Chronic Fatigue and its Syndromes

by Wessely, Simon; Hotopf, Matthew; Sharpe, Michael

• ISBN13: 9780192621818
• ISBN10: 0192621815
• Format: Hardcover
• Copyright: 1998-05-28
• Publisher: Oxford University Press

Summary

Chronic Fatigue Syndrome has been the subject of intense media debate over recent years. Such interest has been partially due to the scarcity of professional and scientific explorations of the topic - what is it, and what causes it? One school of thought argues that there is no medical basis to chronic fatigue and hence any such investigation is fruitless. An alternative view is that we should look at CFS purely as a physical problem, and that to attempt any psychological perspective is to trivialise the illness in the eyes of the sufferers. Chronic fatigue and its syndromes presents a comprehensive review of the problem of chronic fatigue, mixing medical, psychological, social, and historical perspectives. The book examines the historical origins of CFS, considering the epidemiology, and the various aetiological theories for the condition - viral, immunological, psychological, psychiatric, and neurological. The book concludes with a clinical section discussing the assessment and treatment of CFS. Throughout, the authors argue that chronic fatigue and its various syndromes cannot easily be pigeon holed into physical or psychological categories, and that the ambiguous nature of the illness actually provides us with a valuable chance to explore contemporary attitudes to sickness and health, one not offered by better defined or classified disorders.

