Chronic Fatigue Syndrome: New York

Halperin JJ, Shapiro ED, Logigian E, Belman AL, Dotevall L, Wormser GP, Krupp L, Gronseth G, Bever CT, Anonymous00002. · Department of Neurosciences, Overlook Hospital, NYU School of Medicine, Summit, NJ, USA. · Neurology. · Pubmed #17522387 No free full text.

Abstract: OBJECTIVE: To provide evidence-based recommendations on the treatment of nervous system Lyme disease and post-Lyme syndrome. Three questions were addressed: 1) Which antimicrobial agents are effective? 2) Are different regimens preferred for different manifestations of nervous system Lyme disease? 3) What duration of therapy is needed? METHODS: The authors analyzed published studies (1983-2003) using a structured review process to classify the evidence related to the questions posed. RESULTS: The panel reviewed 353 abstracts which yielded 112 potentially relevant articles that were reviewed, from which 37 articles were identified that were included in the analysis. CONCLUSIONS: There are sufficient data to conclude that, in both adults and children, this nervous system infection responds well to penicillin, ceftriaxone, cefotaxime, and doxycycline (Level B recommendation). Although most studies have used parenteral regimens for neuroborreliosis, several European studies support use of oral doxycycline in adults with meningitis, cranial neuritis, and radiculitis (Level B), reserving parenteral regimens for patients with parenchymal CNS involvement, other severe neurologic symptomatology, or failure to respond to oral regimens. The number of children (> or =8 years of age) enrolled in rigorous studies of oral vs parenteral regimens has been smaller, making conclusions less statistically compelling. However, all available data indicate results are comparable to those observed in adults. In contrast, there is no compelling evidence that prolonged treatment with antibiotics has any beneficial effect in post-Lyme syndrome (Level A).

Dietert RR, Dietert JM. · Department of Microbiology and Immunology, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA. · Toxicology. · Pubmed #18336982 No free full text.

Abstract: Chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME) in some countries, is a debilitating disease with a constellation of multi-system dysfunctions primarily involving the neurological, endocrine and immune systems. While substantial information is available concerning the complex dysfunction-associated symptoms of CFS, environmental origins of the disease have yet to be determined. Part of the dilemma in identifying the cause(s) has been the focus on biomarkers (hormones, neurotransmitters, cytokines, infectious agents) that are contemporary with later-life CFS episodes. Yet, recent investigations on the origins of environmental diseases of the neurological, endocrine, reproductive, respiratory and immune systems suggest that early life toxicologic and other insults are pivotal in producing later-life onset of symptoms. As with autism and childhood asthma, CFS can also occur in children where the causes are certainly early-life events. Immune dysfunction is recognized as part of the CFS phenotype but has received comparatively less attention than aberrant neurological or endocrine function. However, recent research results suggest that early life immune insults (ELII) including developmental immunotoxicity (DIT), which is induced by xenobiotics, may offer an important clue to the origin(s) of CFS. The developing immune system is a sensitive and novel target for environmental insult (xenobiotic, infectious agents, stress) with major ramifications for postnatal health risks. Additionally, many prenatal and early postnatal neurological lesions associated with postnatal neurobehavioral diseases are now recognized as linked to prenatal immune insult and inflammatory dysregulation. This review considers the potential role of ELII including DIT as an early-life component of later-life CFS.

Roscoe JA, Kaufman ME, Matteson-Rusby SE, Palesh OG, Ryan JL, Kohli S, Perlis ML, Morrow GR. · Department of Radiation Oncology, University of Rochester School of Medicine and Dentistry, James P Wilmot Cancer Center, Rochester, NY 14642, USA. · Oncologist. · Pubmed #17573454 links to  free full text

