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Corbalán JA, Feltes G, Silva D, Gómez-Utrero E, Núñez-Gil IJ. A Quick and Practical Approach to Secure a Chronic Fatigue Syndrome Diagnosis: The Novel Functional Limitation Index. J Clin Med 2023; 12:7157. [PMID: 38002769 PMCID: PMC10672372 DOI: 10.3390/jcm12227157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 11/04/2023] [Accepted: 11/12/2023] [Indexed: 11/26/2023] Open
Abstract
Chronic Fatigue Syndrome (CFS) is a serious, clinical, long-term condition with an unclear etiology and a difficult diagnosis. Our aim is to propose an objective physiological parameter (Functional Limitation Index, FLI) that describes the degree of functional impairment to support clinical suspicion. MATERIALS AND METHODS We consecutively included all CFS patients who consulted in the Exercise Physiology Department at our hospital, a dedicated referral unit for CFS, from 2009 to 2022. For comparison purposes, we included two control groups. Thus, three cohorts were included: the CFS group (patients with a previous definitive diagnosis), healthy voluntaries and a sportspeople/trained cohort (amateur athletes). All patients underwent a body composition test, spirometry, basal ECG in supine and standing positions and double peak effort ergospirometry with criteria of maximality. RESULTS The CFS+ group comprised 183 patients (85% female, mean age 46.2 years) and the CFS- included 161 cases (25.5% female, mean age 41.2 years); there were 93 patients in the healthy and 68 in the trained cohort. The CFS+ presented a lower functional class and scored worse in all of the performance parameters. The FLI was significantly higher in CFS+ (2.7 vs. 1.2; p < 0.001). The FLI displayed a good discrimination power (AUC = 0.94, p < 0.001), with a higher AUC than all of the other spirometric variables recorded. The best dichotomic overall FLI cutoff would be 1.66 with good specificity and sensitivity (S = 0.874, E = 0.864, Youden Index = 0.738). CONCLUSIONS The Functional Limitation Index (FLI) could provide an easy and accurate diagnosis of this condition in both genders in a one-day assessment.
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Affiliation(s)
| | - Gisela Feltes
- Cardiology Department, Vithas Arturo Soria Hospital, 28043 Madrid, Spain;
- Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - Daniela Silva
- Geriatric Department, Vithas International Arturo Soria Hospital, 28043 Madrid, Spain;
| | - Eduardo Gómez-Utrero
- Neurophysiology Department, Vithas International Arturo Soria Hospital, 28043 Madrid, Spain;
| | - Iván J. Núñez-Gil
- Cardiology Department, Vithas Arturo Soria Hospital, 28043 Madrid, Spain;
- Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
- Cardiology Department, Hospital Clínico San Carlos, 28040 Madrid, Spain
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Fernández Solà J. Central sensitization syndrome: towards the structuring of a multidisciplinary concept. Med Clin (Barc) 2018; 151:68-70. [PMID: 29398009 DOI: 10.1016/j.medcli.2017.12.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 12/05/2017] [Indexed: 11/24/2022]
Affiliation(s)
- Joaquim Fernández Solà
- Unidad de Sensibilización Central, Servicio de Medicina Interna, Hospital Clínic, Universitat de Barcelona, Barcelona, España.
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Calvo N, Sáez-Francàs N, Valero S, Castro-Marrero J, Alegre Martín J, Casas M. Diagnostic Concordance Between Categorical and Dimensional Instruments to Assess Personality Disorder in Chronic Fatigue Syndrome. EUROPEAN JOURNAL OF PSYCHOLOGICAL ASSESSMENT 2017. [DOI: 10.1027/1015-5759/a000281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. The study examines the relationship between a categorical and a dimensional personality assessment instrument in patients with Chronic Fatigue Syndrome (CFS). A total of 162 CFS patients were included in the study (91.4% women; mean age 47.5 years). All subjects completed the Spanish versions of the Personality Diagnostic Questionnaire-4+ (PDQ-4+) and the Temperament and Character Inventory-Revised (TCI-R). Results: 78 (48.1%) of the patients presented a Personality Disorder (PD), the most frequent being Cluster C, specifically Obsessive-compulsive disorder, followed by Avoidant disorder. PDs showed a specific pattern of correlation with temperament scales. All PD clusters correlated positively with Harm Avoidance and Self-Transcendence, and negatively with Reward Dependence, Self-Directedness, and Cooperativeness. In a logistic regression analysis, Self-Directedness and Cooperativeness predicted PD presence. The findings are consistent with previous studies in non-CFS samples and suggest that the combination of the Temperament and Character dimensions (low Self-Directedness and Cooperativeness and high Harm Avoidance and Self-Transcendence) correlates with PD severity, and that Self-Directedness and Cooperativeness are associated with PD presence in CFS patients. The integration of these two perspectives expands the current comprehension of personality pathology in CFS patients.
