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.

Download full-text


Available from: Leonard A Jason
  • Source
    • "The DSQ is an extended, structured and standardized self-report symptom assessment aimed to evaluate according to three different sets of criteria: the Fukuda,[6] the CCC criteria,[14] and the ICC. [10] The instrument is thus based upon established diagnostic criteria, and developed from a CFS Questionnaire that has shown good inter-rater and test–retest reliability and proven to distinguish between individuals with CFS, Major Depressive Disorders and healthy controls.[15] If the DSQ is found to be sufficiently sensitive, the instrument 2 E.B Strand et al. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Diagnostic assessment of chronic fatigue syndrome (CFS) and myalgic encephalomyelitis (ME) is largely based on a two part process; screening patients who might meet criteria and following up this assessment with physicians’ clinical evaluation of a range of inclusionary symptoms and exclusionary illnesses. Purpose: The aim was to assess how well the DePaul Symptom Questionnaire (DSQ) screened for patients who were ultimately diagnosed by physicians using the Canadian Consensus Criteria (CCC). Methods: Sixty-four patients referred for evaluation of possible CFS or ME were screened initially using the DSQ, and then evaluated and subsequently diagnosed by physicians. To assess the consistency between the self-report DSQ and the physicians’ diagnosis, sensitivity and specificity as well as predictive values were calculated. Results: The DSQ identified 60 and the physicians identified 56 as having a CCC diagnosis. The overall agreement between the two ratings on the diagnostic assessment part was moderate (Kappa = 0.45, p < .001). The sensitivity of DSQ was good (92%) while the specificity was moderate (75%). Positive and negative predictive values were 98% and 38%, respectively. Conclusion: DSQ is useful for detecting and screening symptoms consistent with a CCC diagnosis in clinical practice and research. However, it is important for initial screening of self-report symptoms to be followed up by subsequent medical and psychiatric examination in order to identify possible exclusionary medical and psychiatric disorders.
    Full-text · Article · Jan 2016
  • Source
    • "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]. "
    [Show abstract] [Hide abstract]
    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.
    Full-text · Article · Mar 2013 · BMC Medicine
  • Source
    • "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]. "
    [Show abstract] [Hide abstract]
    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.
    Preview · Article · Jul 2011 · Medical Hypotheses
Show more