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Predictions & associations of fatigue syndromes & mood disorders post IM (White et al, 2001)

Tom Kindlon

Senior Member
Messages
1,734
I'm not a great fan of this paper - I'm posting it to post the comment in messages #2 & #3.
Lancet. 2001 Dec 8;358(9297):1946-54.

Predictions and associations of fatigue syndromes and mood disorders that occur after infectious mononucleosis.

White PD1, Thomas JM, Kangro HO, Bruce-Jones WD, Amess J, Crawford DH, Grover SA, Clare AW.

Author information

Abstract

BACKGROUND:

Certain infections can trigger chronic fatigue syndromes (CFS) in a minority of people infected, but the reason is unknown.

We describe some factors that predict or are associated with prolonged fatigue after infectious mononucleosis and contrast these factors with those that predicted mood disorders after the same infection.

METHODS:

We prospectively studied a cohort of 250 primary-care patients with infectious mononucleosis or ordinary upper-respiratory-tract infections until 6 months after clinical onset.

We sought predictors of both acute and chronic fatigue syndromes and mood disorders from clinical, laboratory, and psychosocial measures.

FINDINGS:

An empirically defined fatigue syndrome 6 months after onset, which excluded comorbid psychiatric disorders, was most reliably predicted by a positive Monospot test at onset (odds ratio 2.1 [95% CI 1.4-3.3]) and lower physical fitness (0.35 [0.15-0.8]).

Cervical lymphadenopathy and initial bed rest were associated with, or predicted, a fatigue syndrome up to 2 months after onset.

By contrast, mood disorders were predicted by a premorbid psychiatric history (2.3 [1.4-3.9]), an emotional personality score (1.21 [1.11-1.35]), and social adversity (1.7 [1.0-2.9]).

Definitions of CFS that included comorbid mood disorders were predicted by a mixture of those factors that predicted either the empirically definedfatigue syndrome or mood disorders.

INTERPRETATION:

The predictors of a prolonged fatigue syndrome after an infection differ with both definition and time, depending particularly on the presence or absence of comorbid mood disorders.

The particular infection and its consequent immune reaction may have an early role, but physical deconditioning may also be important. By contrast, mood disorders are predicted by factors that predict mood disorders in general.

PMID: 11747919 [PubMed - indexed for MEDLINE]
 

Tom Kindlon

Senior Member
Messages
1,734
(from a post to Co-Cure in 2008, but still relevant today)

Subject: Online Videos of the HHV-6 Conference June 2008 (including International Symposium on Viruses in CFS & Post-Viral Fatigue) and comment on Peter D White's claim at the conference that "prevention is better than cure" (for CFS)
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HHV-6 Foundation's Pubcasts and Videos (72 in total) can be found at: http://www.scivee.tv/user/5257/video

A lot of them are not to do with CFS specifically but there are a good number which are.

I could not post this out without challenging PD White's claim at the conference that "Prevention is better than Cure" http://www.scivee.tv/node/6895. The prevention can be summarised as getting people active soon after they had an infection.

It is presented in what at first glance can appear compelling, with fancy statistics to "back up" the claim.

I happen to have the paper in question [I bought it along with a series of papers last year when I wanted to know about Prof Anthony Clare (since deceased) a psychiatrist who was the main representative of those of the CBT/GET school of Thought with regard to CFS in the Rep. of Ireland. Nearly all of Prof Clare's papers on CFS were co-written with Peter D White so, along with reading other papers, I have become very familiar with Prof White's writings].

The paper presented is this paper:
"Predictions and associations of fatigue syndromes and mood disorders that occur after infectious mononucleosis. Lancet. 2001 Dec 8;358(9297):1946-54. White PD, Thomas JM, Kangro HO, Bruce-Jones WD, Amess J, Crawford DH, Grover SA, Clare AW. Department of Psychological Medicine, St Bartholomew's and the Royal London School of Medicine and Dentistry, London, UK. P.D."

Unfortunately it is not online.

Anyway I'm appending how "physical fitness" was assessed. I don't think one need to see the full paper to understand what was discussed, just watching the clip explains it.

