Severe fatigue in narcolepsy with cataplexy

Excessive daytime sleepiness (EDS) is the core symptom of narcolepsy. However, there have been indications that fatigue – which should be separated from EDS – is also a frequent complaint. We determined the prevalence of severe fatigue in a group of narcolepsy patients and its relation with excessive daytime sleepiness, psychological distress, functional impairment and quality of life. We included 80 patients fulfilling the International Classification of Sleep Disorders (ICSD)‐2 diagnostic criteria of narcolepsy with cataplexy. Fatigue was measured using the Checklist Individual Strength (CIS). In addition psychological distress, including symptoms of depression, functional impairment and quality of life, were assessed. Comparisons were made between patients with (CIS‐fatigue score ≥ 35) and without severe experienced fatigue. Fifty patients (62.5%) reported severe fatigue. There were no sex or age differences between patients with and without severe fatigue. Both fatigued and non‐fatigued patients had the same amount of daytime sleepiness (Epworth Sleepiness Score 14.3 ± 4.2 versus 13.1 ± 4.4, P = 0.22), confirming the separation between sleepiness and fatigue. Interestingly, fatigued patients more often used stimulant medication (64% versus 40%, P = 0.02). Severe fatigue was associated with a significantly increased functional impairment, increased depressive symptoms and a lowered general quality of life. In conclusion, a majority of patients with narcolepsy suffer from severe fatigue, which can be distinguished from daytime sleepiness, and results in severe functional impairment.     

Examining the relationship between object relations and interpersonal distress in a clinical sample

The goal of the present study was to explore the relationship between patients' object relational functioning (Social Cognition and Object Relations Scale‐Global Ratings) as rated by clinicians during the course of outpatient psychodynamic psychotherapy in a university‐based clinic and patient self‐reported interpersonal vulnerabilities (Inventory of Interpersonal Problems‐64). Participants (n = 112) were outpatients entering treatment at a university‐based psychotherapy clinic and were diagnosed primarily with mood disorders as well as Axis II relational problems and features. Participants completed the IIP‐64 prior to receiving therapy, and SCORS‐G ratings were based on patients' level of relational functioning during the evaluation process (i.e., the semistructured interview, follow‐up and feedback) and across the first two psychotherapy sessions. Results showed a significant relationship between the IIP‐64 Total score with SCORS‐GSelf‐Esteem (r = ?.21, p < .05) and Affective Quality of Representations (r = ?.20, p < .05), wherein self‐reported interpersonal dysfunction was greater among patients who had lower self‐worth and perceived others as more malevolent. These findings suggest that patients who rated themselves as having more significant interpersonal difficulty reported more negative expectations and experiences of relationships in their psychotherapy narratives. The utility of the SCORS‐G and the IIP‐64 as two different avenues of assessing patient relational functioning is explored.     

Application of a chronic illness model as a means of understanding pre‐operative psychological adjustment in coronary artery bypass graft patients

Objectives. To increase understanding of the factors associated with pre‐operative psychological adjustment in coronary artery bypass graft (CABG) patients by assessing the utility of a chronic illness model developed by Scharloo, Kaptein, Weinman, Willems, and Rooijmans (2000) . Design. A cross‐sectional design was employed. Method. Elective CABG patients (N = 119) completed self‐report measures of illness representation, self‐rated health, social support, coping methods, and pre‐operative adjustment (depression and post‐traumatic stress disorder (PTSD) symptomatology) an average of 30 days prior to surgery. Hierarchical multiple regression was used to assess the mediational relationships proposed by the chronic illness model. Results. Five 3‐variable mediational chains were assessed. In all instances, the results conformed to the relationships suggested by the chronic illness model where the strength of the relationship between the independent and dependent variables was reduced when the mediator variable was controlled. However, a significant reduction of this relationship was found in three of the five chains examined. The most rigorous support for the model occurred, where increased use of avoidance coping mediated the relationship between poorer self‐rated health and increased PTSD symptomatology, and also where increased use of avoidance coping partially mediated the relationship between a more negative illness representation and increased PTSD symptomatology, and poorer self‐rated health and increased depression. Conclusions. The chronic illness model of Scharloo and colleagues shows potential in explaining pre‐operative adjustment in CABG patients. Longitudinal examination of the model is recommended.     

