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            Chronic Fatigue Syndrome Electronic Newsletter

 --------------------------------------------------------------------
 No. 47                     May 31, 1995                Washington DC
 --------------------------------------------------------------------


                STUDY FINDS NO INFECTIOUS LINK TO CFS

        CONTENTS

 >>>1.  Study finds no infectious link to CFS
 >>>2.  Book on CFS, edited by Dr. Stephen Straus
 >>>3.  Discussion of Hopkins study, and CBT


 -------------------------------------------------------------------

 >>>1.  Study finds no CFS link to infection

A British study just published in Lancet (27 May 1995) finds no
evidence to suggest an association between common viral infections
and chronic fatigue or CFS.  The researchers suggest that there is
more likely a link to pre-illness fatigue and psychological disorder.
The citation for the study is as follows:

   Wessely S, Chalder T, Hirsch S, Pawlikowska T, Wallace P, Wright
   DJM.  Postinfectious fatigue: prospective cohort study in primary
   care.  Lancet 1995: 345; 1333-38

Simon Wessely, MD (King's College Institute of Psychiatry, London)
and colleagues write in their paper that the notion of an infectious
origin of chronic fatigue has become "popular", but that such a
conclusion is mainly based on retrospective studies that have an
ascertainment bias (i.e., reliance upon patients' memories of the
circumstances associated with the onset of illness, and also other
confounding factors).

Wessely et al. have conducted their study in a different manner.
Specifically, *infections* were identified by physicians as a first
step, and then during follow-up the determination is made as to how
many cases qualify as being chronic fatigue or CFS.  This study
involved an original sample of nearly 2,000 which after various
eliminations yielded 185 cases of chronic fatigue matched by an equal
number of controls.  (These results come from a broad study, some of
whose results have already been published as: Pawlikowska et al.  A
population based study of fatigue and psychological distress. BMJ
1994; 308:743-46.  Additional results focusing on allergies and
psychological aspects will be published in the future.)  The current
study's results showed roughly equal numbers of infectious cases (9.9
percent) and controls (11.7 percent) exhibiting chronic fatigue, and
no differences for those meeting CFS criteria.  Many other related
results were also reported.

The researchers summarized their findings by writing:

   We conclude that common infections play little part in the
   aetiology of chronic fatigue in primary care.  This conclusion
   does not exclude a role for less common infections, caused by
   Epstein-Barr virus, toxoplasma, or cytomegalovirus, for example.
   Nor does it exclude a rare complication of a common infection....
   Overall, we conclude that the population attributable risk of
   acute infections on the prevalence of chronic fatigue syndrome is
   low....  Instead, our results suggest a link with previous fatigue
   and previous psychological disorder.

[Thanks for assistance provided by the staff of the Lancet, the CFIDS
Association of America, and a report from the Reuter News Service.]


 -=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-

 >>>2.  Book on CFS, edited by Dr. Stephen Straus

An anthology titled "Chronic Fatigue Syndrome" has been published as
a book, edited by Dr. Stephen Straus, MD of the National Institute of
Allergies and Infectious Disease, NIH (Bethesda, Maryland USA).  Dr.
Straus offers the following description in the book's preface:

   In recognition of this evolving synthesis of perspectives on
   chronic fatigue I became motivated to capture our current
   knowledge of it within the bounds of a multidisciplinary book.  In
   so doing, I aimed to assemble a volume that fairly represents a
   spectrum of creditable and authoritative positions from virtually
   all established disciplines engaged in the study of chronic
   fatigue syndrome and the subset of individuals who could be said
   to suffer from chronic fatigue syndrome.

   This is by no means a comprehensive compendium, for the field has
   always been, and remains still, open to extravagant claims.  I
   view that my role as editor is to assure that each vantage point
   is presented as clearly as possible.  The reader will discern
   inconsistencies in some arguments and even frank disagreements
   among them.  This is inevitable in an area as unsettled as this
   one.

   The chapters are organized to present to the clinician or the
   highly informed lay reader a statement of the problem and its deep
   historical and multidisciplinary perspectives.  There is a series
   of refined analyses of putative causes for the syndrome and of
   body systems affected by it or affecting it in turn.  The volume
   closes with a discussion of well-considered contemporary
   approaches to management.

   Consensus has not been reached on many of these issues, and the
   flow through the book is not entirely seamless, as would be more
   likely were it penned by one hand.  But then it would be devoid of
   the exhilarating tension that arises from rational discourse and
   collegial debate and might fail to offer as broad a conceptual
   palette as it does.

