Dedra Buchwald

Dedra Buchwald, MD is a primary care physician, professor of the College of Medicine at Washington State University, and the director of the Institute for Research and Education to Advance Community Health. She is currently studying chronic disease in American Indian, Alaska Native, Native Hawaiian, and Pacific Islander communities.

Buchwald was president of the American Association of Chronic Fatigue Syndrome, now called the International Association for Chronic Fatigue Syndrome/Myalgic Encephalomyelitis from 1998 to 2001 and the chairperson for that organization’s January 2001, Fifth International Conference in Bloomington, Minnesota, USA.

Dr. Buchwald's experience goes back to the 1980's, where in 1988, Dr. Buchwald established the Chronic Fatigue Clinic at the Harborview Medical Center in Seattle, Waashington. In 1995, Dr Buchwald headed the Seattle Chronic Fatigue Syndrome Cooperative Research Center, a center partially funded by a National Institutes of Health grant.

Awards

 * 2004, Rudy Perpich Senior Lectureship Award, presented to a distinguished CFS/FM scientist, physician or healthcare worker awarded by IACFS/ME

Notable studies

 * 2012, The Comorbidity of Self-Reported Chronic Fatigue Syndrome, Posttraumatic Stress Disorder, and Traumatic Symptoms (FULL TEXT)"'Abstract - Background: Data from primary care and community samples suggest higher rates of posttraumatic stress disorder (PTSD) among individuals with chronic fatigue syndrome (CFS). Objective: This study investigated the co-occurrence of CFS, PTSD, and trauma symptoms and assessed the contribution of familial factors to the association of CFS with lifetime PTSD and current traumatic symptoms. Method: Data on lifetime CFS and PTSD, as measured by self report of a doctor’s diagnosis of the disorder, and standardized questionnaire data on traumatic symptoms, using the Impact of Events Scale (IES), were obtained from 8,544 female and male twins from the community-based University of Washington Twin Registry. Results: Lifetime prevalence of CFS was 2% and lifetime prevalence of PTSD was 4%. Participants who reported a history of PTSD were over 8 times more likely to report a history of CFS. Participants with scores ≥ 26 on the IES were over 4 times more likely to report CFS than those who had scores ≤ 25. These associations were attenuated but remained significant after adjusting for familial factors through within-twin pair analyses. Conclusion: These results support similar findings that a lifetime diagnosis of CFS is strongly associated with both lifetime PTSD and current traumatic symptoms, although familial factors such as shared genetic and environmental contributions played a limited role in the relationship between CFS, PTSD, and traumatic symptoms. These findings suggest that future research should investigate both the familial and the unique environmental factors that may give rise to both CFS and PTSD.'"
 * 2007, Body Mass Index and Fatigue Severity in Chronic Fatigue Syndrome"'Abstract - Background: It is uncertain how much fatigue is related to weight in patients with chronic fatigue syndrome (CFS). Objective: To assess the association of body mass index (BMI) and fatigue in CFS patients. Methods: Consecutive patients seen in a referral-based specialty clinic were eligible if they met CFS criteria and had completed required measures. Fatigue measures were the vitality subscale of the Medical Outcomes Short-Form 36 and the global fatigue index from the Multidimensional Assessment of Fatigue. Results: In women, there was no relationship between BMI and vitality subscale or global fatigue index scores (P = 0.99 and P = 0.44). For men, vitality subscale scores significantly decreased as BMI increased (P = 0.02). Conclusions: In CFS patients, the prevalence of obesity was low despite risk factors for weight gain. Fatigue severity and BMI were unrelated in women with CFS, but this relationship may differ for men.'"
 * 2007, Prospective Study of Body Mass Index, Weight Change, and Fatigue in Acute Infectious Mononucleosis"'Abstract - Objective: To examine the influence of body mass index (BMI) and weight change on fatigue severity and failure to recover in individuals with acute infectious mononucleosis. Methods: We prospectively studied 148 individuals presenting with a positive monospot test. We obtained measured weights and vitality subscale scores from the Short Form-36 Health Survey (SF-36) at the index visit and at 6 months. Results: The mean age of the participants was 21 years and 24% were overweight or obese. During acute illness, overweight and obese participants had an adjusted odds ratio for low vitality scores of 2.9 (confidence interval 1.2–7.1) compared to normal weight subjects. Neither index BMI nor 6-month weight gain was significantly associated with prolonged fatigue or failure to recover. Conclusion: Overweight and obese patients with acute infectious mononucleosis are more likely to experience severe fatigue. In contrast, neither baseline weight nor weight gain appear to impede recovery.'"
