Cognitive behavior therapy for chronic fatigue syndrome.
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Cognitive Behavioral Therapy↗
Biomedical subjects
M Sharpe
Publications and source records attributed to M Sharpe.
Cytochrome c oxidase control by delta pH and delta psi gradients: effects of fatty acids.
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Electron Transport Complex IV↗
Diagnosis, disease and illness.
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Diagnosis↗
Depressive disorders in long-term survivors of stroke. Associations with demographic and social factors, functional status, and brain lesion volume.
Sixty surviving patients from a community-based stroke register who had computerised tomography (CT) scan evidence of a single brain lesion were interviewed three to five years after their first ever stroke. Depression (DSM-III-R major depression, partially resolved major depression, and dysthymia) was present in 11 (18%) of the patients and was associated with impaired physical and cognitive functioning, greater age, residence in an institution, absence of a close personal relationship, and larger original brain lesion. Of these variables, only functional dependence (odds ratio 16.4; confidence interval 1.6-170), larger lesion volume (6.6; 1-50), and female sex (8; 1.1-56) remained significantly associated with depression after controlling for all other variables. We conclude that depression in long-term survivors of stroke has many of the same associations as depression in non-stroke elderly populations. Depression in long-term stroke survivors may also be associated with larger original brain lesions, although this requires confirmation in a prospective study.
Age Factors↗
Why do doctors find some patients difficult to help?
Almost all doctors encounter difficulties in managing some patients. Previous studies have examined the characteristics of such patients: we have additionally studied the reasons why hospital doctors find these patients 'difficult to help'. Three clinics (two medical and one surgical) were studied. The consultants rated 60 (22%) of 293 attenders s severely or extremely difficult to help. Difficulty was associated with greater patient distress (odds ratio 3.9; 95% CI 2.0-7.7), less patient satisfaction (2.6; 1.3-5.0) and chronic attendance (5.0; 1.4-17.3). An interview study of 40 'difficult' patients indicated that doctors considered psycho-social factors more important in difficult patients (3.2; 1.3-7.7). Objective differences between the doctor's and the patient's aims for care also occurred more frequently for difficult patients (2.8; 1.1-7.2). Three common types of difficulty were identified; medically unexplained symptoms; co-existing social problems; and severe untreatable illness. A review of the management aims for patients whom doctors find 'difficult to help', combined with improved access to psycho-social care, could improve both the quality and the cost-effectiveness of hospital out-patient services.
Adolescent↗
Abnormalities of sleep in patients with the chronic fatigue syndrome.
OBJECTIVE: To determine whether patients with the chronic fatigue syndrome have abnormalities of sleep which may contribute to daytime fatigue. DESIGN: A case-control study of the sleep of patients with the chronic fatigue syndrome and that of healthy volunteers. SETTING: An infectious disease outpatient clinic and subjects' homes. SUBJECTS: 12 patients who met research criteria for the chronic fatigue syndrome but not for major depressive disorder and 12 healthy controls matched for age, sex, and weight. MAIN OUTCOME MEASURES: Subjective reports of sleep from patients' diaries and measurement of sleep patterns by polysomnography. Subjects' anxiety, depression, and functional impairment were assessed by interview. RESULTS: Patients with the chronic fatigue syndrome spent more time in bed than controls (544 min v 465 min, p < 0.001) but slept less efficiently (90% v 96%, p < 0.05) and spent more time awake after initially going to sleep (31.9 min v 16.6 min, p < 0.05). Seven patients with the chronic fatigue syndrome had a sleep disorder (four had difficulty maintaining sleep, one had difficulty getting to sleep, one had difficulty in both initiating and maintaining sleep, and one had hypersomnia) compared with none of the controls (p = 0.003). Those with sleep disorders showed greater functional impairment than the remaining five patients (score on general health survey 50.4% v 70.4%, p < 0.05), but their psychiatric scores were not significantly different. CONCLUSIONS: Most patients with the chronic fatigue syndrome had sleep disorders, which are likely to contribute to daytime fatigue. Sleep disorders may be important in the aetiology of the syndrome.
