Fatigue: Biomedicine, Health & Behavior - Volume 8, Issue 2, 2020

Titles and abstracts for the journal, Fatigue: Biomedicine, Health & Behavior, Volume 8, Issue 2, 2020.

Volume 8, Issue 2, 2020

• Post-viral fatigue and COVID-19: lessons from past epidemics

  Abstract - The COVID-19 pandemic, resulting from Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), has severely impacted the population worldwide with a great mortality rate. The current article reviews the literature on short- and long-term health consequences of prior epidemics and infections to assess potential health complications that may be associated with post-COVID-19 recovery. Past research on post-epidemic and post-infection recovery has suggested that such complications include the development of severe fatigue. Certain factors, such as the severity of infection, in addition to the ‘cytokine storm’ experienced by many COVID-19 patients, may contribute to the development of later health problems. We suggest that the patterns observed in past epidemics and infections may re-occur in the current COVID-19 pandemic. - (Full text)

• Myalgic Encephalomyelitis (ME) outbreaks can be modelled as an infectious disease: a mathematical reconsideration of the Royal Free Epidemic of 1955

  Abstract - In 1970, two clinicians, McEvedy and Beard [McEvedy CP, Beard AW (1970) Royal Free Epidemic of 1955: A Reconsideration The British Medical Journal 1: No. 5687: 7-11] re-analysed some of the case notes, and hypothesised that the Royal Free outbreak was epidemic hysteria. This hypothesis was the beginning of an entrenched belief that the disease at the Royal Free, and similar cluster outbreaks, were psychosomatic. This was to have a profound effect on the interpretation of the same illness for nearly 50 years as a presumptive psychosomatic, an interpretation that has lasted nearly 50 years. Methods: The 1927 Susceptible Infected Recovered (SIR) mathematical model [Kermack WO, McKendrick AG. Contribution to the mathematical theory of epidemics. Proc Royal Soc London. 1927;772:701–721] for the transmission of disease has been used to examine the published admission data from the Royal Free Hospital. for the purpose of finding out if the disease had the characteristics of a contagious disease. Similar cluster outbreaks have also been modelled to assess whether they have similar characteristics to the Royal Free outbreak. Results: Using the 1927 Susceptible Infected Recovered (SIR) model [Kermack WO, McKendrick AG. Contribution to the mathematical theory of epidemics. Proc Royal Soc London. 1927;772:701–721] for the transmission of disease, we show that the epidemic of a disease of an unknown aetiology at the Royal Free Hospital in 1955, and other similar twentieth-century outbreaks, have the characteristics of a communicable disease. The disease causing the Royal Free outbreak was given the name ‘Benign Myalgic Encephalomyelitis' by Acheson [A new clinical entity? Lancet. 1956;1:789–790] in 1956, now identified as ME. Conclusions: By showing that the Royal Free and other ME attributed outbreaks fit the SIR disease model, we demonstrate that the McEvedy and Beard hysteria hypothesis is mathematically incorrect. The ensuing management of the treatment of ME/CFS-like conditions evolving from that, now mathematically improbable belief may need to be re-evaluated.

• Patient experiences and the psychosocial benefits of group aquatic exercise to reduce symptoms of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: a pilot study

  Abstract - Background: The aim of the study was to explore the experiences of participants in a short aquatic exercise programme for individuals with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, and to gain insight into the perceived psychosocial benefits. Methods: The exercise programme was of five-weeks duration, with two self-paced aquatic sessions per week. Eleven female participants (mean age 54.8 ± 12.4 yr) reported the onset and changes (24–48 h) in post-exercise fatigue, pain and other symptoms after each session, and completed a post-intervention interview comprising nine open-ended questions, with additional discussions. The reported symptoms and interview responses were entered into a spreadsheet, grouped and coded to identify the themes and subthemes. Results: The main themes were ‘symptoms’, ‘benefits’, ‘engagement and compliance’, and ‘limitations’. The analysis found that group aquatic exercises reduced social isolation through shared experiences and enhanced support; were beneficial and enjoyable without exacerbating symptoms; were preferable to other modes of exercise; and were seen as a long-term exercise option. Participants reported a reduction in pain, fatigue and anxiety after the intervention. Conclusions: Psychosocial benefits suggest that self-paced group aquatic exercise is a safe, enjoyable and effective mode of exercise rehabilitation for people with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.