It is important to point out, as I'm not sure how clear PDW makes it in the clip, that this wasn't a measure of pre-existing fitness - they could only contact the patients after they knew they were sick. On average, it was one month after the infection. (So the people who were still sick at sick months could in fact have been more fit)

As I pointed out in my comment (on another study PDW wrote) "Accumulating evidence that CFS patients were actually more active on average than controls before becoming ill" http://www.biomedcentral.com/1471-244X/6/53/comments , most of the evidence points to people who develop CFS having being more active than the general population before they became ill. So any suggestion that any preexisting lack of fitness is causing CFS is extremely questionable.

With regard to the exercise testing in the White et al (2001) study below, the first thing to bring up is that measuring the difference in pulse after an upright exercise test, in a cohort of patients who got ill with an infection on average one month earlier, may not be the best measure of their fitness at their time. The patients who develop CFS may have more extreme orthostatic issues so that that may be the reason why their pulse went up.

Secondly, you'll note that two measures have been measured "Exercise power" and "Fitness". In the paper, "exercise power" was not associated at a statistically significant level with the empirical fatigue syndrome, CFS (Oxford) or CDC CFS/ISF (which was merged for the study) although PDW does not mention that "exercise power" was not associated on the clip. (The scores are all less than 1 i.e. worse but none are statistically significant).

Thirdly, the people who go on to have the empirical fatigue syndrome/CFS CFS (Oxford) or CDC CFS/ISF (which was merged for the study) at six months may have worse scores because they're iller and/or they haven't gotten over the infection and its effect. The Dubbo study found that the severity of the initial infection was the predictor of who has a post-infectious syndrome. It could well be the same in this case. This is a case of finding a correlation and jumping to a causation.

There was also no measuring of which patients did or did not try to move so again the 2001 study did not prove that doctors should mobilise their patients soon after an infection and that this will prevent them developing CFS.

Overall, the talk may be another example that if one wants to "prevent" an audience being exposed to a one-sided presentation of data that promotes GET as the treatment for CFS patients, the "cure" may be not to have somebody like Peter White as a speaker or to make sure he can be challenged.

Survey after survey have found that people with ME have been made worse by exercise programs so the issue of people who promote exercise programs without warnings is an important issue for the ME and CFS community. In medicine generally, interventions such as drugs and surgical procedures come with warnings - why should exercise in ME/CFS be any different and why should "risk-benefit" assessments not be undertaken before an intervention is promoted? And why should there not be a "yellow card" system so that patients, who have been made worse by exercise, can report it?

Tom Kindlon

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"Predictions and associations of fatigue syndromes and mood disorders that occur after infectious mononucleosis. Lancet. 2001 Dec 8;358(9297):1946-54. White PD, Thomas JM, Kangro HO, Bruce-Jones WD, Amess J, Crawford DH, Grover SA, Clare AW. Department of Psychological Medicine, St Bartholomew's and the Royal London School of Medicine and Dentistry, London, UK. P.D. [log in to unmask]"

"All participants completed an assessment of their exercise work capacity and cardiovascular response to exercise at each interview. Because all participants were recovering from infection, we did not use a robust measure of aerobic fitness, validated on people without infections. Instead, we modified a 1 min step test, which was designed to measure fitness in untrained young women. 25 The participant's resting pulse rate was measured after at least 1 h sitting down, just before the exercise. Participants were then asked to walk up and down a flight of nine standard stairs (each of height 0.18 m) at a reasonable but not fixed pace, for 1 min. The pulse rate was measured 30 s after completion of exercise; the recording took 20 s. We calculated power output as the number of stairs climbed, multiplied by the height of each stair, and the participant's weight. The cardiovascular response to exercise was calculated as the difference between the resting and postexercise pulse rates (exercise pulse-rate difference), in case the postexercise pulse rate (which would normally be used) was raised partly because of the systemic effects of the infection. A measure of physical fitness was calculated by dividing the number of stairs climbed by the exercise pulse-rate difference."
 
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Messages
13,774
Also, that video is mentioned in this thread: http://forums.phoenixrising.me/inde...o-educational-intervention-to-aid-reco.13326/

At around 14:00 White is talking about a study which shows a 'huge effect size' for encouraging patients to get back to normal activity post glandular fever. He doesn't mention that, at 12 months, the difference between intervention and control (no therapist time) groups is not statistically significant.