Adult↗
Non-pharmacological approaches to treatment.
Chronic fatigue syndrome (CFS) as currently defined overlaps with other syndromes including chronic pain, fibromyalgia, anxiety and depression. It also resembles historical descriptions of neurasthenia. The role of psychological (cognitive) and behavioural therapies in CFS is examined. There are both pragmatic and theoretical arguments for their application to CFS. It is pragmatic to target obvious and treatable factors including inactivity and depression. A theoretical model in which psychological, physiological and social factors interact offers a plausible rationale for such treatment but is not yet empirically proven. While there is evidence for the efficacy of this type of therapy in related syndromes, the evidence in CFS is inconclusive. A randomized controlled trial of combined cognitive and behavioural therapy currently in progress is described. Initial results suggest that most patients receiving cognitive behaviour therapy improve, especially in terms of functional impairment. It remains to be seen whether this therapy will prove to be more effective than standard general practitioner care. In the meantime cognitive behaviour therapy offers a pragmatic and rational therapy for patients with CFS.
Behavior Therapy↗
Hepatocyte growth factor/scatter factor (HGF/SF), the c-met receptor and the behaviour of epithelial cells.
Hepatocyte growth factor/scatter factor (HGF/SF) is a multifunctional protein produced by fibroblasts and other mesenchymal cells and active on epithelial and endothelial cells. The factor shares the basic domain organization of plasminogen and other blood proteases and is produced as a single-chain high molecular weight precursor which is subsequently cleaved to produce a biologically active heterodimer. HGF/SF acts on target cells through binding to a cell surface, high-affinity receptor with tyrosine kinase activity encoded by the c-met proto-oncogene. Transduction of the HGF/SF signal in epithelial cells by the met receptor leads either to: (i) cell dissociation, with loss of adhesion and junctional communication, (ii) cell division or (iii) differentiation and morphogenesis. These responses depend on target cells and culture conditions. There is preliminary evidence for a role for HGF/SF in vivo, suggesting that the factor may be involved in the early stages of embryo development and in liver regeneration. A role in cancer growth or dissemination has been proposed but remains to be clarified.
Animals↗
Properties and structure-function relationship of HGF-SF.
HGF-SF is a cytokine independently isolated and characterized for its activities as a mitogen for liver cells in culture (hepatocyte growth factor, HGF) and as a factor which enhances the movement and induces the dissociation of epithelial colonies (scatter factor, SF). The factor is composed of two subunits (A and B) with a M(r) of approximately 57 K and approximately 30 K produced by proteolytic cleavage of a polypeptide precursor. Based on the complete conservation of critical cysteine residues, the domain structure of HGF-SF appears to be remarkably similar to the domain structures of plasminogen, (a blood protease involved in fibrinolysis) and the HGF-like protein (the translation product of a gene recently isolated and which shares extensive sequence identity with HGF-SF). The A subunit of HGF-SF consists of an N-terminal domain, homologous to plasminogen preactivation peptide (PAP), followed by four kringle domains. The B subunit has the basic structure of a serine protease domain although HGF-SF has no protease activity due to replacement substitutions in two of the three residues of the catalytic site. Experiments with a truncated form of HGF-SF generated by alternative splicing and with a series of deletion and point mutants generated by site-directed mutagenesis, have established that both the N-terminal and the kringle domains of the A chain and the B chain are all required for biological activity. Loss of mitogenic activity in the HGF-SF mutants is always associated with loss of motogenic activity and vice versa. Thus, the protein engineering experiments confirm the hypothesis that the mitogenic and motogenic responses to HGF-SF diverge at the post-receptor level.
Amino Acid Sequence↗
Follow up of patients presenting with fatigue to an infectious diseases clinic.
