 

In the United Kingdom, CFS covers a number of conditions, including myalgic encephalopathy (ME) also known as post viral fatigue syndrome (PVFS). The latter is characterised by fatigability and slow recovery following minimal exertion, marked fluctuations in the severity of symptoms throughout the day, impaired circulation and the involvement of the CNS. Most patients who fulfil the British criteria for CFS appear to have disorders other than ME including undiagnosed hypothyroidism, masked depression, and problems related to lifestyle and nutrition (e.g. deficiencies of vitamins D and B12). In America, the stricter criteria devised by the CDC (1988, 1992) select a more homogeneous population, so many cases of CFS so defined are probably the equivalent of ME/PVFS.

The prevalence of ME and strictly-defined CFS is about 1 per 1000; the prevalence of CFS selected using the British criteria may be as high as 2%.

The following papers generally refer to studies on ME/PVFS and strictly-defined CFS.

Research into ME/PVFS/CFS has shown:

1. The presence of enteroviral particles in a significant number of muscle biopsies taken from ME/PVFS patients (e.g. Bowles et al, Gow et al). This was rare in healthy controls. Enteroviral specific sequences have also been detected in the serum of 41% of patients with post-infectious chronic fatigue (Clements et al). The proportion of positive results was significantly higher than that found in acutely ill patients with possible enteroviral disease (27%) and in healthy controls (2%).

2. Abnormalities in muscle tissue. In a study on a fairly homogeneous population, 80% of the biopsies showed evidence of structural damage to the mitochondria.

3. A deficiency in the levels of carnitine and serum acylcarnitine. Researchers believe that this may be involved in the muscular symptoms of ME and CFS.

4. Abnormalities in muscle function have been found in a subgroup and do not seem to be related to inactivity (Lane et al). In people with ME, objective tests have found prolonged recovery rates following exercise (Paul et al).

5. MRI scans have revealed abnormalities in up to 80% of the patients in one study (Daugherty et al). According to researchers, these defects are probably caused by chronic viral encephalitis. There was a correlation between the areas involved and the symptoms experienced. Abnormalities on SPECT scans provide further objective evidence of CNS dysfunction. Studies published to date show patterns of reduced blood flow which are markedly different from those documented in major depression (Costa et al). Moreover, the number of defects are correlated with clinical status (e.g. Schwartz et al).

5a. The results on SPECT have been replicated using PET.

6. Enteroviral sequences have been detected in tissue samples taken from the hypothalamus and brain stem of a patient with ME. Such sequences were not found in samples from depressed patients who had not suffered from ME.

7. Several studies have found evidence of an overactive immune system. The abnormalities are generally more common in the severely affected, and are consistent with a persisting viral infection. The disturbances of cell-mediated immunity in patients with ME and CFS differ in prevalence and magnitude from those which have been observed in people suffering from major depression (e.g. Lloyd et al). There is also growing evidence implicating HHV-6 (e.g. Ablashi et al).

8. Some symptoms of CFS may be related to due to an inflammatory process. Findings from experiments in mice are consistent with the notion that fatigue could be due to "cytokine production within the CNS".

9. Research has revealed a number of disturbances in the function of the hypothalamic-pituitary-adrenal axis. Some of these are different from the abnormalities documented in patients suffering from depression (e.g. Demitrack et al, Scott et al).

10. Neuropsychological tests on patients with ME/PVFS and strictly-defined CFS have revealed abnormalities which are consistent with an organic brain disorder (e.g. Daugherty et al). The deficits have been found in both community and hospital samples and they were not the result of psychiatric disorders, such as depression (e.g. Smith, DeLuca et al).

10a. Exercise has an adverse effect on cognitive functioning.

11. The depression experienced by patients with ME/PVFS and strictly defined CFS is different from that reported by psychiatric patients and closely related to the severity of the other symptoms. Some patients report more anxiety (Lindal et al).