The book's table of contents is as follows:

    Part I:  The Illness

1. The History of CFS -- Simon Wessely

2. Defining CFS -- Dedra Buchwald

3. Clinical Presentation and Evaluation of Fatigue and CFS
       -- Anthony Komaroff

4. An Anthropological Approach to Understanding CFS -- Norma Ware

    Part II:  Infection and Immunity

5. Infection and CFS -- Robert Fekety

6. Human Herpesviruses and CFS -- John Hay and Frank Jenkins

7. Retroviruses and CFS -- Walid Heneine and Thomas Folks

8. Immunological Function in CFS -- Warren Strober

    Part III:  Neurological, Psychological, and Psychiatric Issues

9. Muscle Metabolism, Histopathology, and Physiology in CFS
       -- Richard Edwards, John Clague, Henry Gibson, and Timothy
          Helliwell

10. Neuropsychological Features of CFS -- Jordan Grafman

11. Neuroendocrine Aspects of CFS: Implications for Diagnosis and
       Research -- Mark Demitrack

     Part IV:  Relation to Other Disorders

12. The Fibromyalgia Syndrome and CFS -- Don Goldenberg

13. The Relevance of Psychiatric Research on Somatization to the
       Concept of CFS -- Michael Clark and Wayne Katon

     Part V:  An International Perspective

14. Studies on the Pathophysiology of CFS in Australia
       -- Andrew Lloyd, Ian Hickie, and Denis Wakefield

     Part VI:  Approaches to Treatment

15. Medical Therapy of CFS -- Cheryl Hirata-Dulas, Charles
       Halstenson, and Phillip Peterson

16. Psychopharmacology and CFS -- Susan Abbey

17. Cognitive-Behavioral Therapy and the Treatment of CFS
       -- Michael Sharpe

     Index

 -----------

   Chronic Fatigue Syndrome, edited by Stephen E. Straus
   461 pages
   ISBN 0-8247-9187-8
   U.S. price: $135 plus shipping

For sales in the Americas, contact the publisher as follows:

Marcel Dekker, Inc.
270 Madison Ave.
New York, NY 10016
phone 1-212-696-9000
fax 1-212-685-4540

Elsewhere, contact the publisher as follows:

Marcel Dekker, Inc.
Hutgaffe 4 Postfach 812
CH 4001
Basel, Switzerland
phone 41-61-261-2232
fax 41-61-261-8896

[Thanks to the staff of publisher Marcel Dekker for assistance.]


 -=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-

 >>>3.  Discussion of Hopkins study, and CBT

Correspondence published in recent medical journals have discussed
the "Hopkins study", and cognitive behavioral therapy for CFS.

A discussion about the recent Hopkins study appeared in the Lancet of
29 April 1995.  The Hopkins study proposes a possible link between
neurally mediated hypotension and CFS, and was originally published
in the Lancet of 11 March 1995 (and discussed in CFS-NEWS number 45).
Now four letters have appeared in the Lancet of 29 April 1995 (pages
1112-1113) which discuss this study.

R.J. Walden wrote expressing concern about both the diagnostic method
and the recommended treatment.  Simon Wessely expressed doubt about
associating low blood pressure with fatigue or dizziness, and he
pointed to possible confounding conditions such as depression and
deconditioning.  Walden and Wessely both recommended simple
rehabilitation and activity management programs as treatment.  The
Hopkins researchers (Rowe, Bou-Holaigah, Kan, and Calkins) replied
that neurally mediated hypotension is a different condition than
general hypotension, and that the tests and treatments that were
mentioned in their paper are the commonly accepted ones for that
specialized condition.  They further mention that there is no data
which recommends physical rehabilitation as being effective for
either neurally mediated hypotension or CFS.  David H.P. Streeten and
Gunnar Anderson wrote that findings similar to Rowe et al. had
previously been published in their paper titled "Delayed orthostatic
intolerance" (Arch Intern Med 1992;174:180).

In a separate set of correspondence, cognitive behavioral therapy
(CBT) for CFS was discussed in the April 1995 American Journal of
Medicine (volume 98, pages 419-422).  Commenting on a previous
article by Lloyd et al. (Am J Med 1993;94:197-203) which found CBT
less than effective, writers T Chalder, A Deale and S Wessely stated
that the Lloyd study did not make a true comparison to the CBT
program described by Butler, Chalder, et al.  Similarly, in another
letter Michael Sharpe criticized the Lloyd study for applying CBT too
briefly, and for failing to challenge the patients' belief in a
physical disease.

Lloyd et al. replied by pointing out the disadvantages of the Butler
program, and that the Lloyd study included objective measures of
response.  They also wrote that their study was similar to other
established CBT programs, and that their study was not predicated on
an assumption of either a wholly physical nor a wholly psychological
illness.


 ===================================================================
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