Chronic Fatigue Syndrome: Harvey SB

Harvey SB, Wessely S. · No affiliation provided · Br J Gen Pract. · Pubmed #19341551 No free full text.

This publication has no abstract.

Harvey SB, Wessely S, Kuh D, Hotopf M. · Institute of Psychiatry, King's College London, London, UK. · J Psychosom Res. · Pubmed #19379961 No free full text.

Abstract: OBJECTIVE: Fatigue and psychiatric disorders frequently occur comorbidly and share similar phenomenological features. There has been debate as to whether chronic fatigue, or neurasthenia, should be considered an independent syndrome distinct from psychiatric disorders. We aimed to establish whether persistent fatigue can occur independently from psychiatric disorders and to test the hypothesis that fatigue without comorbid psychiatric symptoms has unique premorbid risk factors. We also aimed to investigate the psychological outcome of any individuals with fatigue. METHODS: The MRC National Survey of Health and Development was used to prospectively follow 5362 participants from birth. A sample of nonfatigued individuals without psychiatric disorder was selected at age 36 and followed until age 43 years (n=2714). At age 43, the presence of new onset fatigue and/or psychiatric disorder was assessed. Information on a number of potential premorbid risk factors was collected between ages 0 and 36 years. Individuals with fatigue but no comorbid psychiatric disorder were then followed up at age 53 years. RESULTS: At age 43 years, 201 (7.4%) participants reported significant levels of new onset fatigue in the absence of comorbid psychiatric disorder. Despite the absence of case level psychiatric disorder, these individuals did report increased levels of some psychological symptoms. Excessive childhood energy (adjusted OR 2.63, 95% CI 1.55-4.48, P<.001) and being overweight at age 36 (adjusted OR 1.62, 95% CI 1.05-2.49, P=.03) were specific risk factors for fatigue without psychiatric disorder but not fatigue with comorbid psychiatric illness. Neuroticism was a risk factor for fatigue both with and without comorbid psychiatric disorder. Negative life events and a family history of psychiatric illness were only risk factors for fatigue when it occurred comorbidly with psychiatric illness. CONCLUSIONS: A significant proportion of the adult population will suffer from fatigue without comorbid psychiatric disorder. While fatigue and psychiatric disorders share some risk factors, excessive energy in childhood and being overweight as an adult appear to be specific risk factors for fatigue. Our results confirm the significant overlap between fatigue and psychiatric disorders, while also providing evidence for neurasthenia as a separate diagnosis.

Harvey SB, Wadsworth M, Wessely S, Hotopf M. · Institute of Psychiatry, King's College London, London, UK. · Psychosom Med. · Pubmed #18378866 No free full text.

Abstract: OBJECTIVE: To review the etiology of chronic fatigue syndrome (CFS) and test hypotheses relating to immune system dysfunction, physical deconditioning, exercise avoidance, and childhood illness experiences, using a large prospective birth cohort. METHODS: A total of 4779 participants from the Medical Research Council's National Survey of Health and Development were prospectively followed for the first 53 years of their life with >20 separate data collections. Information was collected on childhood and parental health, atopic illness, levels of physical activity, fatigue, and participant's weight and height at multiple time points. CFS was identified through self-report during a semistructured interview at age 53 years with additional case notes review. RESULTS: Of 2983 participants assessed at age 53 years, 34 (1.1%, 95% Confidence Interval 0.8-1.5) reported a diagnosis of CFS. Those who reported CFS were no more likely to have suffered from childhood illness or atopy. Increased levels of exercise throughout childhood and early adult life and a lower body mass index were associated with an increased risk of later CFS. Participants who later reported CFS continued to exercise more frequently even after they began to experience early symptoms of fatigue. CONCLUSIONS: Individuals who exercise frequently are more likely to report a diagnosis of CFS in later life. This may be due to the direct effects of this behavior or associated personality factors. Continuing to be active despite increasing fatigue may be a crucial step in the development of CFS.

Harvey SB, Wadsworth M, Wessely S, Hotopf M. · Department of Psychological Medicine, Institute of Psychiatry, Kings College London, London, UK. · Psychol Med. · Pubmed #17976252 No free full text.

Abstract: BACKGROUND: Increased rates of psychiatric disorder have previously been reported in those diagnosed with chronic fatigue syndrome (CFS) or myalgic encephalomyelitis (ME), although the direction of causation in this relationship has not been established. We aimed to test the hypothesis that individuals with self-reported CFS/ME have increased levels of psychiatric disorder prior to the onset of their fatigue symptoms. METHOD: A total of 5,362 participants were prospectively followed with various measures of personality, psychiatric disorder and fatigue levels collected over the first 43 years of their life. CFS/ME was identified through self-report during a semi-structured interview at age 53 years. RESULTS: Thirty-four (1.1%) of the 3,035 subjects assessed at age 53 years reported a diagnosis of CFS/ME. CFS/ME was more common among females, but there was no association between CFS/ME and either social class, social mobility or educational level. Those with psychiatric illness between the ages of 15 and 36 years were more likely to report CFS/ME later in life with an odds ratio (OR, adjusted for sex) of 2.65 [95% confidence interval (CI) 1.26-5.57, p=0.01]. Increased levels of psychiatric illness, in particular depression and anxiety, were present prior to the occurrence of fatigue symptoms. There was a dose-response relationship between the severity of psychiatric symptoms and the likelihood of later CFS/ME. Personality factors were not associated with a self-reported diagnosis of CFS/ME. CONCLUSIONS: This temporal, dose-response relationship suggests that psychiatric disorders, or shared risk factors for psychiatric disorders, are likely to have an aetiological role in some cases of CFS/ME.