OBJECTIVES: To determine the symptomatic and functional status during follow up of patients referred to hospital with unexplained fatigue and to identify patient variables associated with persistent functional impairment. DESIGN: Follow up by postal questionnaire six weeks to four years (median 1 year) after initial clinical assessment of patients referred to hospital during 1984-8. SETTING: Infectious diseases outpatient clinic in a teaching hospital. PATIENTS: 200 consecutive patients with fatigue of uncertain cause for at least six weeks; 177 fulfilled the inclusion criteria. MAIN OUTCOME MEASURES: Findings at initial assessment; current symptoms, beliefs about the cause of illness, coping behaviours emotional disorder, social variables including membership of self help organizations, and degrees of recovery and functional impairment from questionnaire responses. RESULTS: 144 (81%) patients returned completed questionnaires. Initial assessment did not indicate the cause of fatigue, other than preceding infection. The proportion of patients with functional impairment was significantly smaller with longer follow up (33% (11/33) at two to four years, 73% (29/40) at six weeks to six months; chi 2 for trend = 12.5, df = 1; p less than 0.05). Functional impairment was significantly associated with belief in a viral cause of the illness (odds ratio = 3.9; 95% confidence interval 1.5 to 9.9), limiting exercise (3.2; 1.5 to 6.6), avoiding alcohol (4.5; 1.8 to 11.3), changing or leaving employment (3.1; 1.4 to 6.9), belonging to a self help organization (7.8; 2.5 to 23.9), and current emotional disorder (4.4; 2.0 to 9.3). CONCLUSIONS: Short term prognosis for recovery of function was poor but improved with time. Most patients had made a functional recovery by two years after initial clinic attendance. Impaired functioning was more likely with certain patient characteristics. Prospective studies are required to clarify whether these associations are the consequences of a more disabling illness or indicate factors contributing to impaired function.
Adaptation, Psychological↗
The psychological treatment of patients with functional somatic symptoms: a practical guide.
Functional somatic symptoms (FSS) are bodily sensations which do not result from physical disease, but which the patient responds to as if they did. Such symptoms are common and usually transient. In some patients they become persistent and associated with distress and disability. In such cases specific treatment is indicated. A cognitive-behavioural model of the aetiology of FSS and a psychological treatment approach based on the model, are outlined. The practical details of treatment are described.
Cognitive Behavioral Therapy↗
Cromolyn versus triamcinolone acetonide for youngsters with moderate asthma.
Although both cromolyn (C) and inhaled corticosteroids are anti-inflammatory therapies for childhood asthma, there are few controlled comparisons of these medications for asthma therapy in children. None were conducted in the United States, and none specifically study triamcinolone acetonide (T) versus C. This 12-week evaluation followed 31 youths, aged 8 to 18 years, with moderate asthma who were assigned to receive C or T according to a prerandomized and blinded code. Patients were instructed to take two inhalations from the study metered-dose inhaler (active T or placebo) and to inhale the contents of one study-provided ampule (C, 20 mg, or placebo) from a compressor-driven home nebulizer three times per day. Patients also used albuterol, two inhalations from a metered-dose inhaler, three times a day (before study medication) and, additionally, if needed. Patients maintained a daily diary, recording extra medication use, adverse experiences, peak flow rates morning and night, and asthma symptom scores. Laboratory assessment of pulmonary function was done at 1, 4, 8, and 12 weeks. Cosyntropin challenge and methacholine bronchoprovocation challenge were performed at the beginning and end of the study. C and T provided similar, adequate asthma control. Symptoms of wheezing, cough, and chest tightness decreased, and daily peak expiratory flow rate increased with both regimens compared to during a 2-week baseline when patients received medication only as needed. There was no significant change in methacholine sensitivity and no change in endocrine function, as measured with fasting plasma control before and after administration of cosyntropin.(ABSTRACT TRUNCATED AT 250 WORDS)
Administration, Inhalation↗
Psychiatric management of PVFS.