 * 2006, Mortality in a cohort of chronically fatigued patients"'Abstract - BACKGROUND: Comprehensive studies of mortality among patients with chronic fatigue (CF) and chronic fatigue syndrome (CFS) have not been published, but several sources suggest that CFS is associated with an elevated risk for suicide. METHOD: Data on 1201 chronically fatigued patients followed in a university-affiliated tertiary-care clinic for up to 14 years were submitted to the Center for Disease Control and Prevention (CDC) National Death Index (NDI) to evaluate all-cause and suicide-caused death rates against standardized mortality rates (SMRs). We used Life Table Analysis to examine the influence of sex and diagnoses of CFS and depression. RESULTS: All-cause mortality in chronically fatigued patients was no higher than expected, but suicide-caused death rates were more than eight times higher than in the US general population. The significant elevation in the SMR of suicide was restricted to those who did not meet criteria for CFS [SMR(CF)=14.2, 95% confidence interval (CI) 5.7-29.3 versus SMR(CFS)=3.6, 95% CI 0.4-12.9]. Among chronically fatigued patients who did not meet CFS criteria, those with a lifetime history of major depression (MD) had higher suicide-caused death rates than among their non-depressed counterparts (SMR(MD)=19.1, 95% CI 7.0-41.5 versus SMR(NMD)=5.6, 95% CI 0.1-31.4), although the difference was not significant. CONCLUSIONS: CFS does not appear to be associated with increased all-cause mortality or suicide rates. Clinicians, however, should carefully evaluate patients with CF for depression and suicidality.'"
 * 2004, Post-traumatic stress disorder among patients with chronic pain and chronic fatigue."'Abstract - BACKGROUND: Fibromyalgia (FM), a chronic pain condition of unknown aetiology often develops following a traumatic event. FM has been associated with post-traumatic stress disorder (PTSD) and major depression disorder (MDD). METHOD: Patients seen in a referral clinic (N=571) were evaluated for FM and chronic fatigue syndrome (CFS) criteria. Patients completed questionnaires, and underwent a physical examination and a structured psychiatric evaluation. Critical components of the diagnostic criteria of FM (tender points and diffuse pain) and CFS (persistent debilitating fatigue and four of eight associated symptoms) were examined for their relationship with PTSD. RESULTS: The prevalence of lifetime PTSD was 20% and lifetime MDD was 42%. Patients who had both tender points and diffuse pain had a higher prevalence of PTSD (OR=3.4, 95% CI 2.0-5.8) compared with those who had neither of these FM criteria. Stratification by MDD and adjustment for sociodemographic factors and chronic fatigue revealed that the association of PTSD with FM criteria was confined to those with MDD. Patients with MDD who met both components of the FM criteria had a three-fold increase in the prevalence of PTSD (95% CI 1.5-7.1); conversely, FM patients without MDD showed no increase in PTSD (OR=1.3, 95% CI 0.5-3.2). The components of the CFS criteria were not significantly associated with PTSD. CONCLUSION: Optimal clinical care for patients with FM should include an assessment of trauma in general, and PTSD in particular. This study highlights the importance of considering co-morbid MDD as an effect modifier in analyses that explore PTSD in patients with FM.'"