Psychodynamic technique early in treatment related to outcome for depressed patients

We examined the relationship between psychodynamic techniques early in treatment with reliable change in depressive symptomatology. Forty‐six patients admitted for individual psychodynamic psychotherapy who received a diagnosis representative of a depressive spectrum disorder were assessed pretreatment and posttreatment through self‐report of depressive symptoms. Videotapes from two early treatment sessions (3rd and 9th) were independently rated on the Comparative Psychotherapy Process Scale for use of psychodynamic‐interpersonal and cognitive–behavioural techniques, with excellent interrater reliability (intraclass correlation coefficient > .75). We found a significant relationship between overall use of psychodynamic technique across early treatment (r = .31, p = .036), as well as specific psychodynamic techniques delivered across early treatment, with change in patient‐reported depressive symptoms. Our findings suggest that focusing on affective experiencing and expression, as well as providing interpretations are particularly helpful early in psychodynamic treatment for depression. Clinical implications and future directions are discussed.     

Clinical implications of daytime sleepiness for the academic performance of middle school‐aged adolescents with attention deficit hyperactivity disorder

This study investigated the relative impact of total time slept per night and daytime sleepiness on the academic functioning of 100 middle school‐aged youth (mean age = 11.9) with attention deficit hyperactivity disorder (ADHD). The primary goal of the study was to determine if total time slept per night and/or daytime sleepiness, as measured by youth self‐report on the Pediatric Daytime Sleepiness Scale (PDSS), predicted academic functioning above and beyond symptoms of ADHD and relevant covariates, such as intelligence, achievement scores and parent education level. Self‐reported daytime sleepiness but not self‐reported total time slept per night was associated significantly with all academic outcomes. When examined in a hierarchical regression model, self‐reported daytime sleepiness significantly predicted parent‐rated homework problems and academic impairment and teacher‐rated academic competence above and beyond symptoms of ADHD and relevant covariates, but did not predict grade point average or teacher‐rated academic impairment. The implications of these findings for understanding more clearly the association between ADHD and sleep and the functional implications of this relationship are discussed.     

Specific relationships between core beliefs and personality disorder symptoms in a non‐clinical sample

The current study examined the relationship of clinically relevant core beliefs measured by the Young Schema Questionnaire‐Short Form (YSQ‐SF) to personality disorder (PD) symptoms in a large non‐clinical sample (N = 804). Results indicated that the 15 YSQ‐SF scales added sizeable explained variance (4% to 13%) to self‐reported symptoms of 12 PDs, above variance explained by gender and symptoms of other PDs. In addition, several specific core beliefs related uniquely to individual PDs after controlling for the other core beliefs. Given that core beliefs related to personality disorder symptoms in a non‐clinical sample of people at the typical onset age of PDs, it is possible that such beliefs might be important to understanding the development of PDs. Copyright © 2007 John Wiley & Sons, Ltd.     

Poor sleep quality associates with self‐reported psychiatric and cardiometabolic symptoms independently of sleep timing patterns in a large sample of rural and urban workers

