• Welcome to Phoenix Rising!

    Created in 2008, Phoenix Rising is the largest and oldest forum dedicated to furthering the understanding of and finding treatments for complex chronic illnesses such as chronic fatigue syndrome (ME/CFS), fibromyalgia (FM), long COVID, postural orthostatic tachycardia syndrome (POTS), mast cell activation syndrome (MCAS), and allied diseases.

    To become a member, simply click the Register button at the top right.

Bansal: Investigating unexplained fatigue in general practice with a particular focus on CFS/ME

Dolphin

Senior Member
Messages
17,567
The underlined bit might be useful for something. Pity about the preamble.

A family history of CFS/ME and certain personality traits are also noted to be increased in those with CFS/ ME including conscientiousness and high personal and parental expectations [48]. Ciccone et al. [49] while noting a higher prevalence of psychiatric illness and personality disorder in CFS/ME did not find any major correlation between these and levels of physical functioning and disability. More recently we have noted an increased frequency of CFS/ME symptoms in those with borderline personality disorder which has not hitherto been reported. Previous work has also suggested an increased prevalence of childhood physical, emotional and sexual abuse in those with idiopathic chronic fatigue and chronic fatigue associated with medical and psychiatric illness [50]. Borsnini et al. [51] have also confirmed childhood stressors to increase the possibility of subsequent CFS/ ME. We do not routinely explore this area in detail as it seldom helps to reduce the symptoms of CFS/ME but does have the possibility of aggravating matters by raising stress and anxiety levels. In some instances where the past impacts significantly on the present, referral to an appropriate psychologist may be helpful. However, patients are warned that there may be an initial deterioration in symptoms before any improvement.
 

Dolphin

Senior Member
Messages
17,567
Not sure I've heard this before. But doesn't seem to be very common anyway.
Early dementia can rarely present with chronic fatigue and the diagnosis can be very difficult. Two out of the two thousand patients seen in this service had early dementia presenting with fatigue as the main problem.
 

Dolphin

Senior Member
Messages
17,567
Sensible point:
Secondly, reports assessing the frequency of depression and anxiety in those with CFS/ME have investigated patients when the diagnosis has been established. By definition this can only be at least four months after the onset of symptoms. By this stage many patients are saddened and perplexed by their illness and it is not surprising that their mood is low and some will be depressed.
 

Dolphin

Senior Member
Messages
17,567
From: CFS/ME and depression section:

As mentioned previously care is required in the use of anti-depressant medication in those with CFS/ME. Thus many agents introduced in conventional dosage induce a state of tension and irritability with a worsening of the fatigue and headaches, increased difficulty sleeping and sometimes muscle twitching. Indeed if these symptoms develop in patients with depression when commenced on SSRI, SNRI or TCAs then an underlying CFS/ME should be suspected and investigated. Although these symptoms can also be seen in people without CFS/ME it is certainly more frequent and prolonged in those with CFS/ME. The mechanism is unclear but a pre-existing state of central nervous system hyperactivity may be aggravated by these agents that often work by inhibiting the reuptake of serotonin and noradrenalin. In some ways the adverse response suffered by CFS/ME patients is similar to a mild serotonin syndrome or in some cases an anti-cholinergic syndrome. Regardless, anti-depressants should be introduced very slowly in those with CFS/ME and probably commencing at a quarter of the lowest strength medication. They should then be increased every two weeks until a therapeutic level is reached although quite often this remains at the lower end of that needed for those without CFS/ ME.
 
Last edited:

Tom Kindlon

Senior Member
Messages
1,734
I just posted the following on PubMed Commons:

http://www.ncbi.nlm.nih.gov/pubmed/27436349#cm27436349_16660

Some information on an unpublished study on pupil responses:
Dr Bansal mentions he has observed unusual responses by the pupils to light. I thought I would highlight a study that was done in the late 1990s looking at this. Unfortunately the researcher passed away before it could be published. Perhaps there are better sources than these lay articles but I thought they might be of some use in the hope that the finding might be followed up again.

Eye test hope for ME sufferers

Jenny Hope

A new eye test can 'see' changes in the brain triggered by the crippling disease ME. The advance comes from a number of research projects that could lead to better treatments for the illness once ridiculed as 'yuppie flu'.

It gives fresh hope to an estimated 150,000 victims of chronic fatigue syndrome, which can leave those worst affected bedridden with pain, suffering short-term memory loss and unable to walk even short distances.

Scientists at the Royal Free Hospital and the City University in London have found a way to measure changes in the eyes of ME patients which may show they lack an important brain chemical.

A study by Dr Ian James and Professor John Barbur checked the pupils of 16 ME patients and 24 healthy individuals, using a computer to measure changes identified between the two groups.

They found patients with chronic fatigue had larger pupils and also had a stronger reaction to light and other stimuli. The changes could be linked to a deficiency of the brain chemical serotonin, which is known to occur in ME and is also linked to depression.

Professor John Hughes, chairman of the Chronic Fatigue Syndrome Research Foundation, said the research should make it possible to understand changes occurring in the brain of a sufferer.

This could help those studying the effect of different drugs and possibly help doctors diagnose CFS, he added.

At present there are no reliable tests, although a checklist of symptoms developed five years ago is being used by doctors worldwide.

BREAKTHROUGH FOR ME by Geraint Jones

For years, ME has been treated with suspicion by doctors. Many believe that for every genuine sufferer there is another who simply believes himself to be ill. Experts cannot agree on whether the condition is a physical illness or a psychological disorder which exists only in the victim's mind. One reason for this scepticism is that, as yet, no one has been able to provide an accurate diagnosis for ME, or myalgic encephalomyelitis, which is known to affect 150,000 people in Britain. There is no known cure and treatment is often based on antidepressant drugs like Prozae, with limited success.

All this may be about to change. Dr Ian James, consultant and reader in clinical pharmacology at London's Royal Free Hospital School of Medicine, believes that he has found a way of diagnosing the chronic fatigue syndrome and hopes to use it to develop a treatment programme. The breakthrough came after months of research spearheaded by Dr James and Professor John Barbur of London's City University. It centres round the discovery that the eyes of ME sufferers respond to light and motion stimuli in an unusual way.

"Several doctors treating ME patients noticed that they showed an abnormal pupil response", says Dr James. "When the pupil is subjected to changes in light, or is required to alter focus from a close object to one further away, it does so by constricting and dilating. ME patients' eyes do this as well but there is an initial period of instability when the pupil fluctuates in size".

Using a computerised "pupilometer", which precisely measures eye responses, Dr James embarked on a detailed study of this phenomenon on ME patients, using non-sufferers as a control. A variety of shapes were flashed on to a screen and moved across it, while a computer precisely measured pupil reflex to each of the 40 tests. Results confirmed that the pupil fluctuation was peculiar to those participants who suffered from ME.

Dr James concluded that the abnormal pupil response is a result of some kind of interference in the transfer of impulses from the brain to the eye. He believes that ME is the result of a deficiency of a neuro-transmitter called 5HT, whose job it is to pass impulses through nerves to cells. The eyes of ME sufferers treated with 5HT behave normally. "I do not yet know how the ME virus causes abnormalities in 5HT transmission but it does inhibit its function", says Dr James.
 

Tom Kindlon

Senior Member
Messages
1,734
Bansal criteria.png