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Can the Chronic Fatigue Syndrome (CFS) be defined by distinct clinical features?

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To determine whether patients diagnosed as having chronic fatigue
syndrome (CFS) constitute a clinically homogeneous class,
multivariate statistical analyses were used to derive symptom
patterns and potential patient subclasses in 565 patients.

The notion that patients currently diagnosed as having CFS
constitute a single homogeneous class was rejected. An
alternative set of clinical subgroups was derived. The
validity of these subgroups was assessed by sociodemographic,
psychiatric, immunological and illness behaviour variables. A
two-class statistical solution was considered most coherent,
with patients from the smaller class (27% of the sample)
having clinical characteristics suggestive of somatoform
disorders. The larger class (73% of sample) presented a more
limited combination of fatigue and neuropsychological
symptoms, and only moderate disability but remained
heterogeneous clinically. The two patient groups differed with
regard to duration of illness, spontaneous recovery, severity
of current psychological morbidity, utilization of medical
services and CD8 T cell subset counts.

The distribution ofsymptoms among patients was not unimodal,
supporting the notion that differences between the proposed subclasses
were not due simply to differences in symptom severity. This study
demonstrated clinical heterogeneity among patients currently
diagnosed as CFS, suggesting aetiological heterogeneity. In
the absence of discriminative clinical features, current
consensus criteria do not necessarily reduce the heterogeneity
of patients recruited to CFS research studies. [References:
60] EM- 9605

Hickie I, Lloyd A, Hadzi-Pavlovic D, Parker G, Bird K, Wakefield D

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