From CFS-NEWS@LIST.NIH.GOV Wed May 31 22:10:30 1995 with BSMTP id 3067; Wed, 31 May 95 21:30:12 EDT BSMTP id 3031; Wed, 31 May 95 21:28:45 EDT HHHHHH HHHHHH HHHHHH H H HHHHHH H H HHHHHH H H H HH H H H H H H HHHHH HHHHHH HHHH H H H HHHH H H H HHHHHH H H H H HHH H H H H H HHHHHH H HHHHHH H HH HHHHHH HHHHH HHHHHH Chronic Fatigue Syndrome Electronic Newsletter -------------------------------------------------------------------- No. 47 May 31, 1995 Washington DC -------------------------------------------------------------------- STUDY FINDS NO INFECTIOUS LINK TO CFS CONTENTS >>>1. Study finds no infectious link to CFS >>>2. Book on CFS, edited by Dr. Stephen Straus >>>3. Discussion of Hopkins study, and CBT ------------------------------------------------------------------- >>>1. Study finds no CFS link to infection A British study just published in Lancet (27 May 1995) finds no evidence to suggest an association between common viral infections and chronic fatigue or CFS. The researchers suggest that there is more likely a link to pre-illness fatigue and psychological disorder. The citation for the study is as follows: Wessely S, Chalder T, Hirsch S, Pawlikowska T, Wallace P, Wright DJM. Postinfectious fatigue: prospective cohort study in primary care. Lancet 1995: 345; 1333-38 Simon Wessely, MD (King's College Institute of Psychiatry, London) and colleagues write in their paper that the notion of an infectious origin of chronic fatigue has become "popular", but that such a conclusion is mainly based on retrospective studies that have an ascertainment bias (i.e., reliance upon patients' memories of the circumstances associated with the onset of illness, and also other confounding factors). Wessely et al. have conducted their study in a different manner. Specifically, *infections* were identified by physicians as a first step, and then during follow-up the determination is made as to how many cases qualify as being chronic fatigue or CFS. This study involved an original sample of nearly 2,000 which after various eliminations yielded 185 cases of chronic fatigue matched by an equal number of controls. (These results come from a broad study, some of whose results have already been published as: Pawlikowska et al. A population based study of fatigue and psychological distress. BMJ 1994; 308:743-46. Additional results focusing on allergies and psychological aspects will be published in the future.) The current study's results showed roughly equal numbers of infectious cases (9.9 percent) and controls (11.7 percent) exhibiting chronic fatigue, and no differences for those meeting CFS criteria. Many other related results were also reported. The researchers summarized their findings by writing: We conclude that common infections play little part in the aetiology of chronic fatigue in primary care. This conclusion does not exclude a role for less common infections, caused by Epstein-Barr virus, toxoplasma, or cytomegalovirus, for example. Nor does it exclude a rare complication of a common infection.... Overall, we conclude that the population attributable risk of acute infections on the prevalence of chronic fatigue syndrome is low.... Instead, our results suggest a link with previous fatigue and previous psychological disorder. [Thanks for assistance provided by the staff of the Lancet, the CFIDS Association of America, and a report from the Reuter News Service.] -=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=- >>>2. Book on CFS, edited by Dr. Stephen Straus An anthology titled "Chronic Fatigue Syndrome" has been published as a book, edited by Dr. Stephen Straus, MD of the National Institute of Allergies and Infectious Disease, NIH (Bethesda, Maryland USA). Dr. Straus offers the following description in the book's preface: In recognition of this evolving synthesis of perspectives on chronic fatigue I became motivated to capture our current knowledge of it within the bounds of a multidisciplinary book. In so doing, I aimed to assemble a volume that fairly represents a spectrum of creditable and authoritative positions from virtually all established disciplines engaged in the study of chronic fatigue syndrome and the subset of individuals who could be said to suffer from chronic fatigue syndrome. This is by no means a comprehensive compendium, for the field has always been, and remains still, open to extravagant claims. I view that my role as editor is to assure that each vantage point is presented as clearly as possible. The reader will discern inconsistencies in some arguments and even frank disagreements among them. This is inevitable in an area as unsettled as this one. The chapters are organized to present to the clinician or the highly informed lay reader a statement of the problem and its deep historical and multidisciplinary perspectives. There is a series of refined analyses of putative causes for the syndrome and of body systems affected by it or affecting it in turn. The volume closes with a discussion of well-considered contemporary approaches to management. Consensus has not been reached on many of these issues, and the flow through the book is not entirely seamless, as would be more likely were it penned by one hand. But then it would be devoid of the exhilarating tension that arises from rational discourse and collegial debate and might fail to offer as broad a conceptual palette as it does. The book's table of contents is as follows: Part I: The Illness 1. The History of CFS -- Simon Wessely 2. Defining CFS -- Dedra Buchwald 3. Clinical Presentation and