|
Volume 2, number 3 |
ME
AND CFS
|
13th August 1999 |
The last few months have seen more articles linking CFS with somatisation. I've included just one to show you what your GP may have been reading, and to give you some ideas on how you might respond to anyone with similar views. (See the updates for details of the other papers and accompanying comments). The rest are my pick of the most interesting findings and theories published in recent weeks.
Barsky, AJ and Borus, JF. Functional somatic syndromes. Annals of Internal Medicine, 1999, 130, 11, 910-921.
This review suggests that CFS may be a variant of somatisation disorder, where "benign symptoms and self-limited conditions" are "incorrectly" attributed to a serious abnormality or "new" disease. As a result, the symptoms seem more intense, which then reinforces the patient's belief that (s)he's ill. The authors maintain that this process is aided and abetted by sympathetic physicians, special clinics, media publicity, litigation and "hotlines". Chronicity is associated with secondary gains. The conclusion notes the suffering and distress associated with these conditions and argues for a more accurate and sophisticated model of these syndromes (i.e. one that includes biological and psychological factors).
*[Ed. note. The arguments in this paper rely heavily on other people's opinions, e.g. Elaine Showalter (a Professor of English). The article stereotypes patients and portrays them in a totally negative light (highly suggestible, misguided, influenced by litigation, not very sensible). It ignores or distorts research findings, which is a trend also evident in other recent articles by psychiatrists (e.g. Henningsen and Priebe 1999, Reid and Wessely 1999 etc.).The authors also consistently refer to the research on fatigue when describing CFS. Medical explanations for CFS are dismissed as premature, though this does not apply to theories relating to phobic avoidance etc. If one study suggests a psycho-social influence, the authors imply that this is relevant to all patients with these syndromes. They also argue that their theory is supported by the effectiveness of CBT.
The articles which formed the basis for this paper were identified through Medline ("1966 to the present"), although the search seems to have missed all the studies and reviews suggesting that biological factors play a major role. Or for that matter, the various studies challenging the effectiveness of CBT.
This revisionist article provides further support for the introduction of evidence-based psychiatry.]
De Becker, P et al. Dehydroepiandrosterone (DHEA) response to i.v. ACTH in patients with chronic fatigue syndrome. Hormone and Metabolic Research, 1999, 31, 1, 18-21.
These researchers measured serum levels of dehydroepiandrosterone (DHEA) before and after stimulation by the hormone ACTH. DHEA is a hormone secreted by the adrenal glands (implicated in CFS before). It has an effect on immune function and may have anti-viral properties. It is also thought that low levels of DHEA can explain patients' increased inability to deal with stress. ACTH is also part of the body's response to stress. It's produced in the brain and acts on the adrenal gland.
The study involved 22 patients with CFS (CDC criteria '88 and '94, severely affected, most post-viral onset, no psychiatric illness) and 14 healthy controls.
The baseline levels of DHEA were normal although the secretion as a result of stimulation by ACTH was rather sluggish.
Two other studies on DHEA are also worth mentioning. The first, by Himmel and Seligman (Journal of Clinical Rheumatology, 1999, 5, 2, 56-59), involved 116 patients with CFS (CDC criteria '88). They found that 89% had low levels of DHEA-sulphate. (DHEA-S is a derivative of DHEA.*)
Supplementation with 25-100 mg DHEA led to fair improvements in fatigue, pain, memory and other symptoms in the 23 women who tried it. The main side-effect was acne.
The other study was conducted by a team headed by Dr. Scott and the widely respected Prof. Dinan (Journal of Affective Disorders, 1999, 54, 129-137). They found abnormally low levels of DHEA and DHEA-S in 15 people with CFS. People with depression had normal levels of DHEA but low levels of DHEA-S. According to these authors, taking hydrocortisone supplements may further lower levels of DHEA and DHEA-S and thus make things worse.
[Ed. note: These findings add to the growing evidence of hormonal abnormalities in CFS, particularly in relation to the functioning of the adrenal gland. If you're interested in trying DHEA as a supplement, please consult a doctor with up-to-date knowledge of the literature on this hormone. If you come across a doctor who still believes that CFS is a type of depression, refer them to the Scott et al paper above, and one by Natelson et al (Journal of Affective Disorders, 1999, 53, 179-184).]
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.
In the first study, 20 confirmed CFS patients were assessed using a number of computerised cognitive tests. On most of these tests, the impairment in CFS was comparable to that seen in mild to moderate Alzheimer's disease. In the second study, 16 individuals with CFS inspired either oxygen or air (placebo) and were administered tests as before. Following oxygen inspiration, participants showed significantly improved reaction times and a trend towards improved word recall. Mood scores were unaffected.
A separate study by Scholey et al reported on the same page, provides further support for the suggestion that cognitive performance is 'fuel limited'.
Laylander, JA. Nutrient/toxin interaction theory of the etiology and pathogenesis of chronic pain-fatigue syndromes. Journal of Chronic Fatigue Syndrome, 1999, 5, 1, part 1: 67-91 and part 2: 93-126.
Hypothesis suggesting that CFS and related disorders (like Gulf War Syndrome and fibromyalgia) may be the result of a relative excess of fluoride and a relative deficiency of magnesium.
[Ed note: There is little evidence for a link with fluoride though there's some support for the involvement of magnesium. (It may play a contributory role in a proportion of cases.)If you want to take a magnesium supplement, remember that this mineral is difficult to absorb when taken by mouth. It's not easy to get magnesium glycinate (Prof. Cheney's first choice), but I know that some British doctors recommend magnesium EAP (Biocare).]
Chaudhuri, A and Behan, PO. Chronic fatigue syndrome is an acquired neurological channelopathy. Human Psychopharmacology - Clinical and Experimental, 1999, 14, 1, 7-17.
Review article noting that the fatigue in CFS is distinct from the fatigue of neuromuscular disorders but similar to that found in disorders of the central nervous system such as multiple sclerosis, Parkinson's disease and multiple system atrophy. In this paper, the authors propose that dysfunctional ion channels in the cell membranes are the key abnormality in CFS which may also be responsible for the altered neuroendocrine functions reported in this condition (e.g. Scott et al above).
[Ed. note: This new hypothesis has been discussed in more detail in Perspectives (e.g. Feb '99). My intuition as an archivist says there's more to ME than a simple disturbance in sodium, potassium, calcium etc. If such a basic abnormality involving cellular membranes was the cause, I'd expect more clear-cut symptoms as in MS, Parkinson's etc. Perhaps it's part of the puzzle? Still, there's enough interest in this theory to warrant a mention in our Update. It's definitely a theory to keep an eye on!]
Finally, Wright et al (Irish Journal of Psychological Medicine, 1999, 16, 67-71) checked out 13 CFS-related websites on the Internet and concluded that few provide useful management advice. "Some of the advice is either contrary to current research or not supported by it." Having seen examples of the advice, I agree. Do note, however, that the authors didn't include the information my colleagues and I provide on Axford's Abode.
We pride ourselves on producing totally accurate summaries and giving evidence-based advice. You'll also find a note about our aims, qualifications, and independence. The Lancet recently advised their readers to be wary of sites which did not include such information. Perhaps patients should adopt a similar approach?
Copyright EM. Goudsmit 1999.
©
All rights reserved. This article may not be reproduced without
permission from the author. See the full
copyright
notice.
Be sure to see the many other valuable articles at our Main M.E. Home Page