Poor sleep associates with mental and cardiometabolic pathological outcomes. The participation of sleep timing features in the pathways by which this relationship occurs is not clear. This study aims to evaluate the interrelationship between sleep quality and self‐reported psychiatric/cardiometabolic symptoms, considering mediation and moderation effects of sleep timing patterns, and urban versus rural work environment, respectively; and to verify the association between sleep quality and polymorphisms of AANAT, RORA and TIMELESS genes. An epidemiological survey was performed in a rural area in southern Brazil. Eight‐hundred and twenty‐nine subjects were evaluated for sleep quality using the Pittsburgh Sleep Quality Index, and sleep timing patterns using the Munich Chronotype Questionnaire. Work characteristics and psychiatric/cardiometabolic symptoms were assessed using a structured self‐report questionnaire. Three polymorphisms of AANAT, RORA and TIMELESS (rs3760138, rs782931 and rs774045, respectively) were genotyped in blood samples. We found statistically significant associations of poor sleep quality with self‐reported psychiatric symptoms (B = 0.382; 95% CI 0.289–0.476; adjusted p‐value <.001), and with self‐reported cardiometabolic symptoms (B = 0.079; 95% CI 0.013–0.151; adjusted p‐value = .048). The genetic analysis showed that RORA GA/AA genotype was associated to poor sleep quality (B = 0.146, 95% CI 0.054–0.239; adjusted p‐value = .004). No moderated mediation effects were observed in the conditional analysis. TIMELESS polymorphism was not included in the analysis due to the low frequency of risk genotypes. These results yield new insights regarding the interrelationship between sleep characteristics and psychiatric/cardiometabolic self‐reported symptoms, taking into account genes related to the biological clocks and melatonin pathways.     

Anger rumination,social support,and cardiac symptoms in patients undergoing angiography

Objectives . Socially isolated individuals report more cardiac symptoms, suffer increased cardiovascular morbidity and mortality, and experience higher levels of stress and anxiety than those with more effective support resources. However, the complex interactions of psychosocial factors implicated in the disease process remain to be fully elucidated. We sought to explore these relationships, with the addition of a novel psychosocial variable, anger rumination, which could be associated with increased cardiovascular risk. Design . We examined the association of psychological stress, social support, and anger rumination, with surgical anxiety, self‐reported cardiac symptoms, and angiographically documented coronary artery disease, using a correlational ex post facto design. Methods . One hundred and one patients scheduled for elective coronary angiography completed questionnaires during the week prior to angiography. Disease severity was objectively assessed using the Gensini scoring system. Results . Self‐reported cardiac symptom severity was significantly correlated with higher perceived stress, less social support, and higher anger rumination, but none of the psychosocial variables predicted Gensini score. Social support partially mediated the relationship between anger rumination and surgical anxiety. Perceived stress mediated the relationship between anger rumination and cardiac symptoms. Conclusions . For patients awaiting angiography, stress, and lack of social support are important predictors of self‐reported cardiac symptoms, irrespective of actual disease severity. Intervention could focus on reducing perceived stress by encouraging reappraisal and a support seeking, rather than a ruminative, anger coping style.     

Emotional functioning among children with neurofibromatosis type 1 or Noonan syndrome

While neurofibromatosis type 1 (NF1) and Noonan syndrome (NS) are clinically distinct genetic syndromes, they have overlapping features because they are caused by pathogenic variants in genes encoding molecules within the Ras‐mitogen‐activated protein kinase signaling pathway. Increased risk for emotional and behavioral challenges has been reported in both children and adults with these syndromes. The current study examined parent‐report and self‐report measures of emotional functioning among children with NF1 and NS as compared to their unaffected siblings. Parents and children with NS (n = 39), NF1 (n = 39), and their siblings without a genetic condition (n = 32) completed well‐validated clinical symptom rating scales. Results from parent questionnaires indicated greater symptomatology on scales measuring internalizing behaviors and symptoms of attention deficit hyperactivity disorder (ADHD) in both syndrome groups as compared with unaffected children. Frequency and severity of emotional and behavioral symptoms were remarkably similar across the two clinical groups. Symptoms of depression and anxiety were higher in children who were also rated as meeting symptom criteria for ADHD. While self‐report ratings by children generally correlated with parent ratings, symptom severity was less pronounced. Among unaffected siblings, parent ratings indicated higher than expected levels of anxiety. Study findings may assist with guiding family‐based interventions to address emotional challenges.     