12. ME/PVFS affects people of all ages and backgrounds.

13. ME/PVFS and strictly-defined CFS are different from fibromyalgia, a rheumatic condition.

14. The fatigue reported by patients with ME/PVFS and strictly-defined CFS is very different from that experienced by the general population. Scores on fatigue scales are more like those of people with M.S.

15. The fatigue is not due to a lack of motivation or effort.

16. Recent evidence indicates that most patients with CFS do not spend the whole of the daytime resting. A number of coping strategies are used, some of which are associated with a positive outcome (e.g. Saltzstein et al).

16a. Patients with CFS are no different from other medically ill groups in terms of personality.

17. Longitudinal studies using appropriate measures have shown that physical attributions do not affect outcome (e.g. Lawrie et al). Moreover, research on patients with ME indicated that a belief in a biological cause was not associated with avoidance behaviour or poor mental health.

18. Exercise does not lead to a major reduction in activity levels (Sisto et al, Van der Werf et al). There is no evidence for the phobic avoidance of activity amongst the majority of patients with CFS, or support for the view that deconditioning plays a major role in the perpetuation of fatigue (Bazelmans et al, Sargent et al).

19. Graded exercise, where activity is increased according to a plan irrespective of symptoms, is not appropriate for all patients with CFS (Friedberg and Krupp, Jason et al). Indeed, overexertion can lead to relapse (eg Lapp). Although cognitive behavioural therapy is not superior to counselling for CFS in general (Ridsdale et al), it may be helpful for a subgroup, for example, those who are particularly anxious and depressed, those with inadequate coping strategies or where activity levels are largely determined by a fear of symptom flare-ups. Follow-up studies suggest that improvements are often limited and transient (e.g. Akagi et al). There are no follow-up studies indicating benefits for those with somatic symptoms (cf. Deale et al).

20. Symptoms indicative of autonomic nervous system dysfunction are not related to psychiatric disorder and can not be fully explained by deconditioning.

21. CFS remains a research diagnosis. A number of subgroups have been identified. These appear to have different causes, different rates of psychiatric disorders, may have different prognoses and probably require different treatments.

N.B. The immunological changes documented in ME/PVFS and strictly-defined CFS are related to the severity of the illness and correlated with the presence of cognitive dysfunction

The immunological changes are not the same as those documented in depression (Landay et al 1991, Lloyd et al 1992, as above).

21a. Among patients reporting chronic fatigue, subgroups appear to vary according to the degree of post exertional fatigue, not severity of fatigue per se.

22. The documented links between CFS and psychiatric disorders may reflect the use of broader diagnostic criteria and the researcher's choice of measures. More psychiatric morbidity is diagnosed using the DIS than the SCID.

23. There is growing evidence of oxidative damage in CFS.

24. A significant minority of patients with CFS as currently defined may have been wrongly diagnosed. More specific criteria should improve accuracy.

25. Evidence supports the differentiation of CFS from functional somatic syndromes.

26. Patients selected using the 1988 definition appear to be more symptomatic and impaired than people selected using the 1994 criteria. This is not explained by psychiatric reasons.

De Becker, P., McGregor, N and De Meirleir, K. A definition-based analysis of symptoms in a large cohort of patients with chronic fatigue syndrome. Journal of Internal Medicine, 2001, 250, 3, 234-240.

Jason, LA., Torres-Harding, SR., Taylor, RR and Carrico, AW. A comparison of the 1988 and 1994 diagnostic criteria for chronic fatigue syndrome. Journal of Clinical Psychology in Medical Settings, 2001, 8, 4, 337-343.

 

Copyright.

February 2002


Additional reading list

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Arnold, MC., Papanicolaou, DA., O'Grady, JA., Lotsikas, A., Dale, JK., Straus, SE and Grafman, J. Using an interleukin-6 challenge to evaluate neuropsychological performance in chronic fatigue syndrome. Psychological Medicine, 2002, 32, 6, 1075-1089.

Behan, WMH and Behan, PO. The role of viral infection in polymyositis, dermatomyositis and chronic fatigue syndrome. Bailliere's Clinical Neurology, 1993, 2, 3, 637-657.

