Reducing heterogeneity in Chronic Fatigue Syndrome (CFS): a comparison with depression & multiple sclerosis

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Chronic fatigue syndrome (CFS) is a heterogeneous illness
characterized by a high prevalence of psychiatric problems. We
reasoned that we could reduce heterogeneity by excluding
patients with psychiatric problems preceding CFS. We compared
the functional status, mood, fatigue level, and psychiatric
status of this more homogeneous group of CFS patients with the
same parameters in patients with mild multiple sclerosis and
in patients with major depression or dysthymia. Patients with
CFS and those with multiple sclerosis were similar in terms of
level of anger, severity of depression, level of anxiety, and
frequency of current psychiatric diagnoses. Patients with CFS
resembled depressed patients in having impaired vigor and
experiencing substantial fatigue and confusion–problems
constituting part of the case definition of CFS.

The group with CFS was not psychologically vulnerable before the
development of this condition and maintained adequate networks
of social support despite disabling illness. Stratification to
exclude patients with prior psychiatric disease and those with
mild CFS allowed us to define a group of patients with CFS who
more resembled patients with mild MS than patients with major
depression or dysthymia and thus were more likely to have
illness with an infectious or immunologic cause. Use of such a
stratification strategy should prove important in testing of
the viral/immunologic hypothesis of the etiology of CFS.

Natelson BH, Johnson SK, DeLuca J, Sisto S, Ellis SP, Hill N, Bergen

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