Adolescent chronic fatigue syndrome and somatoform disorders: A prospective clinical study

[Dolphin]

http://onlinelibrary.wiley.com/doi/10.1111/jpc.12653/abstract

Adolescent chronic fatigue syndrome and somatoform disorders: A prospective clinical study.

J Paediatr Child Health. 2014 Oct;50(10):775-81. doi: 10.1111/jpc.12653. Epub 2014 Jun 18.
Klineberg E1, Rushworth A, Bibby H, Bennett D, Steinbeck K, Towns S.
Author information

• 1Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia; Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.

Abstract
AIM:

To examine and compare the presenting characteristics and the change in the physical and psychosocial functioning of adolescents with chronic fatigue syndrome (CFS) or somatoform disorders who have received an adaptable multidisciplinary intervention over a 12-month period.

METHODS:

Fifty adolescents presenting to the Complex Adolescent Clinic at The Children's Hospital at Westmead, Sydney, Australia were assessed.

Their physical and psychosocial functioning was rated by the adolescents and their parents using the Child Health Questionnaire. Participants were assessed at baseline, 4 months and 12 months after initiating treatment.

Analyses examined whether diagnosis and/or illness precipitants were related to treatment outcome.

RESULTS:

Adolescents with both CFS and somatoform disorders demonstrated improvement in physical and psychosocial functioning over the first 4 months of treatment, sustained at 12-month follow-up.

A diagnosis of CFS was associated with poorer physical functioning over time and a trend towards a longer illness time course compared with somatoform disorder.

Adjustment for a physical precipitant reduced the association between diagnosis and physical functioning.

Those who had a physical precipitant to their illness had significantly poorer physical functioning over time than those who did not, regardless of diagnostic category.

Diagnosis and physical precipitant were not associated with psychosocial functioning.

CONCLUSIONS:

Improvement in adolescent physical and psychosocial functioning over time suggests that a multidisciplinary treatment model may be effective for varied complex medico-psychosocial presentations, irrespective of diagnosis and illness precipitant. Illness precipitant may have a greater influence on treatment outcome than diagnostic category.

© 2014 The Authors. Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

KEYWORDS:
adolescent; biopsychosocial approach; chronic fatigue; multidisciplinary treatment; rehabilitation; somatoform disorder

PMID:

24944088

[PubMed - in process]

 

[Dolphin]

The authors don't mention any biological research. They are very much into the psychobabble/biopsychosocial model.

From the introduction:

The very sentence:

Physical symptoms in which severity or duration are disproportionate to any identified organic factors imply a complex interplay of physical and psychosocial stressors.

Clinical experience suggests that a rehabilitative approach which aims to assist patients and their parents integrate biological and psychological elements of the symptoms is the preferred strategy as previous research has linked inflexible, medically focused illness beliefs to poorer outcomes. 17

In addition to these separate approaches, there is an argument that CFS and somatoform disorders are two manifestations which share underlying mechanisms.25,2

 

[Dolphin]

The results did not match the second of their predictions:

Hypotheses were that
(i) a multidisciplinary bio-psychosocial approach involving adolescents and their families/carers would result in improvement in physical and psychosocial functioning for adolescents diagnosed with CFS and somatoform disorders;
and
(ii) the improvement in functioning would not differ between these two diagnostic groups.

 

[Dolphin]

Intervention

The intervention was the adaptable, multi-modal approach of the multidisciplinary Complex Adolescent Clinic. 14 This was a family-centred, rehabilitative programme based on the Medical Family Therapy Model, 34 tailored to the specific needs of each adolescent, aiming to improve functioning, while containing the number of additional medical investigations undertaken.