Psychiatric management of PVFS (considered as a subtype of CFS) is a pragmatic approach to a disorder for which strictly biomedical treatments have so far had little to offer. Psychiatric assessment embraces a comprehensive (biopsychosocial) approach, and distinguishes factors that perpetuate the condition from those that may have precipitated it. Treatments are targeted at perpetuating factors. Few controlled treatment trials have been reported in patients selected specifically as meeting criteria for CFS. There is evidence available, however, that suggests useful management strategies. An uncontrolled study of treatment of CFS with combined antidepressant drug and psychological treatment has produced promising results. In addition there is useful evidence arising from the study and treatment of the individual symptoms of CFS, occurring both in isolation as part of other syndromes. The results of controlled trials of antidepressant drugs, and of psychological and rehabilitative treatment are awaited. It is already possible to offer provisional guidelines for treatment.
Fatigue Syndrome, Chronic↗
Systemic family therapy in adult psychiatry. A review of 50 families.
The place of family therapy in adult clinical psychiatry remains unclear, despite considerable theoretical developments in the subject. In order to delineate the potential role of a family therapeutic approach, a study was conducted of the first 50 families treated in a newly established family-therapy clinical located in an adult psychiatric hospital.
Adjustment Disorders↗
Mood disorders in long-term survivors of stroke: associations with brain lesion location and volume.
Sixty surviving patients from a community-based stroke register who had CT scan evidence of a single brain lesion and neurological signs appropriate to it were interviewed three to five years following their first-ever stroke. Mood disorder (anxiety and depression), physical disability, and intellectual impairment were assessed using standardized measures. The position and volume of the brain lesion was determined from CT scans performed soon after the stroke. The prevalence of depressive disorder was lower in this sample than that reported in previous studies (DSM-IIIR major depression 8.3%; all DSM-IIIR depressive disorders 18.3%). Reports by other workers for an association of depressive disorder either with left-sided brain lesions, or with anteriorly placed lesions in the left cerebral hemisphere, were not supported. Neither was there evidence of a correlation between symptom score and proximity of the lesion to the anterior pole of the left cerebral hemisphere. Psychiatric symptom scores were however greater with larger volume brain lesions. Anxiety disorders, especially agoraphobia, were relatively common (20% if diagnosed in the presence of depressive disorder), but were not related to lesion location or volume.
Activities of Daily Living↗
The use of graphical life charts in psychiatry.
A graphical representation of the course of all or part of a patient's life is an underused and potentially valuable clinical tool in psychiatry. Such 'life charts' were employed by Meyer and Kraepelin at the beginning of the century but have received little attention since. The following article briefly reviews the history of life charts, describes their construction and illustrates their uses.
Humans↗
Failure to convulse with electroconvulsive therapy. A case report.
A case is reported of a severely depressed patient in whom treatment with electroconvulsive therapy was abandoned because of repeated failure to induce a convulsion. Reasons for the failure to convulse and alternative treatment approaches are discussed.
Adult↗
Double-blind, dose-response study of metaproterenol inhalant solution in children with acute asthma.
One hundred children, aged 6 to 12 years, with acute asthma received nebulized therapy with saline, 5, 10, or 15 mg of metaproterenol aerosol solution according to a prerandomized, double-blind protocol. Pulmonary function and cardiac function were assessed for 60 minutes. All patients then received 5 mg of metaproterenol aerosol solution, and observation continued for another 30 minutes. The best response to therapy in terms of rise in FEV1, forced expiratory flow rate between 25% and 75% of FVC, and area under the curve (change in lung function with time) occurred with 5 and 10 mg of metaproterenol. The highest dose, 15 mg, produced significantly less bronchodilation. Although there were no electrocardiographic abnormalities, pulse rate was significantly higher with 10 and 15 mg of metaproterenol than with 5 mg. Five milligrams of metaproterenol aerosol solution is the optimal bronchodilating dose for treating acute asthma in children. Repeating this dose provides some additional bronchodilation and is well tolerated.
Administration, Inhalation↗