A 4-Day Mindfulness-Based Cognitive Behavioral Intervention Program for CFS/ME. An Open Study, With 1-Year Follow-Up

Background: Chronic Fatigue Syndrome/Myalgic Encephalopathy (CFS/ME) is an incapacitating illness in which single treatment interventions seem to have variable effects. Based on an earlier study we have conducted a new study with a concentrated intervention program. The aims of this study were to: (1) explore the clinical course for patients with CFS/ME who participated in a treatment program delivered during four consecutive days, and (2) evaluate their satisfaction with this program.Methods: 305 patients diagnosed with CFS/ME (Oxford criteria), recruited from a clinical population referred to a specialist outpatient clinic, participated in an open uncontrolled study of the clinical course through 1 year. The study group participated in a 4-day group intervention program, comprised by education, cognitive group therapy sessions, mindfulness sessions, physical activity and writing sessions, within a context of cognitive behavioral therapy, mindfulness, acceptance and commitment model.Assessments were done by self-reports prior to the first consultation, 1 week before and 1 week after the intervention program, and at 3 months and 1 year after the intervention. SPSS 23 and R 3.3 were used for statistical analyses. The associations between case definitions and the outcome measures (Chalder Fatigue Scale (FS), Short Form 36 (SF-36) physical functioning scale) were assessed by a linear mixed effects model (LME).Results: Results showed statistically significant clinical changes for 80% of the patients after the intervention, changes being sustained through 1 year after the program. For both Fatigue Scale (FS) and the SF-36 there were statistically significant effects of time from baseline to all time points with a statistically significant drop in scores, applying the linear mixed effects model.A subgroup fulfilling the inclusion criteria from the PACE study (Chalder Fatigue Scale >6/11, SF-36 Physical functioning <65/100) showed clinically significant improvement through 1 year, changes in outcome measures were statistically significant (p < 0.001). None of the patients included in the program dropped out, and a great majority of patients expressed high satisfaction with the content, focus and amount of treatment. Conclusion: Clinical changes observed from pre-treatment to 1 year follow-up could represent effects of the 4-day concentrated intervention program, and should be further explored in a controlled study

Quality of life among patients undergoing bariatric surgery: associations with mental health- A 1 year follow-up study of bariatric surgery patients

Background: Preoperative mental health seems to have useful predictive value for Health Related Quality of Life (HRQOL) after bariatric surgery. The aim of the present study was to assess pre- and postoperative psychiatric disorders and their associations with pre- and postoperative HRQOL. Method: Data were assessed before (n = 127) and one year after surgery (n = 87). Psychiatric disorders were assessed by Mini International Neuropsychiatric Interview (M.I.N.I.) and Structured Clinical Interview (SCID-II). HRQOL was assessed by the Short Form 36 (SF-36) questionnaire. Results: Significant improvements were found in HRQOL from preoperative assessment to follow-up one year after surgery. For the total study population, the degree of improvement was statistically significant (p values < .001) for seven of the eight SF-36 subscales from preoperative assessment to follow-up one year after surgery. Patients without psychiatric disorders had no impairments in postoperative HRQOL, and patients with psychiatric disorders that resolved after surgery had small impairments on two of the eight SF-36 subscales compared to the population norm (all effect sizes < .5) at follow-up one year after surgery. Patients with psychiatric disorders that persisted after surgery had impaired HRQOL at follow-up one year after surgery compared to the population norm, with effect sizes for the differences from moderate to large (all effect sizes ≥ .6). Conclusion: This study reports the novel finding that patients without postoperative psychiatric disorders achieved a HRQOL comparable to the general population one year after bariatric surgery; while patients with postoperative psychiatric disorders did not reach the HRQOL level of the general population. Our results support monitoring patients with psychiatric disorders persisting after surgery for suboptimal improvements in quality of life after bariatric surgery