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Affiliation(s)
- Natalia Calvo
- Psychiatry Department, Hospital Universitari Vall d’Hebron, CIBERSAM, Universitat Autònoma de Barcelona, Spain
- Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona, Spain
| | - Naia Sáez-Francàs
- Psychiatry Department, Hospital Universitari Vall d’Hebron, CIBERSAM, Universitat Autònoma de Barcelona, Spain
| | - Sergi Valero
- Psychiatry Department, Hospital Universitari Vall d’Hebron, CIBERSAM, Universitat Autònoma de Barcelona, Spain
- Institut Recerca Hospital Universitari Vall d'Hebron (VHIR), Universitat Autònoma de Barcelona, Spain
| | - Jesús Castro-Marrero
- Chronic Fatigue Syndrome Research Unit, Institut de Recerca Hospital Universitari Vall d’Hebron (VHIR), Universitat Autònoma de Barcelona, Spain
| | - José Alegre Martín
- Psychiatry Department, Hospital Sant Rafael, FIDMAG. Hospital Universitari Vall d'Hebron, CIBERSAM, Departament of Psychiatry, Uniercitat Autònoma Barcelona
- Department of Internal Medicine, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Miquel Casas
- Psychiatry Department, Hospital Universitari Vall d’Hebron, CIBERSAM, Universitat Autònoma de Barcelona, Spain
- Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona, Spain
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Sáez-Francàs N, Calvo N, Alegre J, Castro-Marrero J, Ramírez N, Hernández-Vara J, Casas M. Childhood trauma in Chronic Fatigue Syndrome: focus on personality disorders and psychopathology. Compr Psychiatry 2015; 62:13-9. [PMID: 26343462 DOI: 10.1016/j.comppsych.2015.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 06/01/2015] [Accepted: 06/13/2015] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Personality Disorders (PDs) and childhood traumatic experiences have been considered risk factors for Chronic Fatigue Syndrome (CFS). However, the relationship between these factors and their associated psychopathological impact has not been explored in this population. This study was designed to evaluate the association between different childhood traumas and the presence and number of PDs and current psychopathology in a sample of CFS patients. MATERIAL AND METHODS For this purpose, 166 CFS patients were evaluated with the Personality Diagnostic Questionnaire-4+ (PDQ-4+) and the Child Trauma Questionnaire. Other instruments were used to assess the associated psychopathology and the impact of fatigue. RESULTS Of the total sample, 55 (33.1%) presented childhood trauma, the most frequent of which were emotional neglect (21.7%) and emotional abuse (18.1%). Considering PD presence, 79 (47.6%) patients presented some PD. There were no differences in frequency of physical childhood trauma in patients with and without PD. However, patients with PD had more frequently experienced emotional childhood trauma (OR=2.18, p=0.034). Severity of childhood trauma was related to a higher number of PDs, more severe depressive symptoms (p=0.025) and suicide risk (p=0.001). Patients with PD and any childhood trauma presented more severe depressive and irritable symptoms and a higher suicide risk than those without any PD and non-childhood traumatic event. These patients' psychopathological symptoms were similar to those of patients with childhood trauma and without PD. CONCLUSIONS These results suggest that emotional childhood trauma but not physical childhood trauma is related to higher frequency of PD presence. More severe childhood emotional and physical traumas are related to a higher number of PDs and to more severe psychopathological symptoms.
