Chronic Fatigue and Its Syndromes

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

• ISBN13: 9780192630469
• ISBN10: 0192630466
• Format: Paperback
• Copyright: 1999-07-08
• 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 trivialize 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 I: The nature and extent of fatigue
The nature of fatigue?	3	(21)
What is fatigue?	3	(1)
History and fatigue	4	(8)
Medicine and fatigue	12	(1)
Measurement of fatigue	13	(6)
Conclusions	19	(5)
References	19	(5)
Epidemiology of fatigue	24	(21)
Epidemiology and its application to fatigue	24	(1)
The problem of the definition of fatigue for epidemiological surveys	24	(6)
Prevalence of fatigue	30	(5)
Epidemiology and aetiology of fatigue	35	(5)
Conclusion	40	(5)
References	40	(5)
Physical mechanisms of fatigue	45	(42)
Introduction	45	(1)
Muscle fatigue	46	(4)
Fatigue and exercise	50	(4)
Fatigue, sleep, and sleep disorders	54	(7)
Fatigue and inactivity	61	(3)
Fatigue and physical illness: introduction	64	(2)
Fatigue and cardiology: the case of chronic heart failure	66	(2)
Fatigue and neurological disorders	68	(2)
Fatigue and rheumatological disorders	70	(1)
Fatigue and cancer	71	(1)
Fatigue and HIV	72	(1)
Fatigue and renal failure	72	(1)
Post-operative fatigue	73	(2)
Mechanisms of fatigue in physical illness: conclusions	75	(1)
Cytokines, cortisol, and fatigue	76	(2)
Conclusion	78	(9)
References	79	(8)
Fatigue and emotional disorders	87	(18)
Introduction	87	(1)
Fatigue and depression	87	(3)
Fatigue and anxiety	90	(1)
Fatigue and somatization	91	(1)
Fatigue -- depression or anxiety?	92	(1)
Stress and personality	93	(1)
The nature of the association between fatigue and psychiatric disorders	93	(1)
Fatigue -- neither depression nor anxiety?	94	(1)
Myalgia and psychiatric disorder	95	(1)
The causes of fatigue in the community	96	(1)
The story so far	97	(8)
References	98	(7)
Section II: The history of chronic fatigue
Neurasthenia	105	(21)
What was neurasthenia?	105	(1)
The arrival of neurasthenia	106	(2)
The aetiologies of neurasthenia	108	(3)
Changes in the treatment of neurasthenia	111	(2)
The reaction against neurasthenia	113	(1)
Neurasthenia, stigma, and prejudice	114	(2)
The disease that did not disappear	116	(2)
Modern neurasthenia	118	(1)
Conclusion	118	(8)
References	120	(6)
From neurasthenia to CFS	126	(15)
Introduction	126	(1)
The beginnings of ME: from Los Angeles to the Royal Free Hospital London	127	(3)
The origins of post-viral fatigue syndrome	130	(1)
ME: from epidemic to sporadic cases	131	(2)
From chronic Epstein-Barr virus to CFS	133	(2)
Fibromyalgia	135	(6)
References	136	(5)
Section III: Chronic fatigue syndrome
CFS: definitions, epidemiology, presentation, prognosis	141	(17)
Definitions of CFS	141	(3)
CFS: dimension or category?	144	(2)
Epidemiology of CFS	146	(1)
Social class and CFS	147	(1)
Presentation	148	(1)
Physical signs and CFS	149	(1)
Prognosis	149	(9)
References	154	(4)
CFS: muscles and nerves	158	(18)
Muscle pathology and biochemistry	158	(4)
Neurophysiology and neuromuscular function	162	(4)
The roles of inactivity and fitness	166	(1)
Myalgia	167	(1)
Effort syndrome	168	(1)
Autonomic dysfunction	168	(1)
Conclusion	169	(7)
References	170	(6)
Viruses, immunity, and CFS	176	(44)
Viruses and CFS: establishing an association	176	(2)
Epstein -- Barr Virus and CFS	178	(1)
Chronic mononucleosis	179	(1)
Cohort studies of Epstein -- Barr Virus	180	(2)
Enteroviruses and CFS	182	(4)
Cohort studies of the outcome of enterovirus infection	186	(1)
Other viruses and CFS	187	(1)
Psychological vulnerability to infection and post-infectious fatigue	188	(4)
Infection and psychological disorders	192	(1)
Viruses and CFS: conclusions	193	(1)
Immunological abnormalities in CFS	194	(2)
Immunological studies in CFS: lymphocyte number and function	196	(2)
Immunological studies in CFS: humoral immune responses	198	(3)