Abstract: Sleep disorders, such as difficulty falling asleep, problems maintaining sleep, poor sleep efficiency, early awakening, and excessive daytime sleepiness, are prevalent in patients with cancer. Such problems can become chronic in some patients, persisting for many months or years after completion of cancer therapy. For patients with cancer, sleep is potentially affected by a variety of factors, including the biochemical changes associated with the process of neoplastic growth and anticancer treatments, and symptoms that frequently accompany cancer, such as pain, fatigue, and depression.Fatigue is highly prevalent and persistent in patients with cancer and cancer survivors. Although cancer-related fatigue and cancer-related sleep disorders are distinct, a strong interrelationship exists between these symptoms, and a strong possibility exists that they may be reciprocally related. The majority of studies that have assessed both sleep and fatigue in patients with cancer provide evidence supporting a strong correlation between cancer-related fatigue and various sleep parameters, including poor sleep quality, disrupted initiation and maintenance of sleep, nighttime awakening, restless sleep, and excessive daytime sleepiness.This paper reviews the data from these studies with a view toward suggesting further research that could advance our scientific understanding both of potential interrelationships between sleep disturbance and cancer-related fatigue and of clinical interventions to help with both fatigue and sleep disturbance.Disclosure of potential conflicts of interest is found at the end of this article.

Ryan JL, Carroll JK, Ryan EP, Mustian KM, Fiscella K, Morrow GR. · Department of Radiation Oncology, University of Rochester School of Medicine and Dentistry, James P Wilmot Cancer Center, Rochester, NY 14642, USA. · Oncologist. · Pubmed #17573453 links to  free full text

Abstract: Cancer-related fatigue (CRF) is one of the most prevalent symptoms patients with cancer experience, both during and after treatment. CRF is pervasive and affects patients' quality of life considerably. It is important, therefore, to understand the underlying pathophysiology of CRF in order to develop useful strategies for prevention and treatment. At present, the etiology of CRF is poorly understood and the relative contributions of the neoplastic disease, various forms of cancer therapy, and comorbid conditions (e.g., anemia, cachexia, sleep disorders, depression) remain unclear. In any individual, the etiology of CRF probably involves the dysregulation of several physiological and biochemical systems. Mechanisms proposed as underlying CRF include 5-HT neurotransmitter dysregulation, vagal afferent activation, alterations in muscle and ATP metabolism, hypothalamic-pituitary-adrenal axis dysfunction, circadian rhythm disruption, and cytokine dysregulation. Currently, these hypotheses are largely based on evidence from other conditions in which fatigue is a characteristic, in particular chronic fatigue syndrome and exercise-induced fatigue. The mechanisms that lead to fatigue in these conditions provide a theoretical basis for future research into the complex etiology of this distressing and debilitating symptom. An understanding of relevant mechanisms may offer potential routes for its prevention and treatment in patients with cancer.Disclosure of potential conflicts of interest is found at the end of this article.

Abeles AM, Pillinger MH, Solitar BM, Abeles M. · New York University School of Medicine, New York University Hospital for Joint Diseases, and New York Harbor Healthcare System, New York, New York 10003, USA. · Ann Intern Med. · Pubmed #17502633 links to  free full text

Abstract: Primary fibromyalgia is a common yet poorly understood syndrome characterized by diffuse chronic pain accompanied by other somatic symptoms, including poor sleep, fatigue, and stiffness, in the absence of disease. Fibromyalgia does not have a distinct cause or pathology. Nevertheless, in the past decade, the study of chronic pain has yielded new insights into the pathophysiology of fibromyalgia and related chronic pain disorders. Accruing evidence shows that patients with fibromyalgia experience pain differently from the general population because of dysfunctional pain processing in the central nervous system. Aberrant pain processing, which can result in chronic pain and associated symptoms, may be the result of several interplaying mechanisms, including central sensitization, blunting of inhibitory pain pathways, alterations in neurotransmitters, and psychiatric comorbid conditions. This review provides an overview of the mechanisms currently thought to be partly responsible for the chronic diffuse pain typical of fibromyalgia.

Axelrod FB, Chelimsky GG, Weese-Mayer DE. · Dysautonomia Treatment and Evaluation Center, Department of Pediatrics and Neurology, New York University School of Medicine, 530 First Ave, Suite 9Q, New York, New York 10016, USA. · Pediatrics. · Pubmed #16818580 links to  free full text

Abstract: The scope of pediatric autonomic disorders is not well recognized. The goal of this review is to increase awareness of the expanding spectrum of pediatric autonomic disorders by providing an overview of the autonomic nervous system, including the roles of its various components and its pervasive influence, as well as its intimate relationship with sensory function. To illustrate further the breadth and complexities of autonomic dysfunction, some pediatric disorders are described, concentrating on those that present at birth or appear in early childhood.

