Adolescent Chronic Fatigue Syndrome Research Articles

FINDINGS OF PHASE 3 OF THE CATIE SCHIZOPHRENIA TRIAL

Patients with chronic fatigue syndrome (CFS) frequently report chronic pain symptoms. Cognitive behavioural therapy (CBT) for CFS results in a reduction of fatigue, but is not aimed at pain symptoms. In this study, we tested the hypothesis that a successful treatment of CFS can also lead to a reduction of pain. The second objective was to explore possible mechanisms of changes in pain. The third objective was to assess the predictive value of pain for treatment outcome. Data from two previous CBT studies were used, one of adult CFS patients (n=96) and one of adolescent CFS patients (n=32). Pain severity was assessed with a daily self-observation list at baseline and post-treatment. The location of pain in adults was assessed with the McGill Pain Questionnaire (MPQ). Patients were divided into recovered and non-recovered groups. Recovery was defined as reaching a post-treatment level of fatigue within normal range. Recovered adult and adolescent CFS patients reported a significant reduction of pain severity compared to non-recovered patients. Recovered adult patients also had fewer pain locations following treatment. The decrease in fatigue predicted the change in pain severity. In adult patients, a higher pain severity at baseline was associated with a negative treatment outcome.

Sympathetic cardiovascular control during orthostatic stress and isometric exercise in adolescent chronic fatigue syndrome

The chronic fatigue syndrome (CFS) has been shown to be associated with orthostatic intolerance and cardiovascular dysregulation. We investigated the cardiovascular responses to combined orthostatic stress and isometric exercise in adolescents with CFS. We included a consecutive sample of 15 adolescents 12-18 years old with CFS diagnosed according to a thorough and standardized set of investigations, and a volunteer sample of 56 healthy control subjects of equal sex and age distribution. Heart rate, systolic, mean and diastolic blood pressure, stroke index, and total peripheral resistance index were non-invasively recorded during lower body negative pressure (LBNP) combined with two consecutive periods of handgrip. In addition, we measured baseline plasma catecholamines, and recorded symptoms. At rest, CFS patients had higher heart rate, diastolic blood pressure, plasma norepinephrine (P < 0.01), mean blood pressure and plasma epinephrine (P < 0.05) than controls. During LBNP, CFS patients had a greater increase in heart rate, diastolic blood pressure, mean blood pressure (P < 0.05) and total peripheral resistance index (n.s.) than controls. During handgrip, CFS patients had a smaller increase in heart rate, diastolic blood pressure (P < 0.05), mean blood pressure and total peripheral resistance index (n.s.) than controls. Our results indicate that adolescents with CFS have increased sympathetic activity at rest with exaggerated cardiovascular response to orthostatic stress, but attenuated cardiovascular response when performing isometric exercise during orthostatic stress. This suggests that CFS might be causally related to sympathetic dysfunction.

Is cognitive behaviour therapy for chronic fatigue syndrome also effective for pain symptoms?

Patients with chronic fatigue syndrome (CFS) frequently report chronic pain symptoms. Cognitive behavioural therapy (CBT) for CFS results in a reduction of fatigue, but is not aimed at pain symptoms. In this study, we tested the hypothesis that a successful treatment of CFS can also lead to a reduction of pain. The second objective was to explore possible mechanisms of changes in pain. The third objective was to assess the predictive value of pain for treatment outcome. Data from two previous CBT studies were used, one of adult CFS patients (n=96) and one of adolescent CFS patients (n=32). Pain severity was assessed with a daily self-observation list at baseline and post-treatment. The location of pain in adults was assessed with the McGill Pain Questionnaire (MPQ). Patients were divided into recovered and non-recovered groups. Recovery was defined as reaching a post-treatment level of fatigue within normal range. Recovered adult and adolescent CFS patients reported a significant reduction of pain severity compared to non-recovered patients. Recovered adult patients also had fewer pain locations following treatment. The decrease in fatigue predicted the change in pain severity. In adult patients, a higher pain severity at baseline was associated with a negative treatment outcome.

