Therapy of chronic fatigue syndrome]

Chronic fatigue syndrome (CFS) is characterized by unexplained, debilitating fatigue or easy fatigability lasting longer than six months. While a number of clinical trials have been performed in CFS patients, there is currently no established therapy for CFS. Treatment with acyclovir of CFS patients is ineffective. Intravenous immunoglobulin therapy appears to be effective, though the results are controversial. Antidepressants might help the associated depression and anxiety but not other symptoms. Trials with magnesium have improved the well-being of patients. Restoration of NK activity by biological response modifiers, such as sizofirann, resulted in restoration of NK cell activity and recovery from CFS. Taken together, immunological abnormalities may be involved in CFS, and its restoration may produce clinical benefit in CFS.     

History of chronic fatigue syndrome

Chronic fatigue syndrome (CFS) is not a new disease. Similar morbidities have been known as different names since past several centuries. For example, neurasthenia, epidemic neuromyasthenia, myalgic encephalomyelitis, Akureyri disease, Royal Free disease, chronic EBV disease, post-viral fatigue syndrome etc. Much of the recent interest in CFS was generated by incidence of infection-like outbreak at Lake Tahoe in Nevada. The Center for Disease Control (USA) realized that correlation was poor between those patients who had virologic evidence of EBV infection and those who had the symptoms of chronic fatigue. This is a review of the history of CFS. (1) Historical perspectives in chronic fatigue cases in past old period, (2) Post-viral infectious fatigue and chronic fatigue (myalgic encephalomyelitis), (3) Recent trend of CFS studies and its clinical similar situation. Finally, I would like to state that we intend to draw up a new diagnostic guideline for CFS in Japan.     

慢性疲劳综合征个体的情绪特征研究

目的：分析慢性疲劳综合征（CFS）个体的情绪特征,为今后临床干预提供理论依据.方法：采用疲劳评定量表（FS-14）和症状自评量表（SCL-90）,对329例慢性疲劳综合征及363例健康对照者进行调查.结果：CFS人群疲劳总分和躯体疲劳因子分显著高于对照组,差异具有显著性意义（P＜0.01）;CFS人群SCL-90总分、抑郁、焦虑、躯体化、强迫、偏执及精神病性等因子分均显著高于正常对照组（P＜0.01）.结论：CFS人群的疲劳以躯体疲劳为主,普遍存在抑郁、焦虑、强迫、躯体化和偏执等情绪问题,疲劳越重,抑郁和躯体化症状越明显,影响工作效率和生活质量.     

Overview of psychiatric therapy for chronic fatigue syndrome

Chronic fatigue syndrome (CFS) is recognized as a special condition based on abnormality of psycho-neuro-endocrine-immunological system, which is caused by several cytokines and autoantibodies. For CFS diagnosis, it is required to exclude psychiatric diseases which could cause chronic fatigue. On the other hand, recent studies proved the effectiveness cognitive behavioral therapy(CBT) for CFS. Distorted cognition relevant to CFS includes the characteristics such as over adaptation, perfectionism, avoidance and so on. In the CBT for CFS, it is important to quit seeking physical causes, to accept the pathological state as it is, to monitor daily activity and recognize the cognitive and behavioral patterns which might prolong fatigue, to maintain a constant activity level and to make planned increases in activity.     

慢性疲劳综合征的中医特色疗法研究进展

本文通过检索国内外相关文献,对中医护理特色疗法治疗慢性疲劳综合征（CFS）的相关研究进行综述,从CFS的病因机制、辨证分型、中西医治疗在CFS患者护理中的临床应用等方面进行总结概括,以期为中医护理特色疗法在临床上的灵活运用提供借鉴。     

Overview of chronic fatigue syndrome focusing on prevalence and diagnostic criteria

Chronic fatigue syndrome (CFS) is an operational concept proposed by Centers for Disease Control and Prevention to clarify the unknown etiology of the syndrome characterized by the sensation of abnormally prolonged fatigue. Lots of investigators reported various abnormalities such as virus infection, immune abnormalities, HPA axis abnormalities, metabolic abnormalities, etc., but there are a few abnormalities common to vast majority cases of CFS. Therefore, lots of people as well as medical doctors are still skeptical about the presence of CFS. However, recent studies reveal that CFS can be understood to be a special condition based on the abnormality of neuroendocrine-immunologic system caused by the psycho-social stress and some genetic components. Under these conditions, a reactivation of various kinds of herpes virus infections and/or chronic infections might occur as a result of immune dysfunction, causing the abnormal production of several cytokines. A distinctive feature of CFS is thought to be the secondary brain dysfunction caused by the abnormal production of several cytokines. In this paper, I show the overview of CFS focusing around prevalence, economic impact and diagnostic criteria in Japan.     