Core transference themes in depression

BACKGROUND: Psychodynamic and psychoanalytic theories assume that depression is concomitant with typical transference patterns. We tested whether depression can indeed be understood in these terms, and determined a parsimonious set of transference themes that are most typical of depression. METHOD: Transference patterns were assessed with the Core Conflictual Relationship Theme (CCRT) method, which examines transference patterns (wishes, responses of the other, and responses of the self), and which was applied to clinical interview data from mental health outpatients. Depression was assessed with the Beck Depression Inventory-II. Data were analyzed by means of the leaps and bounds regression algorithm and bootstrapping. RESULTS: Depression can significantly be explained by typical wishes, typical subjective perceptions of how the other responds, and typical responses of the self to the other. We mapped a set of four transference themes that are most representative of depression: (1) a strong wish to feel happy guides interactions, (2) the perception that others dislike one is typical, (3) one's own reactions of disliking others are apparent, and (4) one experiences feelings of helplessness. LIMITATIONS: No control group was used. The limited amount of research in the field and the various methodological approaches in different studies make it difficult to compare our findings. CONCLUSION: Linking depression to transference patterns is valid. The set of transference themes that were selected cohere in a meaningful way. These themes can be expected when clinically treating depressed patients.     

Relationships between self‐consistency,trauma‐centred identity,and post‐traumatic adjustment

Background: Post‐traumatic stress disorder (PTSD) models suggest that trauma‐centred self‐change is motivated by self‐consistency. Aim: The objective of this study was to investigate the relationships between self‐consistency, trauma‐centred identity, and PTSD symptoms. Method: University students (n = 134) completed measures of trauma‐centred identity (Centrality of Events Scale), self‐consistency, and post‐traumatic stress symptoms (Impact of Events Scale—Revised, Centre for Epidemiological Studies—Depression Scale). Results: A significant positive correlation was found between trauma‐centred identity and post‐traumatic symptoms. However, self‐consistency was not related to post‐traumatic symptoms or trauma‐centred identity. Given the relationship between depressive symptoms and self‐consistency, the correlations were also conducted controlling for depression. When the effects of depressive symptoms were partialled out, both self‐consistency and trauma‐centred identity were positively correlated with intrusion symptoms. Discussion and Conclusion: The implications for PTSD models, which suggest self‐change is motivated by self‐consistency, are discussed and implications for clinical treatments are considered.     

Real‐world problem solving and quality of life in older people

Objectives. This study examined relationships between quality of life (QoL) in older people and cognitive functioning in both abstract and real‐world problem solving. Design. Contributions of levels of mental, physical and social activities, self‐rated and objective health status, self‐rated cognitive functioning, socio‐economic status, gender, real‐world and abstract problem solving were examined in a regression study of factors related to QoL in older people. Method. Participants (N = 145) were 70–91 years of age. The current cognitive functioning was assessed by psychometric tests and real‐world problem‐solving tasks. Prior functioning was indexed by crystallized ability measures. QoL was assessed using the Leiden‐Padua questionnaire (LEIPAD), Faces scales and Hospital and Anxiety Depression Scale. A single QoL factor was derived. Results. Simultaneous multiple regressions indicated that QoL was related to real‐world but not to abstract problem‐solving ability. Separate contributions to QoL were also found for health and self‐rated cognitive functioning. Conclusions. The present study replicates previous findings that abstract problem‐solving ability is not related to QoL and supports the hypothesis that real‐world or everyday problem‐solving ability is associated with QoL in older people.     