Incidence, Prognosis, and Risk Factors for Fatigue and Chronic Fatigue Syndrome in Adolescents: A Prospective Community Study

The objective of this study was to describe the incidence, prevalence, risk factors, and prognosis of fatigue, chronic fatigue, and chronic fatigue syndrome in 11- to 15-year-olds. A random general population sample (n = 842) of British adolescents and their parents were assessed at baseline and 4 to 6 months later. The main outcomes were fatigue, chronic fatigue, and chronic fatigue syndrome, operationally defined. The incidence over 4 to 6 months was 30.3% for fatigue, 1.1% for chronic fatigue, and 0.5% for chronic fatigue syndrome. The point prevalence was 34.1% and 38.1% for fatigue, 0.4% and 1.1% for chronic fatigue, and 0.1% and 0.5% for chronic fatigue syndrome at time 1 and time 2, respectively. Of participants who were fatigued at time 1, 53% remained fatigued at time 2. The 3 cases of chronic fatigue and 1 case of chronic fatigue syndrome at time 1 had recovered by time 2. Higher risk for development of chronic fatigue at time 2 was associated with time 1 anxiety or depression, conduct disorder, and maternal distress; in multivariate analysis, baseline anxiety or depression remained a significant predictor of chronic fatigue. Increased risk for development of fatigue at time 2 was associated with time 1 anxiety or depression, conduct disorder, and older age; in multivariate analyses, these factors and female gender all were significant predictors of fatigue. The incidence rates for chronic fatigue and chronic fatigue syndrome in this adolescent sample were relatively high, but the prognosis for these conditions was good. This prospective study provides evidence for an association between emotional/behavioral problems and subsequent onset of fatigue/chronic fatigue.

Mirrored Symptoms in Mother and Child With Chronic Fatigue Syndrome

Our aim with this study was to assess the relation between chronic fatigue syndrome in adolescents and fatigue and associated symptoms in their fathers and mothers, more specifically the presence of chronic fatigue syndrome-like symptoms and psychologic distress. In this cross-sectional study, 40 adolescents with chronic fatigue syndrome according to the Centers for Disease Control and Prevention criteria were compared with 36 healthy control subjects and their respective parents. Questionnaires regarding fatigue (Checklist Individual Strength), fatigue-associated symptoms, and psychopathology (Symptom Checklist-90) were applied to the children and their parents. Psychologic distress in the mother corresponds with an adjusted odds ratio of 5.6 for the presence of CFS in the child. The presence of fatigue in the mother and dimensional assessment of fatigue with the Checklist Individual Strength revealed odds ratios of, respectively, 5.29 and 2.86 for the presence of chronic fatigue syndrome in the child. An increase of 1 SD of the hours spent by the working mother outside the home reduced the risk for chronic fatigue syndrome in their child with 61%. The fathers did not show any risk indicator for chronic fatigue syndrome in their child. Mothers of adolescents with chronic fatigue syndrome exhibit fatigue and psychologic symptoms similar to their child in contrast with the fathers. The striking difference between the absent association in fathers and the evident association in mothers suggests that the shared symptom complex of mother and child is the result of an interplay between genetic vulnerability and environmental factors.

Chronic fatigue syndrome

Chronic fatigue syndrome (CFS) is characterized by disabling fatigue that significantly interferes with people's ability to carry out their normal daily activities. This article describes the core symptoms and details diagnostic criteria, in addition to discussing aetiology, risk factors, onset, prognosis and prevalence. Many patients diagnosed with CFS also meet the criteria for common psychiatric disorders, particularly depression. Issues regarding co-morbidity and the relationship between CFS and psychiatric illness are discussed. We outline two popular approaches to understanding CFS; the cognitive behavioural and deconditioning paradigms. The cognitive behavioural model attempts to explain how life stresses can precipitate CFS in predisposed persons, and how cognitive, physiological, behavioural and social factors then interact to perpetuate the illness creating a vicious cycle of chronic fatigue and disability. Deconditioning, a physiological process leading to a decrease in the body's efficiency, reduces the body's capacity for physical exertion, leading to an increase in fatigue symptoms at lower levels of exercise than previously. Treatments for CFS are discussed, with the focus being on two non-pharmacological interventions; cognitive behavioural therapy (CBT) and graded exercise therapy (GET), which have been shown to be very effective in treating CFS. Finally, we discuss CFS in children and adolescents which in recent years, has become more acknowledged. Prevalence and treatment of CFS in children is discussed with special attention being paid to developmental issues.

