Hostname: page-component-77c89778f8-m42fx Total loading time: 0 Render date: 2024-07-19T12:53:49.492Z Has data issue: false hasContentIssue false
  • English
  • Français

Chronic fatigue syndrome in the psychiatric practice

Published online by Cambridge University Press:  24 June 2014

A. Van Duyse ,
A. Mariman ,
C. Poppe ,
W. Michielsen  and
R. Rubens
A. Van Duyse*
Affiliation:
Psychosomatic Centre, Ghent, Belgium Department of Psychiatry, University Hospital, Ghent, Belgium
A. Mariman
Affiliation:
Department of Psychiatry, University Hospital, Ghent, Belgium
C. Poppe
Affiliation:
Psychosomatic Centre, Ghent, Belgium
W. Michielsen
Affiliation:
Internal Medicine University Hospital, Ghent, Belgium
R. Rubens
Affiliation:
Endocrinology, University Hospital, Ghent, Belgium
*
University Hospital, Psychosomatic Center, Poli 2, De Pintelaan 185–9000 Ghent, Belgium.Tel: + 32 9240 23 50; Fax: + 32 9240 3895.e-mail: anne.vanduyse@rug.ac.be
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Chronic fatigue syndrome (CFS) is a complex syndrome with a psychiatric comorbidity of 70–80%. A psychiatric interview is necessary in order to exclude psychiatric illness and to identify psychiatric comorbidity. Studies have demonstrated that in general medical practice and in the non-psychiatric specialist practice, physicians tend to underdiagnose psychopathology in patients with CFS. There are many questions unanswered about the treatment of CFS

Aim:

Typical issues for the psychiatric practice are reviewed: psychiatric comorbidity, dysregulation of the PHA-axis and the treatment of CFS.

Conclusions:

Depression, somatization, sleeping disorders and anxiety disorders are the most important psychopathological symptoms found in CFS patients. CFS should not be regarded as a masked (somatoform) depression. Although the results from neuroendocrinological studies assessing the hypothalamic–pituitary–adrenal axis (HPA-axis) are inconsistent, they suggest that there is a subgroup of CFS patients suffering from a discrete dysregulation of the HPA-axis resulting in basal hypocortisolaemia. These findings, however, do not reveal a causal relationship. Antidepressants do not seem to have a positive influence on the symptom of fatigue, but appear to be beneficial in alleviating the symptoms of depression and social functioning. Cognitive behaviour therapy and graded exercise show a significant improvement on fatigue and other symptoms and are the only treatments available for CFS patients.

Keywords

antidepressantsanxiety disorderschronic fatigue syndromecognitive behaviour therapycomorbiditydepressionneuroendocrinologypsychiatry
Type
Review Article
Information
Acta Neuropsychiatrica , Volume 14 , Issue 3 , June 2002 , pp. 127 - 133
Copyright
Copyright © Acta Neuropsychiatrica 2002

