From the Journal of Psychosomatic Research, published online 19 July 2016.
Enhanced psychological flexibility and improved quality of life in chronic fatigue syndrome/myalgic encephalomyelitis
Sarah Densham(1), Deborah Williams(2), Anne Johnson(2), Julie M. Turner-Cobb(1)
1) Department of Psychology, University of Bath, Claverton Down, Bath, UK
2) The Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath, NHS Foundation Trust, Bath, UK
HIGHLIGHTS
* Interdisciplinary group treatment may improve quality of life in CFS/ME.
* Psychological Flexibility (PF) has applied utility in the treatment of CFS/ME.
* Changes in PF activity/occupational engagement suggest greatest benefit in CFS/ME.
Abstract
OBJECTIVE
Psychological Flexibility (PF) is a relatively new concept in physical health. It can be defined as an overarching process of being able to accept the presence of wanted/unwanted experiences, choosing whether to change or persist in behaviour in response to those experiences. Associations between processes of PF and quality of life (QoL) have been found in long-term health conditions such as chronic pain, PF has not yet been applied to Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME).
METHODS
Changes in PF, fatigue severity and QoL were examined in one hundred and sixty-five patients with CFS/ME engaged in a six-week outpatient interdisciplinary group treatment programme. Participants were assessed using a series of self-report measures at the start of the start (T1) and end of a six-week programme (T2) and at six months follow up (T3).
RESULTS
Significant changes in PF and QoL were observed from pre-treatment (T1) to post treatment follow-up (T2 and T3); changes in fatigue severity were observed from T1 to T3 only. Controlling for fatigue severity, changes in the PF dimension of activity/occupational engagement were associated with improvement in QoL at six month follow up (T3) but not at six weeks post programme (T2).
CONCLUSION
Findings indicate an interdisciplinary group treatment approach for people with CFS/ME may be associated with improved QoL, processes of PF and fatigue severity, supporting a link between PF and long term health conditions. Results highlight links between PF and patient QoL in CFS/ME and the value of interdisciplinary treatment approaches in this patient population.
From the Journal of Cardiology, 28 January 2016.
Down-regulation of renin–aldosterone and antidiuretic hormone systems in patients with myalgic encephalomyelitis/chronic fatigue syndrome
Kunihisa Miwa
Miwa Naika Clinic, Toyama, Japan
Abstract
BACKGROUND
Central nervous system dysfunction associated with myalgic encephalomyelitis (ME) has been postulated as the cause of chronic fatigue syndrome (CFS). A small heart or reduced left ventricular volume with reduced cardiac output has been reported to be common in patients with ME. The main circulatory blood volume regulators may be down-regulated.
METHODS
Plasma levels of the neurohumoral factors that regulate circulatory blood volume were determined in 18 patients with ME and 15 healthy subjects (Controls).
RESULTS
The echocardiographic examination revealed that the mean values for the left ventricular end-diastolic diameters, stroke volume index, and cardiac index as well as the mean blood pressure were all significantly smaller in the ME group than in the Controls. The mean plasma renin activity (1.6 ± 1.0 ng/ml/h vs. 2.5 ± 1.5 ng/ml/h, p = 0.06) was considerably lower in the ME group than in the Controls. Both the mean plasma aldosterone (104 ± 37 pg/ml vs. 157 ± 67 pg/ml, p = 0.004) and antidiuretic hormone (ADH) (2.2 ± 1.0 pg/ml vs. 3.3 ± 1.5 pg/ml, p = 0.02) concentrations were significantly lower in the ME group than in the Controls. Desmopressin (120 μg), a synthetic version of arginine vasopressin, was orally administered for five successive days to 10 patients with ME. In five patients (50%), the symptoms of orthostatic intolerance during a 10 min active standing test were ameliorated in association with a significant increase in urinary osmotic pressure and decrease in heart rate. Furthermore, in five patients (50%), the performance status scores for the activities of daily living were improved.
CONCLUSIONS
Both the renin–aldosterone and ADH systems were down-regulated despite the existence of reduction in cardiac preload and output in patients with ME. Desmopressin improved symptoms in half of the patients.