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Affiliation(s)
- Naia Sáez-Francàs
- Servei de Psiquiatria, Hospital Sant Rafael, FIDMAG, Hospital Universitari Vall d'Hebron, CIBERSAM, Department of Psychiatry, Universitat Autònoma de Barcelona, Passeig Vall d´Hebron 107-117, 08035, Barcelona, Spain.
| | - Natalia Calvo
- Servei de Psiquiatria, Hospital Universitari Vall d'Hebron, CIBERSAM, Department of Psychiatry, Universitat Autònoma de Barcelona, Passeig Vall d´Hebron 119-129, 08035, Barcelona, Spain.
| | - José Alegre
- Servei de Medicina Interna, Hospital Universitari Vall d´Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Passeig Vall d´Hebron 119-129, 08035, Barcelona, Spain.
| | - Jesús Castro-Marrero
- Servei de Medicina Interna, Hospital Universitari Vall d´Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Passeig Vall d´Hebron 119-129, 08035, Barcelona, Spain.
| | - Nicolás Ramírez
- Servei de Psiquiatria, Hospital Sant Rafael, FIDMAG, Hospital Universitari Vall d'Hebron, CIBERSAM, Department of Psychiatry, Universitat Autònoma de Barcelona, Passeig Vall d´Hebron 107-117, 08035, Barcelona, Spain.
| | - Jorge Hernández-Vara
- Servei de Neurologia, Hospital Universitari Vall d´Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Passeig Vall d´Hebron 119-129, 08035, Barcelona, Spain.
| | - Miguel Casas
- Servei de Psiquiatria, Hospital Universitari Vall d'Hebron, CIBERSAM, Department of Psychiatry, Universitat Autònoma de Barcelona, Passeig Vall d´Hebron 119-129, 08035, Barcelona, Spain.
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Sáez-Francàs N, Valero S, Calvo N, Gomà-I-Freixanet M, Alegre J, de Sevilla TF, Casas M. Chronic fatigue syndrome and personality: a case-control study using the Alternative Five Factor Model. Psychiatry Res 2014; 216:373-8. [PMID: 24630915 DOI: 10.1016/j.psychres.2014.02.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 02/19/2014] [Accepted: 02/22/2014] [Indexed: 01/24/2023]
Abstract
Neuroticism is the personality dimension most frequently associated with chronic fatigue syndrome (CFS). Most studies have also shown that CFS patients are less extraverted than non-CFS patients, but results have been inconsistent, possibly because the facets of the extraversion dimension have not been separately analyzed. This study has the following aims: to assess the personality profile of adults with CFS using the Alternative Five-Factor Model (AFFM), which considers Activity and Sociability as two separate factors of Extraversion, and to test the discriminant validity of a measure of the AFFM, the Zuckerman-Kuhlman Personality Questionnaire, in differentiating CFS subjects from normal-range matched controls. The CFS sample consisted of 132 consecutive patients referred for persistent fatigue or pain to the Department of Medicine of a university hospital. These were compared with 132 matched normal population controls. Significantly lower levels of Activity and significantly higher levels of Neuroticism-Anxiety best discriminated CFS patients from controls. The results are consistent with existing data on the relationship between Neuroticism and CFS, and clarify the relationship between Extraversion and CFS by providing new data on the relationship of Activity to CFS.
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Affiliation(s)
- Naia Sáez-Francàs
- Department of Psychiatry, Hospital Universitari Vall d׳Hebron, Passeig de la Vall d׳Hebron 119-129, 08035 Barcelona, Catalonia, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain.
| | - Sergi Valero
- Department of Psychiatry, Hospital Universitari Vall d׳Hebron, Passeig de la Vall d׳Hebron 119-129, 08035 Barcelona, Catalonia, Spain.
| | - Natalia Calvo
- Department of Psychiatry, Hospital Universitari Vall d׳Hebron, Passeig de la Vall d׳Hebron 119-129, 08035 Barcelona, Catalonia, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain.
| | - Montserrat Gomà-I-Freixanet
- Department of Health Psychology, Universitat Autònoma de Barcelona, Edifici B, 08193 Bellaterra, Catalonia, Spain.
| | - José Alegre
- Department of Internal Medicine, Hospital Universitari Vall D´Hebron, Passeig de la Vall d׳Hebron 119-129, 08035 Barcelona, Catalonia, Spain.
| | - Tomás Fernández de Sevilla
- Department of Internal Medicine, Hospital Universitari Vall D´Hebron, Passeig de la Vall d׳Hebron 119-129, 08035 Barcelona, Catalonia, Spain.
| | - Miquel Casas
- Department of Psychiatry, Hospital Universitari Vall d׳Hebron, Passeig de la Vall d׳Hebron 119-129, 08035 Barcelona, Catalonia, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain.