Waltman P, Pearlman A, Mishra B. · New York University, Courant Institute of Mathematical Sciences, 715 Broadway, New York, NY 10003, USA. · Pharmacogenomics. · Pubmed #16610960 No free full text.

Abstract: Comprehensive, systematic and integrated data-centric statistical approaches to disease modeling can provide powerful frameworks for understanding disease etiology. Here, one such computational framework based on redescription mining in both its incarnations, static and dynamic, is discussed. The static framework provides bioinformatic tools applicable to multifaceted datasets, containing genetic, transcriptomic, proteomic, and clinical data for diseased patients and normal subjects. The dynamic redescription framework provides systems biology tools to model complex sets of regulatory, metabolic and signaling pathways in the initiation and progression of a disease. As an example, the case of chronic fatigue syndrome (CFS) is considered, which has so far remained intractable and unpredictable in its etiology and nosology. The redescription mining approaches can be applied to the Centers for Disease Control and Prevention's Wichita (KS, USA) dataset, integrating transcriptomic, epidemiological and clinical data, and can also be used to study how pathways in the hypothalamic-pituitary-adrenal axis affect CFS patients.

Frissora CL, Koch KL. · Department of Medicine, The Weill Medical College of Cornell University, 520 E. 70th Street, Suite J-314, New York, NY 10021, USA. · Curr Gastroenterol Rep. · Pubmed #16042909 No free full text.

Abstract: Irritable bowel syndrome (IBS) is one of several highly prevalent, multi-symptom gastrointestinal motility disorders that have a wide clinical spectrum and are associated with symptoms of gastrointestinal dysmotility and visceral hypersensitivity. Symptom overlap and comorbidity between IBS and other gastrointestinal motility disorders (eg, chronic constipation, functional dyspepsia, gastroesophageal reflux disease), with gastrointestinal disorders that are not related to motility (eg, celiac disease, lactose intolerance), and with somatic conditions (eg, fibromyalgia, chronic fatigue syndrome), are frequent. The clinical associations and pathophysiologic links between IBS and these disorders continue to be explored. This review discusses overlapping symptoms and comorbidity of IBS with select gastrointestinal and non-gastrointestinal disorders and attempts to identify commonalities among these conditions.

Frieri M. · Department of Medicine, Pediatrics and Pathology, Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, NY 11554, USA. · Allergy Asthma Proc. · Pubmed #14763244 No free full text.

Abstract: There are several rheumatologic and autoimmune disorders that can masquerade as allergic disease. Identification of these conditions in an office setting can be a challenge for the practicing allergist-immunologist. These conditions include rheumatoid and juvenile arthritis, Sjogren's syndrome, systemic lupus erythematosus, Behcet's and antiphospholipid syndromes, systemic sclerosis, vasculitis, sarcoidosis, chronic fatigue syndrome, and fibromyalgia. The article will address these topics and include clinical uses of immunologic tests for diagnosis.

Michelsen H, Posner MA. · Department of Orthopaedic Surgery, New York University-Hospital for Joint Diseases, New York, NY 10128, USA. · Hand Clin. · Pubmed #12371028 No free full text.

Abstract: The anatomical configuration of the carpal tunnel is that of an inelastic channel. Consequently, any increase in its volume or alteration in shape will usually result in a significant increase in interstitial pressure. At a pressure threshold of 20 mm Hg to 30 mm Hg, epineurial blood flow is compromised. When that pressure is sustained, the symptoms and physical findings associated with CTS appear. Typically, patients present with intermittent pain and paresthesias in all or part of the median nerve distribution of their hand(s). As weeks and months pass, symptoms progressively increase in frequency and severity. Eventually, thenar muscle weakness develops that initially manifests itself as "fatigue," or "tiredness." The progressive increase in symptoms and physical findings, usually accompanied by a progressive deterioration in electrodiagnostic studies, facilitates the classification of the condition into early, intermediate, and advanced stages. The increase in interstitial pressure in the carpal tunnel is in the vast majority of cases idiopathic (spontaneous). It can also be caused by a myriad of other conditions that can be classified into three other categories: intrinsic factors that increase the volume of the tunnel (outside and inside the nerve), extrinsic factors that alter the contour of the tunnel, and repetitive/overuse conditions. In addition, there is another category of neuropathic factors that affect the nerve without increasing interstitial pressure. In rare situations CTS can present as an acute problem. Far less common than the chronic form of the condition, it can follow acute wrist trauma, rheumatologic disorders, hemorrhagic problems, vascular disorders affecting a patent median artery, and high pressure injection injuries. Prompt recognition is important, followed in most cases by urgent surgical decompression of the median nerve.

