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Can sustained arousal explain the Chronic Fatigue Syndrome?

By Vegard B Wyller, Hege R Eriksen and Kirsti Malterud

Abstract

We present an integrative model of disease mechanisms in the Chronic Fatigue Syndrome (CFS), unifying empirical findings from different research traditions. Based upon the Cognitive activation theory of stress (CATS), we argue that new data on cardiovascular and thermoregulatory regulation indicate a state of permanent arousal responses – sustained arousal – in this condition. We suggest that sustained arousal can originate from different precipitating factors (infections, psychosocial challenges) interacting with predisposing factors (genetic traits, personality) and learned expectancies (classical and operant conditioning). Furthermore, sustained arousal may explain documented alterations by establishing vicious circles within immunology (Th2 (humoral) vs Th1 (cellular) predominance), endocrinology (attenuated HPA axis), skeletal muscle function (attenuated cortical activation, increased oxidative stress) and cognition (impaired memory and information processing). Finally, we propose a causal link between sustained arousal and the experience of fatigue. The model of sustained arousal embraces all main findings concerning CFS disease mechanisms within one theoretical framework

Topics: Review
Publisher: BioMed Central
OAI identifier: oai:pubmedcentral.nih.gov:2654901
Provided by: PubMed Central

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Citations

  1. (2008). A precarious balance: Using self-regulation model to conceptualize and treat chronic fatigue syndrome.
  2. (2006). A: Post-infective and chronic fatigue syndromes precipitated by viral and non-viral pathogens: prospective cohort study. BMJ
  3. (1999). Alaranta H: Mechanisms explaining the association between low back trouble and deficits in information processing. A controlled study with follow-up. Spine
  4. (2007). Arora R: Cardiovascular manifestations of posttraumatic stress disorder.
  5. (1996). Arousal: Revisiting the reticular activating system. Science
  6. (1993). Augmentation of muscle sympathetic nerve activity during fatiguing isometric leg exercise.
  7. (2000). Autonomic nervous system dysfunction in adolescents with postural orthostatic tachycardia syndrome and chronic fatigue syndrome is characterized by attenuated vagal baroreflex and potentiated sympathetic vasomotion. Pediatr Res
  8. (2006). Bleijenberg G: Chronic fatigue syndrome. Lancet
  9. (2000). Chronic fatigue syndrome: the fundamentals still apply.
  10. (1997). Chrousos GP: Chronic pain and fatigue syndromes: overlapping clinical and neuroendcrine features and potential pathogenic mechanisms. Neuroimmunomodulation
  11. (2001). Cluydts R: Neuropsychological functioning in chronic fatigue syndrome: a review. Acta Psychiatr Scand
  12. (1997). Conditions of reduced gravity.
  13. (1998). Coping and adaptive outcome in chronic fatigue syndrome: importance of illness cognitions.
  14. (2005). Delliaux S: Chronic fatigue syndrome: assessment of increased oxidative stress and altered muscle excitability in response to incremental exercise.
  15. (2002). Denney DR: Perception of cognitive performance in patients with chronic fatigue syndrome. Ann Behav Med
  16. (2004). Dysautonomia in chronic fatigue syndrome: facts, hypotheses, implications. Med Hypotheses
  17. (2004). Egle UT: Fibromyalgia: a stress disorder? Piecing the biopsychosocial puzzle together. Psychother Psychosom
  18. (2004). Eriksen HR: The cognitive activation theory of stress. Psychoneuroendocrinology
  19. (1999). Evengard B: Critical life events, infections, and symptoms during the year preceding chronic fatigue syndrome (CFS): an examination of CFS patients and subjects with a nonspecific life crisis. Psychosom Med
  20. (1989). Expectancy theory in animal conditioning. In Contemporary learning theories: Pavlovian conditioning and the status of learning theory Edited by: Klein SB, Mowrer RR.
  21. (2000). Fatigue in chronic disease. Clin Sci
  22. (1998). Ferlin G: Brain positron emission tomography (PET) in chronic fatigue syndrome: preliminary data.
  23. (2005). Goldspink DF: Beta2-adrenergic receptor stimulation in vivo induces apoptosis in the rat heart and soleus muscle.
  24. (1966). Habituation: A model phenomenon for the study of neuronal substrates of behavior. Psychol Rev
  25. (2003). House A: Life events, difficulties and dilemmas in the onset of chronic fatigue syndrome: a case-control study. Psychol Med
  26. (2002). Hypovolemia and neurovascular control during orthostatic stress.
  27. (2005). Impact of chronic psychosocial stress on autonomic cardiovascular regulation in otherwise healthy subjects. Hypertension
  28. (2006). JF: Combination of single nucleotide polymorphisms in neuroendocrine effector and receptor genes predict chronic fatigue syndrome. Pharmacogenomics
  29. (2008). JP: Enhanced vagal withdrawal during mild orthostatic stress in adolescents with chronic fatigue. Ann Noninvasive Electrocardiol
