The prognosis of chronic fatigue and chronic fatigue syndrome: a systematic review

Joyce, John; Hotopf, Matthew; Wessely, Simon

doi:10.1093/qjmed/90.3.223

Cited by 258 publications

(158 citation statements)

References 5 publications

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“…The other belief that predicted outcome in our study was non-attribution of symptoms to psychological causes. This has been previously reported to predict outcome for patients with the chronic fatigue syndrome (Joyce et al 1997) and also for patients with non-epileptic attack disorder (Ettinger et al 1999). The failure of patients to agree with the doctor in attributing somatic symptoms to psychological causes is the essence of the idea of somatization (Lipowski, 1987).…”

Section: Discussionmentioning

confidence: 85%

Neurology out-patients with symptoms unexplained by disease: illness beliefs and financial benefits predict 1-year outcome

et al. 2009

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Background. Patients whose symptoms are ' unexplained by disease ' often have a poor symptomatic outcome after specialist consultation, but we know little about which patient factors predict this. We therefore aimed to determine predictors of poor subjective outcome for new neurology out-patients with symptoms unexplained by disease 1 year after the initial consultation.Method. The Scottish Neurological Symptom Study was a 1-year prospective cohort study of patients referred to secondary care National Health Service neurology clinics in Scotland (UK). Patients were included if the neurologist rated their symptoms as ' not at all ' or only ' somewhat explained ' by organic disease. Patient-rated change in health was rated on a five-point Clinical Global Improvement (CGI) scale (' much better ' to ' much worse ') 1 year later.Results. The 12-month outcome data were available on 716 of 1144 patients (63 %). Poor outcome on the CGI (' unchanged ', ' worse ' or ' much worse ') was reported by 482 (67 %) out of 716 patients. The only strong independent baseline predictors were patients' beliefs [expectation of non-recovery (odds ratio [OR] 2.04, 95 % confidence interval [CI] 1.40-2.96), non-attribution of symptoms to psychological factors (OR 2.22, 95 % CI 1.51-3.26)] and the receipt of illness-related financial benefits (OR 2.30,. Together, these factors predicted 13 % of the variance in outcome.Conclusions. Of the patients, two-thirds had a poor outcome at 1 year. Illness beliefs and financial benefits are more useful in predicting poor outcome than the number of symptoms, disability and distress.

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Section: Discussionmentioning

confidence: 85%

Neurology out-patients with symptoms unexplained by disease: illness beliefs and financial benefits predict 1-year outcome

et al. 2009

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“…Sufferers are frequently avoidant of exertion, and such avoidance is associated with a poorer outcome (Sharpe et al 1992 ;Joyce et al 1997). It is worth asking why CFS patients avoid, and a number of dynamic studies that observe changes in symptoms or psychomotor function in the context of exertion begin to explain better why this may happen.…”

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confidence: 99%

Chronic fatigue syndrome – mapping the interior

Hotopf

Wessely

1999

Psychol. Med.

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Over a century ago Beard referred to fatigue as the ‘Central Africa of medicine – an unexplored territory which few men enter’ (Beard, 1869). The last decade has seen major advances in our understanding of chronic fatigue syndrome (CFS). Much is now known of the epidemiology, clinical features and prognosis of the condition (Wessely et al. 1998), and a number of recent papers have reported randomized trials of successful treatments involving cognitive behaviour therapy (CBT) and graded exercise (Sharpe et al. 1996; Wearden et al. 1996; Deale et al. 1997; Fulcher & White, 1997). Despite these advances, which have defined some of the broad landmarks of the illness, and improved the care of patients, many areas remain uncharted. Several papers published in this issue of Psychological Medicine take us into such unexplored territory.

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“…Only 16 of these 58 (28% of the original group diagnosed with CFS) had a current consistent diagnosis of CFS at the follow-up. Recovery is not a likely explanation for this, as evidence suggests that the proportion of patients who recover is smaller [22]. It could be that the use of Fukuda, a fairly broad case definition, resulted in the identification of cases that differed substantially from what is typically seen in tertiary settings.…”

Section: Identification Of Core Features Of the Illnessmentioning

confidence: 99%

The implications of using a broad versus narrow set of criteria in research

Jason¹,

Gleason²,

Fox³

2017

J Med Therap

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The Fukuda et al. criteria is the most widely used clinical case definition for diagnosing patients with chronic fatigue syndrome (CFS). Despite the frequency with which the Fukuda criteria are applied, the list of symptoms outlined in this case definition were not well enough specified to be easily applied to research settings. In 2005, Reeves et al. laid out a set of standards for operationalizing the Fukuda definition, specifying scales and cutoff scores for measuring the symptom criteria. This operationalization, often known as the empirical criteria, has been shown to identify an unexpectedly large number of patients, seemingly widening the net of inclusion for CFS diagnostic criteria. However, in a recent study in 2016 by Unger and colleagues it has been suggested that the 2005 Reeves et al. 2005 operationalization of the Fukuda criteria does not over-identify the number of patients with CFS as had been previously reported. This article reviews prior studies which provide context for these findings and offers a possible explanation for the discrepancies. Clearly, determining what case definition to use and how to operationalize it remains an important activity for scientists in this field, as it will influence work in multiple domains, including etiology, pathophysiology, epidemiology and treatment. We review these new findings, putting them in context and trying to highlight some of the reasons for the dramatic shifts in CFS prevalence rates across various studies.Most notably, the Center for Disease Control (CDC) estimates of CFS prevalence rates have increased dramatically over the years. In 2003, Reyes et al. published a prevalence study using the traditional approach to diagnosing CFS via Fukuda and found a prevalence rate of .24% in Wichita, Kansas [5].1 This rate was somewhat comparable to a previous population prevalence study in Chicago, which found a rate of .42% [6], again using the traditional approach to the Fukuda criteria. However, in a subsequent CDC population based study in Georgia, using the 2005 Reeves et al. empirical criteria, Reeves and colleagues concluded that the CFS prevalence rate had risen to 2.54% [4], which represents a 10-fold increase compared to the earlier CDC estimates. One explanation for the 10-fold increase is that cases of CFS did indeed increase over time, though this seems unlikely. When Jason and colleagues [7] conducted a follow-up to their original communitybased prevalence study [6] using the same traditional approach to diagnosing with the Fukuda criteria, they found that 10 years later CFS prevalence rates had remained relatively stable [7]. In light of this, other explanations for the increase in CDC prevalence rates need to be explored.

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The prognosis of chronic fatigue and chronic fatigue syndrome: a systematic review

Cited by 258 publications

References 5 publications

Neurology out-patients with symptoms unexplained by disease: illness beliefs and financial benefits predict 1-year outcome

Neurology out-patients with symptoms unexplained by disease: illness beliefs and financial benefits predict 1-year outcome

Chronic fatigue syndrome – mapping the interior

The implications of using a broad versus narrow set of criteria in research

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