From Quality of Life Research, e-published 3 May 2014.
Defining recovery in chronic fatigue syndrome: a critical review
Jenna L. Adamowicz(*), Indre Caikauskaite, Fred Friedberg
– Department of Psychiatry and Behavioral Sciences, Stony Brook
University, Putnam Hall/South Campus, Stony Brook, NY, 11794-8790,
* Corresponding author. Email Jenna.Adamowicz@stonybrookmedicine.edu
In chronic fatigue syndrome (CFS), the lack of consensus on how recovery should be defined or interpreted has generated controversy and confusion. The purpose of this paper was to systematically review, compare, and evaluate the definitions of recovery reported in the CFS literature and to make recommendations about the scope of recovery assessments.
A search was done using the MEDLINE, PubMed, PsycINFO, CINAHL, and Cochrane databases for peer review papers that contained the search terms ‘chronic fatigue syndrome’ and ‘recovery,’ ‘reversal,’ ‘remission,’ and/or ‘treatment response.’
From the 22 extracted studies, recovery was operationally defined by reference with one or more of these domains: (1) pre-morbid functioning; (2) both fatigue and function; (3) fatigue (or related symptoms) alone; (4) function alone; and/or (5) brief global assessment. Almost all of the studies measuring recovery in CFS did so differently. The brief global assessment was the most common outcome measure used to define recovery. Estimates of recovery ranged from 0 to 66 % in intervention studies and 2.6 to 62 % in naturalistic studies.
Given that the term ‘recovery’ was often based on limited assessments and less than full restoration of health, other more precise and accurate labels (e.g., clinically significant improvement) may be more appropriate and informative. In keeping with common understandings of the term recovery, we recommend a consistent definition that captures a broad-based return to health with assessments of both fatigue and function as well as the patient’s perceptions of his/her recovery status.
From Psychosomatic Medicine, 6 May 2014 [Epub ahead of print].
Characterization of Fatigue States in Medicine and Psychiatry by Structured Interview.
Bennett BK, Goldstein D, Chen M, Davenport TA, Vollmer-Conna U, Scott EM, Hickie IB, Lloyd AR.
From the Department of Medical Oncology (B.K.B., M.C., D.G.), Prince of Wales Hospital, Sydney, Australia; Brain & Mind Research Institute
(T.A.D., E.M.S., I.B.H.), The University of Sydney, Sydney, Australia; School of Psychiatry (U.V-C.), Inflammation and Infection Research Centre, School of Medical Sciences (A.R.L.), and New South Wales Cancer Survivors Centre (B.K.B., D.G., A.R.L.), The University of New South Wales, Sydney, Australia.
Unexplained fatigue states are prevalent, with uncertain diagnostic boundaries.
Patients with fatigue-related illnesses were investigated by questionnaire and a novel semistructured interview to identify discriminatory features.
Cross-sectional samples of women from specialist practices with chronic fatigue syndrome (n = 20), postcancer fatigue (PCF; n = 20), or major depression (n = 16) were recruited. Additionally, two longitudinal samples were studied: women with fatigue associated with acute infection who subsequently developed postinfective fatigue syndrome (n = 20) or recovered uneventfully (n = 21), and women undergoing adjuvant therapy for breast cancer experiencing treatment-related fatigue who subsequently developed PCF (n = 16) or recovered uneventfully (n = 16). Patients completed self-report questionnaires, and trained interviewers applied the Semi-structured Clinical Interview for Neurasthenia.
The receiver operating characteristics curves of the interview were measured against clinician-designated diagnoses. Cluster analyses were performed to empirically partition participants by symptom characteristics.
The interview had good internal consistency (Cronbach α “fatigue” = .83), and diagnostic sensitivity and specificity for chronic fatigue syndrome (100% and 83%) and major depression (100% and 72%), with reasonable parameters for PCF (72% and 58%). Empirical clustering by “fatigue” or “neurocognitive difficulties” items allocated most patients to one group, whereas “mood disturbance” items correctly classified patients with depression only.
