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Psychological symptoms, somatic symptoms, & psychiatric disorder in chronic fatigue & CFS: a prospective study in the primary care setting

  [ 41 votes ]   [ Discuss This Article ]
www.ProHealth.com • August 12, 1996


OBJECTIVE: This study assessed relationships among psychological
symptoms, past and current psychiatric disorder, functional
impairment, somatic symptoms, chronic fatigue, and chronic
fatigue syndrome.

METHOD: A prospective cohort study [of pts
that presented to primary care physicians for a possible viral
episode or other medical complaint but *not* for a primary
complaint of fatigue - MCM] was followed by a nested
case-control study. The subjects, aged 18-45 years, had been
in primary care for either clinical viral infections or a
range of other problems. Questionnaire measures of fatigue and
psychological symptoms were completed by 1,985 subjects 6
months later; 214 subjects with chronic fatigue were then
compared with 214 matched subjects without fatigue.
Assessments were made with questionnaires, interviews, and
medical records of fatigue, somatic symptoms, psychiatric
disorder, and functional impairment.

RESULTS: Subjects with
chronic fatigue were at greater risk than those without
chronic fatigue for current psychiatric disorder assessed by
standardized interview (60% versus 19%) or by questionnaire
(71% versus 31%). [CFS pts had incidence of probable
depression of 44% and definite of 28% when fatigue criterion
for depression was excluded - MCM.]Chronic fatigue subjects
were more likely to have received psychotropic medication or
experienced psychiatric disorder in the past. There was a
trend for previous psychiatric disorder to be associated with
comorbid rather than noncomorbid chronic fatigue. Most
subjects with chronic fatigue syndrome also had current
psychiatric disorder when assessed by interview (75%) or
questionnaire (78%). Both the prevalence and incidence of
chronic fatigue syndrome were associated with measures of
previous psychiatric disorder. The number of symptoms
suggested as characteristics of chronic fatigue syndrome was
closely related to the total number of somatic symptoms and to
measures of psychiatric disorder. Only postexertion malaise,
muscle weakness, and myalgia were significantly more likely to
be observed in chronic fatigue syndrome than in chronic
fatigue.

CONCLUSIONS: Most subjects with chronic fatigue or
chronic fatigue syndrome in primary care also meet criteria
for a current psychiatric disorder. Both chronic fatigue and
chronic fatigue syndrome are associated with previous
psychiatric disorder, partly explained by high rates of
current psychiatric disorder. The symptoms thought to
represent a specific process in chronic fatigue syndrome may
be related to the joint experience of somatic and
psychological distress.

Wessely S, Chalder T, Hirsch S, Wallace P, Wright D




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