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[Impact of the fibromyalgia in the chronic fatigue syndrome]. Med Clin (Barc) 2014; 142:519-25. [PMID: 24387955 DOI: 10.1016/j.medcli.2013.06.030] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 06/25/2013] [Accepted: 06/27/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Different studies have showed association of the chronic fatigue syndrome (CFS) with other pathologies, including fibromyalgia (FM). The objective of this study is to analyze whether there are differences in the clinic and in the assessment of fatigue in CFS patients associated or not with FM. PATIENTS AND METHODS A cross-sectional, single-site observational study was undertaken on a consecutive cases of a register of CFS patients at CFS Unit in Vall d'Hebron Hospital, Barcelona, from January 2008 until March 2011. The variables analyzed were FM comorbidity, sleep and fatigue characteristics and cognitive, neurological and autonomic symptoms. Questionnaires of fatigue impact scale, fatigue strength and impact on quality of life SF-36 were evaluated. RESULTS We included 980 CFS patients (mean age: 48±9 years; 91% women). Fibromyalgia was present in 528 patients (54%). The level of fatigue (P=.001) and pain (P<.001) was higher in FM patients. Patients with CFS and FM had more prevalence of sleep-related phenomena. The percentage of patients and the degree of severity of cognitive symptoms, neurological and autonomic dysfunction was higher in FM patients (P<.001). FM patients scored higher on the fatigue impact scale (P<.001) and showed worse results in the quality of life questionnaire (P<.001). CONCLUSIONS FM co-morbidity worse clinical parameters, fatigue and the perception of quality of life in CFS patients.
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Valero S, Sáez-Francàs N, Calvo N, Alegre J, Casas M. The role of neuroticism, perfectionism and depression in chronic fatigue syndrome. A structural equation modeling approach. Compr Psychiatry 2013; 54:1061-7. [PMID: 23759150 DOI: 10.1016/j.comppsych.2013.04.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 04/07/2013] [Accepted: 04/17/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Previous studies have reported consistent associations between Neuroticism, maladaptive perfectionism and depression with severity of fatigue in Chronic Fatigue Syndrome (CFS). Depression has been considered a mediator factor between maladaptive perfectionism and fatigue severity, but no studies have explored the role of neuroticism in a comparable theoretical framework. This study aims to examine for the first time, the role of neuroticism, maladaptive perfectionism and depression on the severity of CFS, analyzing several explanation models. METHODS A sample of 229 CFS patients were studied comparing four structural equation models, testing the role of mediation effect of depression severity in the association of Neuroticism and/or Maladaptive perfectionism on fatigue severity. RESULTS The model considering depression severity as mediator factor between Neuroticism and fatigue severity is the only one of the explored models where all the structural modeling indexes have fitted satisfactorily (Chi square=27.01, p=0.079; RMSE=0.047, CFI=0.994; SRMR=0.033). Neuroticism is associated with CFS by the mediation effect of depression severity. This personality variable constitutes a more consistent factor than maladaptive perfectionism in the conceptualization of CFS severity.
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Affiliation(s)
- Sergi Valero
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, CIBERSAM, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Catalonia, Spain.