Integrating nap and night‐time sleep into sleep patterns reveals differential links to health‐relevant outcomes

Both night‐time sleep and nap behaviour have been linked consistently to health outcomes. Although reasons for napping are usually tied to night‐time sleep, the majority of studies assess their effects independently. The current study thus aimed to examine the health relevance of patterns of sleep behaviour that take into account both night‐time and daytime sleep habits. Night‐time sleep, recorded during 7 days via actigraphy from 313 participants (aged 34–82 years) of the Midlife in the United States II Biomarker study, was assessed. Blood and urine specimens were assayed for noradrenaline, interleukin‐6 and C‐reactive protein. Participants self‐reported nap behaviour, depressive symptoms, perceived chronic stress and the presence of medical symptoms and conditions. Overall, nappers (n = 208) showed elevated waist–hip ratios, C‐reactive protein and interleukin‐6 levels compared to non‐nappers and reported more physiological symptoms and conditions (all P ≤ 0.019). Within nappers, cluster analysis revealed three patterns of sleep behaviour—infrequent nappers with good night‐time sleep, frequent nappers with good night‐time sleep and nappers with poor night‐time sleep. Nappers with poor night‐time sleep thereby exhibited elevated noradrenaline levels, depressive symptoms and perceived stress scores compared to other groups (all P ≤ 0.041). These findings support the idea that nap–health relationships are complex, in that frequency of napping and accumulation of nap sleep is not related linearly to health consequences. Assessing nap behaviour in conjunction with night‐time sleep behaviour appeared crucial to elucidate further the health relevance of napping, particularly in terms of psychological health outcomes, including chronic stress and depressive symptoms.     

Predicting the short‐term course of fatigue symptoms: Does adjustment of habitual coping strategies matter?

The present study investigated whether adjustment of coping strategies would predict the six‐week course of fatigue symptoms in a primary care sample (N = 221) and whether the contribution of adjusting coping strategies would depend on the duration of fatigue at the time. It was hypothesized that the motivation to adjust coping strategies would be most present in people who are confronted with the possibility of their symptoms turning into a chronic condition, and not in people who have been fatigued for either a short period or a very long period. Moreover, it was hypothesized that adjustments in the employment of coping strategies are a better predictor of fatigue course than the continued use of particular coping strategies. Using a prospective design with a six‐week follow‐up, the results of a multisample LISREL analysis over four groups of participants differing in fatigue duration showed that adjustment of coping strategies is a significant predictor of the course of fatigue symptoms, and that a differential effect related to fatigue duration is present. Findings are discussed in the context of the role of coping in regulating psychosomatic symptoms.     

A qualitative investigation of women's experiences of the self and others in relation to their menstrual cycle

Objectives. This study aimed to compare and contrast detailed accounts of a community sample of women, with prospectively defined low or high premenstrual symptoms, highlighting differences/similarities. Methods. Semi‐structured interviews were conducted with 16 women (9 with ‘low’ and 7 with ‘high’ symptom levels) and analysed using template analysis. Results. ‘Low symptom’ women perceived themselves as generally laid back but demonstrated a need for organization and control in the family environment. They accepted less than perfect relationships, compared themselves favourably to others and perceived themselves as having strong support networks. There was a negative perception of the introduction to menarche but this was coupled with strong maternal support. ‘High symptom’ women showed patterns of perfectionism, an emphasis on self‐sacrifice and unfavourable comparison of self with others. They reported feeling alone, overwhelmed by tasks and experienced relationships as characterized by unresolved tensions. Menarche was viewed as a positive experience but accompanied by low maternal support. Both groups viewed their symptoms as irrational and controllable outside the home, but vented on partner, close family and children. There was acknowledgement of difference from ‘normal’ (‘low’) with an emphasis on the all‐encompassing nature of symptoms (‘high’). Conclusions. Women with high and low menstrual cycle symptoms viewed aspects of themselves and their relationships with others in both similar and different ways. A major issue for high symptom women was that they struggled to tolerate imperfections, both in their own performance or in their relationships with others, potentially emphasizing the role of cognitive appraisals in interventions.     

