Differential diagnosis of chronic fatigue syndrome and major depressive disorder

Hines VA Hospital, Hines, Illinois, USA.
International Journal of Behavioral Medicine (Impact Factor: 2.63). 02/2006; 13(3):244-51. DOI: 10.1207/s15327558ijbm1303_8
Source: PubMed


The goal of this study was to identify variables that successfully differentiated patients with chronic fatigue syndrome, major depressive disorder, and controls. Fifteen participants were recruited for each of these three groups, and discriminant function analyses were conducted. Using symptom occurrence and severity data from the Fukuda et al. (1994) definitional criteria, the best predictors were postexertional malaise, unrefreshing sleep, and impaired memory-concentration. Symptom occurrence variables only correctly classified 84.4% of cases, whereas 91.1% were correctly classified when using symptom severity ratings. Finally, when using percentage of time fatigue reported, postexertional malaise severity, unrefreshing sleep severity, confusion-disorientation severity, shortness of breath severity, and self-reproach to predict group membership, 100% were classified correctly.

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    • "However, clusters of physiosomatic symptoms coupled to increases in immunoinflammatory pathways are significant commonalities in depression and ME/CFS, suggesting significant phenomenological and biochemical similarities that may be relevant to overlaps in subtyping and treatment [20]. Nevertheless, clinical depression and ME/CFS are different syndromes, which may be discriminated with a high predictive value using severity of post-exertion malaise, percentage of time fatigue reported, shortness of breath, unrefreshing sleep, confusion/disorientation and self-reproach [25]. "
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    ABSTRACT: It is of importance whether myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a variant of sickness behavior. The latter is induced by acute infections/injury being principally mediated through proinflammatory cytokines. Sickness is a beneficial behavioral response that serves to enhance recovery, conserves energy and plays a role in the resolution of inflammation. There are behavioral/symptomatic similarities (for example, fatigue, malaise, hyperalgesia) and dissimilarities (gastrointestinal symptoms, anorexia and weight loss) between sickness and ME/CFS. While sickness is an adaptive response induced by proinflammatory cytokines, ME/CFS is a chronic, disabling disorder, where the pathophysiology is related to activation of immunoinflammatory and oxidative pathways and autoimmune responses. While sickness behavior is a state of energy conservation, which plays a role in combating pathogens, ME/CFS is a chronic disease underpinned by a state of energy depletion. While sickness is an acute response to infection/injury, the trigger factors in ME/CFS are less well defined and encompass acute and chronic infections, as well as inflammatory or autoimmune diseases. It is concluded that sickness behavior and ME/CFS are two different conditions.
    BMC Medicine 03/2013; 11(1):64. DOI:10.1186/1741-7015-11-64 · 7.25 Impact Factor
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    • "In addition to these criteria, at least four of the following symptoms must be reported to have developed with or following the above symptoms; self-reported impairment of short term memory and/or concentration, sore throat, tender cervical and/or axillary lymph nodes, muscle pain, the emergence of a new pattern of headache, multiple joint pain lacking signs of swelling or erythema, unrefreshing sleep, and a post-exertion malaise that lasts more than 24 h [5]. The post-exertional malaise is considered to be the most indicative secondary symptom in the diagnosis of CFS [6] [7]. Fatigue, headaches and impaired concentration are the most common symptoms, affecting 90% of patients, followed by sore throat (85%), tender lymph nodes (80%) and musculo-skeletal pain (75%) [8]. "
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    ABSTRACT: The aetiological and pathophysiological basis of chronic fatigue syndrome (CFS) remains a controversial field of inquiry in the research community. While CFS and similar disease conditions such as fibromyalgia (FM) and post-infectious encephalopathy have been the focus of intense scrutiny for the past 20 years, results of research were often contradictory and a cohesive pathological model has remained elusive. However, recent developments in understanding the unique immunophysiology of the brain may provide important clues for the development of a truly comprehensive explanation of the pathology of CFS. We argue that CFS pathogenesis lies in the influence of peripheral inflammatory events on the brain and the unique immunophysiology of the central nervous system. There is also evidence that CFS patients have a relative immunodeficiency that predisposes to poor early control of infection that leads to chronic inflammatory responses to infectious insults. The neurological and endocrine changes have been described in CFS patients support the view that CFS has an inflammatory pathogenesis when considered as a whole. An inflammatory model of disease also provides an explanation for the marked female sex bias associated with CFS. This review therefore posits the hypothesis that CFS as a disease of long-term inflammatory processes of the brain. We will also provide an investigative framework that could be used to justify the use of anti-TNF biological agents as a reliable and effective treatment approach to CFS, a syndrome that to date remains frustratingly difficult for both patients and health care professionals to manage.
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    • "For example, it is possible that some patients with MDD also have chronic fatigue and four CFS Fukuda et al. [1] symptoms that can occur with depression (e.g., unrefreshing sleep, joint pain, muscle pain, impairment in concentration). Yet, CFS and MDD are different disorders , and they can be differentiated by use of appropriate assessment instruments [10]. Great care needs to be exercised when determining which scales, with which cut off points, should indicate that CFS criteria has been reached for CFS samples. "
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    ABSTRACT: In an effort to bring more standardization to the chronic fatigue syndrome (CFS) Fukuda et al. case definition [1], the Centers for Disease Control and Prevention (CDC) has developed an empirical case definition [2] that specifies crite-ria and instruments to diagnose CFS. The present study investigated the sensitivity and specificity of this CFS empirical case definition with diagnosed individuals with CFS from a community based study that were compared to non-CFS cases. All participants completed questionnaires measuring disability (Medical Outcome Survey Short-Form-36) [3], fatigue (the Multidimensional Fatigue Inventory) [4], and symptoms (CDC Symptom Inventory) [5]. Findings of the present study indicated sensitivity and specificity problems with the CDC empirical CFS case definition.
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