Blenkiron, P et al. Associations between perfectionism, mood, and fatigue in chronic fatigue syndrome. A pilot study. Journal of Nervous and Mental Disease, 1999, 187, 9, 566-570.

Boda, WL et al. Gait abnormalities in chronic fatigue syndrome. Journal of the Neurological Sciences, 1995, 156-161.

Bou-Holaigah, I et al. The relationship between neurally mediated hypotension and the chronic fatigue syndrome. JAMA, 1995, 274, 961-967.

Brimacombe, M., Helmer, D and Natelson, BH. Clinical differences exist between patients fulfilling the 1988 and 1994 case definitions of chronic fatigue syndrome. Journal of Clinical Psychology in Medical Settings, 2002, 9, 309-314

Buckley, L et al. Personality dimensions in chronic fatigue syndrome and depression. Journal of Psychosomatic Research, 1999, 46, 4, 395-400.

Chaudhuri, A et al. Chronic fatigue syndrome. Proceedings of the Royal College of Physicians of Edinburgh, 1998, 28, 150-163. Up-to-date review plus personal comments.

Cunningham, L et al. Persistence of enteroviral RNA in chronic fatigue syndrome is associated with abnormal production of equal amounts of positive and negative strands of enteroviral RNA. Journal of General Virology, 1990, 71, 1399-1402.

Daly, E. et al. Neuropsychological function in patients with chronic fatigue syndrome, multiple sclerosis, and depression. Applied Neuropsychology, 2001, 8, 1, 12-22.

Denz-Penhey, H and Murdoch, JC. Service delivery for people with chronic fatigue syndrome: a pilot action research study. Family Practice, 1993, 10, 14-18.

Dowsett, EG and Welsby, PD. Conversation Piece. Postgraduate Medical Journal, 1992, 68, 63-65.

Dowsett, E.G., Ramsay, A.M., McCartney, R.A. and Bell, E.J. Myalgic encephalomyelitis - a persistent enteroviral infection? Postgraduate Medical Journal, 1990, 66, 526‑530.

Dyer, C. Cardiologist admits research misconduct. British Medical Journal, 1997, 314, 1501. (Contains information to consider in relation to the hyperventilation theory).

English, TL. Skeptical of skeptics. Journal of the American Medical Association, 1991, 265, 8, 964.

Fukuda, K., Straus, SE., Hickie, I., Sharpe, MC., Dobbins, JG., Komaroff, A and the International Chronic Fatigue Syndrome Study Group. The chronic fatigue syndrome: a comprehensive approach to its definition and study. Annals of Internal Medicine, 1994, 121, 953-959. (Latest American diagnostic criteria for CFS).

Galbraith, DN., Nairn, C and Clements, GB. Phylogenetic analysis of short enteroviral sequences from patients with chronic fatigue syndrome. Journal of General Virology, 1995, 76, 1701-1707.

Gilliam, AG. Epidemiological study of an epidemic, diagnosed as poliomyelitis, occurring among the personnel of the Los Angeles County General Hospital during the Summer of 1934. Public Health Bulletin, US Treasury Dept. no. 240. Washington: United States Government Printing Office 1938.

Goudsmit, E. Response to Stainton Rogers. Health Psychology Update, 2002, 11, 1, 60-64. (Letter responding to an earlier article by Stainton Rogers (ibid, 10, 4, 29-32) and covering issue of bias in journals).

Gow, JW et al. Antiviral pathway activation in patients with chronic fatigue syndrome and acute infection. Journal of Infectious Diseases, 2001, 33, 12, 2080-2081. E-CID:
http://www.journals.uchicago.edu/CID/journal/rapid.html

Harvey, WT. A flight surgeon's personal view of an emerging illness. Aviation, Space, and Environmental Medicine, 1989, 60, 1199-201.

Hedrick, TE. Chronic fatigue syndrome. Quarterly Journal of Medicine, 1997, 90, 723-725 (letter challenging the psychologisation of CFS).