Interoceptive accuracy is related to long‐term stress via self‐regulation

Interoception describes the ability to perceive internal bodily signals. Previous research found a relationship between interoceptive accuracy (IAcc) and cardiovascular outcomes during or after acute stress. So far, the association between IAcc and long‐term stress has not been investigated, although this would be important to identify a starting point to prevent long‐term stress. To address this idea in the current study, we examined the relationship between IAcc and long‐term stress, which was assessed with different questionnaires and biological markers, including cortisol and dehydroepiandrosterone (DHEA). Furthermore, we investigated self‐regulation as a mechanism linking IAcc to long‐term stress. The sample consisted of 98 participants. To measure IAcc, participants completed the heartbeat perception task. Perceived long‐term stress and self‐regulation were assessed via an online questionnaire. Moreover, hair samples were taken from 65 participants to determine long‐term stress with cortisol and DHEA as well as the ratio of both. Results showed that IAcc was positively related to DHEA and weakly negatively related to the other indicators of long‐term stress, except for the nonsignificant relationships to the indicators cortisol and stress experiences due to negative events. Furthermore, these relationships were mediated by participants' enhanced self‐regulation. Thus, our results suggest that enhanced self‐regulation could be a mechanism explaining why IAcc is associated with long‐term stress.     

A longitudinal study of the relationship between psychological distress and recurrence of upper respiratory tract infections in chronic fatigue syndrome

Objectives. Previous research has found that chronic fatigue syndrome (CFS) patients report increased susceptibility to upper respiratory tract illnesses (URTIs) when compared with healthy volunteers. This study aimed to replicate and extend this research by investigating the role of psychological distress (stress and negative mood) in the recurrence of URTIs in CFS patients as well as its role in the recurrence of CFS symptoms. Design. A 15‐week diary study. Methods. Measures of psychological stress, negative mood, recurrence of URTIs and symptoms were recorded each week for a 15‐week period. CFS patients (N = 21), who had been assessed and diagnosed according to the Oxford criteria, were recruited from the Cardiff Chronic Fatigue Clinic and compared with a matched group of healthy controls (N = 18). Frequency of occurrence of infectious illness and the relationship between psychological stress/negative mood and occurrence of illness were assessed. Results. CFS patients reported more URTIs than the controls. Stress scores (and negative mood) were significantly higher in the week prior to the occurrence of URTIs than in weeks when no subsequent illness occurred. High levels of psychological stress also preceded the severity of reported symptoms of fatigue in the CFS group. Conclusions. CFS patients reported more frequent URTIs than healthy controls and these recurrences were preceded by high levels of psychological stress. High levels of stress were also associated with greater subsequent fatigue. Possible explanations of these results are discussed.     

Self‐reported sleep duration and cognitive functioning in the general population

This study investigated the relationship between self‐reported sleep factors (sleep duration, insomnia, use of sleeping medicine, probable sleep apnoea and feelings of fatigue and tiredness) with cognitive functioning in 5177 people aged 30 years or older from a cross‐sectional representative sample of the adult population in Finland (The Finnish Health 2000 Survey). Previous studies have indicated a U‐shaped association between increased health risks and sleep duration; we hypothesized a U‐shaped association between sleep duration and cognitive functioning. Objective cognitive functioning was assessed with tasks derived from the Consortium to Establish a Registry for Alzheimer’s Disease test battery (verbal fluency, encoding and retaining verbal material). Subjective cognitive functioning and sleep‐related factors were assessed with questionnaires. Health status was assessed during a health interview. Depressive and alcohol use disorders were assessed with the Composite International Diagnostic Interview. Medication was recorded during the health examination. Short and long sleep duration, tiredness and fatigue were found to be associated with both objectively assessed and self‐reported decreased cognitive functioning. The association was stronger between sleep factors and subjective cognitive function than with objective cognitive tests. These data suggest that self‐reported habitual short and long sleep duration reflect both realization of homeostatic sleep need and symptom formation in the context of the individual’s health status.     