Cavanaugh RM. · Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY, USA. · Pediatr Rev. · Pubmed #12359868 No free full text.

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Caserta MT, Mock DJ, Dewhurst S. · Department of Pediatrics, University of Rochester Medical Center, Rochester, NY 14642, USA. · Clin Infect Dis. · Pubmed #11512088 No free full text.

Abstract: The development of techniques for the culture of lymphoid cells and the isolation of viruses that infect these cells led to the discovery of human herpesvirus (HHV) 6 in 1986. At the time, HHV-6 was the first new human herpesvirus to be discovered in roughly a quarter of a century, and its isolation marked the beginning of an era of discovery in herpesvirology, with the identification of HHV-7 and HHV-8 (Kaposi's sarcoma-associated herpesvirus) during the following decade. Like most human herpesviruses, HHV-6 is ubiquitous and capable of establishing a lifelong, latent infection of its host. HHV-6 is particularly efficient at infecting infants and young children, and primary infection with the virus is associated with roseola infantum (exanthem subitum) and, most commonly, an undifferentiated febrile illness. Viral reactivation in the immunocompromised host has been linked to a variety of diseases, including encephalitis, and HHV-6 has been tentatively associated with multiple sclerosis. This article discusses the major properties of HHV-6, its association with human disease, and the pathobiological significance of viral reactivation.

Friedberg F, Jason LA. · Department of Psychiatry and Behavioral Science, State University of New York at Stony Brook, USA. · J Clin Psychol. · Pubmed #11255201 No free full text.

Abstract: Chronic fatigue syndrome (CFS) and fibromyalgia (FM) are closely related illnesses of uncertain etiology. This article reviews the research literature on these biobehavioral conditions, with an emphasis on explanatory models, clinical evaluation of comorbid psychiatric disorders, assessment of stress factors, pharmacologic and alternative therapies, and cognitive-behavioral treatment studies. Furthermore, clinical protocols suitable for professional practice are presented based on an integration of the authors' clinical observations with published data. The article concludes with the recognition that mental health professionals can offer substantial help to these patients.

Madhavan G, Stewart JM, McLeod KJ. · Department of Orthopaedics, School of Medicine, Health Sciences Center, State University of New York, Stony Brook, USA. · Biomed Instrum Technol. · Pubmed #16544794 No free full text.

Abstract: The decreased blood pressure and flow rates associated with orthostasis have been implicated in the etiology of numerous clinical conditions, including deep vein thrombosis, chronic fatigue syndrome, and more recently osteoporosis. Here, we investigate the potential of low-magnitude vibration, applied at the plantar surface, to inhibit the cardiovascular responses of adult women to the orthostatic stress associated with quiet sitting. METHODS: Thirty healthy women, aged 22-82 years, were exposed to a plantar-based vibration immediately after taking a seated position. Seven stimulus frequencies (0, 15, 22, 44, 60, 90, and 120 Hz, all at 0.2g) were tested on each subject, and cardiovascular responses were followed for 20 minutes. Each subject experienced only a single test frequency on any day. Pre- and poststimulus blood pressures and continuous electrocardiogram results were obtained, from which mean arterial pressure (MAP) and heart rate variability (HRV) were calculated. RESULTS: In the per-protocol study population (n = 25), 20 minutes of quiet sitting was associated with an average depression of 8.95 mm Hg in systolic pressure and of 1.9 mm Hg in diastolic blood pressure, corresponding to an average decrease in MAP of 5.15 mm Hg. These orthostasis-based changes in blood pressure were significantly reduced by exposure to plantar vibration, in a frequency-dependent manner, with essentially complete suppression of the drop in MAP achieved with plantar stimulation at 44 Hz (P < or = . 01). In the orthostatically hypotensive subpopulation (n = 15), both the 9.3-mm Hg depression in MAP and the decline in HRV were eliminated by exposure to plantar vibrations in the 40- to 60-Hz range (P = .01 and P = .03, respectively). These results are consistent with the hypothesis that the plantar vibration may be stimulating type IIA muscle fiber activity in the leg, which is critical for effective skeletal muscle pumping in the absence of locomotion. CONCLUSIONS: Our findings lead us to suggest that noninvasive, low-level, plantar-based vibration in the regime of 30-60 Hz can significantly inhibit the effects of the orthostatic stress of quiet sitting on the cardiovascular system.