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Curriu M, Carrillo J, Massanella M, Rigau J, Alegre J, Puig J, Garcia-Quintana AM, Castro-Marrero J, Negredo E, Clotet B, Cabrera C, Blanco J. Screening NK-, B- and T-cell phenotype and function in patients suffering from Chronic Fatigue Syndrome. J Transl Med 2013; 11:68. [PMID: 23514202 PMCID: PMC3614537 DOI: 10.1186/1479-5876-11-68] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 03/14/2013] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Chronic Fatigue Syndrome (CFS) is a debilitating neuro-immune disorder of unknown etiology diagnosed by an array of clinical manifestations. Although several immunological abnormalities have been described in CFS, their heterogeneity has limited diagnostic applicability. METHODS Immunological features of CFS were screened in 22 CFS diagnosed individuals fulfilling Fukuda criteria and 30 control healthy individuals. Peripheral blood T, B and NK cell function and phenotype were analyzed by flow cytometry in both groups. RESULTS CFS diagnosed individuals showed similar absolute numbers of T, B and NK cells, with minor differences in the percentage of CD4+ and CD8+ T cells. B cells showed similar subset frequencies and proliferative responses between groups. Conversely, significant differences were observed in T cell subsets. CFS individuals showed increased levels of T regulatory cells (CD25+/FOXP3+) CD4 T cells, and lower proliferative responses in vitro and in vivo. Moreover, CD8 T cells from the CFS group showed significantly lower activation and frequency of effector memory cells. No clear signs of T-cell immunosenescence were observed. NK cells from CFS individuals displayed higher expression of NKp46 and CD69 but lower expression of CD25 in all NK subsets defined. Overall, T cell and NK cell features clearly clustered CFS individuals. CONCLUSIONS Our findings suggest that alterations in T-cell phenotype and proliferative response along with the specific signature of NK cell phenotype may be useful to identify CFS individuals. The striking down modulation of T cell mediated immunity may help to understand intercurrent viral infections in CFS.
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Affiliation(s)
- Marta Curriu
- Institut de recerca de la sida, IrsiCaixa-HIVACAT, Institut d'Investigació en Ciències de la Salut Germans Trias I Pujol
- , Badalona, Spain
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Sáez-Francàs N, Alegre J, Calvo N, Antonio Ramos-Quiroga J, Ruiz E, Hernández-Vara J, Casas M. Attention-deficit hyperactivity disorder in chronic fatigue syndrome patients. Psychiatry Res 2012; 200:748-53. [PMID: 22648008 DOI: 10.1016/j.psychres.2012.04.041] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Revised: 03/31/2012] [Accepted: 04/24/2012] [Indexed: 12/13/2022]
Abstract
Psychopathological disorders are frequent in chronic fatigue syndrome patients. The present study examines the presence of attention-deficit hyperactivity disorder (ADHD) in a sample of adult chronic fatigue syndrome (CFS) patients, and evaluates its clinical consequences in this population. CFS patients were assessed for childhood and adult ADHD by clinical interview and ADHD-specific scales. Psychopathological comorbidities were evaluated by clinical examination and questionnaires. Forty-seven of 158 CSF patients (29.7%) were diagnosed of childhood ADHD and in 33 (20.9%), the condition persisted into adulthood. CFS patients with adult ADHD had an earlier CSF onset, more severe anxiety and depression symptoms, and a higher risk of suicide than CFS patients without ADHD. Using lineal regression analysis, we found that depressive symptoms and ADHD severity were significant predictors of fatigue intensity. Consequently, ADHD may be common in CFS patients, and is associated with a more severe psychopathologic clinical profile.
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Affiliation(s)
- Naia Sáez-Francàs
- Psychiatry and Legal Medicine Department, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, CIBERSAM, Barcelona, Spain.
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Ruiz E, Alegre J, García Quintana AM, Aliste L, Blázquez A, Fernández de Sevilla T. [Chronic fatigue syndrome: study of a consecutive series of 824 cases assessed in two specialized units]. Rev Clin Esp 2011; 211:385-90. [PMID: 21794854 DOI: 10.1016/j.rce.2011.02.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 02/04/2011] [Accepted: 02/20/2011] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND OBJECTIVE The chronic fatigue syndrome (CFS) is a disabling disorder. Few studies are available in our area on the prevalence and characteristics of CFS. Therefore, we carried out a study of a consecutive series of 824 cases diagnosed in two specialized units. PATIENTS AND METHODS We evaluated all of the CFS patients seen from January 2008 to June 2010. We analyzed social and demographic data, employment status, time of clinical evolution, trigger factors and onset, Fukuda and Canadian criteria, associated comorbidities and treatment. RESULTS A total of 824 patients were included, 748 (91%) woman, mean age 48±9 years. Average age of onset of symptoms was 35±11 years, time to diagnosis 108±88 month. A precipitating factor was identified in 481 (58%) patients, the onset was gradual in 517 (63%) and 515 (62.5%) were not employed. The most outstanding diagnostic criteria of Fukuda were prolonged generalized fatigue after exercise, sleep disturbance and impairments in concentration and short-term memory. The different groups of symptoms defined by the Canadian consensus showed that CFS is a homogeneous entity. Accompanying comorbidity phenomena were anxiety 691 (83%), sicca syndrome 678 (82%), fibromyalgia 450 (55%). A total of 63% of patients (520) received pharmacological treatment. CONCLUSIONS CFS is an illness that preferentially affects young women and results in employment absenteeism. The most relevant clinical features were prolonged generalized fatigue after exercise, neurocognitive impairment and sleep disturbance. In the evaluation of the patient, it is very important to apply the Canadian criteria and to assess comorbidity.