The Semi-structured Clinical Interview for Neurasthenia offers reliable diagnostic use in assessing fatigue-related conditions. The symptom domains of fatigue and neurocognitive difficulties are shared across medical and psychiatric boundaries, whereas symptoms of depression such as anhedonia are distinguishing.
From the Journal of Epidemiology and Infection, 9 May 2014 2014 [Epub ahead of print].
Lyme borreliosis in southern United Kingdom and a case for a new syndrome, chronic arthropod-borne neuropathy.
Dryden MS(1), Saeed K(1), Ogborn S(2), Swales P(2).
1) Department of Microbiology, Royal Hampshire County Hospital, Winchester, UK.
2) Department of Medicine, Royal Hampshire County Hospital, Winchester, UK.
This series of serologically confirmed Lyme disease is the largest reported in the UK and represents 508 patients who presented to one hospital in the South of England between 1992 and 2012. The mean rate of borreliosis throughout this period was 9·8/100 000 population, much higher than the reported national rate of 1·7/100 000. The actual rate increased each year until 2009 when it levelled off.
Patients clinically presented with rash (71%), neurological symptoms (16%, of whom half had VII cranial nerve palsies), arthropathy (8%), pyrexia (5%), cardiac abnormalities (1%) or other manifestations (<1%). Twenty percent of patients had additional non-specific symptoms of fatigue, myalgia, and cognitive changes. Serological diagnosis was with a two-tiered system of ELISA and immunoblot. There was a marked seasonal presentation in the summer months and in the first and sixth decades of life. A third of patients gave a clear history of a tick bite. The median interval between tick bite and clinical symptoms was 15 days [interquartile range (IQR) 9-28 days], with a further interval of 14 days to clinical diagnosis/treatment (IQR 2-31 days). Most cases were acquired locally and only 5% abroad. Patients responded to standard antibiotic therapy and recurrence or persistence was extremely rare. A second group of patients, not included in the clinical case series, were those who believed they had Lyme disease based on a probable tick bite but were seronegative by currently available validated tests and presented with subjective symptoms. This condition is often labelled chronic Lyme disease. These patients have a different disease from Lyme disease and therefore an alternative name, chronic arthropod-borne neuropathy (CAN), and case definition for this condition is proposed. We suggest that this chronic condition needs to be distinguished from Lyme disease, as calling the chronic illness 'Lyme disease' causes confusion to patients and physicians. We recommend research initiatives to investigate the aetiology, diagnosis and therapy of CAN.
From Current Problems in Pediatric and Adolescent Health Care, May – June 2014.
Adolescent Fatigue, POTS, and Recovery: A Guide for Clinicians.
Kizilbash SJ, Ahrens SP, Bruce BK, Chelimsky G, Driscoll SW, Harbeck-Weber C, Lloyd RM, Mack KJ, Nelson DE, Ninis N, Pianosi PT, Stewart JM, Weiss KE, Fischer PR.
Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN.
Many teenagers who struggle with chronic fatigue have symptoms suggestive of autonomic dysfunction that may include lightheadedness, headaches, palpitations, nausea, and abdominal pain. Inadequate sleep habits and psychological conditions can contribute to fatigue, as can concurrent medical conditions.
One type of autonomic dysfunction, postural orthostatic tachycardia syndrome, is increasingly being identified in adolescents with its constellation of fatigue, orthostatic intolerance, and excessive postural tachycardia (more than 40beats/min). A family-based approach to care with support from a
multidisciplinary team can diagnose, treat, educate, and encourage patients. Full recovery is possible with multi-faceted treatment.
The daily treatment plan should consist of increased fluid and salt intake, aerobic exercise, and regular sleep and meal schedules; some medications can be helpful. Psychological support is critical and often includes biobehavioral strategies and cognitive-behavioral therapy to help with symptom management. More intensive recovery plans can be implemented when necessary.