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Fukuda, K, Straus, S, Hickie, I, Sharpe, M, Dobbins, J, Komaroff, A. The chronic fatigue syndrome. a comprehensive approach to its definition and study. Ann Int Med 1994;121: 953–959. CrossRefGoogle ScholarPubMed
Sharpe, M, Archard, L, Banatvala, Jet al. Chronic fatigue syndrome: guidelines for research. J Roy Soc Med 1991;84: 118–121. CrossRefGoogle Scholar
Deale, A, Wessely, S. Diagnosis of psychiatric disorder in clinical evaluation of chronic fatigue syndrome. J Roy Soc Med 2000;93: 310–312. CrossRefGoogle Scholar
Shanks, M, Ho-Yen, D. A clinical study of chronic fatigue syndrome. Br J Psychiatry 1995;166: 798–801.CrossRefGoogle Scholar
Demitrack, MA, Dale, JK, Straus, SEet al. Evidence for impaired activation of the hypothalamic–pituitary–adrenal axis in patients with chronic fatigue syndrome. J Clin Endocrinol Metabol 1991;73: 1224–1234. CrossRefGoogle ScholarPubMed
Johnson, S, Deluca, J, Natelson, B. Assessing somatization disorder in the chronic fatigue syndrome. Psychosom Med 1996;58: 50–57.CrossRefGoogle ScholarPubMed
Wessely, S, Hotopf, M, Sharpe, M. CFS and psychiatric disorder. In: Wessely, S, Hotopf, M, Sharpe, M, eds. Chronic fatigue and its syndromes. New York: Oxford University Press, 1998: 209–238. Google ScholarPubMed
Lane, TJ, Manu, P, Matthews, DA. Depression and somatization in the chronic fatigue syndrome. Am J Med 1991;91: 335–344.CrossRefGoogle ScholarPubMed
Wessely, S, Powell, R. Fatigue syndromes. a comparison of chronic ‘postviral’ fatigue with neuromuscular and affective disorder. J Neurol Neurosurg Psychiatry 1989;52: 940–948.CrossRefGoogle Scholar
Fischler, B, Cluydts, R, De Gucht, V, Kaufman, L, De Meirleir, K. Generalized anxiety disorders in chronic fatigue syndrome. Acta Psychiatr Scand 1997;95: 405–513.CrossRefGoogle ScholarPubMed
Farmer, A, Jones, I, Hillier, J, Llewelyn, M, Borysiewicz, L, Smith, A. Neurasthenia revisited. ICD-10 and DSM-III-R psychiatric syndromes in chronic fatigue patients and comparison subjects. Br J Psychiatry 1995;167: 503–506.CrossRefGoogle ScholarPubMed
Katon, WJ, Buchwald, D, Simon, G, Russo, JE, Mease, PJ. Psychiatric illness in patients with chronic fatigue and those with rheumatoid arthritis. J Gen Intern Med 1991;6: 277–285.CrossRefGoogle ScholarPubMed
Van Hemert, A, Hengeveld, M, Bolk, J, Rooijmans, H, Vandenbroucke, J. Psychiatric disorder in relation to medical illness among patients of a general medical out-patient clinic. Psychol Med 1993;23: 167–173.CrossRefGoogle ScholarPubMed
Goldberg, D, Bridges, K. Somatic presentations of psychiatric illness in primary care. J Psychosom Res 1988;17: 461–470. Google Scholar
Chalder, T, Power, M J, Wessely, S. Chronic fatigue in the community. a question of attribution. Psychol Med 1996;26: 791–800.CrossRefGoogle ScholarPubMed
Clements, A, Sharpe, M, Simkin, S, Borrill, J, Hawton, K. Chronic fatigue syndrome. a qualitative investigation of patients' beliefs about the illness. J Psychosom Res 1997;42: 615–624.CrossRefGoogle ScholarPubMed
Neerinckx, E, Van Houdenhove, B, Lysens, R, Vertommen, H, Onhena, P. Attributions in chronic fatigue syndrome and fibromyalgia syndrome in tertiary care. J Rheumatol 2000;27: 1051–1055.Google ScholarPubMed
Murphy, M. Somatization: embodying the problem. Br Med J 1989;298: 1331–1332. CrossRefGoogle Scholar
Wessely, S, Chalder, T, Hirsch, S, Wallace, P, Wright, D. The prevalence and morbidity of chronic fatigue and chronic fatigue syndrome: a prospective primary care study. Am J Public Health 1997;87: 1449–1455.CrossRefGoogle ScholarPubMed