Chronic fatigue syndrome and neurotransmitters

Chronic fatigue syndrome (CFS) is an idiopathic illness characterized by persistent fatigue, which could be caused by a variety of etiologic factors including viral infection, abnormal production of cytokines and abnormal acylcarnitine metabolism. Recent studies suggest that CFS is closely associated with attenuation of central synaptic transmission mediated by neurotransmitters such as serotonin and glutamate. Attenuation of serotonin neurotransmission can be caused by increased expression of serotonin transporter, which results either from viral infection and subsequent production of interferon--alpha or from abnormal promoter for serotonin transporter gene. Other neurotransmitter systems may be also involved in CFS mediated by abnormal acylcarnitine metabolism and autoantibodies for neurotransmitter receptors. In this review, we focus recent data on CFS in terms of neurotransmitters.     

中医五音疗法在慢性疲劳综合征患者中的应用

目的观察中医五音疗法对慢性疲劳综合征（chronicfatiguesyndrome,CFS）患者的影响。方法将CFS患者分为治疗组30例和对照组29例。治疗组治疗采用中医五音疗法,对照组采用普通音乐疗法,连续治疗3个月。采用疲劳量表（fatiguescale-14,FS-14）、抑郁状态问卷（depressionstatusinventory,DSI）及疼痛视觉模拟量表（visualanaloguescale,VAS）对患者进行测评。结果治疗后,治疗组患者FS-14、DSI及VAS得分均低于对照组（均P〈0．05）。结论中医五音疗法可降低CFS患者疲劳程度和抑郁情绪及缓解患者疼痛的程度。     

PET研究慢性疲劳综合征中枢机制现状

慢性疲劳综合征(CFS)与中枢系统功能异常密切相关,常伴认知困难、焦虑抑郁及痛觉改变等,目前尚无特异性诊断方法。PET可为研究CFS中枢系统异常提供重要参考依据。本文就PET研究CFS中枢机制现状进行综述。     

Autonomic function and child chronic fatigue syndrome

It is postulated that child chronic fatigue syndrome (CFS) involves the autonomic nervous system, although the precise mechanism has not been clearly indicated. This paper reviews recent reports focusing the role of the autonomic nervous system which plays in CFS. Many of the method for measuring autonomic function have appeared in the clinical setting in parallel with advancing computer technology, but these are limited when applied in children. In these blood pressure and heart rate changes during orthostatic stress and these variability are favorably used. As a result, one third of children with CFS showed abnormal cardiovascular adjustment during posture change (orthostatic dysregulation: OD) which is characterized by instantaneous orhthostatic hypotension, postural tachycardia or neurally-mediated syncope. Most of the studies using power spectral analysis of heart rate variability showed sympathetic activation, however no consistent finding has been obtained. In conclusion, autonomic function might be partly involved in CFS such as OD, but its priority in causing CFS is unclear.     

慢性疲劳综合征患者的社会功能及躯体表现特征的研究

目的：调查分析慢性疲劳综合征患者（CFS）的社会功能状态及躯体表现的特征,为健康干预提供理论依据.方法：对329例CFS患者和363例健康体检者分别采用疲劳评定量表（FS-14）、社会功能综合评定问卷（GQOLI-74）和康奈尔医学指数量表（CMI）进行社会功能情况及其躯体表现特征的调查.结果：CFS组患者的社会支持和婚姻家庭因子分均显著低于对照组（P＜0.01）,躯体各系统症状因子分均显著高于对照组（P＜0.05）.结论：慢性疲劳综合征表现为非特异性的多系统的躯体症状,伴有社会支持和婚姻家庭为特征的社会功能低下.建立针对性干预体系将有助于消除患者躯体症状,恢复社会功能,改善生存质量.     

Viral infections in chronic fatigue syndrome

Chronic fatigue syndrome (CFS) is a heterogeneous illness in which patients can have different, overlapping signs and symptoms. No single underlying cause has been established for all CFS patients. Epidemiological studies reveal that a flu-like sickness precedes the onset in the majority of cases. The major hypothesis of the pathogenesis of CFS is that infectious agents such as viruses, may trigger and lead to chronic activation of the immune system with abnormal regulation of cytokine production. Many studies have been performed to identify the possible microbial triggers and to understand the epidemiological microbial agents. We have summarized the recent progressive literature of virus, rickettsia, and mycoplasma implicated in the pathogenesis of CFS.     

慢性疲劳综合征患者的社会功能与饮食行为因素的相关分析

目的：探讨慢性疲劳综合征（CFS）患者的社会功能与其饮食行为因素的相关性,为制订生活方式的干预处方提供依据.方法：对329例CFS患者和363例健康体检者分别采用疲劳评定量表、饮食行为量表和社会功能综合评定问卷进行调查,对各因素进行Pearson相关分析.结果：受检人群的疲劳总分与饮食心理、代理摄食和饮食内容因素呈正相关,CFS患者的社会支持程度、人际交往频度、家庭婚姻满意度等主要社会功能与体质认识、代理摄食和满腹感等饮食行为因子呈负相关.对照组人群的人际交往频度、业余娱乐形式、婚姻家庭状况等社会功能与饮食心理、饮食方法、饮食内容和饮食节律等因子呈负相关.结论：体质认识、代理摄食和满腹感等饮食行为上的认知偏差直接影响CFS患者的社会功能状态;调整饮食方法和饮食内容,提倡饮食规律化,学会正确处理工作、学习和生活的关系,有助于改善疲劳状态,提高社会功能.     

