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Natural history of severe Chronic Fatigue Syndrome (CFS)

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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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