In on-going appreciation of tomk - advocate extraordinairre
Dr. Marc-Alexander Fluks posted this to co-cure Mar 20 2010
(if: in reading yet another of tomk's letters to the editor, I was struck, yet again, by how much Tom contributes to advocacy for ME/CFS. And how he has been consistently doing so for years. And now is expanding his horizons to include well-referenced, balanced letters to editors.
I have brain envy. And a deep respect for all that he does for us. I wish I could follow more closely in his footsteps. I believe that well-written articles/letters of the nature that he contributes do so much for us and the profile of ME/CFS in the medical world and general media.
And now that I'm sure I've embarrassed Tom :innocent1: - you can take a look at this latest addition to his oeuvre.)
Source: Psychological Medicine
Vol. 40, #2, page 352
Date: February 2010
URL: http://journals.cambridge.org/action/displayJournal?jid=PSM
http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=7018864
Stratification using biological factors should be performed in more CFS studies.
-----------------------------------------------------------------------
Kindlon T.
Letter to the Editor:
The careful work of Roberts and colleagues (2009), in examining possible predictors in the response of Chronic Fatigue Syndrome (CFS) patients to Cognitive Behavioural Therapy (CBT), is to be welcomed. The results are consistent with findings reported by Jason et al. (2007). In a study of four non-pharmacological interventions (including CBT), they found that those with abnormal cortisol at the baseline did not improve over time, while those with normal baseline cortisol recorded positive outcomes on a number of immunologic and self-report measures [cortisol levels were considered abnormal if they continued to rise, were flat, or were at abnormally low over time].
More recently, Jason et al. (2008) reported that baseline measures including immune function, as well as activity levels, sleep status and past psychiatric diagnosis significantly differentiated those participants who demonstrated positive change over time from those who did not. Those with a dominance of the Type 2 over the Type 1 immune response, as indicated by the patterns of lymphocyte subset distributions among those with CFS, did not improve over time.
Roberts et al. (2009) state that "no studies have yet looked at whether there might be any biological factors that predict preferential response to CBT in CFS." However in 1991, Butler et al. found that there was a trend for patients positive for VP1 (a specific enteroviral antigen) to do worse, although this did not reach conventional statistical significance (Fisher's exact = 0.08). Lane et al. (2003) found an association between abnormal lactate response to exercise, reflecting impaired muscle energy metabolism, and the presence of enterovirus sequences in muscle in a proportion of CFS patients, providing a possible reason for the disappointing results for some patients from CBT programmes which are focused on increasing activity.
It is generally acknowledged that CFS covers a heterogeneous population (Jason et al., 2005). More research is required to elucidate the factors underlying neuroendocrine dysregulation in CFS, and to ascertain what treatment modalities may improve outcomes in individuals with evidence of endocrine and immunological abnormalities.
Tom Kindlon
References:
Butler S, Chalder T, Ron M, Wessely S (1991).
Cognitive behaviour therapy in chronic fatigue syndrome.
Journal of Neurology, Neurosurgery and Psychiatry 54, 153-158.
Jason LA, Corradi K, Torres-Harding S, Taylor RR, & King C (2005).
Chronic fatigue syndrome: The need for subtypes. Neuropsychology Review 15, 29-58.
Jason LA, Torres-Harding S, Maher K, Reynolds N, Brown M, Sorenson M, Donalek J, Corradi K, Fletcher MA, & Lu T (2007). Baseline cortisol levels predict treatment outcomes in chronic fatigue syndrome.
Journal of Chronic Fatigue Syndrome 14, 4, 39-59.
Jason LA, Torres-Harding S, Brown M, Sorenson M, Julie D, Corradi K, Maher K, Fletcher MA (2008).
Predictors of change following participation in non-pharmacologic interventions for CFS.
Tropical Medicine and Health 36, 23-32
Lane RJ, Soteriou BA, Zhang H, Archard LC (2003). Enterovirus
related metabolic myopathy: a postviral fatigue syndrome. Journal of Neurology, Neurosurgery and Psychiatry. 4(10):1382-6
Roberts AD, Charler ML, Papadopoulos A, Wessely S, Chalder T,
Cleare AJ (2009).
Does hypocortisolism predict a poor response to
cognitive behavioural therapy in chronic fatigue syndrome?
Psychological Medicine. Jul 17:1-8.