 * 2003, Single-photon emission computerized tomography and neurocognitive function in patients with chronic fatigue syndrome"'Abstract - OBJECTIVE: The purposes of this study were to compare functional imaging under control and experimental conditions among patients with chronic fatigue syndrome (CFS) and healthy persons and to examine perceived and objective performance on a test of attention and working memory previously found to be difficult for persons with CFS. METHODS: Single-photon emission computerized tomography scans were completed on 15 subjects with CFS and 15 healthy persons twice: at rest and when performing the Paced Auditory Serial Addition Test (PASAT). RESULTS: No group differences were found for performance on the PASAT despite CFS subjects' perceptions of exerting more mental effort to perform the task than healthy subjects. Inspection of the aggregate scans by group and task suggested a pattern of diffuse regional cerebral blood flow among subjects with CFS in comparison with the more focal pattern of regional cerebral blood flow seen among healthy subjects. Between-group region-of-interest analysis revealed that although CFS subjects showed less perfusion in the anterior cingulate region, the change in CFS subjects' activation of the left anterior cingulate region during the PASAT was greater than that observed for healthy subjects. The differences were not attributable to lesser effort by the subjects with CFS, confounding effects of mood perturbation, or to poorer performance on the experimental task. CONCLUSIONS: Further research regarding CFS subjects' diffuse cerebral perfusion and its relationship to inefficient neuropsychological performance is warranted.'"
 * 2000, Acute infectious mononucleosis: Characteristics of patients who report failure to recover"'Abstract - We sought to determine how often acute mononucleosis precipitates chronic illness, and to describe the demographic, clinical, and psychosocial features that characterize patients who report failure to recover. We enrolled 150 patients with infectious mononucleosis during the acute illness and asked them to assess their recovery at 2 and 6 months. At baseline, we performed physical and laboratory examinations; obtained measures of psychological and somatic functioning, social support, and life events; and administered a structured psychiatric interview. Self-assessed failure to recover was reported by 38% of patients (55 of 144) at 2 months and by 12% (17 of 142) at 6 months. Those who had not recovered reported a persistent illness characterized by fatigue and poor functional status. No objective measures of disease, including physical examination findings or serologic or laboratory markers, distinguished patients who failed to recover from those who reported recovery. Baseline predictors for failure to recover at 2 months were older age (odds ratio [OR] = 1.4, 95% confidence interval [CI]: 1.1 to 1.8, per 5-year increase), higher temperature (OR = 1.5, 95% CI: 1.1 to 2.2, per 0.5 degrees C increase), and greater role limitation due to physical functioning (OR = 1.5, 95% CI: 1.2 to 1.9, per 20-point decrease in Short Form-36 score). At 6 months, baseline predictors for failure to recover included female sex (OR = 3.3, 95% CI: 1.0 to 12), a greater number of life events more than 6 months before the disease began (OR = 1.7, 95% CI: 1.1 to 2.5, per each additional life event), and greater family support (OR = 1.9, 95% CI: 1.1 to 4.2, per 7-point increase in social support score). We were not able to identify objective measures that characterized self-reported failure to recover from acute infectious mononucleosis. The baseline factors associated with self-reported failure to recover at 2 months differed from those associated with failure to recover at 6 months. Future studies should assess the generalizability of these findings and determine whether interventions can hasten recovery.'"
 * 2001, A twin study of chronic fatigue"'Abstract - OBJECTIVE: The etiology of chronic fatigue syndrome is unknown, but genetic influences may be important in its expression. Our objective was to assess the role of genetic and environmental factors in unexplained chronic fatigue. METHODS: A classic twin study was conducted using 146 female-female twin pairs, of whom at least one member reported > or =6 months of fatigue. After completing questionnaires on symptoms, zygosity, physical health, and a psychiatric interview, twins were classified using three increasingly stringent definitions: 1) chronic fatigue for > or =6 months, 2) chronic fatigue not explained by exclusionary medical conditions, and 3) idiopathic chronic fatigue not explained by medical or psychiatric exclusionary criteria of the chronic fatigue syndrome case definition. Concordance rates in monozygotic and dizygotic twins were calculated for each fatigue definition along with estimates of the relative magnitude of genetic and environmental influences on chronic fatigue. RESULTS: The concordance rate was higher in monozygotic than dizygotic twins for each definition of chronic fatigue. For idiopathic chronic fatigue, the concordance rates were 55% in monozygotic and 19% in dizygotic twins (p =.042). The estimated heritability in liability was 19% (95% confidence interval = 0-56) for chronic fatigue > or =6 months, 30% (95% confidence interval = 0-81) for chronic fatigue not explained by medical conditions, and 51% (95% confidence interval = 7-96) for idiopathic chronic fatigue. CONCLUSIONS: These results provide evidence supporting the familial aggregation of fatigue and suggest that genes may play a role in the etiology of chronic fatigue syndrome.'"
