Fatigue: Biomedicine, Health & Behavior - Volume 6, Issue 1, 2018

Volume 6, Issue 1, 2018

 * Editorial - Using a participatory approach to develop and implement the UK ME/CFS Biobank
 * Fatigued patients with chronic liver disease have subtle aberrations of sleep, melatonin and cortisol circadian rhythms"Abstract - Aims: We sought to examine whether disturbances in central and peripheral circadian rhythms were related to the experience of fatigue in patients with chronic liver disease (CLD). Methods: Fatigued and non-fatigued patients with compensated CLD were enrolled in a prospective pilot study. Patients underwent a one week evaluation of free-living sleep and physical activity patterns, followed by a 24-hour admission, during which they underwent serial blood sampling, polysomnography, a 6-minute walk test and continuous core temperature measurements under standardized conditions. Blood samples were analyzed for liver tests, melatonin levels, lipids, and cortisol. Circadian rhythms were analyzed using single cosinor analyses. Results: Six fatigued and six non-fatigued patients were studied; five participants had cirrhosis. Fatigue severity was positively associated higher peak melatonin levels (rho = 0.59, p = 0.04) and a delay in night-time melatonin peak and inversely associated with sleep efficiency (rho = −0.63, p = 0.04). Polysomnography, 6-minute walk test, and core temperature measurements did not differ significantly between the fatigued and non-fatigued patients. Although liver enzymes, bilirubin and albumin demonstrated a circadian pattern, it was not associated with fatigue. Fatigued patients showed a blunted and delayed cortisol rhythm and fatigue was strongly correlated with cortisol amplitude (rho = −0.77, p = 0.004) and phase (r = −0.66, p = 0.02). Conclusion: Subtle aberrations in melatonin and adrenal circadian rhythms, as well as reduced sleep efficiency, likely contribute to fatigue in patients with CLD. These abnormalities may ultimately be a therapeutic target to improve quality of life for fatigued patients with CLD."
 * Rethinking childhood adversity in chronic fatigue syndrome "Abstract - Background: Previous studies have consistently shown increased rates of childhood adversity in chronic fatigue syndrome (CFS). However, such aetiopathogenic studies of CFS are potentially confounded by co-morbidity and misdiagnosis particularly with depression. Purpose: We examined the relationship between rates of childhood adversity using two complimentary approaches (1) a sample of CFS patients who had no lifetime history of depression and (2) a modelling approach. Methods: Childhood trauma questionnaire (CTQ) administered to a sample of 52 participants with chronic fatigue syndrome and 19 controls who did not meet criteria for a psychiatric disorder (confirmed using the Structured Clinical Interview for DSM-IV). Subsequently, Mediation Analysis (Baye’s Rules) was used to establish the risk childhood adversity poses for CFS with and without depression. Results: In a cohort of CFS patients with depression comprehensively excluded, CTQ scores were markedly lower than in all previous studies and, in contrast to these previous studies, not increased compared with healthy controls. Post-hoc analysis showed that CTQ scores correlated with the number of depressive symptoms during the lifetime worst period of low mood. The probability of developing CFS given a history of childhood trauma is 4%, a two-fold increased risk compared to the general population. However, much of this risk is mediated by the concomitant development of major depression. Conclusions: The data suggests that previous studies showing a relationship between childhood adversity and CFS may be attributable to the confounding effects of co-morbid or misdiagnosed depressive disorder."
 * Stigma in Myalgic Encephalomyelitis and its association with functioning Abstract - Background: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is categorised by the World Health Organisation as a neurological condition. It is poorly understood and people with ME/CFS report experiencing stigma. Research suggests that stigma might be linked to functional ability. Purpose: This study investigated the relationship of stigma to factors associated with functional ability. Additionally, the use of standardised measures allowed for comparison of stigma severity in ME/CFS to other neurological conditions. Method: A convenience sample of 206 people diagnosed with ME/CFS completed mailed or online self-report standardised measures of stigma, health, ability to participate in social roles and activities, and their satisfaction with this ability. Findings were compared to published data for three neurological conditions. Results: Stigma scores were significantly correlated (p < .0001) with all self-report health and functional measures (range: −.30 to −.42). The ME/CFS sample reported higher levels of stigma (d = 1.30) and lower levels of health (d = 1.86–2.16) and functioning (d = 1.63) than the comparison conditions. Conclusions: Consistent with studies over the last two decades, people with ME/CFS report higher levels of stigma when compared to the other conditions. The stigma is not just associated with health but also with specific measures of functional ability.
 * Fatigue in developmental coordination disorder: an exploratory study in adults "Abstract - Background: Fatigue in adult Developmental Coordination Disorder (DCD) is increasingly being acknowledged by clinicians. However, no research to date has explored the nature of fatigue experienced by adults with this disorder. Purpose: This paper aimed to examine fatigue in adult DCD within the context of a range of psychosocial measures such as mood and everyday functioning. Adults with DCD were compared to a group of adults with Chronic Fatigue Syndrome (CFS) and a typically developing/ non-fatigued group. Method: Fifty-three adults with DCD, 84 with CFS and 52 typically developing/ non-CFS adults completed a range of established psychometric measures via an online data collection tool. Results: Findings demonstrated clear differences between the DCD and typically developing/ non-fatigued group for all measures administered, including fatigue (p < 0.001). When compared to the CFS group, adults with DCD showed significantly lower levels of cognitive difficulties (p < 0.05), fatigue (p < 0.001), somatic symptoms (p < 0.001), and total symptoms (p < 0.001). However, no significant differences were found between the DCD and CFS groups in terms of anxiety, depression, cognitive failures, negative and positive affect, and self-esteem. Conclusions: Of particular importance in the current study was the capture of data that corroborated anecdotal evidence of heightened levels of fatigue in adults with DCD along with elevated symptomatology for depression, anxiety, and low self-esteem and difficulties with respect to cognitive functioning and restorative sleep."
 * Article commentary - The importance of a research case definition"Abstract - All scientific activities with diseases rely on the selection of reliable and valid case definitions in order to accurately estimate prevalence rates, to identify biological markers, and to understand the outcomes of treatment trials. The failure to develop a consensus on which research case definition to use for defining Myalgic Encephalomyelitis (ME) and chronic fatigue syndrome (CFS) has had negative consequences for the scientific and patient community. If case definition criteria inappropriately select patients with symptoms due to primary affective disorders, other fatiguing medical conditions, burnout, or over-committed lifestyle issues, the scientific consequences are serious. For example, a case definition that is too broad would include individuals with other illnesses and conditions, complicating the tasks of estimating prevalence rates or identifying effective treatment programs. A consensus on a research case definition and its operationalization and assessment would enable investigators to select more homogenous samples that could expedite the identification of valid biological markers, and consequently reduce misperceptions regarding the role of psychogenic versus biomedical factors. Our editorial reviews the implications of previous research and clinical case definitions in CFS and ME domains."
 * Letter to the editor - Frank Twisk
 * Letter to the editor - Simon Wessely & Michael Sharpe