Handbook of Chronic Fatigue Syndrome

Chronic fatigue syndrome (CFS) has been recognized as an entity since the 1800s, when it was known as “neurasthenia.” A panel of experts who convened in 1994 to establish a set of diagnostic criteria for CFS described it as a syndrome that includes disabling fatigue, cognitive difficulties, nonrefreshing sleep, and myalgias. Autonomic instability, mental illness, immunologic abnormalities, and swollen lymph nodes are sometimes present in patients with CFS. It frequently coexists with fibromyalgia. The Handbook of Chronic Fatigue Syndrome summarizes the current research and clinical knowledge about this disorder. Chronic fatigue syndrome is largely a “diagnostically homeless” entity. No one medical specialty takes ownership of CFS, and it is not routinely included in medical school and residency curricula. There is much controversy surrounding its diagnosis and even its legitimacy as a medical illness. The differential diagnosis of CFS is large, making its diagnosis difficult. Endocrine, rheumatologic, neurologic, infectious, hematologic, nutritional, metabolic, and psychiatric disorders can mimic or contribute to the disorder. Profound occupational, social, and family problems can also result from the illness. A multisystem approach using the biopsychosocial model is best used in the diagnosis and management of CFS. Part I of the Handbook discusses epidemiology, differential diagnosis, sociocultural issues, immunology, and genetics; the major criteria as well as additional symptoms that constitute the diagnosis of CFS, as established by the panel of experts, are listed. Part II is about the social, individual, and family systems effects of CFS. Part III goes into specifics about the symptomatology of CFS, including sections on pain and fatigue, orthostatic intolerance, and sleep, cardiac, and neuroendo-crine dysfunction. Part IV discusses pain rating scales and other diagnostic instruments. Part V is a large section on treatments and interventions. Comprehensive treatment regimens including medical treatment, exercise, nutrition, and psychotherapy are described. Part VI discusses diagnosis and treatment of CFS in children and adolescents. The editors have succeeded in producing a comprehensive and interesting text. Although this volume, at 794 pages, stretches the definition of “handbook,” readers are rewarded with an exhaustively researched and evidence-based work that should prove to be clinically useful.

Cognitive behaviour therapy for adolescents with chronic fatigue syndrome: randomized controlled trial

. Stulemeijer M, de Jong LWAM, Fiselier TJW, Hoogveld SWB, Bleijenberg G . ( 2005 ) , 330 , 14 – 17 . Objective To evaluate the efficacy of cognitive behaviour therapy for adolescents aged 10 to 17 years with chronic fatigue syndrome.Design Randomized controlled trial.Setting Department of child psychology.Participants A total of 71 consecutively referred patients with chronic fatigue syndrome; 36 were randomly assigned to immediate cognitive behaviour therapy and 35 to the waiting list for therapy.Intervention Ten sessions of therapy over 5 months. Treatment protocols depended on the type of activity pattern (relatively active or passive). All participants were assessed again after 5 months.Main outcome measures Fatigue severity (checklist individual strength), functional impairment (SF‐36 physical functioning), and school attendance.Results A total of 62 patients had complete data at 5 months (29 in the immediate therapy group and 33 on the waiting list). Patients in the therapy group reported significantly greater decrease in fatigue severity (difference in decrease on checklist individual strength was 14.5, 95% confidence interval 7.4 to 21.6) and functional impairment (difference in increase on SF‐36 physical functioning was 17.3, 6.2 to 28.4) and their attendance at school increased significantly (difference in increase in percentage school attendance was 18.2, 0.8 to 35.5). They also reported a significant reduction in several accompanying symptoms. Self reported improvement was largest in the therapy group.Conclusion Cognitive behaviour therapy is an effective treatment for chronic fatigue syndrome in adolescents.

Cognitive behaviour therapy for adolescents with chronic fatigue syndrome: randomised controlled trial

Objective To evaluate the efficacy of cognitive behaviour therapy for adolescents aged 10-17 years with chronic fatigue syndrome.Design Randomised controlled trial.Setting Department of child psychology.Participants 71 consecutively referred patients with...

Chronic fatigue syndrome and other fatiguing illnesses in adolescents: a population-based study

Purpose To estimate the prevalence of chronic fatigue syndrome (CFS) and describe characteristics of other fatiguing illnesses in adolescents (aged 12 through 17 years). Methods We conducted a random digit dialing survey of the residents of Wichita, Kansas. Adults identified fatigued adolescents in the household and answered questions relating to the child's health. Selected adolescents were invited to attend a clinic with a parent/guardian. After clinical evaluation they were classified as CFS or another fatigue state as defined in the 1994 CFS definition. Annual telephone interviews and clinical evaluations monitored subjects' fatigue status. Data were analyzed using the Kruskal-Wallis test, the Mantel-Haenszel test, and the exact McNemar test. Results The survey contacted 34,018 households with 90,316 residents. Of 8586 adolescents, 138 had fatigue for ≥1 month and most (107 or 78%) had chronic fatigue (≥6 months) at some point during the 3-year follow-up. Twenty-eight had exclusionary diagnoses. Thirty-one were considered to have a CFS-like illness and were invited for clinical evaluation. Eleven agreed to participate and none met the CFS case definition. The baseline weighted prevalence of CFS-like illness was 338 per 100,000. Significant differences existed between parental and adolescents' descriptions of illness. Conclusions The prevalence of CFS among adolescents was considerably lower than among adults. Evaluation of CFS in adolescents must consider both parent and patient perception of fatigue and other illnesses that might explain the symptom complex.