Chronic fatigue syndrome. Health and impairment, treatment and prognosis

Chronic fatigue syndrome (CFS) has been known as “neurasthenia” for more than hundred years and is today often called ME (myalgic encephalopathy), CFS/ME. The illness is characterized by excessive, prolonged and disabling fatigue, pain and somatic complaints, with functional and mental impairment and with major consequences in occupational and social life. Several case definitions with varying criteria are used for CFS. The prevalence is 0.5 % in a general population; the average length of the illness is more than 5 years, and rate of work disability is high. Prognosis is varying; few patients recover totally, but most patients improve substantially over 2-5 years. The objectives in this thesis were to investigate a clinical population with neurasthenia and chronic fatigue syndrome, by assessing subjective health complaints, functional impairment and work disability, by examining treatment effects of specific interventions, by studying long-term illness course and by analyzing the comorbidity of depression and personality patterns. 72 patients with ‘neurasthenia’ were compared with a reference population of 1000 patients in general practitioners’ waiting-rooms. Patients with neurasthenia had more prevalent and more severe subjective health complaints than the reference population of patients, longer periods of sick leave and higher rates of work disability. The patients with neurasthenia/ CFS went through a 6 months randomised clinical trial of mirtazapine, placebo and a comprehensive cognitive-behavioural intervention (CCBT) program of CBT, body awareness therapy and graded exercise. By 3 months the CCBT program had better effect on fatigue symptoms and clinical global severity than mirtazapine medication or placebo alone. By combining the interventions, the combination of CCBT followed by mirtazapine had significantly better effect on fatigue severity by 6 months than placebo or the opposite sequence of initial medication followed by CCBT. Generally, the whole group with neurasthenia and CFS showed substantial clinical improvement after the treatment interventions. In a 5 years follow-up study of this patient group, half of the patients reported a substantial reduction in fatigue symptoms, and diagnoses tended to shift from CFS towards neurasthenia and unspecific chronic fatigue during the follow-up period. Sudden onset, severity of fatigue at the initial phase of illness and slow improvement predicted a poor prognosis. Long-term course seemed more dependent of illness characteristics than of time-limited treatment interventions. The prevalence of personality disorders was found equal to non-clinical populations (13%) in CFS patients; the mean personality score was at an average level, indicating low general personality pathology. CFS patients had a clinical personality profile similar to that of somatoform disorder, with elevated scores of somatisation and health concerns and low scores of self-esteem and perfectionism. The findings in this thesis support the view of CFS as a severe illness with extensive health complaints and severe impairment. The findings also indicate that psychiatric symptoms and personality disorders are low in CFS. Although the prognosis of a full recovery in CFS seems poor, the effect of a comprehensive treatment intervention is generally good, and most patients improve gradually

Quality of life among patients undergoing bariatric surgery: associations with mental health- A 1 year follow-up study of bariatric surgery patients

<p>Abstract</p> <p>Background</p> <p>Preoperative mental health seems to have useful predictive value for Health Related Quality of Life (HRQOL) after bariatric surgery. The aim of the present study was to assess pre- and postoperative psychiatric disorders and their associations with pre- and postoperative HRQOL.</p> <p>Method</p> <p>Data were assessed before (n = 127) and one year after surgery (n = 87). Psychiatric disorders were assessed by Mini International Neuropsychiatric Interview (M.I.N.I.) and Structured Clinical Interview (SCID-II). HRQOL was assessed by the Short Form 36 (SF-36) questionnaire.</p> <p>Results</p> <p>Significant improvements were found in HRQOL from preoperative assessment to follow-up one year after surgery. For the total study population, the degree of improvement was statistically significant (<it>p </it>values < .001) for seven of the eight SF-36 subscales from preoperative assessment to follow-up one year after surgery. Patients without psychiatric disorders had no impairments in postoperative HRQOL, and patients with psychiatric disorders that resolved after surgery had small impairments on two of the eight SF-36 subscales compared to the population norm (all effect sizes < .5) at follow-up one year after surgery. Patients with psychiatric disorders that persisted after surgery had impaired HRQOL at follow-up one year after surgery compared to the population norm, with effect sizes for the differences from moderate to large (all effect sizes ≥ .6).</p> <p>Conclusion</p> <p>This study reports the novel finding that patients without postoperative psychiatric disorders achieved a HRQOL comparable to the general population one year after bariatric surgery; while patients with postoperative psychiatric disorders did not reach the HRQOL level of the general population. Our results support monitoring patients with psychiatric disorders persisting after surgery for suboptimal improvements in quality of life after bariatric surgery.</p> <p>Trial Registration</p> <p>The trial is registered at <url>http://www.clinicaltrials.gov</url> prior to patient inclusion (ProtocolID16280).</p

