The relationship between prior psychiatric disorder and chronic fatigue: Evidence from a national birth cohort study

Department of Psychological Medicine, Institute of Psychiatry, Kings College London, London, UK.
Psychological Medicine (Impact Factor: 5.94). 08/2008; 38(7):933-40. DOI: 10.1017/S0033291707001900
Source: PubMed


Increased rates of psychiatric disorder have previously been reported in those diagnosed with chronic fatigue syndrome (CFS) or myalgic encephalomyelitis (ME), although the direction of causation in this relationship has not been established. We aimed to test the hypothesis that individuals with self-reported CFS/ME have increased levels of psychiatric disorder prior to the onset of their fatigue symptoms.
A total of 5,362 participants were prospectively followed with various measures of personality, psychiatric disorder and fatigue levels collected over the first 43 years of their life. CFS/ME was identified through self-report during a semi-structured interview at age 53 years.
Thirty-four (1.1%) of the 3,035 subjects assessed at age 53 years reported a diagnosis of CFS/ME. CFS/ME was more common among females, but there was no association between CFS/ME and either social class, social mobility or educational level. Those with psychiatric illness between the ages of 15 and 36 years were more likely to report CFS/ME later in life with an odds ratio (OR, adjusted for sex) of 2.65 [95% confidence interval (CI) 1.26-5.57, p=0.01]. Increased levels of psychiatric illness, in particular depression and anxiety, were present prior to the occurrence of fatigue symptoms. There was a dose-response relationship between the severity of psychiatric symptoms and the likelihood of later CFS/ME. Personality factors were not associated with a self-reported diagnosis of CFS/ME.
This temporal, dose-response relationship suggests that psychiatric disorders, or shared risk factors for psychiatric disorders, are likely to have an aetiological role in some cases of CFS/ME.

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    • "We should be mindful that the adaptive response to the HPA axis changes of such genetic factors or stressors may confer an allostatic load which predisposes to CFS [64]. It has, for instance, been suggested that the allostatic response to persistent cortisol elevation may be a “switch” to hypocortisolaemia [35, 65–67] mediated by a relative increased reliance on AVP rather than CRH to drive [68], or on MR rather than GR to control, the axis [69, 70]. We are still a long way from understanding the evolutionary advantage of the altered regulation of the HPA axis in patients who have, and those who go on to develop, CFS; perhaps CFS is the cost of the cortisol response to challenge (including social challenge) which may be necessary to adapt to the complex dynamics of human social competition [71]. "
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    ABSTRACT: Hypothalamic-pituitary-adrenal (HPA) axis dysfunction has been found in a high proportion of chronic fatigue syndrome (CFS) patients and includes enhanced corticosteroid-induced negative feedback, basal hypocortisolism, attenuated diurnal variation, and a reduced responsivity to challenge. A putative causal role for genetic profile, childhood trauma, and oxidative stress has been considered. In addition, the impact of gender is demonstrated by the increased frequency of HPA axis dysregulation in females. Despite the temporal relationship, it is not yet established whether the endocrine dysregulation is causal, consequent, or an epiphenomenon of the disorder. Nonetheless, given the interindividual variation in the effectiveness of existing biological and psychological treatments, the need for novel treatment strategies such as those which target the HPA axis is clear.
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    • "It is usually associated with middle age, being female, and having lower education and occupation attainment [4]. Fatigue is common in psychiatric conditions such as anxiety and depression (25–36%) [5] [6] [7] and in chronic medical conditions such as cancer, Parkinson's disease, multiple sclerosis, diabetes, and viral infection [8] [9] [10] [11] [12]. Fatigue worsens with increasing physical disease severity [10] and is independent of medication suggesting that medication itself is not responsible for fatigue. "
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    ABSTRACT: This study sought to examine the association between sleep, fatigue, and functional health in psychotic patients. Participants included 93 psychotic inpatients (n = 67 with schizophrenia) who completed the Chalder Fatigue Scale (ChFS), the Fatigue Symptom Inventory (FSI), the Pittsburgh Sleep Quality Index (PSQI), and the SF36 Health Survey. Patients were classified on the basis of their performance on sleep and fatigue measures: 60% reported significant levels of fatigue and 67% significant sleep disturbances. 28.4% reported both, suggesting that fatigue and sleep dysfunctions do not necessarily cooccur. A closer examination of patterns showed that fatigue was only related to qualitative aspects of sleep and not quantifiable aspects of sleep disturbances. The results also showed that functional health was the lowest in patients with high levels of fatigue, compared to patients with sleep problems only or patients with neither symptom. A regression analysis further showed that the size of the contribution of fatigue onto functional health was twice as much as that of sleep dysfunctions. In conclusion, the results show that (i) dissatisfaction with sleep-and not sleep itself-is related to fatigue symptoms and that (ii) fatigue is particularly detrimental to functional health, regardless of the presence of sleep dysfunctions.
    Full-text · Article · Apr 2013
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    • "Weitere Risikofaktoren sind frühkindliche Belastungen (Heim et al. 2006), Somatisierungsneigung (Addington et al. 2001) wie auch psychische Störungen im Erwachsenenalter, insbesondere Angst und depressive Störungen (Harvey et al. 2008; Goodwin et al. 2011). Da das CFS bei Frauen deutlich häufiger auftritt als bei Männern (Harvey et al. 2008), ohne dass die Gründe hierfür klar sind, kann schlussendlich auch das weibliche Geschlecht als Risikofaktor gewertet werden. "

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