Table of Contents

List of Abbreviations	xvii
Section 1: The nature and extent of fatigue	1	(95)
1 What is fatigue?	1	(17)
1.1 What is fatigue?	1	(1)
1.2 History and fatigue	2	(8)
1.3 Medicine and fatigue	10	(1)
1.4 The measurement of fatigue	11	(6)
1.5 Conclusions	17	(1)
2 The epidemiology of fatigue	18	(21)
2.1 Epidemiology and its application to fatigue	18	(1)
2.2 The problem of the definition of fatigue for epidemiological surveys	18	(6)
2.3 Tthe prevalence of fatigue	24	(5)
2.4 Epidemiology and the aetiology of fatigue	29	(5)
2.5 Conclusions	34	(1)
References	34	(5)
3. Physical mechanisms of fatigue	39	(42)
3.1 Introduction	39	(1)
3.2 Muscle fatigue	40	(4)
3.3 Fatigue and exercise	44	(4)
3.4 Fatigue, sleep, and the sleep disorders	48	(7)
3.5 Fatigue and inactivity	55	(3)
3.6 Fatigue and physical illness: introduction	58	(2)
3.7 Fatigue and cardiology: the case of chronic heart failure	60	(2)
3.8 Fatigue and neurological disorders	62	(2)
3.9 Fatigue and rheumatological disorders	64	(1)
3.10 Fatigue and cancer	65	(1)
3.11 Fatigue and HIV	65	(1)
3.12 Fatigue and renal failure	66	(1)
3.13 Post-operative fatigue	67	(1)
3.14 Mechanisms of fatigue in physical illness	68	(2)
3.15 Cytokines, cortisol, and fatigue	70	(2)
3.16 Conclusions	72	(1)
References	73	(8)
4 Fatigue and emotional disorders	81	(15)
4.1 Introduction	81	(1)
4.2 Fatigue and depression	81	(3)
4.3 Fatigue and anxiety	84	(1)
4.4 Fatigue and somatization	85	(1)
4.5 Fatigue -- depression or anxiety?	86	(1)
4.6 Stress and personality	86	(1)
4.7 The nature of the association between fatigue and psychiatric disorders	87	(1)
4.8 Fatigue -- neither depression nor anxiety	88	(1)
4.9 Myalgia and psychiatric disorder	89	(1)
4.10 The causes of fatigue in the community	90	(1)
4.11 The story so far	91	(1)
References	92	(4)
Section 2: The history of chronic fatigue	96	(34)
5 Neurasthenia	96	(21)
5.1 What was neurasthenia?	96	(1)
5.2 The arrival of neurasthenia	97	(2)
5.3 The aetiologies of neurasthenia	99	(3)
5.4 Changes in the treatment of neurasthenia	102	(2)
5.5 The reaction against neurasthenia	104	(1)
5.6 Neurasthenia, stigma, and prejudice	105	(2)
5.7 The disease that did not disappear	107	(2)
5.8 Modern neurasthenia	109	(1)
5.9 Conclusion	109	(2)
References	111	(6)
6 From neurasthenia to CFS	117	(13)
6.1 From neurasthenia to CFS	117	(1)
6.2 The beginnings of ME; from Los Angeles to the Royal Free	118	(3)
6.3 The origins of post-viral fatigue syndrome	121	(1)
6.4 ME: from epidemic to sporadic	122	(2)
6.5 From chronic epstein-Barr virus to the chronic fatigue syndrome	124	(2)
6.6 Fibromyalgia	126	(1)
References	127	(3)
Section 3: Chronic fatigue syndrome	130	(208)
7. Chronic fatigue syndrome: definition, epidemiology, presentation, prognosis	130	(17)
7.1 Definitions of chronic fatigue syndrome	130	(3)
7.2 CFS: dimension or category?	133	(2)
7.3 Epidemiology of CFS	135	(1)
7.4 Social class and CFS	136	(1)
7.5 Presentation	137	(1)
7.6 Physical signs and CFS	138	(1)
7.7 Prognosis	138	(5)
References	143	(4)
8 CFS: Muscles and nerves	147	(18)
8.1 Muscle pathology and biochemistry	147	(4)
8.2 Neurophysiology and neuromuscular function	151	(4)
8.3 The role of inactivity and fitness	155	(1)
8.4 Myalgia	156	(1)
8.5 Effort syndrome	157	(1)
8.6 Autonomic dysfunction	157	(1)
8.7 Conclusion	158	(1)
References	159	(6)
9 CFS: viruses and immunity	165	(44)
9.1 Viruses and CFS: establishing an association	165	(2)
9.2 EBV and CFS	167	(1)
9.3 Chronic mononucleosis	168	(1)
9.4 Cohort studies of EBV	169	(2)
9.5 Enteroviruses and CFS	171	(4)
9.6 Cohort studies of the outcome of enterovirus infection	175	(1)
9.7 Other viruses and CFS	176	(1)
9.8 Psychological vulnerability to infection and post-infectious fatigue	177	(4)
9.9 Infection and psychological disorders	181	(1)
9.10 Viruses and CFS: conclusions	182	(1)
9.11 Immunological abnormalities in CFS	182	(1)
9.12 Immunological studies in CFS: lymphocyte number and function	183	(4)
9.13 Immunological studies in CFS: humoral immune responses	187	(3)
9.14 Allergy and CFS	190	(1)
9.15 Immune disorder and viral infection	190	(1)
9.16 Immunological disturbances and clinical symptoms	191	(1)
9.17 Sample choice, selection bias, and confounders	192	(1)