Krupp LB, Hyman LG, Grimson R, Coyle PK, Melville P, Ahnn S, Dattwyler R, Chandler B. · Department of Neurology, Stony Brook University Medical Center, Stony Brook, NY 11794-8121, USA. · Neurology. · Pubmed #12821734 No free full text.

Abstract: OBJECTIVE: To determine whether post Lyme syndrome (PLS) is antibiotic responsive. METHODS: The authors conducted a single-center randomized double-masked placebo-controlled trial on 55 patients with Lyme disease with persistent severe fatigue at least 6 or more months after antibiotic therapy. Patients were randomly assigned to receive 28 days of IV ceftriaxone or placebo. The primary clinical outcomes were improvement in fatigue, defined by a change of 0.7 points or more on an 11-item fatigue questionnaire, and improvement in cognitive function (mental speed), defined by a change of 25% or more on a test of reaction time. The primary laboratory outcome was an experimental measure of CSF infection, outer surface protein A (OspA). Outcome data were collected at the 6-month visit. RESULTS: Patients assigned to ceftriaxone showed improvement in disabling fatigue compared to the placebo group (rate ratio, 3.5; 95% CI, 1.50 to 8.03; p = 0.001). No beneficial treatment effect was observed for cognitive function or the laboratory measure of persistent infection. Four patients, three of whom were on placebo, had adverse events associated with treatment, which required hospitalization. CONCLUSIONS: Ceftriaxone therapy in patients with PLS with severe fatigue was associated with an improvement in fatigue but not with cognitive function or an experimental laboratory measure of infection in this study. Because fatigue (a nonspecific symptom) was the only outcome that improved and because treatment was associated with adverse events, this study does not support the use of additional antibiotic therapy with parenteral ceftriaxone in post-treatment, persistently fatigued patients with PLS.

Wormser GP, Schwartz I. · Division of Infectious Diseases, Department of Medicine, York Medical College, Munger Pavilion Room 245, Valhalla, NY 10595, USA. · Clin Microbiol Rev. · Pubmed #19597005 No free full text.

Abstract: Despite resolution of the objective manifestations of Lyme disease after antibiotic treatment, a minority of patients have fatigue, musculoskeletal pain, and/or difficulties with concentration or short-term memory of uncertain etiology; these are called post-Lyme disease symptoms or, in more severe cases, post-Lyme disease syndrome or "chronic Lyme disease." Several recent studies in which Borrelia burgdorferi-infected animals were treated with antibiotic therapy have demonstrated the presence of PCR positivity for B. burgdorferi DNA in the absence of culture positivity. In mice that were treated with antibiotic therapy, residual spirochetes could be taken up by ticks during a blood meal and could be transmitted to SCID mice. These spirochetes are attenuated; their presence is not associated with either inflammation or disease. In this review the methodology and findings of these studies are critically analyzed, and the significance of the results with regard to human Lyme disease is evaluated, with special emphasis on whether these studies provide useful insights into post-Lyme disease syndrome. A serious methodological concern is the failure to consider the pharmacokinetic-pharmacodynamic properties of the antibiotic in choosing the dosage regimen used. We conclude that there is no scientific evidence to support the hypothesis that such spirochetes, should they exist in humans, are the cause of post-Lyme disease syndrome.

Wormser GP, Shapiro ED. · Division of Infectious Diseases, Department of Medicine, New York Medical College, Munger Pavilion Room 245, Valhalla, NY 10595, USA. · J Womens Health (Larchmt). · Pubmed #19514824 No free full text.

