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Longitudinal study of glandular fever and CFS

Jenny

Jenny

Senior Member
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Dorset
http://journals.cambridge.org/abstract_S003329171000139X

The pathway from glandular fever to chronic fatigue syndrome: can the cognitive behavioural model provide the map?
R. Moss-Morrisa1 c1, M. J. Spencea2 and R. Houa3
a1 School of Psychology, University of Southampton, UK
a2 Psychological Medicine, The University of Auckland, New Zealand
a3 School of Medicine, University of Southampton, UK
Abstract
Background The cognitive behavioural model of chronic fatigue syndrome (CFS) suggests that the illness is caused through reciprocal interactions between physiology, cognition, emotion and behaviour. The purpose of this study was to investigate whether the psychological factors operationalized in this model could predict the onset of CFS following an acute episode of infectious mononucleosis commonly known as glandular fever (GF).
Method A total of 246 patients with GF were recruited into this prospective cohort study. Standardized self-report measures of perceived stress, perfectionism, somatization, mood, illness beliefs and behaviour were completed at the time of their acute illness. Follow-up questionnaires determined the incidence of new-onset chronic fatigue (CF) at 3 months and CFS at 6 months post-infection.
Results Of the participants, 9.4% met the criteria for CF at 3 months and 7.8% met the criteria for CFS at 6 months. Logistic regression revealed that factors proposed to predispose people to CFS including anxiety, depression, somatization and perfectionism were associated with new-onset CFS. Negative illness beliefs including perceiving GF to be a serious, distressing condition, that will last a long time and is uncontrollable, and responding to symptoms in an all-or-nothing behavioural pattern were also significant predictors. All-or-nothing behaviour was the most significant predictor of CFS at 6 months. Perceived stress and consistently limiting activity at the time of GF were not significantly associated with CFS.
Conclusions The findings from this study provide support for the cognitive behavioural model and a good basis for developing prevention and early intervention strategies for CFS.

Can anyone access the full paper?

Interesting that Moss-Morris is now at the Institute of Psychiatry, Kings College London

Jenny
 
Esther12

Esther12

Senior Member
Messages
13,774
There's discussion and long quotes here: http://forums.phoenixrising.me/show...ever-to-CFS-can-the-CBT-model-provide-the-map

There's also this different paper that I came upon when I searched the forums, and makes different findings which I thought I'd include for balance:


Lloyd Hickie et al 2006 Post-infective and chronic fatigue syndromes

Post-infective and chronic fatigue syndromes precipitated by viral and non-viral pathogens: prospective cohort study
Ian Hickie, Tracey Davenport, Denis Wakefield, Ute Vollmer-Conna, Barbara Cameron, Suzanne D Vernon, William C Reeves, Andrew Lloyd, for the Dubbo Infection Outcomes Study Group

Objective. To delineate the risk factors, symptom patterns, and longitudinal course of prolonged illnesses after a variety of acute infections.

Design. Prospective cohort study following patients from the time of acute infection with Epstein-Barr virus (glandular fever), Coxiella burnetii (Q fever), or Ross River virus (epidemic polyarthritis).

Setting. The region surrounding the township of Dubbo in rural Australia, encompassing a 200 km geographical radius and 104 400 residents.

Participants. 253 patients enrolled and followed at regular intervals over 12 months by self report, structured interview, and clinical assessment.

Outcome measures. Detailed medical, psychiatric, and laboratory evaluations at six months to apply diagnostic criteria for chronic fatigue syndrome. Premorbid and intercurrent illness characteristics recorded to define risk factors for chronic fatigue syndrome. Self reported illness phenotypes compared between infective groups.

Results. Prolonged illness characterised by disabling fatigue, musculoskeletal pain, neurocognitive difficulties, and mood disturbance was evident in 29 (12%) of 253 participants at six months, of whom 28 (11%) met the diagnostic criteria for chronic fatigue syndrome. This post-infective fatigue syndrome phenotype was stereotyped and occurred at a similar incidence after each infection. The syndrome was predicted largely by the severity of the acute illness rather than by demographic,
psychological, or microbiological factors.

Conclusions. A relatively uniform post-infective fatigue syndrome persists in a significant minority of patients for six months or more after clinical infection with several different viral and non-viral micro-organisms. Post-infective fatigue syndrome is a valid illness model for investigating one pathophysiological pathway to chronic fatigue syndrome.
 
Jenny

Jenny

Senior Member
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Location
Dorset
Thanks Esther - I hadn't realised there was a previous thread on this. I'd thought it was a newish paper as it was only published in the print edition of the journal in July 2011, but people had picked up the on-line version last year.