Pharmaceutical Interventions in Chronic Fatigue Syndrome: A Literature-based Commentary

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating disorder characterized by prolonged periods of fatigue, chronic pain, depression, and a complex constellation of other symptoms. Currently, ME/CFS has no known cause, nor are the mechanisms of illness well understood. Therefore, with few exceptions, attempts to treat ME/CFS have been directed mainly toward symptom management. These treatments include antivirals, pain relievers, antidepressants, and oncologic agents as well as other single-intervention treatments. Results of these trials have been largely inconclusive and, in some cases, contradictory. Contributing factors include a lack of well-designed and -executed studies and the highly heterogeneous nature of ME/CFS, which has made a single etiology difficult to define. Because the majority of single-intervention treatments have shown little efficacy, it may instead be beneficial to explore broader-acting combination therapies in which a more focused precision-medicine approach is supported by a systems-level analysis of endocrine and immune co-regulation.     

Chronic fatigue syndrome: biochemical examination of blood

Though patients with chronic fatigue syndrome (CFS) have lots of complaints, abnormal findings cannot be detected by biochemical screening tests. However, some specialized blood tests have revealed neuroendocrine immune axis abnormalities, which is closely associated with each other. Recent studies indicate that CFS can be understood as a special condition based on abnormality of the psycho-neuro-endocrino-immunological system, with the distinguishing feature of CFS seeming to be the secondary brain dysfunction caused by several cytokines and/or autoantibodies. In this paper, we summarize these abnormalities found in CFS and show the neuro-molecular mechanism leading to chronic fatigue.     

Neuro-psychiatric aspects of chronic fatigue syndrome]

Chronic fatigue syndrome (CFS) is easily differentiated from various neurological organic disorders by conventional clinical examinations. The most important disease for distinguishment from CFS is fibromyalgia syndrome, in which the prominent and cardinal feature is a deprivation of stage 4 slow wave sleep. Experimentally, the sleep disturbance in controls can induce general myalgia, muscle tender points, severe fatigue and stiffness on awakening. The EEG abnormality is slow alpha wave contaminants on slow wave background, which is identical to EEG of CFS. The results clearly imply that CFS is not a hysterical or psychogenic disease, and that fibromyalgia may be a central fundamental of CFS. Fibromyalgia, however, has distinct features such as no antecedent inflammatory process and no endemics. Therefore, the syndrome has features distinct from, in addition to common features to CFS. It is also very difficult to distinguish CFS from depression. The above-mentioned features can be observed in depression. Now, study of brain blood flow or metabolism by PET or SPECT can be a possible tool for establishment of the CFS identity.     

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Essentials of Diagnosis and Management

Despite myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) affecting millions of people worldwide, many clinicians lack the knowledge to appropriately diagnose or manage ME/CFS. Unfortunately, clinical guidance has been scarce, obsolete, or potentially harmful. Consequently, up to 91% of patients in the United States remain undiagnosed, and those diagnosed often receive inappropriate treatment. These problems are of increasing importance because after acute COVID-19, a significant percentage of people remain ill for many months with an illness similar to ME/CFS. In 2015, the US National Academy of Medicine published new evidence-based clinical diagnostic criteria that have been adopted by the US Centers for Disease Control and Prevention. Furthermore, the United States and other governments as well as major health care organizations have recently withdrawn graded exercise and cognitive-behavioral therapy as the treatment of choice for patients with ME/CFS. Recently, 21 clinicians specializing in ME/CFS convened to discuss best clinical practices for adults affected by ME/CFS. This article summarizes their top recommendations for generalist and specialist health care providers based on recent scientific progress and decades of clinical experience. There are many steps that clinicians can take to improve the health, function, and quality of life of those with ME/CFS, including those in whom ME/CFS develops after COVID-19. Patients with a lingering illness that follows acute COVID-19 who do not fully meet criteria for ME/CFS may also benefit from these approaches.     

Chronic fatigue syndrome--symptoms, signs, laboratory tests, and prognosis]

Chronic fatigue syndrome (CFS) is an undefined clinical problem and is perceived as a complex of multiple symptomatology with an unexplained persistent fatigue. Major symptoms include fatigue lasting for more than 6 months, low-grade fever, moderate lymphadenopathy, muscle and joint pain, and various psychological presentations. Since no specific laboratory tests are available, clinical diagnosis demands that known causes of chronic fatigue should be excluded. The pathogenesis is at present unknown, but it is suspected that CFS is a physical and psychological condition associated with some unrecognized infectious agent. Further study is needed to clarify the precise pathophysiology of this newly recognized entity.