Treatment involved a combination of medical monitoring, graded physical activity, individual counselling/cognitive behavioural therapy, family support/ therapy, occupational therapy and school liaison. A period of inpatient care may have been included providing more intensive physiotherapy, physical and psychological rehabilitation for those with significantly disabling symptoms or lacking progress with outpatient management. In the clinic, approximately 40% of the patients receive inpatient care, median length of 2 weeks. Outpatient review was initially weekly or fortnightly and then at increasingly longer intervals as functioning improved. The intervention lasted between 6 and 24 months. Figure 1 summarises the approach.

 

[Dolphin]

There were big differences in Figure 1 in terms of how the adolescent, mother and father rated the health of the adolescent.
The final figure for the Mother Report Physical Health Summary Scale was around 40 (out of 100).
The final figure for the Adolescent Report Physical Health Summary Scale was over 80 (out of 100).

I'm suspicious of the adolescent ratings. I think there is a possibility some might say they're well to get away. Alternatively, the therapy may have convinced them they were healthier than they really were.

 

[Dolphin]

Here's info on the diagnoses and precipitants, which the statistics showed influenced outcomes:

Thirty-six per cent (n=18) of participants were diagnosed with CFS. Other somatoform disorder diagnoses included pain disorder (n=13), undifferentiated somatoform disorder (n = 9), conversion disorder (n = 7), somatisation disorder (n = 1) and somatoform disorder not otherwise specified (n=2).

Fifty-six per cent of the adolescents (n=28) had a physical precipitant, such as glandular fever, tonsillitis, respiratory tract infection or an injury. Twenty-eight per cent (n=14) had a stress precipitant, such as a change in family circumstances or bullying at school. Three adolescents had other symptom triggers, such as symptoms worsening in association with the menstrual cycle. For 11 adolescents (22%), no clear precipitant was identified. Where both a stress and a physical precipitant were noted, adolescents were placed in both categories (n=5)

 

[Dolphin]

Summary of findings:

A diagnosis of CFS was associated with poorer parent-rated physical functioning over time when compared with adolescents diagnosed with a somatoform disorder. Those diagnosed with CFS tended to stay in treatment longer than those diagnosed with somatoform disorders. Adolescents whose illness had a physical precipitant had poorer physical functioning over time than those who did not, regardless of diagnostic category. Adjustment for a physical precipitant reduced the association between diagnosis and physical functioning, emphasising the importance of the precipitant.

 

[Esther12]

Thanks for Dolphin. I'd been meaning to look at this after seeing the abstract posted somewhere but the lack of a control group makes the whole thing so irritating.

Those who had a physical precipitant to their illness had significantly poorer physical functioning over time than those who did not, regardless of diagnostic category.

I did wonder if they'd see that as reason to target psychological therapies to those who report psychological problems... or if they'd present it as evidence of the harm done to patient's by their belief that their illness has a physical cause.

 

[Dolphin]

Those who had a physical precipitant to their illness had significantly poorer physical functioning over time than those who did not, regardless of diagnostic category.

I did wonder if they'd see that as reason to target psychological therapies to those who report psychological problems... or if they'd present it as evidence of the harm done to patient's by their belief that their illness has a physical cause.

Neither was mentioned, that I recall.

 

[Snow Leopard]

It is hard to conclude anything about the treatment of CFS compared to the other disorders as the data was not shown separately.

Secondly, the overall effect of the treatment for any patient is highly questionable, due to the large difference between parental and patient rating of scores, combined with the fact that no objective evidence of functioning was used.

In conclusion: no conclusion.

 

[Min]

So tbe whole thing is just waffle? I wonder how much it cost.

 

[Snow Leopard]

So tbe whole thing is just waffle? I wonder how much it cost.

The costs would have been much the same with or without the study, as these patients were studied as part of a regular treatment programme.

 

[Sean]

Adolescents whose illness had a physical precipitant had poorer physical functioning over time than those who did not, regardless of diagnostic category.

You'd think that would be a clue to the researchers, wouldn't you.

 

[Min]

The costs would have been much the same with or without the study, as these patients were studied as part of a regular treatment programme.

Well the 'researchers' must have received renumeration.