Hickie, I et al. Can the chronic fatigue syndrome be defined by distinct clinical features? Psychological Medicine, 1995, 25, 925-935.

Hilgers, A and Frank, J. Chronic fatigue immundysfunction syndrome bei 103 patienten: diagnostik, befunde und therapie. Zeitschrift fur Klinische Medizin, 1992, 47, 152-164.

Hill, NF et al. Natural history of severe chronic fatigue syndrome. Archives of Physical Medicine and Rehabilitation, 1999, 80, 9, 1090-1094.

Innes, S.B.G. Encephalomyelitis resembling benign myalgic encephalomyelitis. Lancet, 1970, 1: 969-971. (Evidence of inflammation within the CNS).

Iriarte, J et al. Modalities of fatigue in multiple sclerosis: correlation with clinical and biological factors. Multiple Sclerosis, 2000, 6, 2, 124-130. (Indicates the complexity of fatigue and its links with immune system).

Jason, LA et al. A community-based study of chronic fatigue syndrome. Archives of Internal Medicine, 1999, 159, 2129-2137.

Johnson, SK et al. Assessing somatization disorder in the chronic fatigue syndrome. Psychosomatic Medicine, 1996, 58, 50-57.

Keller, RH et al. Association between HLA Class II antigens and the chronic fatigue immune dysfunction syndrome. Clinical Infectious Diseases (1994), 18, (Suppl.1), S154-S156.

Komaroff, AL et al. Health status in patients with chronic fatigue syndrome and in general population and disease comparison groups. American Journal of Medicine, 1996, 101, 3, 281-290. (This shows that the level of disability associated with CFS is higher than that documented in several medically-ill groups).

Kuratsune, H., Yamaguti, K., Lindh, G., Evengard, B., Hagberg, G., Matsumura, K., Iwase, M., Onoe, H., Takahashi, M., Machii, T., Kanakura, Y., Kitani, T., Langstrom, B and Watanabe Y. Brain regions involved in fatigue sensation: reduced acetylcarnitine uptake into the brain. Neuroimage, 2002, 17, 3, 1256-1265.

LaManca JJ et al. Cardiovascular response during head-up tilt in chronic fatigue syndrome. Clinical Physiology, 1999, 19, 2, 111-120. (OI may be due to inactivity).

Lane, RJM et al. Exercise responses and psychiatric disorder in chronic fatigue syndrome. BMJ, 1995, 311, 544-5.

Lange, G et al. Quantitative assessment of cerebral ventricular volumes in chronic fatigue syndrome. Applied Neuropsychology, 2001, 8, 1, 23-30.

Levine, S. Prevalence in the cerebrospinal fluid of the following infectious agents in a cohort of 12 CFS subjects: human herpes virus‑6 and 8; chlamydia species; mycoplasma species; EBV; CMV; and Coxsackievirus. Journal of Chronic Fatigue Syndrome, 2001, 9, 1/2, 41-51.

Levine, S et al. Prevalence of IgM and IgG antibody to HHV-6 and HHV‑8 and results of plasma PCR to HHV-6 and HHV-7 in a group of CFS patients and healthy donors. Journal of Chronic Fatigue Syndrome, 2001, 9, 1/2, 31-40.

Lieberman, J and Bell, DS. Serum angiotensin-converting enzyme as a marker for the chronic fatigue immune dysfunction syndrome: a comparison to serum angiotensin-converting enzyme in sarcoidosis. American Journal of Medicine, 1993, 95, 4, 407-412.

Manu, P et al. Idiopathic chronic fatigue: depressive symptoms and functional somatic complaints. In, MA Demitrack and SE Abbey (Eds.) Chronic Fatigue Syndrome. NY: Guildford Press. 1996.

Mengshoel, AM et al. Pain and fatigue induced by exercise in fibromyalgia patients and sedentary healthy subjects. Clinical and Experimental Rheumatology, 1995, 13, 477-482.