Chronic fatigue syndrome 5 years after giardiasis: differential diagnoses, characteristics and natural course

Background: A high prevalence of chronic fatigue has previously been reported following giardiasis after a large waterborne outbreak in Bergen, Norway in 2004. The aim of this study was to describe and evaluate differential diagnoses and natural course of fatigue five years after giardiasis among patients who reported chronic fatigue three years after the infection. Methods: Patients who three years after Giardia infection met Chalder’ s criteria for chronic fatigue (n=347) in a questionnaire study among all patients who had laboratory confirmed giardiasis during the Bergen outbreak (n=1252) were invited to participate in this study five years after the infection (n=253). Structured interviews and clinical examination were performed by specialists in psychiatry, neurology and internal medicine/infectious diseases. Fukuda et al’s 1994 criteria were used to diagnose chronic fatigue syndrome (CFS) and idiopathic chronic fatigue (ICF). Self-reported fatigue recorded with Chalder Fatigue Questionnaire three and five years after infection were compared. Results: 53 patients were included. CFS was diagnosed in 41.5% (22/53) and ICF in 13.2% (7/53). Chronic fatigue caused by other aetiology was diagnosed in 24.5% (13/53); five of these patients had sleep apnoea/hypopnoea syndrome, six had depression and five anxiety disorder, and among these two had more than one diagnosis. Fatigue had resolved in 20.8% (11/53). Self-reported fatigue score in the cohort was significantly reduced at five years compared to three years (p<0.001). Conclusion: The study shows that Giardia duodenalis may induce CFS persisting as long as five years after the infection. Obstructive sleep apnoea/hypopnoea syndrome, depression and anxiety were important differential diagnoses, or possibly comorbidities, to post-infectious fatigue in this study. Improvement of chronic fatigue in the period from three to five years after giardiasis was found

Diagnostisering og behandling av kronisk utmattelsessyndrom/myalgisk encefalopati (CFS/ME).

Bakgrunn Det kliniske bildet ved CFS/ME domineres av en opplevelse av fullstendig utmattelse eller energisvikt – ofte brukes den engelske betegnelsen fatigue. Dette hovedsymptomet beskrives som uvanlig kraftig og kvalitativt annerledes enn alminnelig slitenhet. Utmattelsen/energisvikten forverres som regel av beskjedne fysiske og mentale anstrengelser, og den lindres i liten grad av søvn og hvile. Pasientene rapporterer i varierende grad en rekke tilleggsplager som svimmelhet, feberfølelse, vekslende varme- og kuldefølelse, blekhet, balanseproblemer og endret avføringsmønster. Mange beskriver smerteplager fra ledd og muskler, dessuten søvnforstyrrelser og en uttalt sensitivitet for sanseinntrykk som lukt, lys og lyd. I tillegg opptrer symptomer som nedsatt konsentrasjon og hukommelse og redusert evne til innlæring av nye ferdigheter. Metode Vi søkte etter systematiske oversiktsartikler om behandling av kronisk utmattelsessyndrom i databasene CDSR, DARE, MEDLINE, EMBASE, PsycINFO og AHMED. For de tidsperiodene som oversiktsartiklene ikke dekket, søkte vi også etter primærstudier. To personer vurderte søkeresultatene uavhengig av hverandre, og ekstraherte data om behandlingseffekt fra artiklene med høyest kvalitet