Evaluation of Fatigue and CFS -- Anthony Komaroff 4. An Anthropological Approach to Understanding CFS -- Norma Ware Part II: Infection and Immunity 5. Infection and CFS -- Robert Fekety 6. Human Herpesviruses and CFS -- John Hay and Frank Jenkins 7. Retroviruses and CFS -- Walid Heneine and Thomas Folks 8. Immunological Function in CFS -- Warren Strober Part III: Neurological, Psychological, and Psychiatric Issues 9. Muscle Metabolism, Histopathology, and Physiology in CFS -- Richard Edwards, John Clague, Henry Gibson, and Timothy Helliwell 10. Neuropsychological Features of CFS -- Jordan Grafman 11. Neuroendocrine Aspects of CFS: Implications for Diagnosis and Research -- Mark Demitrack Part IV: Relation to Other Disorders 12. The Fibromyalgia Syndrome and CFS -- Don Goldenberg 13. The Relevance of Psychiatric Research on Somatization to the Concept of CFS -- Michael Clark and Wayne Katon Part V: An International Perspective 14. Studies on the Pathophysiology of CFS in Australia -- Andrew Lloyd, Ian Hickie, and Denis Wakefield Part VI: Approaches to Treatment 15. Medical Therapy of CFS -- Cheryl Hirata-Dulas, Charles Halstenson, and Phillip Peterson 16. Psychopharmacology and CFS -- Susan Abbey 17. Cognitive-Behavioral Therapy and the Treatment of CFS -- Michael Sharpe Index ----------- Chronic Fatigue Syndrome, edited by Stephen E. Straus 461 pages ISBN 0-8247-9187-8 U.S. price: $135 plus shipping For sales in the Americas, contact the publisher as follows: Marcel Dekker, Inc. 270 Madison Ave. New York, NY 10016 phone 1-212-696-9000 fax 1-212-685-4540 Elsewhere, contact the publisher as follows: Marcel Dekker, Inc. Hutgaffe 4 Postfach 812 CH 4001 Basel, Switzerland phone 41-61-261-2232 fax 41-61-261-8896 [Thanks to the staff of publisher Marcel Dekker for assistance.] -=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=- >>>3. Discussion of Hopkins study, and CBT Correspondence published in recent medical journals have discussed the "Hopkins study", and cognitive behavioral therapy for CFS. A discussion about the recent Hopkins study appeared in the Lancet of 29 April 1995. The Hopkins study proposes a possible link between neurally mediated hypotension and CFS, and was originally published in the Lancet of 11 March 1995 (and discussed in CFS-NEWS number 45). Now four letters have appeared in the Lancet of 29 April 1995 (pages 1112-1113) which discuss this study. R.J. Walden wrote expressing concern about both the diagnostic method and the recommended treatment. Simon Wessely expressed doubt about associating low blood pressure with fatigue or dizziness, and he pointed to possible confounding conditions such as depression and deconditioning. Walden and Wessely both recommended simple rehabilitation and activity management programs as treatment. The Hopkins researchers (Rowe, Bou-Holaigah, Kan, and Calkins) replied that neurally mediated hypotension is a different condition than general hypotension, and that the tests and treatments that were mentioned in their paper are the commonly accepted ones for that specialized condition. They further mention that there is no data which recommends physical rehabilitation as being effective for either neurally mediated hypotension or CFS. David H.P. Streeten and Gunnar Anderson wrote that findings similar to Rowe et al. had previously been published in their paper titled "Delayed orthostatic intolerance" (Arch Intern Med 1992;174:180). In a separate set of correspondence, cognitive behavioral therapy (CBT) for CFS was discussed in the April 1995 American Journal of Medicine (volume 98, pages 419-422). Commenting on a previous article by Lloyd et al. (Am J Med 1993;94:197-203) which found CBT less than effective, writers T Chalder, A Deale and S Wessely stated that the Lloyd study did not make a true comparison to the CBT program described by Butler, Chalder, et al. Similarly, in another letter Michael Sharpe criticized the Lloyd study for applying CBT too briefly, and for failing to challenge the patients' belief in a physical disease. Lloyd et al. replied by pointing out the disadvantages of the Butler program, and that the Lloyd study included objective measures of response. They also wrote that their study was similar to other established CBT programs, and that their study was not predicated on an assumption of either a wholly physical nor a wholly psychological illness. =================================================================== CFS-NEWS (ISSN 1066-8152) is an international newsletter published and edited by Roger Burns in Washington D.C. It is distributed: through the "CFS echo" (discussion group) on the Fidonet volunteer network of BBSs; via the NIHLIST Listserv on Internet; and as USENET Newsgroup bit.listserv.cfs.newsletter. Back issues are on file on the Project ENABLE BBS in West Virginia USA at telephone 1-304-759- 0727 in file area 23, and the valuable patient resource file named CFS-RES.TXT is available there too. Suggestions and contributions of news may be sent to Roger Burns at Internet CFS-NEWS@LIST.NIH.GOV or by Fido NetMail to 1:109/432, or at telephone 1-202-966-8738, or postal address 2800 Quebec St NW, no. 1242, Washington DC 20008 USA, or post a message to the CFS echo or to the Internet CFS-L group or to newsgroup alt.med.cfs. Copyright (c) 1995 by Roger Burns. Per- mission is granted to excerpt this document if the source (CFS-NEWS Electronic Newsletter) is cited. Permission is also granted to reproduce the entirety of this document unaltered. 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