Faculty Bibliography

To evaluate the effect of cognitive behavioral intervention on chronic fatigue syndrome (CFS), we studied three patient groups: a CFS-treatment group (n = 22), a primary depression-treatment group (n = 20), and a no-treatment control group of subjects with CFS (n = 22). For the CFS-treatment group, a trend toward reduced depression-symptom scores was noted, but there were no significant changes in stress-related symptoms or fatigue severity. For the most depressed treated subjects with CFS, significant score reductions were observed in measures of depression, stress, fatigue severity, and fatigue-related thinking. In the depression group, significant reductions in depression, stress, and fatigue severity scores were found. No significant changes in any measure were observed in the CFS control group. A new fatigue-related cognitions scale, developed to assess cognitive and emotional reactions to fatigue, showed a significant reduction in such reactions in the CFS-treatment group, a finding suggesting that depression in this group was mediated by maladaptive thinking. The results suggest that a subset of CFS patients with cognition-related depressive symptomatology may respond to short-term behavioral intervention.

Borrelia burgdorferi is the pathogen that causes Lyme disease. Patients frequently experience fatigue and malaise that can persist after antibiotic treatment. This study examined serological reactivity to B. burgdorferi in patients with chronic fatigue who were from a region in which Lyme disease is endemic. Blood and CSF were collected from patients without a history of infection due to B. burgdorferi (n = 12) and patients with persistent fatigue after antibiotic treatment of Lyme disease (n = 13). Serum and CSF were examined by ELISA for antibodies to B. burgdorferi, and routine studies of CSF were done. In the first group, one patient (8%) was seropositive; no patients had detectable antibodies in CSF. In the second group, nine patients (69%) were seropositive or borderline seropositive; seven (54%) had detectable antibodies in CSF. Unexplained abnormalities in CSF were noted in 42% and 31% of patients in each group, respectively. In this study positive serologies for Lyme disease were not found at a higher than expected rate for patients from a region of Lyme disease endemicity who had idiopathic chronic fatigue. Fatigued patients did show a surprisingly high rate of unexplained minor CSF abnormalities suggestive of CNS or meningeal dysfunction.

Nineteen of 283 consecutive patients evaluated in the Multiple Sclerosis (MS) Comprehensive Care Center had a borderline or positive B. burgdorferi serology. In 8 patients a repeat serology was nonconfirmatory. Cerebrospinal fluid was examined in 10 seropositive patients and showed anti-B. burgdorferi antibodies without intrathecal production in 5 patients. Antibiotic treatment did not prevent subsequent neurological relapses. The finding of reactive Lyme serology in an MS patient with no suggestive features of the infection is unlikely to indicate neurological Lyme disease.

Fatigue is a frequent medical symptom which has not been routinely measured. We present a 29-item fatigue assessment instrument, describe its psychometric properties, and use it to differentiate normal fatigue from fatigue related medical disorders. Differences in fatigue across a variety of medical disorders, the reproducibility of the fatigue instrument, and its convergent validity with other fatigue measures are also described.