 * 1996, Race and Ethnicity in Patients with Chronic Fatigue"'Abstract - Purpose: Chronic fatigue (CF) is a common complaint in ambulatory settings. Chronic fatigue syndrome (CFS) is characterized by profound fatigue associated with other symptoms that is rarely reported in racial/ethnic minorities. Our objectives were to determine if differences exist between Caucasian and minority patients presenting with CF, particularly in the frequency meeting criteria for CFS. Patients: 690 patients with CF seen in a university-based referral clinic. Design/Methods: Demographic, historical, physical examination, laboratory, and psychosocial information was prospectively collected and compared. Psychosocial assessment consisted of a structured psychiatric interview, the Medical Outcomes Study Short-Form Health Survey to assess functional status, the General Health Questionnaire to ascertain psychological distress, and measures of health locus of control, illness attribution, social support, and coping. Results: With the exception of less social support from friends, no significant race/ethicity-related differences were identified. Minority patients tended less commonly to report a moderate level of fatigue, and to have poorer social function, less social support from families, and lower rates of lifetime major depression and alcohol abuse. Conclusions: Demographic, clinical, and psychosocial factors do not distinguish Caucasian from minority CF patients. Help-seeking behaviors, access to care, and the significance attributed to the central complaints should be examined as potentially competing explanations for these findings.'"
 * 1992, A chronic illness characterized by fatigue, neurologic and immunologic disorders, and active human herpesvirus type 6 infection"'Abstract - OBJECTIVE: To conduct neurologic, immunologic, and virologic studies in patients with a chronic debilitating illness of acute onset. DESIGN: Cohort study with comparison to matched, healthy control subjects. PATIENTS: We studied 259 patients who sought care in one medical practice; 29% of the patients were regularly bedridden or shut-in. MAIN OUTCOME MEASURES: Detailed medical history, physical examination, conventional hematologic and chemistry testing, magnetic resonance imaging (MRI) studies, lymphocyte phenotyping studies, and assays for active infection of patients' lymphocytes with human herpesvirus type 6 (HHV-6). MAIN RESULTS: Patients had a higher mean (+/- SD) CD4/CD8 T-cell ratio than matched healthy controls (3.16 +/- 1.5 compared with 2.3 +/- 1.0, respectively; P less than 0.003). Magnetic resonance scans of the brain showed punctate, subcortical areas of high signal intensity consistent with edema or demyelination in 78% of patients (95% CI, 72% to 86%) and in 21% of controls (CI, 11% to 36%) (P less than 10(-9)). Primary cell culture of lymphocytes showed active replication of HHV-6 in 79 of 113 patients (70%; CI, 61% to 78%) and in 8 of 40 controls (20%; CI, 9% to 36%) (P less than 10(-8], a finding confirmed by assays using monoclonal antibodies specific for HHV-6 proteins and by polymerase chain reaction assays specific for HHV-6 DNA. CONCLUSIONS: Neurologic symptoms, MRI findings, and lymphocyte phenotyping studies suggest that the patients may have been experiencing a chronic, immunologically mediated inflammatory process of the central nervous system. The active replication of HHV-6 most likely represents reactivation of latent infection, perhaps due to immunologic dysfunction. Our study did not directly address whether HHV-6, a lymphotropic and gliotropic virus, plays a role in producing the symptoms or the immunologic and neurologic dysfunction seen in this illness. Whether the findings in our patients, who came from a relatively small geographic area, will be generalizable to other patients with a similar syndrome remains to be seen.'"

Online presence

 * PubMed

Learn more

 * "Seattle Doctor, Dedra Buchwald, Performs Unique Twin Research" by John Addington in ProHealth
 * Partners 4 Native Health, Washington State University Bio page
 * Northwest Center for Public Health Practice Faculty page