Nairn, C et al. Comparison of Coxsackie B neutralisation and enteroviral PCR in chronic fatigue patients. Journal of Medical Virology, 1995, 46, 310-313.

Natelson, BH et al. Reducing heterogeneity in chronic fatigue syndrome: a comparison with depression and multiple sclerosis. Clinical Infectious Diseases, 1995, 21, 5, 1204-1210.

Patarca, R et al. Dysregulated expression of tumor necrosis factor in chronic fatigue syndrome: intercorrelations with cellular sources and patterns of soluble immune mediator expression. Clinical Infectious Diseases (1994), 18, (Suppl.1), S147-S153.

Plioplys, AV., Plioplys, S and Davis, JS. Meeting the frustrations of chronic fatigue syndrome. Hospital Practice, 1997, 32, 6, 147-166. (Good on diagnosis).

Preedy, VR et al. Biochemical and muscle studies in patients with acute onset post-viral fatigue syndrome. Journal of Clinical Pathology, 1993, 46, 722-726.

Puri, BK., Counsell, SJ., Zaman, R., Main, J., Collins, AG., Hajnal JV and Davey, NJ. Relative increase in choline in the occipital cortex in chronic fatigue syndrome. Acta Psychiatrica Scandinavica, 2002, 106, 3, 224-226.

Regland, B et al. Increased concentrations of homocysteine in the cerebrospinal fluid in patients with fibromyalgia and chronic fatigue syndrome. Scandinavian Journal of Rheumatology, 1997, 26, 301-307.

Reyes, M et al. Chronic fatigue syndrome progression and self-defined recovery: evidence from the CDC Surveillance System. Journal of Chronic Fatigue Syndrome, 1999, 5, 1, 17-27.

Richardson, J. Four cases of pesticide poisoning, presenting as "ME", treated with a choline and ascorbic acid mixture. Journal of Chronic Fatigue Syndrome, 2000, 6, 2, 11-21.

Scholey, A et al. Cognitive defects in chronic fatigue syndrome are reversed by oxygen administration. Paper presented at the BPS conference, Belfast, April 8-11th, 1999. Proceedings of the British Psychological Society, 1999, 7, 2, 137.

Schweitzer, R et al. Quality of life in chronic fatigue syndrome. Social Science and Medicine, 195, 41, 1367-1372.

Scott, LV et al. Small adrenal glands in chronic fatigue syndrome: a preliminary computer tomography study. Psychoneuroendocrinology, 1999, 24, 7, 759-768.

Shanks, MF and Ho-Yen, DO. A clinical study of chronic fatigue syndrome. British Journal of Psychiatry, 1995, 166, 798-801.

Sigurdsson, B and Gudmundsson, KR. Clinical findings six years after outbreak of Akureyri disease. Lancet, 1956, 1 766-767.

Simon, TR., Cowden. E., Seastrunk, JW., Weiner, E and Hickie, DC. Chronic fatigue syndrome: flow and functional abnormalities seen with SPECT. Radiology, 1991, 181, Suppl. 173.

Teitelbaum, J and Bird, B. Effective treatment of severe chronic fatigue: a report of a series of 64 patients. Journal of Musculoskeletal Pain, 1995, 3, 4, 91-110.

Trigwell, P et al. 'Abnormal' illness behaviour in chronic fatigue syndrome and multiple sclerosis. BMJ, 1995, 311, 15-18.

Vercoulen, JHMM., Bazelmans, E., Swanink, CMA., Fennis, JFM et al. Physical activity in chronic fatigue syndrome: Assessment and its role in fatigue. Journal of Psychiatric Research, 1997, 31, 6, 661-673.

Vojdani, A et al. Elevated apoptotic cell population in patients with chronic fatigue syndrome: the pivotal role of protein kinase RNA. Journal of Internal Medicine, 1997, 242, 6, 465-478

Wood, B and Wessely, S. Personality and social attitudes in chronic fatigue syndrome. Journal of Psychosomatic Research , 1999, 47, 4, 385-397.