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Affiliation(s)
- E Ruiz
- Servicio de Medicina Interna, Unidad de Urgencias, Hospital General Universitario Vall d'Hebron, Barcelona, España.
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Health-related quality of life in patients with chronic fatigue syndrome: group cognitive behavioural therapy and graded exercise versus usual treatment. A randomised controlled trial with 1 year of follow-up. Clin Rheumatol 2011; 30:381-9. [PMID: 21234629 DOI: 10.1007/s10067-010-1677-y] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Revised: 12/20/2010] [Accepted: 12/23/2010] [Indexed: 12/11/2022]
Abstract
Chronic fatigue syndrome (CFS) produces physical and neurocognitive disability that significantly affects health-related quality of life (HRQL). Multidisciplinary treatment combining graded exercise therapy (GET) cognitive behavioural therapy (CBT) and pharmacological treatment has shown only short-term improvements. To compare the effects on HRQL of (1) multidisciplinary treatment combining CBT, GET, and pharmacological treatment, and (2) usual treatment (exercise counselling and pharmacological treatment) at 12 months of follow-up. Prospective, randomized controlled trial with a follow-up of 12 months after the end of treatment. Patients consecutively diagnosed with CFS (Fukuda criteria) were randomly assigned to intervention (n = 60) or usual treatment (n = 60) groups. HRQL was assessed at baseline and 12 months by the Medical Outcomes Study Short-Form questionnaire (SF-36). Secondary outcomes included functional capacity for activities of daily living measured by the Stanford Health Assessment Questionnaire (HAQ) and comorbidities. At baseline, the two groups were similar, except for lower SF-36 emotional role scores in the intervention group. At 12 months, the intervention did not improve HRQL scores, with worse SF-36 physical function and bodily pain scores in the intervention group. Multidisciplinary treatment was not superior to usual treatment at 12 months in terms of HRQL. The possible benefits of GET as part of multidisciplinary treatment for CFS should be assessed on an individual patient basis.
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Arruti Bustillo M, Avellaneda Fernández A, Barbado Hernández F, de la Cruz Labrado J, Díaz-Delgado Peñas R, Gutiérrez Rivas E, Izquierdo Martínez M, Palacín Delgado C, Pérez Martín Á, Ramón Giménez J, Rivera Redondo J. Síndrome de fatiga crónica. Semergen 2009. [DOI: 10.1016/s1138-3593(09)72676-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Godás Sieso T, Gómez Gil E, Salamero Baró M, Fernandez-Huerta JM, Fernandez-Solá J. Relación entre el síndrome de fatiga crónica y el patrón de conducta tipo A. Med Clin (Barc) 2009; 133:539-41. [DOI: 10.1016/j.medcli.2009.04.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2008] [Accepted: 04/23/2009] [Indexed: 10/20/2022]
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Mujer de 34 años con astenia extrema de larga evolución. Abordaje multidisciplinar. Semergen 2008. [DOI: 10.1016/s1138-3593(08)71844-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Nogué S, Fernández-Solá J, Rovira E, Montori E, Fernández-Huerta JM, Munné P. Sensibilidad química múltiple: análisis de 52 casos. Med Clin (Barc) 2007; 129:96-8; quiz 99. [PMID: 17594860 DOI: 10.1157/13107370] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Multiple chemical sensitivity (MCS) is characterized by a loss of tolerance to various environmental chemicals. The objective of this study was to describe patients with MCS seen in our hospital. PATIENTS AND METHOD Patients consecutively seen by the Toxicology and Chronic Fatigue Units who presented symptoms of MCS were included. The diagnosis was clinical. All patients completed the Quick Environmental Exposure and Sensitivity Inventory (QEESI) questionnaire. RESULTS Fifty-two patients were included. The average age (standard deviation) was 47.2 (7.6) years, and 46 (88%) were females. The origin of the syndrome was related to occupational exposure to various chemical agents in 31 cases (59.6%), including occupational accidents in 14 patients (fumigation of the workplace with insecticides). In 20 patients (38.5%), the syndrome could not be associated with any toxic exposure and was considered a manifestation of chronic fatigue syndrome. The QEESI showed mean scores of 72.9 (18.6) on the chemical inhalant intolerance scale, 45.5 (20.6) on the other intolerances scale, 69.8 (20.6) on the symptom severity scale, 4.4 (1.8) on the masking index and 66.6 (21.7) on the life impact scale. All patients were followed up for a minimum of 12 months, and during this period they remained stable with no deaths. CONCLUSIONS MCS normally affects middle-aged women. It is frequently triggered by exposure to chemical agents, especially insecticides. An association with chronic fatigue syndrome is common. The prognosis is good but the patients' quality of life is seriously affected.