McDonald, E, David, A, Pelosi, A, Mann, A. Chronic fatigue in general practice attenders. Psychol Med 1993;23: 987–998.CrossRefGoogle Scholar
Cope, H, Mann, A, Pelosi, A, David, A. Psychosocial risk factors for chronic fatigue and chronic fatigue syndrome following presumed viral infection: a case–control study. Psychol Med 1996;26: 1197–1209.CrossRefGoogle ScholarPubMed
Hickie, I, Koojer, A, Hadzi-Pavlovic, D, Bennett, B, Wilson, A, Lloyd, A. Fatigue in selected primary care settings: socio-demographic and psychiatric correlates. Med J Aust 1996;164: 585–588 .Google Scholar
Hickie, I, Lloyd, A, Wakefield, D, Parker, G. The psychiatric status of patients with chronic fatigue syndrome. Br J Psychiatry 1990;156: 534–540.CrossRefGoogle ScholarPubMed
Blakely, A, Howard, R, Sosich, R, Murdoch, J, Menkes, D, Spears, G. Psychological symptoms, personality and ways of coping in chronic fatigue syndrome. Psychol Med 1991;21: 347–362.CrossRefGoogle ScholarPubMed
Vercoulen, J, Swanink, C, Fennis, J, Galama, J, Van Der Meer, J, Bleijenberg, G. Dimensional assessment of chronic fatigue syndrome. J Psychosom Res 1994;38: 383–392.CrossRefGoogle ScholarPubMed
Buchwald, D, Pearlman, T, Kith, P, Schmaling, K. Gender differences in patients with chronic fatigue syndrome. J General Intern Med 1994;9: 397–401. CrossRefGoogle ScholarPubMed
Taerk, GS, Toner, B, Salit, IE, Garfinkel, PE, Ozersky, S. Depression in patients with neuromyasthenia (benign myalgic encephalomyelitis). Int J Psychiatr Med 1987;17: 49–56. CrossRefGoogle Scholar
Komaroff, AL, Straus, SE, Gantz, NM, Jones, JF. The chronic fatigue syndrome. Ann Int Med 1989;110: 407–408. CrossRefGoogle ScholarPubMed
Euba, R, Chalder, T, Deale, A, Wessely, S. A comparison of the characteristics of chronic fatigue syndrome in primary and tertiary care. Br J Psychiatry 1996;168: 121–126.Google ScholarPubMed
Cleare, AJ, Bearn, J, Allain, Tet al. Contrasting neuroendocrine responses in depression and chronic fatigue syndrome. J Affect Disord 1995;34: 283–289.CrossRefGoogle ScholarPubMed
Scott, LV, Dinan, TG. Urinary free cortisol excretion in chronic fatigue syndrome, major depression and in healthy volunteers. J Affect Disord 1998;47: 49–54.CrossRefGoogle ScholarPubMed
Strickland, P, Morriss, R, Wearden, A, Deakin, B. A comparison of salivary cortisol in chronic fatigue syndrome, community depression and healthy controls. J Affect Disord 1998;47: 191–194.CrossRefGoogle ScholarPubMed
Scott, LV, Medbak, S, Dinan, TG. Blunted adrenocorticotropin and cortisol responses to corticotropin-releasing hormone. Acta Psychiatr Scand 1998;97: 450–457.CrossRefGoogle ScholarPubMed
Scott, LV, Medbak, S, Dinan, TG. The low dose ACTH test in chronic fatigue syndrome and in health. Clin Endocrinol 1998;48: 733–737. CrossRefGoogle ScholarPubMed
Hudson, M, Cleare, AJ. The 1 μg short Synacten test in chronic fatigue syndrome. Clin Endocrinol 1999;51: 625–630. CrossRefGoogle Scholar
Leese, G, Chattington, P, Fraser, W, Vora, J, Edwards, R, Williams, G. Short term night shift working mimics the pituitary-adrenocortical dysfunction in chronic fatigue syndrome. JCEM 1996;81: 1867–1870. Google Scholar
Bearn, J, Allain, T, Coskeran, Pet al. Neuroendocrine responses to d-fenfluramine and insulin-induced hypoglycemia in chronic fatigue syndrome. Biol Psychiatry 1995;37: 245–252.CrossRefGoogle Scholar
McKenzie, R, O'Fallon, A, Dale, Jet al. Low dose hydrocortisone for treatment of chronic fatigue syndrome: a randomized controlled trial. JAMA 1998;280: 1061–1066.CrossRefGoogle ScholarPubMed
Cleare, AJ, Heap, E, Mahli, GS, Wessely, S, O'Keane, V, Miell, J. Low dose hydrocortisone in chronic fatigue syndrome: a randomised crossover trial. Lancet 1999;353: 455–458.CrossRefGoogle ScholarPubMed
