TGI Friday! Our weekly round-up of recently published research abstracts | 5 September 2014

September 5, 2014

From Behaviour Research and Therapy, 26 August 2014.

Prevalence and predictors of recovery from chronic fatigue syndrome in a routine clinical practice

Elisabeth Flo(a,b), Trudie Chalder(c)
a) Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
b) Department of Psychosocial Science, University of Bergen, Bergen, Norway
c) Institute of Psychiatry, King's College London, London, United Kingdom
Corresponding author. Norwegian Competence Center for Sleep Disorders,
Haukeland Universitetssjukehus, Jonas Lies vei 65, 5021 Bergen. Tel.:
+47 55 97 07 86; fax: +47 55 97 46 10.


• This study investigates recovery from CFS in a routine practice.

• Approximately 18% of people with CFS recover after CBT.

• The study of CBT in routine practice demonstrated recovery rates akin to RCTs.


Cognitive behavioural therapy (CBT) is one of the treatments of choice for patients with chronic fatigue syndrome (CFS). However, the factors that predict recovery are unknown.

The objective of this study was to ascertain the recovery rate among CFS patients receiving CBT in routine practice and to explore possible predictors of recovery.

Recovery was defined as no longer meeting Oxford or CDC criteria for CFS measured at 6 months follow-up. A composite score representing full recovery additionally included the perception of improvement, and normal population levels of fatigue and of physical functioning.

Logistic regression was used to examine predictors of recovery. Predictors included age, gender, cognitive and behavioural responses to symptoms, work and social adjustment, beliefs about emotions, perfectionism, anxiety and depression at baseline.

At 6 months follow-up 37.5% of the patients no longer met either the Oxford or the CDC criteria for CFS while 18.3% were fully recovered. Multivariate analyses showed that worse scores on the work and social adjustment scale, unhelpful beliefs about emotions, high levels of depression and older age were associated with reduced odds for recovery.

Recovery rates in this routine practice were comparable to previous RCTs. There was a wide spectrum of significant predictors for recovery.

FromPhysiological Reports (open access), 28 August 2014. Links to pdf of full text.

High flow variant postural orthostatic tachycardia syndrome amplifies the cardiac output response to exercise in adolescents.

Pianosi PT(1), Goodloe AH(2), Soma D(3), Parker KO(4), Brands CK(5), Fischer PR(3).
1) Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota.
2) Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota Department of Pediatrics, Vanderbilt University, Nashville, Tennessee.
3) Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota.
4) Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota.
5) Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota Department of Pediatrics, All Children's Hospital, St. Petersburg, Florida and Johns Hopkins School of Medicine, Baltimore, Maryland.
Paolo T. Pianosi, Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN 55905. Tel: (507) 284-3373 Fax: (507) 284-0727 E-mail:


Postural orthostatic tachycardia syndrome (POTS) is characterized by chronic fatigue and dizziness and affected individuals by definition have orthostatic intolerance and tachycardia. There is considerable overlap of symptoms in patients with POTS and chronic fatigue syndrome (CFS), prompting speculation that POTS is akin to a deconditioned state.

We previously showed that adolescents with postural orthostatic tachycardia syndrome (POTS) have excessive heart rate (HR) during, and slower HR recovery after, exercise – hallmarks of deconditioning. We also noted exaggerated cardiac output during exercise which led us to hypothesize that tachycardia could be a manifestation of a high output state rather than a consequence of deconditioning.

We audited records of adolescents presenting with long-standing history of any mix of fatigue, dizziness, nausea, who underwent both head-up tilt table test and maximal exercise testing with measurement of cardiac output at rest plus 2-3 levels of exercise, and determined the cardiac output (Q) versus oxygen uptake (VO2) relationship.

Subjects with chronic fatigue were diagnosed with POTS if their HR rose ≥40 beat·min(-1) with head-up tilt. Among 107 POTS patients the distribution of slopes for the Q–VO2 , relationship was skewed toward higher slopes but showed two peaks with a split at ~7.0 L·min(-1) per L·min(-1), designated as normal (5.08 ± 1.17, N = 66) and hyperkinetic (8.99 ± 1.31, N = 41) subgroups.

In contrast, cardiac output rose appropriately with in 141 patients with chronic fatigue but without POTS, exhibiting a normal distribution and an average slope of 6.10 ± 2.09 L·min(-1) per L·min(-1). Mean arterial blood pressure and pulse pressure from rest to exercise rose similarly in both groups.

We conclude that 40% of POTS adolescents demonstrate a hyperkinetic circulation during exercise. We attribute this to failure of normal regional vasoconstriction during exercise, such that patients must increase flow through an inappropriately vasodilated systemic circulation to maintain perfusion pressure.

From Health Psychology, September 2014.

The impact of significant other expressed emotion on patient outcomes in chronic fatigue syndrome.

Band R, Barrowclough C, Wearden A.
School of Psychological Sciences, University of Manchester.



Previous literature has identified the importance of interpersonal processes for patient outcomes in chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME), particularly in the context of significant other relationships.

The current study investigated expressed emotion (EE), examining the independent effects
of critical comments and emotional overinvolvement (EOI) in association with patient outcomes.


Fifty-five patients with CFS/ME and their significant others were recruited from specialist CFS/ME services. Significant other EE status was coded from a modified
Camberwell Family Interview. Patient outcomes (fatigue severity, disability, and depression) were derived from questionnaire measures.

Forty-four patients (80%) completed follow-up questionnaires 6-months after recruitment.


Significant other high-EE categorized by both high levels of critical comments and high EOI was predictive of worse fatigue severity at follow-up. High-critical EE was associated
with higher levels of patient depressive symptoms longitudinally; depressive symptoms were observed to mediate the relationship between high critical comments and fatigue severity reported at follow-up.

There were higher rates of high-EE in parents than in partners, and this was because of higher rates of EOI in parents.


Patients with high-EE significant others demonstrated poorer outcomes at follow-up compared with patients in low-EE dyads. One mechanism for this appears to be as a result of increased patient depression.

Future research should seek to further clarify whether the role of interpersonal processes in CFS/ME differs across different patient-significant other relationships. The development of significant other-focused treatment interventions may be particularly beneficial for both patients and significant others.

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