• Solving the ME/CFS criteria and name conundrum: the aftermath of IOM

  Abstract - In 2015, the Institute of Medicine (IOM) proposed a new name and set of clinical criteria for what had previously been referred to as Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). This committee recommended the adoption of the term systemic exertion intolerance disease (SEID) and clinical criteria that required specific symptoms such as post-exertional malaise and unrefreshing sleep. This article reviews efforts to evaluate the revised criteria as well as reactions to the new criteria and name. Since these recommendations have been made, the proposed name change has not been widely adopted by the scientific or patient community. Even though the IOM’s proposed criteria were intended to be a clinical rather than a research case definition, over the past few years, an increasing number of studies have employed these criteria for research purposes. One unwitting consequence of the IOM criteria, which excludes few other illnesses, is the broadening of the number of individuals who are diagnosed and included in research studies. There is still a need to implement the IOM’s recommendation to form a multidisciplinary committee to review research and policy changes following the release of the new criteria. We conclude by presenting a possible roadmap for overcoming barriers in order to make progress on developing a consensus for a name and criteria.

• Psychological distress among postural tachycardia syndrome patients in the Fennell Crisis phase

  Abstract - Postural tachycardia syndrome (POTS) is a chronic illness that disrupts the autonomic nervous system and decreases quality of life. The Fennell Phase Inventory is a developmental instrument that divides the experience of chronic illness into four phases: Crisis, Stabilization, Resolution, and Integration. This study applied the Fennell Phase Inventory to POTS patients. Methods: 360 women with a primary diagnosis of POTS completed the World Health Organization Quality of Life BREF scale, Fennell Phase Inventory, Beck Depression Inventory-II, Beck Hopelessness Scale, Interpersonal Needs Questionnaire-15, Ten Item Personality Inventory, and the Suicide Behaviors Questionnaire-Revised. Results: Among these POTS patients, 35.8% were in the Fennell Crisis phase, 14.7% Stabilization, 46.7% Resolution, and 2.8% were in the Integration phase. One-way analyses of variance showed significant differences between the four Fennell groups on Overall Quality of Life, Physical Health, Psychological Health, Social Health, Depression, Hopelessness, Thwarted Belongingness, and Perceived Burdensomeness. Post hoc tests revealed that the Crisis group was more distressed than the other three groups on nearly every symptom scale (p < .05), but that the Stabilization, Resolution, and Integration groups were statistically similar to each other. Conclusions: Nearly one-third of participants were in Crisis, a phase characterized by lower quality of life and significant psychological distress. Recognizing and addressing the concerns of POTS patients according to their current chronic illness phase may help decrease the overall trauma experienced by the patient and improve compliance to proposed treatment regimens.

cytokine storm an uncontrolled, sometimes life-threatening, excessive immune response, involving very high levels of proinflammatory cytokines and widespread tissue damage.

myalgic encephalomyelitis (M.E.) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

BMJ The BMJ (previously the British Medical Journal) is a weekly peer-reviewed medical journal.

somatic symptom disorder A psychiatric term to describe an alleged condition whereby a person's thoughts somehow cause physical symptoms. The actual existence of such a condition is highly controversial, due to a lack of scientific evidence. It is related to other psychiatric terms, such as "psychosomatic", "neurasthenia", and "hysteria". Older terms include "somatization", "somatoform disorder", and "conversion disorder". Such terms refer to a scientifically-unsupported theory that claims that a wide range of physical symptoms can be created by the human mind, a theory which has been criticized as "mind over matter" parapsychology, a pseudoscience.

National Academy of Medicine (NAM) - An American non-profit, non-governmental organization which provides expert advice to governmental agencies on issues relating to biomedical science, medicine and health. Formerly known as the Institute of Medicine (IOM).

National Academy of Medicine (NAM) - An American non-profit, non-governmental organization which provides expert advice to governmental agencies on issues relating to biomedical science, medicine and health. Formerly known as the Institute of Medicine (IOM).

systemic exertion intolerance disease (SEID) - A term for ME/CFS that aims to avoid the stigma associated with the term "chronic fatigue syndrome", while emphasizing the defining characteristic of post-exertional malaise (PEM). SEID was defined as part of the diagnostic criteria put together by the Institute of Medicine (IOM) report of 10 February 2015.

post-exertional malaise (PEM) - A notable exacerbation of symptoms brought on by small physical or cognitive exertions. PEM may be referred to as a "crash" or "collapse" and can last for days or weeks. Symptoms can include cognitive impairments, muscle pain, trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, and others.

tachycardia An unusually rapid heart beat. Can be caused by exercise or illness. A symptom of postural orthostatic tachycardia syndrome (POTS). (Learn more: www.heart.org)

postural orthostatic tachycardia syndrome (POTS) - A form of orthostatic intolerance where the cardinal symptom is excessive tachycardia due to changing position (e.g. from lying down to sitting up).