SLAM_P4_Supplementary_Materials_CCPP_R1_20.01.19 – Supplemental material for Cognitive and behavioural responses to symptoms in adolescents with chronic fatigue syndrome: A case-control study nested within a cohort

Supplemental material, SLAM_P4_Supplementary_Materials_CCPP_R1_20.01.19 for Cognitive and behavioural responses to symptoms in adolescents with chronic fatigue syndrome: A case-control study nested within a cohort by Maria Elizabeth Loades, Katharine Rimes, Kate Lievesley, Sheila Ali and Trudie Chalder in Clinical Child Psychology and Psychiatry</p

Salivary cortisol response to awakening in chronic fatigue syndrome

Background: There is accumulating evidence of hypothalamic-pituitary-adrenal (HPA) axis disturbances in chronic fatigue syndrome (CFS). The salivary cortisol response to awakening hasbeen described recentlyas a non-invasive test of the capacityof the HP Aaxis to respond to stress. The results of this test correlate closely with those of more invasivedynamic tests reported in the literature; furthermore, i tcan be undertaken in a naturalistic setting.Aims: To assess the HPA axis using the salivary cortisol response to awakening in CFS.Method: We measured salivary cortisol upon awakening and 10, 20, 30 and 60 min afterwards in 56 patients with CFS and 35 healthy volunteers.Results: Patients had a lower cortisol response to awakening, measured by the area under the curve.Conclusions: This naturalistic test of the HPA axis response to stress showed impaired HPA axis function in CFS.</p

Salivary cortisol response to awakening in chronic fatigue syndrome

Background: There is accumulating evidence of hypothalamic-pituitary-adrenal (HPA) axis disturbances in chronic fatigue syndrome (CFS). The salivary cortisol response to awakening hasbeen described recentlyas a non-invasive test of the capacityof the HP Aaxis to respond to stress. The results of this test correlate closely with those of more invasivedynamic tests reported in the literature; furthermore, i tcan be undertaken in a naturalistic setting.Aims: To assess the HPA axis using the salivary cortisol response to awakening in CFS.Method: We measured salivary cortisol upon awakening and 10, 20, 30 and 60 min afterwards in 56 patients with CFS and 35 healthy volunteers.Results: Patients had a lower cortisol response to awakening, measured by the area under the curve.Conclusions: This naturalistic test of the HPA axis response to stress showed impaired HPA axis function in CFS.</p

Salivary cortisol output before and after cognitive behavioural therapy for chronic fatigue syndrome

Background: There is evidence that patients with chronic fatigue syndrome (CFS) have mild hypocortisolism. One theory about the aetiology of this hypocortisolism is that it occurs late in the course of CFS via factors such as inactivity, sleep disturbance, chronic stress and deconditioning. We aimed to determine whether therapy aimed at reversing these factors – cognitive behavioural therapy for CFS – could increase cortisol output in CFS.Methods: We measured diurnal salivary cortisol output between 0800 and 2000h before and after 15 sessions (or 6 months) of CBT in 41 patients with CDC-defined CFS attending a specialist, tertiary outpatient clinic.Results: There was a significant clinical response to CBT, and a significant rise in salivary cortisol output after CBT.Limitations: We were unable to control for the passage of time using a non-treated CFS group.Conclusions: Hypocortisolism in CFS is potentially reversible by CBT. Given previous suggestions that lowered cortisol may be a maintaining factor in CFS, CBT offers a potential way to address this.</p

Salivary cortisol output before and after cognitive behavioural therapy for chronic fatigue syndrome

Background: There is evidence that patients with chronic fatigue syndrome (CFS) have mild hypocortisolism. One theory about the aetiology of this hypocortisolism is that it occurs late in the course of CFS via factors such as inactivity, sleep disturbance, chronic stress and deconditioning. We aimed to determine whether therapy aimed at reversing these factors – cognitive behavioural therapy for CFS – could increase cortisol output in CFS.Methods: We measured diurnal salivary cortisol output between 0800 and 2000h before and after 15 sessions (or 6 months) of CBT in 41 patients with CDC-defined CFS attending a specialist, tertiary outpatient clinic.Results: There was a significant clinical response to CBT, and a significant rise in salivary cortisol output after CBT.Limitations: We were unable to control for the passage of time using a non-treated CFS group.Conclusions: Hypocortisolism in CFS is potentially reversible by CBT. Given previous suggestions that lowered cortisol may be a maintaining factor in CFS, CBT offers a potential way to address this.</p

Chronic fatigue syndrome in adolescents: do parental expectations of their child's intellectual ability match the child's ability?

Objective: This cross-sectional study aimed to measure the discrepancy between actual and perceived IQ in a sample ofadolescents with CFS compared to healthy controls. We hypothesized that adolescents with CFS and their parent would have higher expectations of the adolescent's intellectual ability than healthy adolescents and their parent. Methods: The sample was 28 CFS patients and 29 healthy controls aged 11–19 years and the parent of each participant. IQ was assessed using the AH4 group test of general intelligence and a self-rating scale which measuredperceived IQ. Results: Parents' perceptions of their children's IQ were significantly higher for individuals with CFS than healthy controls. Conclusions: High expectations may need to be addressed within the context of treatment.</p

Chronic fatigue syndrome in adolescents: do parental expectations of their child's intellectual ability match the child's ability?

Objective: This cross-sectional study aimed to measure the discrepancy between actual and perceived IQ in a sample ofadolescents with CFS compared to healthy controls. We hypothesized that adolescents with CFS and their parent would have higher expectations of the adolescent's intellectual ability than healthy adolescents and their parent. Methods: The sample was 28 CFS patients and 29 healthy controls aged 11–19 years and the parent of each participant. IQ was assessed using the AH4 group test of general intelligence and a self-rating scale which measuredperceived IQ. Results: Parents' perceptions of their children's IQ were significantly higher for individuals with CFS than healthy controls. Conclusions: High expectations may need to be addressed within the context of treatment.</p

Baseline demographic and clinical data.

<p>Data are N (%) unless otherwise stated.</p><p>APT  =  adaptive pacing therapy, CBT  =  cognitive behaviour therapy, GET  =  graded exercise therapy, SMC  =  specialist medical care alone, ME  =  myalgic encephalomyelitis, BMI  =  body mass index.</p

EQ-5D utilities and QALYs accrued during follow-up period.

<p>APT  =  adaptive pacing therapy, CBT  =  cognitive behaviour therapy, GET  =  graded exercise therapy, SMC  =  specialist medical care alone.</p

N (%) receiving welfare benefits or other financial payments.

<p>APT  =  adaptive pacing therapy, CBT  =  cognitive behaviour therapy, GET  =  graded exercise therapy, SMC  =  specialist medical care alone.</p