بروز علائم در افراد مبتلا به سندرم خستگی مزمن
|کد مقاله||سال انتشار||مقاله انگلیسی||ترجمه فارسی||تعداد کلمات|
|33134||2002||13 صفحه PDF||سفارش دهید||محاسبه نشده|
Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : Biological Psychology, Volume 59, Issue 1, February 2002, Pages 15–27
This investigation compared differences in the occurrence of symptoms in participants with CFS, melancholic depression, and no fatigue (controls). The following Fukuda et al. [Ann. Intern. Med. 121 (1994) 953] criteria symptoms differentiated the CFS group from controls, but did not differentiate the melancholic depression group from controls: headaches, lymph node pain, sore throat, joint pain, and muscle pain. In addition, participants with CFS uniquely differed from controls in the occurrence of muscle weakness at multiple sites as well as in the occurrence of various cardiopulmonary, neurological, and other symptoms not currently included in the current case definition. Implications of these findings are discussed.
Chronic fatigue syndrome (CFS) remains a poorly understood and controversial disease, because the exact causal agents are unknown, physical signs and symptoms are variant, and diagnostic laboratory tests have poor sensitivity and specificity (Holmes, 1991 and Jason et al., 1995). In the absence of laboratory tests or other objective indicators, case identification of CFS relies upon the clinical assessment of a constellation of symptoms that have been present for 6 or more months since the onset of the fatiguing illness (Fukuda et al., 1994). Since its emergence as a new disease category in the 1980s, four definitions of CFS have been proposed, but none have been empirically derived (Jason et al., 1997). The current US case definition of CFS (Fukuda et al., 1994) requires that the following criteria be met for diagnosis: (a) 6 or more months of persistent or relapsing chronic fatigue of a new or definite onset that is neither the result of ongoing exertion nor alleviated by rest, which results in substantial reductions in previous levels of occupational, educational, social, or personal activities; and (b) the concurrent occurrence of at least four of eight symptoms (postexertional malaise, unrefreshing sleep, memory and concentration difficulties, new headaches, sore throat, lymph node pain, muscle pain, and joint pain) that persist or reoccur during 6 or more months of the illness and do not predate the fatigue. Researchers have sought to validate the criteria for CFS established by the CDC using factor analytic methods. Nisenbaum et al. (1998) found that three correlated factors (fatigue-mood-cognition symptoms, flu-type symptoms, and visual impairment symptoms) explained a set of additional correlations between fatigue lasting for 6 or more months and 14 inter-related symptoms. No factor explained observed correlations among fatigue lasting for 1–5 months and other symptoms, indicating that only fatigue lasting 6 or more months (with selected symptoms) overlaps with published criteria to define CFS. In another study, Friedberg et al. (2000) examined symptoms of patients with CFS who had an illness duration of 10 or more years and found three factors: cognitive problems, flu-like symptoms, and neurologic symptoms. Other research has focused on classifying persons with CFS based on symptom profiles. Using latent class analysis, Hadzi-Pavlovic et al. (2000) determined that patients with CFS could be grouped into three classes: those with multiple severe symptoms, those with lower rates of cognitive symptoms and higher rates of pain; and those with a less severe form of multiple symptoms. Participants with a less severe form of multiple symptoms tended to be younger and with shorter illness duration. Jason and Taylor (2002) performed a cluster analysis of persons in a community-based sample of persons with chronic fatigue (fatigue lasting 6 or more months) to define a typology of chronic fatigue symptomatology. Among the participants with CFS, findings suggested that a majority of individuals with moderate to severe symptoms could be classified into two important subgroups: one distinguished by severe postexertional malaise with fatigue that was partially alleviated by rest; and one distinguished by severe overall symptomatology, severe postexertional malaise, and fatigue that was not alleviated by rest. Researchers have also examined the occurrence of specific symptoms reported by persons with chronic fatigue and CFS (Hartz et al., 1998 and Komaroff et al., 1996). Komaroff et al. (1996) examined the occurrence of minor symptoms (Holmes et al., 1988), as well as respiratory, gastrointestinal, neurologic, rheumatologic, cardiac, and miscellaneous objective and subjective symptoms that were not included in the 1988 case definition. The occurrence of these symptoms were compared among persons with severe, disabling fatigue lasting for 6 or more months, persons with multiple sclerosis, persons with major depression, and healthy controls. Komaroff et al. (1996) concluded that rheumatologic and gastrointestinal symptoms were found more frequently in patients meeting the major criteria. Based upon these findings, researchers recommended adding anorexia and nausea as well as eliminating the symptoms of muscle weakness, arthralgias, and sleep disturbance to strengthen the case definition. Finally, Hartz et al. (1998) examined the association between the number and severity of symptoms of CFS in persons with idiopathic chronic fatigue and determined that persons with fatigue could be classified by the degree to which they match the case definition of CFS (Fukuda et al., 1994). In addition, Hartz et al. (1998) suggested including symptoms such as frequent fever and chills, muscle weakness, and sensitivity to alcohol in the current US case definition. The occurrence of neurally mediated hypotension (NMH) has also been investigated in persons with CFS. NMH is defined as a 30 mmHg drop in systolic (or a 15 mmHg drop in diastolic) blood pressure in response to an orthostatic challenge such as standing upright (Rowe and Calkins, 1998). This precipitous drop in blood pressure is thought to be due to low blood volume (Streeten and Bell, 1998) or excessive venous pooling in the extremities (Stewart et al., 1999 and Stewart and Weldon, 2000). Symptoms of NMH include but are not limited to: lightheadedness, dizziness when standing, nausea, fatigue, tremors, breathing or swallowing difficulties, headaches, visual disturbances, and pallor (Streeten et al., 2000). While the frequency of NMH in persons with CFS has not been consistently reported across investigations, cardiopulmonary and neurological abnormalities are heterogeneous and common (Wilke et al., 1998). The findings reviewed herein suggest that other symptoms in addition to the eight symptoms listed as part of the definitional criteria may be important and occur frequently in persons with CFS. The present investigation examined the occurrence of symptoms in the Fukuda et al. (1994) case definition of CFS to determine whether these symptoms uniquely differentiated those with CFS from controls. In addition, other fatigue/weakness related, sleep related, neuropsychiatric, infectious, rheumatological, cardiopulmonary, gastrointestinal, neurological, and reproductive symptoms not specified in the current US case definition were examined. The occurrence of these additional symptoms was examined to determine whether other symptoms occur with greater frequency in persons with CFS when compared to controls, as well as what symptoms occurred with greater frequency in the melancholic depression group compared to controls.