  30. (1991). JW: Hypothalamic-pitutitary-adrenal dysfunction in posttraumatic stress disorder. Biol Psychiatry
  31. (2007). Kelestimur F: The hypothalamo-pituitary-adrenalin axis in chronic fatigue syndrome and fibromyalgia syndrome. Stress
  32. (1998). Kiecolt-Glaser JK: Stress-associated immune modulation: relevance to viral infections and chronic fatigue syndrome.
  33. (2002). Lenders JW: Hemodynamic and neurohumoral responses to head-up tilt in patients with chronic fatigue syndrome. Clin Auton Res
  34. (1998). Lightman SL: Inflammatory disease as chronic stress.
  35. (1999). Lucini D: Chronic fatigue syndrome: a hypothesis focusing on the autonomic nervous system. Clin Sci
  36. (1999). Luheshi GN: Central administration of rat IL-6 induces HPA activation and fever but not sickness behaviour in rats.
  37. (2002). ML: Peripheral and central sensitization in fibromyalgia: pathogenic role. Curr Pain Headache Rep
  38. (1997). Natelson BH: Cognitive functioning is impaired in patients with chronic fatigue syndrome devoid of psychiatric disease.
  39. (2000). Netticadan T: Role of oxidative stress in cardiovascular diseases.
  40. (2006). NL: Permorbid predictors of chronic fatigue. Arch Gen Psychiatry
  41. (1995). O'Keane V: Contrasting neuroendocrine responses in depression and chronic fatigue syndrome.
  42. (2005). OB: Effects of lactic acid and catecholamines on contractility in fast-twitch muscles exposed to hyperkalemia.
  43. (2005). Oxidative stress levels are raised in chronic fatigue syndrome and are associated with clinical symptoms. Free Radical Biol Med
  44. (1963). Perception and the conditioned reflex Oxford:
  45. (1998). Protective and damaging effects of stress mediators.
  46. (2006). Quartermain D: Role of CNS alpha1-adrenoceptor activity in central fos responses to novelty. Synapse
  47. (1972). Reinforcement, expectancy and learning. Psychol Rev
  48. (1987). Respiratory physiology and pathological anxiety. Gen Hosp Psychiatry
  49. Salit IE: Post-viral fatigue syndrome.
  50. (2002). Sensitization, conditioning, and learning: can they help us understand somatization and disability?
  51. (1998). SF: Escapable and inescapable stress differentially alter extracellular levels of 5-HT in the basolateral amygdala of the rat. Brain Res
  52. (1998). SF: Exposure to inescapable but not escapable shock increases extracellular levels of 5-HT in the dorsal raphe nucleus of the rat. Brain Res
  53. (2000). Skoge AM, Malterud K: I could not lift my arm holding the fork...". Living with chronic fatigue syndrome. Scand J Prim Health Care
  54. (2002). Somatization and functional dyspepsia.
  55. (2005). Somatization: a psychoneuroimmune perspective. Psychoneuroendocrinology
  56. (1997). SP: Possible mechanisms of central nervous fatigue during exercise. Med Sci Sport Exerc
  57. (2000). Surface EMG and psychophysiological stress reactions in women during repetitive work.
  58. (2007). Thaulow E, Walløe L: Abnormal thermoregulatory responses in adolescents with chronic fatigue syndrome: relation to clinical symptoms. Pediatrics
  59. (2008). Thaulow E: Sympathetic cardiovascular control during orthostatic stress and isometric exercise in adolescents with chronic fatigue syndrome.
  60. (2007). Thaulow E: Sympathetic predominance of cardiovascular regulation during mild orthostatic stress in adolescents with chronic fatigue. Clin Physiol Funct Imaging
  61. (2007). Thaulow E: Usefulness of an abnormal cardiovascular response during low-grade head-up tilt-test for discriminating adolescents with chronic fatigue from healthy controls.
  62. (2001). The autonomic nervous system in health and disease
  63. (2007). The cognitive behavioural model of medically unexplained symptoms: A theoretical and empirical view. Clin Psychol Rev
  64. (2003). The neuroendocrinology of chronic fatigue syndrome. Endocr Rev
  65. (2004). The overtraining syndrome in athletes: a stress-related disorder.
  66. (2007). The pathophysiology of chronic fatigue syndrome in adolescents Oslo:
  67. (2006). The perseverative cognition hypothesis: a review of worry, prolonged stress-related physiological activation, and health. Psychosom Res
  68. (1995). The relationship between neurally mediated hypotension and the chronic fatigue syndrome. JAMA
  69. (2005). The role of enterovirus in chronic fatigue syndrome.
  70. (2002). Unconscious amygdalar fear conditioning in a subset of chronic fatigue syndrome patients. Med Hypotheses
  71. (2004). Ursin H: Subjective health complaints, sensitization and sustained cognitive activation (stress).
  72. (2000). Vizi ES: The sympathetic nerve – an integrative interface between two supersystems: the brain and the immune system. Pharmacol Rev
  73. (2006). Wessely S: Chronic fatigue syndrome: an update focusing on phenomenology and pathophysiology. Curr Opin Psychiatry
  74. (1991). What is stress?
  75. (2000). White PD: Strength and physiological response to exercise in patients with chronic fatigue syndrome.
  76. (2004). Zwarts MJ: Diminished central activation during maximal voluntary contraction in chronic fatigue syndrome. Clin Neurophysiol

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