Allergy and CFS	201	(1)
Immune disorder and viral infection	201	(1)
Immunological disturbances and clinical symptoms	202	(1)
Sample choice, selection bias, and confounders	203	(1)
Mood, stress, and immune disorder	203	(3)
Genetics of CFS	206	(1)
Conclusion	207	(13)
References	208	(12)
CFS and psychiatric disorders	220	(30)
Introduction	220	(6)
CFS and depression	226	(2)
CFS and anxiety	228	(1)
CFS, somatic symptoms, and somatization disorder	229	(3)
CFS and hysteria	232	(1)
CFS and hypochondriasis	232	(1)
CFS and eating disorders	233	(1)
CFS, stress, and life events	233	(2)
CFS, personality, and personality disorder	235	(2)
Why might psychiatric disorders be associated with CFS?	237	(5)
Conclusion	242	(8)
References	243	(7)
The neurobiology of CFS	250	(27)
Neuropsychology of CFS	250	(3)
Viruses and the neuropsychiatry of fatigue	253	(1)
Neurophysiology	254	(1)
Neuroimaging	255	(2)
Neuroendocrinology and neurochemistry	257	(7)
Serotonin, and other fatigue syndromes	264	(1)
CFS, fibromyalgia, and sleep	265	(12)
References	269	(8)
The role of psychological factors in CFS	277	(18)
The nature and origin of patients' beliefs about CFS	277	(7)
The importance of illness beliefs	284	(4)
A cognitive behavioural model of CFS	288	(1)
Conclusion	289	(1)
Caveat	289	(6)
References	290	(5)
CFS in children	295	(14)
Fatigue in childhood	295	(1)
CFS in childhood	296	(1)
Clinical features	296	(1)
Aetiology	297	(3)
Assessment and investigation	300	(1)
Management	301	(1)
Outcome	302	(2)
Conclusion	304	(5)
References	305	(4)
Other chronic fatigue syndromes	309	(13)
Introduction	309	(1)
Fibromyalgia	310	(2)
Irritable bowel syndrome	312	(1)
Effort syndromes (Da Costa's syndrome, neurocirculatory asthenia, soldier's heart, mitral valve prolapse)	313	(2)
Chronic brucellosis and chronic Lyme disease	315	(1)
Burnout	316	(6)
References	317	(5)
CFS: a social history of twentieth-century illness	322	(29)
The world of fiction	322	(2)
Chronic fatigue and the fear of mental illness	324	(4)
The media and CFS	328	(1)
ME/CFIDS as a political movement	329	(3)
CFS is a twentieth-century disease	332	(3)
CFS is not a twentieth-century illness	335	(1)
CFS and other modern illness	336	(2)
CFS as narrative	338	(1)
CFS and modern science	339	(1)
CFS as protest	340	(2)
The practical consequences	342	(1)
Conclusion	343	(8)
References	343	(8)
Section IV: Assessment and management of chronic fatigue and chronic fatigue syndrome
Assessment of the chronically fatigued patient	351	(19)
Introduction	351	(1)
Aims of the assessment	351	(3)
The history	354	(5)
The mental status examination	359	(2)
The physical examination	361	(1)
Investigations	361	(1)
Specialist referral	362	(1)
Diagnosis	363	(1)
Biopsychosocial formulation	363	(2)
Management plans	365	(1)
Special issues	366	(1)
Conclusion	366	(4)
References	367	(3)
Treatment of CFS: the evidence	370	(24)
Introduction	370	(1)
The randomized controlled trial: strengths and weaknesses	370	(4)
Anti-inflammatories and analgesics	374	(1)
Antidepressants	374	(2)
Immune modulators	376	(3)
Corticosteroids	379	(1)
Antiviral agents	379	(1)
Dietary supplements	380	(1)
RCTs of exercise in CFS	381	(2)
Cognitive behaviour therapy	383	(3)
Alternative medicine	386	(1)
Conclusion	387	(7)
References	388	(6)
Management of the patient with CFS	394	(21)
Introduction	394	(1)
Who should treat patients with CFS?	394	(2)
How should patients with CFS be treated?	396	(1)
Education and advice	397	(2)
Pharmacological interventions	399	(1)
Behavioural interventions	400	(1)
Cognitive behaviour therapy	401	(6)
Potential problems	407	(1)
The future	408	(7)
References	408	(7)
Section V: Overview
Conclusions	415	(8)
What is fatigue?	415	(1)
What is chronic fatigue syndrome?	416	(2)
CFS as a final common pathway	418	(1)
Why does it matter? -- the significance of CFS	419	(4)
References	421	(2)
Index	423