Madison Sunnquist

Madison Lindsay Sunnquist, B.S., M.A., is a Graduate Research Assistant in Clinical-Community Psychology from DePaul University, Center for Community Research, Chicago, Illinois.

Awards

 * 2014, Junior Investigator Award to encourage young CFS/FM researchers in recognition of their work awarded by IACFSME.

Thesis

 * 26 July 2016, "A Reexamination of the Cognitive Behavioral Model of Chronic Fatigue Syndrome: Investigating the Cogency of the Model’s Behavioral Pathway" "'Abstract: Cognitive behavioral theories of chronic fatigue syndrome (CFS) assert that cognitions and behaviors perpetuate the fatigue and impairment that individuals with CFS experience (Wessely, Butler, Chalder, & David, 1991). Vercoulen and colleagues (1998) utilized structural equation modeling to empirically develop a cognitive behavioral model of CFS. The resulting model indicated that attributing symptoms to a physical cause, focusing on symptoms, and feeling less control over symptoms were associated with increased fatigue. Additionally, individuals who attributed symptoms to a physical cause reported lower activity levels and more fatigue and impairment. However, in an attempt to replicate this model, Song and Jason (2005) demonstrated that the model displayed inadequate fit statistics for a well-characterized group of individuals with CFS; the model resulted in appropriate fit for individuals with chronic fatigue from psychiatric conditions. Despite uncertainty surrounding the model’s validity, it continues to be cited to support the application of cognitive behavioral and graded exercise therapies to individuals with CFS (White et al., 2011). The current study utilized second-stage conditional process modeling (i.e., moderated mediation) to reexamine the behavioral pathway of the Vercoulen et al. (1998) model. This pathway is characterized by the association among causal attribution for symptoms, activity level, and fatigue and impairment. The use of a large sample allowed for a robust examination of the pathway, and moderators isolated potential factors that contributed to previous studies’ discrepant results. Findings were generally inconsistent with the Vercoulen et al. (1998) model. Results indicated that individuals did not reduce their activity level due to illness beliefs. Although activity level and impairment were significantly correlated, this correlation decreased as case definition stringency increased. Furthermore, a canonical correlation analysis demonstrated that activity level, impairment, and fatigue could be conceptualized as indicators of illness severity. Rather than implicating activity level as the cause of fatigue and impairment, the relation among these variables may be due to their shared association with the latent construct of illness severity. This study represents the second attempt to replicate the Vercoulen et al. (1998) model; neither the Song and Jason (2005) nor the current study resulted in findings consistent with the original model. As this model provides the theoretical foundation for cognitive behavioral and graded exercise treatments for ME and CFS, these failed replication attempts support patient-expressed concerns about the appropriateness and efficacy of these treatments.'"