Am I (hyper)aroused or anxious? Clinical significance of pre‐sleep somatic arousal in young adults

Self‐reported somatic arousal remains a challenging clinical construct, particularly because only a subset of patients report symptoms such as racing heart, palpitations or increased body temperature interfering with their sleep. It is unclear whether self‐reported somatic arousal is a marker of hyperarousal or co‐morbid clinical anxiety in individuals with insomnia. Participants included 196 young adults aged 20.2 ± 1.0 years old who were predominantly females (75%). About 39% of the sample reported subthreshold insomnia, and about 8% reported clinically significant insomnia, based on their Insomnia Severity Index. Participants completed the Pre‐Sleep Arousal Scale, Beck Anxiety Inventory, Beck Depression Inventory, Arousal Predisposition Scale, and Ford Insomnia Response to Stress Test. Multivariable stepwise regression assessed which factors were independently associated with pre‐sleep cognitive (Pre‐Sleep Arousal Scale‐Cognitive) and somatic (Pre‐Sleep Arousal Scale‐Somatic) arousal. Receiver‐operating characteristic analysis assessed the predictive value to identify clinically significant anxiety (Beck Anxiety Inventory ≥ 20), insomnia (Insomnia Severity Index ≥ 15) and arousability (Arousal Predisposition Scale ≥ 32). Beck Anxiety Inventory (β = 0.42) was the best single correlate of Pre‐Sleep Arousal Scale‐Somatic, while Insomnia Severity Index (β = 0.33) was of Pre‐Sleep Arousal Scale‐Cognitive. A Pre‐Sleep Arousal Scale‐Somatic score of 12 or more identified those with clinically significant anxiety with 65% specificity and 65% sensitivity, while a cut‐off score of 14 increased its sensitivity (86%). Self‐reported pre‐sleep somatic arousal may be an index of co‐morbid clinical anxiety in individuals with insomnia. These findings aid clinicians with assessment and treatment, particularly in the absence of clinical guidelines indicating when somatically focused relaxation techniques should be included as part of multicomponent cognitive behavioural treatment of insomnia.     

Response to valganciclovir in chronic fatigue syndrome patients with human herpesvirus 6 and Epstein–Barr virus IgG antibody titers

Valganciclovir has been reported to improve physical and cognitive symptoms in patients with chronic fatigue syndrome (CFS) with elevated human herpesvirus 6 (HHV‐6) and Epstein–Barr virus (EBV) IgG antibody titers. This study investigated whether antibody titers against HHV‐6 and EBV were associated with clinical response to valganciclovir in a subset of CFS patients. An uncontrolled, unblinded retrospective chart review was performed on 61 CFS patients treated with 900 mg valganciclovir daily (55 of whom took an induction dose of 1,800 mg daily for the first 3 weeks). Antibody titers were considered high if HHV‐6 IgG ≥1:320, EBV viral capsid antigen (VCA) IgG ≥1:640, and EBV early antigen (EA) IgG ≥1:160. Patients self‐rated physical and cognitive functioning as a percentage of their functioning prior to illness. Patients were categorized as responders if they experienced at least 30% improvement in physical and/or cognitive functioning. Thirty‐two patients (52%) were categorized as responders. Among these, 19 patients (59%) responded physically and 26 patients (81%) responded cognitively. Baseline antibody titers showed no significant association with response. After treatment, the average change in physical and cognitive functioning levels for all patients was +19% and +23%, respectively (P < 0.0001). Longer treatment was associated with improved response (P = 0.0002). No significant difference was found between responders and non‐responders among other variables analyzed. Valganciclovir treatment, independent of the baseline antibody titers, was associated with self‐rated improvement in physical and cognitive functioning for CFS patients who had positive HHV‐6 and/or EBV serologies. Longer valganciclovir treatment correlated with an improved response. J. Med. Virol. 84:1967–1974, 2012. © 2012 Wiley Periodicals, Inc.