Jeffcoate, WJ. Chronic fatigue syndrome and functional hypoadrenia-fighting vainly the old ennui. Lancet 1999;353: 424–425.CrossRefGoogle ScholarPubMed
Fischler, B, Le Bon, O, Hoffmann, G, Cluydts, R, Kaufman, L, De Meirleir, K. Sleep anomalies in the chronic fatigue syndrome. A comorbidity study. Neuropsychobiology 1997;35: 115–122.CrossRefGoogle ScholarPubMed
Vercoulen, J, Swanink, C, Zitman, F. Fluoxetine in chronic fatigue syndrome: a randomized, double-blind, placebo-controlled trial. Lancet 1996;347: 858–861.CrossRefGoogle Scholar
Wearden, A, Morriss, R, Mullis, Ret al. Randomised, double-blind, placebo controlled treatment trial of fluoxetine and graded exercise for chronic fatigue syndrome. Br J Psychiatry 1998;172: 485–490.CrossRefGoogle Scholar
Natelson, BH, Cheu, J, Pareja, J, Ellis, SP, Poliscastro, T, Findley, TW. Randomised, double blind, controlled placebo-phase in trial of low dose phenelzine in the chronic fatigue syndrome. Psychopharmacology 1996;124: 226–230.CrossRefGoogle Scholar
Behan, PO, Hannifah, H. 5-HT reuptake inhibitors in CFS. J Immunol Immunopharmacol 1995;15: 66–69. Google Scholar
Goldenberg, DL, Simms, RW, Geiger, A, Komaroff, A. High frequency of fibromyalgia in patients with chronic fatigue seen in a primary care practice. Arthritis Rheumatol 1990;33: 381–387. CrossRefGoogle Scholar
Buchwald, D, Garrity, D. Comparison of patients with chronic fatigue syndrome, fibromyalgia, and multiple chemical sensitivities. Arch Intern Med 1994;154: 2049–2053.CrossRefGoogle ScholarPubMed
Hudson, JI, Goldenberg, DL, Pope, HG, Keck, R, Schlesinger, L. Comorbidity of fibromyalgia with medical an psychiatric disorders. Am J Med 1992;92: 363–367.CrossRefGoogle ScholarPubMed
Simms, RW. Controlled trials of therapy in fibromyalgia syndrome. Ballière's Clin Rheumatol 1994;8: 917–934. CrossRefGoogle Scholar
Carrette, S, McCain, GA, Bell, DAet al. Evaluation of amitriptyline in primary fibrositis: a double blind, placebo-controlled study. Arthritis Rheumat 1986;29: 655–659. CrossRefGoogle Scholar
Carrette, S, Bell, MJ, Reynolds, WJet al. Comparison of amitriptyline, cyclobenzaprine and placebo in fibromyalgia: a randomized double-blind clinical trial. Arthritis Rheum 1994;37: 32–40.CrossRefGoogle Scholar
Goldenberg, DI. Fibromyalgia syndrome: an emerging but controversial condition. J Am Med Ass 1987;257: 2782–2787. CrossRefGoogle ScholarPubMed
Morriss, RK, Ahmed, M, Wearden, AJet al. The role of depression in pain, psychophysiological syndromes and medically unexplained symptoms associated with chronic fatigue syndrome. J Affect Disord 1999;55: 143–148.CrossRefGoogle Scholar
Friedberg, F, Krupp, LB. A comparison of. cognitive behavioural treatment for chronic fatigue syndrome and primary depression. CID 1994;18 (Suppl. 1):105–110. CrossRefGoogle Scholar
Lloyd, A R, Hickie, I, Brockman, Aet al. Immunologic and psychological therapy for patients with chronic fatigue syndrome: a double-blind placebo-controlled trial. Am J Med 1993;94: 197–203.CrossRefGoogle Scholar
Sharpe, M, Hawton, K, Simkin, Set al. Cognitive behaviour therapy for the chronic fatigue syndrome: a randomised controlled trial. Br Med J 1996;312: 22–26. CrossRefGoogle Scholar
Deale, A, Chalder, T, Marks, I, Wessely, S. Cognitive behaviour therapy for chronic fatigue syndrome: a randomized controlled trial. Am J Psychiatry 1997;154: 408–414.Google ScholarPubMed
Prins, JB, Bleijenberg, G, Bazelmans, Eet al. Cognitive behaviour therapy for chronic fatigue syndrome: a randomized controlled trial. a multicentre randomised controlled trial. Lancet 2001;375 (9259):841–847. CrossRefGoogle Scholar