Chronic fatigue syndrome and other fatiguing illnesses in adolescents: a population-based study

PurposeTo estimate the prevalence of chronic fatigue syndrome (CFS) and describe characteristics of other fatiguing illnesses in adolescents (aged 12 through 17 years). MethodsWe conducted a random digit dialing survey of the residents of Wichita, Kansas. Adults identified fatigued adolescents in the household and answered questions relating to the child's health. Selected adolescents were invited to attend a clinic with a parent/guardian. After clinical evaluation they were classified as CFS or another fatigue state as defined in the 1994 CFS definition. Annual telephone interviews and clinical evaluations monitored subjects' fatigue status. Data were analyzed using the Kruskal-Wallis test, the Mantel-Haenszel test, and the exact McNemar test. ResultsThe survey contacted 34,018 households with 90,316 residents. Of 8586 adolescents, 138 had fatigue for ≥1 month and most (107 or 78%) had chronic fatigue (≥6 months) at some point during the 3-year follow-up. Twenty-eight had exclusionary diagnoses. Thirty-one were considered to have a CFS-like illness and were invited for clinical evaluation. Eleven agreed to participate and none met the CFS case definition. The baseline weighted prevalence of CFS-like illness was 338 per 100,000. Significant differences existed between parental and adolescents' descriptions of illness. ConclusionsThe prevalence of CFS among adolescents was considerably lower than among adults. Evaluation of CFS in adolescents must consider both parent and patient perception of fatigue and other illnesses that might explain the symptom complex.

Adolescent Chronic Fatigue Syndrome: Healthcare in partnership with education

Background Chronic fatigue syndrome is being recognised increasingly in children and adolescents and most schools see it as a familiar problem. Available information through the Internet and the media is both confusing and in conflict with scientific research. Cognitive behaviour therapy with a graded approach to activity appears to be the most effective treatment for adults with chronic fatigue syndrome and a similar approach is used with children. Previous studies had looked at the beliefs and attitudes of adults with chronic fatigue syndrome, but no studies had looked specifically at teachers.

Chronic fatigue syndrome should not be diagnosed in children.

The diagnosis of chronic fatigue syndrome (CFS) is based on inclusionary and exclusionary criteria.1 There are no known diagnostic markers for this condition. Different diagnostic criteria were developed in the US,2 Great Britain,3 and Australia.4 More recently an international panel has suggested a revised set of criteria5(Table). In all these cases, the diagnosis of CFS is limited to adults. Recently, the issue of diagnosing CFS in children has been raised.6 During the October 1996 meeting of the American Association for Chronic Fatigue Syndrome in San Francisco, two separate panels were convened to discuss this issue. If CFS were a distinct disease process, there is no a priori reason why it should not occur in younger individuals. Diagnosing CFS in adolescents may not be difficult. The same criteria used in adults may be applied, or simply modified. It is an entirely different problem defining CFS in children less than 13 years of age. The clinical manifestations of CFS in younger individuals are impossible to predict. In young children fatigue-producing diseases often manifest paradoxical symptoms. Sleep deprivation …

Double-blind randomized controlled trial to assess the efficacy of intravenous gammaglobulin for the management of chronic fatigue syndrome in adolescents

A double blind randomized controlled trial was conducted in 71 adolescents aged 11–18 years. Inclusion in the trial required fulfilment of the diagnostic criteria, (Fukuda et al., 1994). Three infusions of 1 gm/kg (max 1 litre of 6 gm/100 ml in 10% w/v maltose solution) were given one month apart. The dummy solution was a 10% w/v maltose solution with 1% albumin of equivalent volume for weight. Efficacy was assessed by difference in a mean functional score including school attendance, school work, social activity and physical activity, between baseline, three months and six months after the final infusion. There was a significant mean functional improvement at the six month follow-up of 70 adolescents with Chronic Fatigue Syndrome of average duration 18 months. There was also a significant improvement for both groups from the beginning of the trial to the six month post infusion follow-up. Adverse effects were common with both solutions but not predictive of response. Neither solution could be identified by recipients.