Abstract: BACKGROUND: "Post-Lyme disease syndrome" refers to prolonged subjective symptoms after antibiotic treatment and resolution of an objective manifestation of Borrelia burgdorferi infection (Lyme disease). "Chronic Lyme disease" is a vaguely defined term that has been applied to patients with unexplained prolonged subjective symptoms, whether or not there was or is evidence of B. burgdorferi infection. OBJECTIVE: To determine if the population of patients with chronic Lyme disease differs from the populations of patients with either Lyme disease or post-Lyme disease syndrome by examining the gender of patients with these diagnoses. Methods: Data on gender were compiled in this cross-sectional study based on a systematic review of published studies of antibiotic treatment in United States patients with post-Lyme disease syndrome (n = 184) or chronic Lyme disease (n = 490), and on cases of adults with Lyme disease reported to the Centers for Disease Control and Prevention from 2003 to 2005 (n = 43,282). RESULTS: Patients with chronic Lyme disease were significantly more likely to be female than were patients diagnosed with either Lyme disease (odds ratio [OR] 2.42, 95% confidence interval [CI] 1.98-2.94, p < 0.0001) or with post-Lyme disease syndrome (OR 2.32, 95% CI 1.62-3.34, p < 0.0001). CONCLUSIONS: Patients with chronic Lyme disease differ with regard to gender from those with either B. burgdorferi infection or post-Lyme disease syndrome. This finding suggests that illnesses with a female preponderance, such as fibromyalgia, chronic fatigue syndrome, or depression, may be misdiagnosed as chronic Lyme disease.

Maurer MS, Cuddihy P, Weisenberg J, Delisle S, Strong BM, Gao Q, Kachnowski S, Howell J. · Cardiology Division, Department of Medicine, Columbia University Medical Center, New York, New York, USA. · J Card Fail. · Pubmed #19254674 No free full text.

Abstract: BACKGROUND: Anergia (lack of energy) is a newly delineated, criterion-based geriatric syndrome. Because heart failure (HF) is a common chronic condition among older adults and a because a cardinal symptom of HF is reduced energy, we characterized the degree of anergia in subjects with HF and evaluated its relevance to disease severity, functional performance, and quality of life. METHODS AND RESULTS: Prospective 3-month cohort study among a convenience sample of 61 subjects (61 +/- 15 years, 48% women, ejection fraction 41 +/- 16%) with New York Heart Association (NYHA) Class I-III HF were studied. The criterion for anergia was based on the major criterion "sits around for lack of energy" and any 2 of 6 minor criteria. Principal measures in addition to demographic and clinical characteristics included functional performance (NYHA class, 6-minute walk, cardiopulmonary exercise testing), plasma B-type natriuretic peptide, and quality of life (SF-12 and Minnesota Living with Heart Failure Questionnaire). To evaluate the relevance of anergia to daily function, each subject wore an Actigraph, a watch-like wrist device that continuously and automatically monitors patient activity levels and energy expenditure, for 3 months. Anergia was prevalent in 39% of this population. Anergia was associated with decrements in functional capacity (higher NYHA Class and lower 6-minute walk distance) as well as reduction in quality of life, but was not associated with ejection fraction. Actigraphy data demonstrated that HF subjects with anergia spent significantly less time performing moderate physical activity and the peak activity counts per day were significantly lower than HF subjects without anergia. Additionally, the amplitude of circadian rhythm was lower, suggesting altered sleep and activity patterns in HF subjects with anergia compared with those without anergia. Over the 3 months of follow-up, there was a significant association between anergia and intercurrent hospitalization. CONCLUSIONS: Anergia is significantly associated with several of the cardinal domains of HF. Its presence is associated with demonstrable differences in both physical activity and circadian rhythm as measured by actigraphy and an increased risk of hospitalizations. Accordingly, anergia may be a target for intervention among HF subjects.

Edd EM, Flores S. · College of Nursing, New York University, John A. Hartford Institute for Geriatric Nursing, New York University, New York, NY, USA. · Geriatr Nurs. · Pubmed #19215814 No free full text.