Notable studies

 * 2017, A Comparison of Case Definitions for [[Myalgic Encephalomyelitis] and Chronic Fatigue Syndrome] Abstract: Many professionals have described the clinical presentation of myalgic encephalomyelitis (ME), but recent efforts have focused on the development of ME criteria that can be reliably applied. The current study compared the symptoms and functioning of individuals who met the newly-developed Institute of Medicine (IOM) clinical criteria to a revised version of the London criteria for ME. While 76% of a sample diagnosed with chronic fatigue  syndrome (CFS) met the IOM criteria, 44% met the revised London criteria. The revised London criteria identified patients with greater physical impairment. The results of this study indicate the need for a standard case definition with specific guidelines for operationalization. The application of case definitions has important implications for the number of individuals identified with ME, the pattern of symptoms experienced by these individuals, and the severity of their symptoms and functional  limitations. Sample heterogeneity across research studies hinders researchers from replicating findings and impedes the search for biological markers and effective treatments.
 * 2017, Clinical criteria versus a possible research case definition in chronic fatigue syndrome/myalgic encephalomyelitis
 * 2017, A Prospective Study of Infectious Mononucleosis in College Students"'Abstract - Background: The present study aims to prospectively investigate possible biological and psychological factors present in college students who will go on to develop chronic fatigue syndrome (CFS) following Infectious Mononucleosis (IM). Identification of risk factors predisposing patients towards developing CFS may help to understand the underlying mechanisms and ultimately prevent its occurrence. Our study is enrolling healthy college students over the age of 18. Enrollment began in March of 2013 and is ongoing. Methods: Biological and psychological data are collected when students are well (Stage 1), when they develop IM (Stage 2), and approximately 6 months after IM diagnosis (Stage 3). Results: Two case studies demonstrate the progression of student symptomology across all three stages. Conclusion: The Case Studies presented illustrate the usefulness of a prospective research design that tracks healthy.'"
 * 2016, Case definitions integrating empiric and consensus perspectives
 * 2016, Comparing the DePaul Symptom Questionnaire with physician assessments: a preliminary study"'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 (98%) while the specificity was 38%. Positive and negative predictive values were 92% and 75%, 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.'"
 * 2016, Housebound versus nonhousebound patients with myalgic encephalomyelitis and chronic fatigue syndrome"'Abstract - Objectives: The objective of this study was to examine individuals with myalgic encephalomyelitis and chronic fatigue syndrome who are confined to their homes due to severe symptomatology. The existing literature fails to address differences between this group, and less severe, nonhousebound patient populations. Methods: Participants completed the DePaul Symptom Questionnaire, a measure of myalgic encephalomyelitis and chronic fatigue syndrome symptomology, and the SF-36, a measure of health impact on physical/mental functioning. ANOVAs and, where appropriate, MANCOVAS were used to compare housebound and nonhousebound patients with myalgic encephalomyelitis and chronic fatigue syndrome across areas of functioning, symptomatology, and illness onset characteristics. Results: Findings indicated that the housebound group represented one quarter of the sample, and were significantly more impaired with regards to physical functioning, bodily pain, vitality, social functioning, fatigue, post-exertional malaise, sleep, pain, neurocognitive, autonomic, neuroendocrine, and immune functioning compared to individuals who were not housebound. Discussion: Findings indicated that housebound patients have more impairment on functional and symptom outcomes compared to those who were not housebound. Understanding the differences between housebound and not housebound groups holds implications for physicians and researchers as they develop interventions intended for patients who are most severely affected by this chronic illness.'"
 * 2016, Deconstructing [[post-exertional malaise]: An exploratory factor analysis.] "'Abstract: Post-exertional malaise is a cardinal symptom of myalgic encephalomyelitis and chronic fatigue syndrome. There are two differing focuses when defining post-exertional malaise: a generalized, full-body fatigue and a muscle-specific fatigue. This study aimed to discern whether post-exertional malaise is a unified construct or whether it is composed of two smaller constructs, muscle fatigue and generalized fatigue. An exploratory factor analysis was conducted on several symptoms that assess post-exertional malaise. The results suggest that post-exertional malaise is composed of two empirically different experiences, one for generalized fatigue and one for muscle-specific fatigue.'"
 * 2016, Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis"'Abstract:It is unclear what key symptoms differentiate Myalgic Encephalomyelitis (ME) and Chronic Fatigue syndrome (CFS) from Multiple Sclerosis (MS). The current study compared self-report symptom data of patients with ME or CFS with those with MS. The self-report data is from the DePaul Symptom Questionnaire, and participants were recruited to take the questionnaire online. Data were analyzed using a machine learning technique called decision trees. Five symptoms best differentiated the groups. The best discriminating symptoms were from the immune domain (i.e., flu-like symptoms and tender lymph nodes), and the trees correctly categorized MS from ME or CFS 81.2% of the time, with those with ME or CFS having more severe symptoms. Our findings support the use of machine learning to further explore the unique nature of these different chronic diseases.'"
 * 2016, Are Myalgic Encephalomyelitis and chronic fatigue syndrome different illnesses? A preliminary analysis (FULL TEXT) "Abstract - Considerable discussion has transpired regarding whether chronic fatigue syndrome is a distinct illness from Myalgic Encephalomyelitis. A prior study contrasted the Myalgic Encephalomyelitis International Consensus Criteria (ME-ICC; Carruthers et al., 2011) with the Fukuda et al. (1994) CFS criteria and found that the ME-ICC identified a subset of patients with greater functional impairment and physical, mental, and cognitive problems than the larger group who met Fukuda et al. (1994) criteria (Brown et al., 2013). The current study analyzed two discrete data sets and found that the ME-ICC identified more impaired individuals with more severe symptomatology."
 * 2015, Chronic fatigue syndrome versus systemic exertion intolerance disease
 * 2015, Comparing and contrasting consensus versus empirical domains. Abstract
 * 2015, Test–retest reliability of the DePaul Symptom Questionnaire Abstract"'Methods: Test–retest reliability of the measure was examined with a sample of 26 adults self-identifying as having either ME/CFS, ME, and/or CFS and 25 adults who did not self-identify as having these illnesses and were otherwise healthy controls. Results: Overall, the majority of items on the DSQ exhibited good to excellent test–retest reliability, with Pearson's or kappa correlation coefficients that were 0.70 or higher.'"
 * 2015, Factor Analysis of the DePaul Symptom Questionnaire: Identifying Core Domains (FULL TEXT)
 * 2014, Examining case definition criteria for chronic fatigue syndrome and myalgic encephalomyelitis "Abstract - Background: Considerable controversy has transpired regarding the core features of myalgic encephalomyelitis (ME) and chronic fatigue syndrome (CFS). Current case definitions differ in the number and types of symptoms required. This ambiguity impedes the search for biological markers and effective treatments. Purpose: This study sought to empirically operationalize symptom criteria and identify which symptoms best characterize the illness. Methods: Patients (n = 236) and controls (n = 86) completed the DePaul Symptom Questionnaire, rating the frequency and severity of 54 symptoms. Responses were compared to determine the threshold of frequency/severity ratings that best distinguished patients from controls. A Classification and Regression Tree (CART) algorithm was used to identify the combination of symptoms that most accurately classified patients and controls. Results: A third of controls met the symptom criteria of a common CFS case definition when just symptom presence was required; however, when frequency/severity requirements were raised, only 5% met the criteria. Employing these higher frequency/severity requirements, the CART algorithm identified three symptoms that accurately classified 95.4% of participants as patient or control: fatigue/extreme tiredness, inability to focus on multiple things simultaneously, and experiencing a dead/heavy feeling after starting to exercise. Conclusions: Minimum frequency/severity thresholds should be specified in symptom criteria to reduce the likelihood of misclassification. Future research should continue to seek empirical support of the core symptoms of ME and CFS to further progress the search for biological markers and treatments."
 * 2013, Energy conservation/envelope theory interventions. Full Text
 * 2013, The implications of sensitization and kindling for chronic fatigue syndrome
 * 2013, Contrasting chronic fatigue syndrome versus myalgic encephalomyelitis/chronic fatigue syndrome. Abstract

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