9.18 Mood, stress, and immune disorder	192	(3)
9.19 Genetics of CFS	195	(1)
9.20 Conclusion	196	(1)
References	197	(12)
10 CFS and psychiatric disorder	209	(30)
10.1 Introduction	209	(6)
10.2 CFS and depression	215	(2)
10.3 CFS and anxiety	217	(1)
10.4 CFS, somatic symptoms, and somatization disorder	218	(3)
10.5 CFS and hysteria	221	(1)
10.6 CFS and hypochondriasis	221	(1)
10.7 CFS and eating disorders	222	(1)
10.8 CFS, stress, and life events	222	(2)
10.9 CFS, personality, and personality disorder	224	(2)
10.10 Why might psychiatric disorders be associated with CFS?	226	(5)
10.11 Psychiatric disorders and CFS: conclusion	231	(1)
References	232	(7)
11 The neurobiology of CFS	239	(27)
11.1 Neuropsychology of CFS	239	(3)
11.2 Viruses and the neuropsychiatry of fatigue	242	(1)
11.3 Neurophysiology	243	(1)
11.4 Neuroimaging	244	(2)
11.5 Neuroendocrinology and neurochemistry	246	(7)
11.6 Serotonin and other fatigue syndromes	253	(1)
11.7 CFS, fibromyalgia, and sleep	254	(4)
References	258	(8)
12 The role of psychological factors in CFS	266	(18)
12.1 The nature and origin of patient beliefs about CFS	266	(6)
12.2 The importance of illness beliefs	272	(1)
12.3 A cognitive behavioural model of CFS	273	(5)
12.4 Conclusions	278	(1)
12.5 Caveat	278	(1)
References	279	(5)
13 CFS in children	284	(14)
13.1 Fatigue in childhood	284	(1)
13.2 CFS in children	285	(1)
13.3 CFS in children: clinical features	285	(1)
13.4 Aetiology of CFS in children	286	(3)
13.5 Assessment and investigation	289	(1)
13.6 Management	290	(1)
13.7 Outcome	291	(2)
13.8 Conclusion	293	(1)
References	294	(4)
14 Other chronic fatigue syndromes	298	(13)
14.1 Introduction	298	(1)
14.2 Fibromyalgia	299	(2)
14.3 Irritable bowel syndrome	301	(1)
14.4 Effort syndromes (Da Costa's syndrome, neurocirculatory asthenia, soldier's heart, mitral valve prolapse)	302	(2)
14.5 Chronic brucellosis and chronic Lyme disease	304	(1)
14.6 Burnout	305	(1)
References	306	(5)
15 CFS: a social history of twentieth-century illness	311	(27)
15.1 The world of fiction	311	(2)
15.2 Chronic fatigue and the fear of mental illness	313	(4)
15.3 The media and CFS	317	(1)
15.4 ME/CFIDS as a political movement	318	(3)
15.5 CFS is a twentieth-century disease	321	(3)
15.6 CFS is not a twentieth-century illness	324	(1)
15.7 CFS and other modern illness	325	(2)
15.8 CFS as narrative	327	(1)
15.9 CFS and modern science	328	(1)
15.10 CFS as protest	329	(2)
15.11 The practical consequences	331	(1)
15.12 Conclusions	332	(1)
References	332	(6)
Section 4: The assessment and management of chronic fatigue and chronic fatigue syndrome	338	(61)
16 The assessment of the chronically fatigued patient	338	(19)
16.1 Introduction	338	(1)
16.2 Aims of the assessment	338	(3)
16.3 The history	341	(5)
16.4 The mental status examination	346	(2)
16.5 The physical examination	348	(1)
16.6 Investigations	348	(1)
16.7 Specialist referral	349	(1)
16.8 Diagnosis	350	(1)
16.9 Biopsychosocial formulation	350	(2)
16.10 Management plans	352	(1)
16.11 Special issues	353	(1)
16.12 Conclusion	353	(1)
References	354	(3)
17 Treatment of CFS: the evidence	357	(24)
17.1 Introduction	357	(1)
17.2 The randomized controlled trial: strengths and weaknesses	357	(4)
17.3 Anti-inflammatories and analgesics	361	(1)
17.4 Antidepressants	361	(2)
17.5 Immune modulators	363	(3)
17.6 Corticosteroids	366	(1)
17.7 Antiviral agents	366	(1)
17.8 Dietary supplements	367	(1)
17.9 RCTs of exercise in CFS	368	(2)
17.10 Cognitive behaviour therapy	370	(3)
17.11 Alternative medicine	373	(1)
17.12 Conclusions	374	(1)
References	375	(6)
18 Treatment of the patient with CFS	381	(18)
18.1 Introduction	381	(1)
18.2 Who should treat patients with CFS?	381	(2)
18.3 How should patients with CFS be treated?	383	(1)
18.4 Education and advice	384	(2)
18.5 Pharmacological interventions	386	(1)
18.6 Behavioural interventions	387	(1)
18.7 Cognitive behaviour therapy (CBT)	388	(6)
18.8 Potential problems	394	(1)
18.9 The future	395	(1)
References	395	(4)
Section 5: Conclusion	399	(8)
19 Conclusions	399	(8)
19.1 What is fatigue?	399	(1)
19.2 What is CFS?	400	(2)
19.3 CFS as a final common pathway	402	(1)
19.4 Why does it matter? -- the significance of CFS	403	(2)
References	405	(2)
References for Chapter 1	407	(4)
Index	411