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Affiliation(s)
- Santiago Nogué
- Unidades de Toxicología y de Fatiga Crónica, Hospital Clínic, IDIBAPS, Universidad de Barcelona, Barcelona, España.
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Arnold Llamosas PA, Arrizabalaga Clemente P, Bonet Agusti M, de la Fuente Brull X. Hipersensibilidad química múltiple en el síndrome del edificio enfermo. Med Clin (Barc) 2006; 126:774-8. [PMID: 16883665 DOI: 10.1157/13089106] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The sick building syndrome includes irritation of the eyes and the respiratory tract neurotoxicity affectation and skin problems, which can occur in individuals under improperly ventilated buildings. Poor air quality, as shown in CO2 atmospheric levels of more than 1,000 ppm, results in a pathological exposure to biological and chemical products. We present a work-related case of multiple chemical hypersensitivity from a dialysis unit that had no air renewal. This person, who was summitted to continuous exposure despite having taken corrective measures in the ventilation, developed chronic fatigue syndrome. An acoustic voice observation alerted of the case which led to the analysis of the environmental conditions which confirmed the relationship between multiple chemical hypersensitivity and chronic fatigue syndrome. This case stresses the neglected fact that all health service centres pose a high risk of chemical exposure and that there exists a lack of rigoroursness in putting in practice scientific medical knowledge.
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Affiliation(s)
- Pablo A Arnold Llamosas
- Inmunología y Medicina Interna, Servicio de Reumatología, Centro Internacional Medicina Avanzada (CIMA), Servei Acreditat Cat Salut, Barcelona, Spain
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17
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Fernández-Solà J, Lluís Padierna M, Nogué Xarau S, Munné Mas P. Síndrome de fatiga crónica e hipersensibilidad química múltiple tras exposición a insecticidas. Med Clin (Barc) 2005; 124:451-3. [PMID: 15826581 DOI: 10.1157/13073217] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Chronic Fatigue Syndrome (CFS) and Multiple Chemical Sensitivity (MCS) are well-defined illnesses that may appear after some toxic exposures. PATIENTS AND METHOD We report a consecutive series of 26 patients who developed CFS after exposure to insecticide products. It was associated with MCS in a third of cases. RESULTS Toxic exposure was of labour origin after returning to usual work place after a process of fumigation. In 42% of cases there was no fulfilment of fumigation safety rules. The majority of patients were mean-aged women who developed an acute upper airway inflammatory syndrome, without muscarinic or nicotinic manifestations, followed by digestive syndrome, neurocognitive, fibromyalgic and chronic fatigue manifestations. The course of disease was shorter than 1 year in 5 cases (19%), longer than 1 year in 15(58%), and disabling in 6 cases (23%). CONCLUSIONS Due to the possible prevention of this toxic exposure, it is very important to carefully follow measures of environment isolation and ventilation after insecticide use in order to avoid the development of these diseases.
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Affiliation(s)
- Joaquim Fernández-Solà
- Servicio de Medicina Interna, Unidad Multidisciplinar de Fatiga Crónica, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, España.
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