Abstract: Excessive daytime somnolence (EDS) is associated with age-related changes, environment, circadian rhythm or sleep pattern disorder, insomnia, medications, lifestyle factors, depression, pain, and illness. The notion of "sleep architecture" connotes a structure that describes the sleep cycle (i.e., stages) and wakefulness during a single sleep period-that is, rapid eye movement (REM) and non-REM sleep. Circadian rhythms perform a variety of functions including regulation of the quality and distribution of the stages of sleep. Insomnia includes delayed sleep onset as well as premature wakening; sleep is nonrestorative. Comorbidities associated with insomnia are Alzheimer's disease and other dementias, delirium, depression, congestive heart failure, chronic obstructive pulmonary disease, gastroesophageal reflux disease, pain, degenerative diseases of the neurological system, and sleep apnea. Continuous inadequate sleep affects cognitive function, physical performance, overall well-being, and quality of life. There is a greater risk of falls from insomnia than is the use of hypnotics to manage it. Sleep disruption among older adults is underrecognized and undertreated. Assessment using valid tools can be performed rapidly. There are a variety of treatment options, including sleep hygiene and pharmacological and alternative modalities.

Friedberg F, Sohl SJ. · Department of Psychiatry and Behavioral Science Putnam Hall, Stony Brook University, NY 11794-8790, USA. · J Behav Med. · Pubmed #19101789 No free full text.

Abstract: The purpose of this 2-year prospective study was to compare standard self-report and ecologically-based outcome measures in patients with chronic fatigue syndrome (CFS). Standard measures assessed physical function, fatigue impact, psychological variables, and global impression of change ratings. Ecological measures included actigraphy, a structured activity record, and an electronic fatigue/energy diary. Results for this high functioning sample (N = 75) revealed that self-report global improvement was significantly associated with lower momentary fatigue and fatigue impact, and a higher frequency of standing up (at home), but not with actigraphy or psychological variables. However, actigraphy change was significantly correlated with change in self-report physical function. At follow-up, only a small minority (<20%) scored in the healthy adult range for fatigue impact and physical function. The findings suggest that home-based measures of symptom severity and physical functioning may provide evidence of change (or lack of change) that is important for interpreting standard self-report outcomes in CFS.

Mathew SJ, Mao X, Keegan KA, Levine SM, Smith EL, Heier LA, Otcheretko V, Coplan JD, Shungu DC. · Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA. · NMR Biomed. · Pubmed #18942064 No free full text.

Abstract: Chronic fatigue syndrome (CFS) is a controversial diagnosis because of the lack of biomarkers for the illness and its symptom overlap with neuropsychiatric, infectious, and rheumatological disorders. We compared lateral ventricular volumes derived from tissue-segmented T(1)-weighted volumetric MRI data and cerebrospinal fluid (CSF) lactate concentrations measured by proton MRS imaging ((1)H MRSI) in 16 subjects with CFS (modified US Centers for Disease Control and Prevention criteria) with those in 14 patients with generalized anxiety disorder (GAD) and in 15 healthy volunteers, matched group-wise for age, sex, body mass index, handedness, and IQ. Mean lateral ventricular lactate concentrations measured by (1)H MRSI in CFS were increased by 297% compared with those in GAD (P < 0.001) and by 348% compared with those in healthy volunteers (P < 0.001), even after controlling for ventricular volume, which did not differ significantly between the groups. Regression analysis revealed that diagnosis accounted for 43% of the variance in ventricular lactate. CFS is associated with significantly raised concentrations of ventricular lactate, potentially consistent with recent evidence of decreased cortical blood flow, secondary mitochondrial dysfunction, and/or oxidative stress abnormalities in the disorder.

Swoboda DA. · City University of New York, USA. · Health (London). · Pubmed #18818275 No free full text.

Abstract: In the absence of scientific consensus about contested illnesses such as Chronic Fatigue Syndrome (CFS), Multiple Chemical Sensitivities (MCS), and Gulf War Syndrome (GWS), physicians must make sense of competing accounts and develop practices for patient evaluation. A survey of 800 United States physicians examined physician propensity to diagnose CFS, MCS, and GWS, and the factors shaping clinical decision making. Results indicate that a substantial portion of physicians, including nonexperts, are diagnosing CFS, MCS, and GWS. Diagnosing physicians manage the uncertainty associated with these illnesses by using strategies that enhance bounded rationality and aid in thinking beyond current disease models. Strategies include consulting ancillary information sources, conducting analytically informed testing, and considering physiological explanations of causation. By relying on these practices and paradigms, physicians fit CFS, MCS, and GWS into an explanatory system that makes them credible and understandable to them, their patients, and the medical community. Findings suggest that physicians employ rational decision making for diagnosing contested illnesses, creating a blueprint of how illnesses lacking conclusive pathogenic and etiological explanations can be diagnosed. Findings also suggest that patients with contested illnesses might benefit from working with physicians who use these diagnostic strategies, since they help manage the complexity and ambiguity of the contested illness diagnostic process and aid in diagnosis. In addition, findings provide a window into how emerging illnesses get diagnosed in the absence of medical and scientific consensus, and suggest that diagnosing physicians advance the legitimacy of controversial illnesses by constructing the means for their diagnosis.