--------
(c) 2010 Cambridge University Press
Dr. Marc-Alexander Fluks posted this to co-cure Mar 20 2010
(if: in reading yet another of tomk's letters to the editor, I was struck, yet again, by how much Tom contributes to advocacy for ME/CFS. And how he has been consistently doing so for years. And now is expanding his horizons to include well-referenced, balanced letters to editors.
I have brain envy. And a deep respect for all that he does for us. I wish I could follow more closely in his footsteps. I believe that well-written articles/letters of the nature that he contributes do so much for us and the profile of ME/CFS in the medical world and general media.
And now that I'm sure I've embarrassed Tom :innocent1: - you can take a look at this latest addition to his oeuvre.)
Source: Psychological Medicine
Vol. 40, #2, page 352
Date: February 2010
URL: http://journals.cambridge.org/action/displayJournal?jid=PSM
http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=7018864
Stratification using biological factors should be performed in more CFS studies.
-----------------------------------------------------------------------
Kindlon T.
Letter to the Editor:
The careful work of Roberts and colleagues (2009), in examining possible predictors in the response of Chronic Fatigue Syndrome (CFS) patients to Cognitive Behavioural Therapy (CBT), is to be welcomed. The results are consistent with findings reported by Jason et al. (2007). In a study of four non-pharmacological interventions (including CBT), they found that those with abnormal cortisol at the baseline did not improve over time, while those with normal baseline cortisol recorded positive outcomes on a number of immunologic and self-report measures [cortisol levels were considered abnormal if they continued to rise, were flat, or were at abnormally low over time].
More recently, Jason et al. (2008) reported that baseline measures including immune function, as well as activity levels, sleep status and past psychiatric diagnosis significantly differentiated those participants who demonstrated positive change over time from those who did not. Those with a dominance of the Type 2 over the Type 1 immune response, as indicated by the patterns of lymphocyte subset distributions among those with CFS, did not improve over time.
Roberts et al. (2009) state that "no studies have yet looked at whether there might be any biological factors that predict preferential response to CBT in CFS." However in 1991, Butler et al. found that there was a trend for patients positive for VP1 (a specific enteroviral antigen) to do worse, although this did not reach conventional statistical significance (Fisher's exact = 0.08). Lane et al. (2003) found an association between abnormal lactate response to exercise, reflecting impaired muscle energy metabolism, and the presence of enterovirus sequences in muscle in a proportion of CFS patients, providing a possible reason for the disappointing results for some patients from CBT programmes which are focused on increasing activity.
It is generally acknowledged that CFS covers a heterogeneous population (Jason et al., 2005). More research is required to elucidate the factors underlying neuroendocrine dysregulation in CFS, and to ascertain what treatment modalities may improve outcomes in individuals with evidence of endocrine and immunological abnormalities.
Tom Kindlon
References:
Butler S, Chalder T, Ron M, Wessely S (1991).
Cognitive behaviour therapy in chronic fatigue syndrome.
Journal of Neurology, Neurosurgery and Psychiatry 54, 153-158.
Jason LA, Corradi K, Torres-Harding S, Taylor RR, & King C (2005).
Chronic fatigue syndrome: The need for subtypes. Neuropsychology Review 15, 29-58.
Jason LA, Torres-Harding S, Maher K, Reynolds N, Brown M, Sorenson M, Donalek J, Corradi K, Fletcher MA, & Lu T (2007). Baseline cortisol levels predict treatment outcomes in chronic fatigue syndrome.
Journal of Chronic Fatigue Syndrome 14, 4, 39-59.
Jason LA, Torres-Harding S, Brown M, Sorenson M, Julie D, Corradi K, Maher K, Fletcher MA (2008).
Predictors of change following participation in non-pharmacologic interventions for CFS.
Tropical Medicine and Health 36, 23-32
Lane RJ, Soteriou BA, Zhang H, Archard LC (2003). Enterovirus
related metabolic myopathy: a postviral fatigue syndrome. Journal of Neurology, Neurosurgery and Psychiatry. 4(10):1382-6
Roberts AD, Charler ML, Papadopoulos A, Wessely S, Chalder T,
Cleare AJ (2009).
Does hypocortisolism predict a poor response to
cognitive behavioural therapy in chronic fatigue syndrome?
Psychological Medicine. Jul 17:1-8.
--------
(c) 2010 Cambridge University Press