As someone suggested in the previous thread, it would be good if someone felt up to writing a response as there are lots of contentious issues.

Jenny
 
Esther12

Esther12

Senior Member
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13,774
Jenny said:
Thanks Esther - I hadn't realised there was a previous thread on this.
Click to expand...

No probs. I thought this paper seemed familiar... but had totally forgotten all of my own posts about it. I'm outsourcing my memory to this forum, and it's much more reliable that way.
 
Vitalic

Vitalic

Messages
180
Loved this quote from the thread you linked:

I find it rather stressful trying to stay clear headed while questioning my own sanity.
Click to expand...

So it looks like they used a Oxford/Fukuda hybrid, which is pretty much what I suspected.
 
Esther12

Esther12

Senior Member
Messages
13,774
Vitalic said:
Loved this quote from the thread you linked:
Click to expand...

Yeah - just today I've had some unreasonable anxiety after a slight mix up, with a doctor's secretary making a couple of mistakes.

It's weird knowing that, as I've got a CFS diagnosis, if the secretary comes up with some weird excuse which makes me look crazy, lots of doctors would believe it. It does seem that, with a CFS diagnosis, people are much more willing to assume the worst, and that can be stressful.
 
Tony Mach

Tony Mach

Show me the evidence.
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Upper Palatinate, Bavaria
From the Hickie et al 2006 study:
Esther12 said:
The syndrome was predicted largely by the severity of the acute illness rather than by demographic, psychological, or microbiological factors.
Click to expand...

And what do psychiatrists make out of this in their Moss-Morris et al 2011 study?
Jenny said:
Negative illness beliefs including perceiving GF to be a serious, distressing condition, that will last a long time and is uncontrollable, and responding to symptoms in an all-or-nothing behavioural pattern were also significant predictors.
Click to expand...

Confirmation bias at its worst. These psychiatrists look for mental illness, sorry, I mean psychiatric problems, and lo and behold, they find them. Of cause, if GF (EBV) hits someone harder they obviously believe it to be "a serious, distressing condition" DUH! You fail at science forever! These psychiatrist are clowns, and I wonder why they are taken seriously in medicine.

And of those 246 tested by the psychiatrists, only half about percent 1 or 2 patients (!) go on to develop ME/CFS. So what is the significance of this study for someone with ME/CFS? None, I would say.
 
Vitalic

Vitalic

Messages
180
Tony Mach said:
From the Hickie et al 2006 study:


And what do psychiatrists make out of this in their Moss-Morris et al 2011 study?


Confirmation bias at its worst. These psychiatrists look for mental illness, sorry, I mean psychiatric problems, and lo and behold, they find them. Of cause, if GF (EBV) hits someone harder they obviously believe it to be "a serious, distressing condition" DUH! You fail at science forever! These psychiatrist are clowns, and I wonder why they are taken seriously in medicine.

And of those 246 tested by the psychiatrists, only half about percent 1 or 2 patients (!) go on to develop ME/CFS. So what is the significance of this study for someone with ME/CFS? None, I would say.
Click to expand...

How did you derive the figure half a percent? They quoted 7.8% at 6 months but of course that was using Oxford criteria so we can assume it would be much lower if they had used Canadian or ICC definitions but I'm interested to know what the typical reduction in cases would be.
 
ixchelkali

ixchelkali

Senior Member
Messages
1,107
Location
Long Beach, CA
The point is that it doesn't matter that it's another crap study with a design that ensures its outcome, using a nonspecific case definition (Oxford) and circular self-references: it's been published, so now they will use it to refute the findings of the Dubbo study whenever they're mentioned. Now they can say that while the Dubbo study found that no psychological profile was predictive of developing post-viral CFS and that severity of the initial infection was the only predictor, these findings were not supported by subsequent studies, blah, blah. Or that the findings of the Dubbo study are "controversial." Same old fertilizer. Why change tactics when it works so well?

Isn't it just amazing how well their finding supported their initial hypothesis? Poor neurotic overachievers...
 
A

anni66

mum to ME daughter
Messages
563
Location
scotland
Sadly this will be used to augment the push in NICE guidelines to effectively classify CFS/ME as a mental illness. I don' t think the timing is accidental. It perpetuates use of the psychosocial model to ensure its relevance in UK is maintained. ( Just as international research offers concrete alternative suggestions) Clearly with the peer review parameters here , you need to sing from a particular songsheet to further your career.
 
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