Friedberg F, Sohl SJ, Halperin PJ. · Department of Psychiatry and Behavioral Science, Stony Brook University, New York 11794-8790, USA. · Med Teach. · Pubmed #18608944 No free full text.

Abstract: BACKGROUND: This study examined how an interactive seminar focusing on two medically unexplained illnesses, chronic fatigue syndrome (CFS) and fibromyalgia, influenced medical student attitudes toward CFS, a more strongly stigmatized illness. METHODS: Forty-five fourth year medical students attended a 90 minute interactive seminar on the management of medically unexplained illnesses that was exemplified with CFS and fibromyalgia. A modified version of the CFS attitudes test was administered immediately before and after the seminar. RESULTS: Pre-seminar assessment revealed neutral to slightly favorable toward CFS. At the end of the seminar, significantly more favorable attitudes were found toward CFS in general (t (42) = 2.77; P < 0.01) and for specific items that focused on (1) supporting more CFS research funding (t (42) = 4.32; P < 0.001; (2) employers providing flexible hours for people with CFS (t (42) = 3.52, P < 0.01); and (3) viewing CFS as not primarily a psychological disorder (t (42) = 2.87, P < 0.01). Thus, a relatively brief exposure to factual information on specific medically unexplained illnesses was associated with more favorable attitudes toward CFS in fourth year medical students. CONCLUSION: This type of instruction may lead to potentially more receptive professional attitudes toward providing care to these underserved patients.

Friedberg F, Sohl SJ. · Department of Psychiatry and Behavioral Science, Stony Brook University, Stony Brook, NY 11794-8790, USA. · Int J Behav Med. · Pubmed #18444018 No free full text.

Abstract: BACKGROUND: Understanding how patients with chronic fatigue syndrome (CFS) recall their fatigue is important because fatigue is a core clinical dimension of this poorly understood illness. PURPOSE: This study assessed the associations between momentary fatigue ratings and weekly recall of fatigue in 71 participants with CFS. METHOD: During the three-week data collection period, fatigue intensity was recorded six times a day in electronic diaries. At the end of each week, participants were asked to recall their fatigue intensity for that week. Statistical analyses were done with t-tests and Pearson's and intraclass correlations. RESULTS: Average weekly recall of fatigue intensity was significantly higher than average momentary ratings. Furthermore, moderate to high Pearson's correlations and intraclass correlations (consistency and absolute agreement) between recall and momentary fatigue ratings were found. CONCLUSION: Individuals with CFS recalled consistently higher levels of fatigue in comparison to real-time momentary ratings, yet the level of agreement between the two measures was moderate to high. These findings may have implications for the conduct of office examinations for CFS.

Sohl SJ, Friedberg F. · Psychology Department, Stony Brook University, New York, USA. · Behav Med. · Pubmed #18400687 links to  free full text

Abstract: Fatigue in chronic fatigue syndrome (CFS) is usually assessed with retrospective measures rather than real-time momentary symptom assessments. In this study, the authors hypothesized that in participants with CFS, discrepancies between recalled and momentary fatigue would be related to catastrophizing, anxiety, and depression and to variability of momentary fatigue. They also expected that catastrophizing, anxiety, and depression would be associated with momentary fatigue. The authors asked 53 adults with CFS to carry electronic diaries for 3 weeks and record their experiences of momentary fatigue. The authors assessed participants' fatigue recall with weekly ratings and administered questionnaires for catastrophizing, depression, and anxiety. Recall discrepancy was significantly related to the variability of momentary fatigue. In addition, catastrophizing, depression, and momentary fatigue were all significantly related to recall discrepancy. Catastrophizing, depression, anxiety, and momentary negative affect were all significantly associated with momentary fatigue. The findings suggest that momentary fatigue in patients with CFS is related to modifiable psychological factors.