Woodward, RV et al. Diagnosis in chronic illness: disabling or enabling - the case of chronic fatigue syndrome. Journal of the Royal Society of Medicine, 1995, 88, 325-329.

Copyright EM. Goudsmit©
Psychologist/Archivist, London.
November 2002

 

Suggested criteria for ME (based on the work of Dr MA Ramsay):

1. Generalised or localised muscle fatigue following minimal exertion with prolonged recovery time.

2. Neurological disturbances and variable involvement of cardiac and other bodily systems.

3. Impaired circulation.

4. Marked variability of symptoms in the course of a day and from day to day.

5. An extended relapsing course with a tendency to chronicity.

ME can be diagnosed immediately. For research purposes however, a minimum duration of six months may help to differentiate ME from more common, transient post-viral syndromes.

The criteria for ME differ from the American and Oxford definitions for CFS in three ways. Firstly, the latter do not require evidence of central nervous system dysfunction. Secondly, they do not include any references to the fluctuation of symptoms or the close links between symptoms and exertion. Thirdly, the older CDC criteria place a much greater emphasis on infection-related symptoms such as mild fever, sore throat (which are counted twice) and tender glands compared to the definitions of ME.

 

ME/PVFS, CFS AND DEPRESSION

 

ME/PVFS and strictly-defined CFS differ from clinically-significant depression in terms of:

 

1. Type and pattern of symptoms

Hickie, I., Lloyd, A., Wakefield, D and Parker, G. The psychiatric status of patients with the chronic fatigue syndrome. British Journal of Psychiatry, 1990, 156, 534-540.

Pepper, CM, Krupp, LB., Friedberg, F., Doscher, C and Coyle, PK. A comparison of neuropsychiatric characteristics in chronic fatigue syndrome, multiple sclerosis and major depression. Journal of Neuropsychiatry and Clinical Neurosciences, 1993, 5, 200-205.

Yeomans, JDI and Conway, SP. Biopsychosocial aspects of chronic fatigue syndrome (myalgic encephalomyelitis). Journal of Infection, 1991, 23, 263-269.

2. Premorbid and concurrent psychopathology

Pepper, CM, Krupp, LB., Friedberg, F., Doscher, C and Coyle, PK. A comparison of neuropsychiatric characteristics in chronic fatigue syndrome, multiple sclerosis and major depression. Journal of Neuropsychiatry and Clinical Neurosciences, 1993, 5, 200-205.

3. Pattern of associated immunological changes

Landay, AL., Jessop, C., Lennette, ET and Levy, JA. Chronic fatigue syndrome: clinical condition associated with immune activation. Lancet, 1991, 338, 707-712.

Lloyd, A., Hickie, I., Hickie, C., Dwyer, J and Wakefield, D. Cell-mediated immunity in patients with chronic fatigue syndrome, healthy control subjects and patients with depression. Clinical and Experimental Immunology, 1992, 87, 76-79.

4. Abnormalities on brain scans, including PET (Lottenberg 1993) and SPECT (Costa et al 1995, Goldstein 1993)

Costa, DC., Tannock, C and Brostoff, J. Brainstem perfusion is impaired in patients with chronic fatigue syndrome. Quarterly Journal of Medicine, 1995, 88, 767-773.

Goldstein, JA. Chronic Fatigue Syndromes: The Limbic Hypothesis. NY: Haworth Press. 1993.

Lottenberg, S. Paper presented at the conference: The medical neurobiology of chronic fatigue syndrome and fibromyalgia, Los Angeles, May 7-9, 1993.

5. The patients' response to buspirone

Bakheit, AMO., Behan, PO., Dinan, TG., Gray, CE and O'Keane, VO. Possible upregulation of hypothalamic 5-hydroxytryptamine receptors in patients with postviral fatigue syndrome. British Medical Journal, 1992, 304, 1010-2.

6. Functioning of the HPA axis.

Cleare, AJ., Bearn, J., Allain, T., McGregor, A., Wessely, S., Murray, RM and O'Keane, V. Contrasting neuroendocrine responses in depression and chronic fatigue syndrome. Journal of Affective Disorders, 1995, 35, 283-289.