From the Journal of Psychosomatic Research, 16 July 2016.
http://www.jpsychores.com/article/S0022-3999(16)30349-X/abstract
A UK-based review of recommendations regarding the management of chronic fatigue syndrome
Miriam Mallet(1), Eleanor King(1), Peter D. White(2)
1) Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
2) Wolfson Institute of Preventive Medicine, Barts and the London School of medicine and Dentistry, Queen Mary University of London, London, UK
HIGHLIGHTS
* There were marked discrepancies between patient and professional sources' views on treatment recommendations
* Patient organisations preferentially recommended medicines, pacing and complementary treatments
* Medical organisations recommended rehabilitation therapies
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).CONCLUSIONSThere 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.
The Pharmacogenomics Journal, 26 July 2016.
Genetic variation in catechol-O-methyltransferase modifies effects of clonidine treatment in chronic fatigue syndrome
K T Hall, J Kossowsky, T F Oberlander, T J Kaptchuk, J P Saul, V B Wyller, E Fagermoen, D Sulheim, J Gjerstad, A Winger and K J Mukamal
Abstract
Clonidine, an α2-adrenergic receptor agonist, decreases circulating norepinephrine and epinephrine, attenuating sympathetic activity. Although catechol-O-methyltransferase (COMT) metabolizes catecholamines, main effectors of sympathetic function, COMT genetic variation effects on clonidine treatment are unknown.
Chronic fatigue syndrome (CFS) is hypothesized to result in part from dysregulated sympathetic function. A candidate gene analysis of COMT rs4680 effects on clinical outcomes in the Norwegian Study of Chronic Fatigue Syndrome in Adolescents: Pathophysiology and Intervention Trial (NorCAPITAL), a randomized double-blinded clonidine versus placebo trial, was conducted (N=104).
Patients homozygous for rs4680 high-activity allele randomized to clonidine took 2500 fewer steps compared with placebo (Pinteraction=0.04). There were no differences between clonidine and placebo among patients with COMT low-activity alleles.
Similar gene–drug interactions were observed for sleep (Pinteraction=0.003) and quality of life (Pinteraction=0.018).
Detrimental effects of clonidine in the subset of CFS patients homozygous for COMT high-activity allele warrant investigation of potential clonidine–COMT interaction effects in other conditions.
The Journal of Cardiology findings from Japan, including reduced plasma renin activity (both plasma aldosterone & antidiuretic hormone activity were significantly down in ME patients), look v promising.
The fact that there is already a drug on the market (Arginine Vasopressin) which can address this and improve orthostatic intolerance with measurable results in 50% of the tested patients is also highly encouraging.
Dr Shepherd, would it be possible please to discuss these findings in further detail in the next issue of the MEA magazine, together with the “reduced ventricular (heart) output” research, which of course is crucial in the debate as to whether graded exercise is safe at all for ME patients (which of course many have reported it isn’t)?
This all looks very hopeful indeed.
best wishes,
Jackie S.
More than anything else, because the results are so physical and tangible, (& hopefully reproducible), it gives GP’s and other specialists something they can really get to grips with, understand and take action upon, in a way which could measurably improve the lives of a significant percentage of patients with this condition.
Also, but without getting too carried away at this stage – because the findings relate to such distinct and already well-known medical specialities (if the research ‘holds up’ that is), this could also help to appoint & direct much-needed research & treatment funding as the benefits seem very clear, at least with the current available information.
Although .., what if the reduced plasma renin is a deliberate mechanism by the body to protect the heart in some ME patients, due to its small size (& resultant reduced ventricular output) reported in previous research?
If we up the arginine Vasopressin, could this inadvertently trigger heart failure in susceptible patients?
Or would the drug improve circulating blood volume and help the heart, (along with helping improve orthostatic intolerance)?
Would be good to have some further medical input here! Thanks.
Do we all remember the nuclear power station that had leaks, had accidents, got a very bad name for being unsafe, and people began to protest and ask for it to be closed? Policy dictated that the public were worrying unnecessarily and resisting the idea of the power station continuing to be used through ignorance and hysteria. The answer was simple….. change the name of the power station!
So, Cognitive Behavioural Therapy, essentially the patronising psychological ‘reprogramming’ of how people perceive the severity of pain and fatigue and then allow that overvalued and over focused pain and fatigue to impact on their daily lives and rob them of a quality of life that they could otherwise enjoy, is to be done away with, hurray.
It is going to be replaced with Psychological Flexibility Training, which is essentially, the patronising psychological ‘reprogramming’ of how people perceive the severity of pain and fatigue and then allow that overvalued and over focused pain and fatigue to impact on their daily lives and rob them of a quality of life that they could otherwise enjoy.
Thank you MEA for keeping us informed of the tactics the “psychosomatic” camp are employing.