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Rapid Responses: Rapid Responses published:
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Predisposing factors as the underlying triggers in CFS
- Mohamed Amir (9 September 2006)
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The irrelevance of PVIS and CFS to ME
- Les O SIMPSON (5 November 2006)
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Neuroticism as a consequence of illness
- Ellen M Goudsmit, Peter Sneddon, Charles Shepherd, and Sandra Howes (26 February 2008)
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Mohamed Amir, Dental Surgeon/Orthodontist SW15 1JT
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This is a most refreshing study with some very important observations. It observes "the host response to the infection rather than the infection itself" and notes more significantly that the "symptom characteristics merged over time" in spite of the causative agent. It ponders over "alternative neurological mechanisms triggered during the severe acute illness" which may "underpin the persistent symptom domain of post infective fatigue syndrome". There may not be a trigger as such but perhaps an initial susceptibility factor of the patient or predisposing factors which lead to the varying degrees of the initial "host response". For example, we all know that the young and old succumb more to the flu virus than others. Many more examples of such predisposing factors are available if one searches for them and it would have been very informative to know the pre- illness lifetime medical history, sporting activities, past physical injuries etc. of the patients rather than excluding such patients or observations. This may more clearly indicate if there is a certain "behind the scenes" commonality in all the patients in both the infected and the non-infected range of patients in this study. Competing interests: TMJ treatment |
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Les O SIMPSON, retired medical research worker Dunedin, New Zealand, 9077
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This article emphasisies the rather disastrous consequences of the official adoption of "CFS/ME" for those who suffer from ME. The authors totally disregard the fact that the Ramsay criteria enabled the recognition of ME people, both before and after the 1988 announcement of the criteria for CFS. In reaching their conclusions, the authors ignored much published information concerning ME, yet failed to produce an acceptable pathophysiology which would provide a basis for treatment. The article should serve as a wake-up call to ME organisations and all those interested in ME to press for the adoption of the Ramsay criteria, in order to counteract the widening of inclusion criteria for a diagnosis of CFS. Until ME people are separated from thos with CFS, they will continue to have a poor quality of life. Competing interests: None declared |
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Ellen M Goudsmit, Chartered Health Psychologist London TW11 9QX, Peter Sneddon, Charles Shepherd, and Sandra Howes
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We were interested in the findings from Hickie et al (1) that neuroticism (N) scores, recorded shortly after diagnosis of a viral infection, were not a risk factor for chronic fatigue syndrome (CFS) at six and 12 months. This led us to re-examine the N scores we had collected in 1987 from people with myalgic encephalomyelitis (ME), a condition similar to and researched before the introduction of the term CFS. We limited the statistical analysis to 48 patients who had been diagnosed by physicians, who had been ill for at least six months, were not taking psychotropic drugs and who had listed either fatigue or muscle weakness following exertion as a main symptom. All were recruited by a psychologist (EG) or through an advertisement in the ME Association magazine. Participants were asked to complete the Eysenck Personality Inventory (EPI) Form B (2) and to pass on a second form to a close relative or friend of a similar age and background, who could act as a healthy control. We also obtained N scores from 50 patients with multiple sclerosis (MS), who were recruited through various support groups. The aims of this study were to measure neuroticism in patients with a condition similar to those assessed by Hickie et al, to examine the impact of time and to evaluate the influence of five items in the EPI which enquired about somatic symptoms commonly reported by patients with ME and CFS that might reflect disease rather than a personality trait (items 16, 35, 38, 45, 47). The mean N score of the ME group was 12.31 (SD 5.40), the mean of the MS group was 14.24 (SD 4.78) and the mean of the healthy controls was 9.35 (SD 4.77). The difference between the three groups was highly significant, F(2,143) =11.874, p<0.0005. However, post hoc analysis using Tukey’s HSD test found no significant difference between the two patient groups (p=0.139). A similar pattern was observed when the five somatic items were removed, although the effect was greater for the groups with ME and MS than the controls (mean difference: 2.60, 2.34 versus .92 respectively). Using the revised scores, Tukey’s HSD test revealed a significant difference between the patients with MS and controls (p<0.0005) and between the two patient groups (p=0.029) but not between the ME group and controls (p=0.304). Thus while the N scores were higher in the chronically ill groups, the omission of the five items had the effect of reducing the difference between the ME group and the controls, while increasing the difference between the patients with ME and MS. To assess the effect of the duration of illness, we compared the scores of the patients who had been ill between 6 months and five years with those who had been unwell for six years or more. The mean N score for the former was 11.3 (SD 5.37), while that for the latter was 15.29 (SD 4.30). The difference between the groups was significant, both for N (t=2.3, p=0.028) and the revised scores (t=2.19, p=0.036). We conclude that raised neuroticism scores documented in ME and CFS (3) may reflect both the length of time which a patient has been ill, and the inclusion of somatic items which confound the results. References: 1. Hickie, I, Davenport T, Wakefield D, Vollmer-Conna, U, Cameron B, Vernon, SD, et al. Post-infective and chronic fatigue syndromes precipitated by viral and non-viral pathogens: prospective cohort study. BMJ 2006; 333: 575 2. Eysenck HJ, Eysenck SB. Manual of the Eysenck personality questionnaire. London: Hodder and Stoughton, 1964. 3. Buckley L., MacHale SM., Cavanagh JTO, Sharpe M., Deary IJ, Lawrie SM. Personality dimensions in chronic fatigue syndrome and depression. J Psychosom Res 1999; 46(4): 395-400. Competing interests: None declared |
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