Demitrack, MA, Dale, JK, Straus, SE., Laue, L., Listwalk, SJ., Kruesi, MJP., Chrousos, GP and Gold, PW. Evidence for impaired activation of the hypothalamic-pituitary-adrenal axis in patients with chronic fatigue syndrome. Journal of Clinical Endocrinology and Metabolism, 1991, 73, 1224-1234.

Majeed, T., Dinan, TG., Thakore, J., Gray, C and Behan, PO. Defective dexamethasone induced growth hormone release in chronic fatigue syndrome: evidence for glucocorticoid receptor resistance and lack of plasticity? Journal of the Irish Colleges of Physicians and Surgeons, 1995, 24, 1, 20-24.

7. Type of neuropsychological impairments

DeLuca, J., Johnson, SK and Natelson, BH. Information processing efficiency in chronic fatigue syndrome and multiple sclerosis. Archives of Neurology, 1993, 50, 301-304.

DeLuca, J., Johnson, SK., Ellis, SP and Natelson, BH. Cognitive functioning in patients with chronic fatigue syndrome devoid of psychiatric disease. Journal of Neurology, Neurosurgery, and Psychiatry, 1997, 62, 151-155.

Sandman, CA., Barron, JL., Nackoul, K., Goldstein, J and Fidler, F. Memory deficits associated with chronic fatigue immune dysfunction syndrome. Biological Psychiatry, 1993, 33, 618-623.

Smith, AP. Chronic fatigue syndrome and performance. In AP. Smith and D. Jones (eds), Handbook of Human Performance, Vol. 2. London: Academic Press. 1992, p. 261-278.

8. Response to anti-depressants

Goodnick, PJ and Sandoval, R. Psychotropic treatment of chronic fatigue syndrome and related disorders. Journal of Clinical Psychiatry, 1993, 54, 13-20.

Jenkins, R. Assessment and diagnosis of ME in the psychiatric clinic. In Jenkins, R and Mowbray, J (Eds.) Post-viral Fatigue Syndrome. Chichester: John Wiley & Sons. 1991.

9. Type of onset (the vast majority of cases of M.E./CFS follow an infection).

Dowsett, E.G., Ramsay, A.M., McCartney, R.A. and Bell, E.J. Myalgic encephalomyelitis - a persistent enteroviral infection? Postgraduate Medical Journal, 1990, 66, 526-530.

10. Severity of disability and contact with others

Natelson, BH., Johnson, SK., DeLuca, J., Sisto, S., Ellis, SP., Hill, N and Bergen, MT. Reducing heterogeneity in chronic fatigue syndrome: a comparison with depression and multiple sclerosis. Clinical Infectious Diseases, 1995, 21, 5, 1204-1210.

11. ME/PVFS occurs both sporadically and in epidemics. However, there have been no documented epidemics of depression.

Jenkins, R and Mowbray, J (Eds.) Post-viral Fatigue Syndrome. Chichester: John Wiley & Sons. 1991.

12. Research showing that CFS patients resemble people with MS more than a depressed group in terms of personality disturbance and trait neuroticism suggests that "CFS cannot be explained as a form of depression with predominantly somatic symptoms".

Johnson, SK., DeLuca, J and Natelson, BH. Personality dimensions in the chronic fatigue syndrome: a comparison with multiple sclerosis and depression. Journal of Psychiatric Research, 1996, 30, 1, 9-20.

13. Fatigue syndromes like CFS do not resemble "any of the clinical standard clinical syndromes of major and minor depression".

Manu, P., Lane, TJ and Matthews, DA. Idiopathic chronic fatigue: depressive symptoms and functional somatic complaints. In, Demitrack MA and Abbey SE (Eds.) Chronic Fatigue Syndrome. NY: Guildford Press. 1996.

 

 

Copyright EM. Goudsmit February 2001. ©
Psychologist/Archivist, London.
All rights reserved. This article may not be reproduced without
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