Natural history of severe Chronic Fatigue Syndrome (CFS)
September 15, 1999
OBJECTIVE: To evaluate the natural history of chronic fatigue
syndrome (CFS) in a severely ill group of patients at three
points in time.
DESIGN: Patients were enrolled from April 1992
to February 1994 and were evaluated three times. Time 1 (at
enrollment): history, physical evaluation, and psychiatric
evaluation; Time 2 (median = 1.6yrs after initial evaluation):
postal questionnaire to assess current condition; Time 3
(median = 1.8 yrs after Time 2): medical and psychiatric
SETTING: The New Jersey CFS Cooperative Research
Center, an ambulatory setting.
PATIENTS: Twenty-three patients
fulfilled the 1988 case definition for CFS and had symptom
complaints that were substantial or worse in severity. All
patients were ill less than 4.5 years; and none had a
DSM-III-R psychiatric disorder in the 5 years before illness
onset; none had substance abuse in the 10 years before
MAIN OUTCOME MEASURES: Severity of CFS symptoms
was assessed by self-report questionnaires, laboratory tests,
and medical examination. Psychological status was assessed
using the Q-D15 and the Centers for Epidemiological
Study-Depression Scale. At each time of evaluation, patients
were categorized as severe, slightly improved, improved, and
RESULTS: Over the 4 years of the study, 13 patients
remained severely ill, 9 improved but still fulfilled the 1994
case definition for CFS, and 1 recovered. Illness duration,
mode of onset, psychiatric status or depressed mood at intake,
or chemical sensitivity did not predict illness outcome. One
patient was diagnosed with an alternate illness, but it
probably did not explain her CFS symptoms. Mood improved for
those patients whose illness lessened.
prognosis for recovery was extremely poor for the severely ill
subset of CFS patients. The majority showed no symptom
improvement and only 4% of the patients recovered. Illness
severity between Times 2 and 3 remained stable.
Hill NF, Tiersky LA, Scavalla VR, Lavietes M, Natelson BH
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