Discriminating between chronic fatigue syndrome and depression: a cognitive analysis

Background: chronic fatigue syndrome (CFS) and depression share a number of common symptoms and the majority of CFS patients meet lifetime criteria for depression. While cognitive factors seem key to the maintenance of CFS and depression, little is known about how the cognitive characteristics differ in the two conditions.Methods: fifty-three CFS patients were compared with 20 depressed patients and 38 healthy controls on perceptions of their health, illness attributions, self-esteem, cognitive distortions of general and somatic events, symptoms of distress and coping. A 6 month follow-up was also conducted to determine the stability of these factors and to investigate whether CFS-related cognitions predict ongoing disability and fatigue in this disorder.Results: between-group analyses confirmed that the depressed group was distinguished by low self-esteem, the propensity to make cognitive distortions across all situations, and to attribute their illness to psychological factors. In contrast, the CFS patients were characterized by low ratings of their current health status, a strong illness identity, external attributions for their illness, and distortions in thinking that were specific to somatic experiences. They were also more likely than depressed patients to cope with their illness by limiting stress and activity levels. These CFS-related cognitions and behaviours were associated with disability and fatigue 6 months later.Conclusions: CFS and depression can be distinguished by unique cognitive styles characteristic of each condition. The documented cognitive profile of the CFS patients provides support for the current cognitive behavioural models of the illness

An analysis of training requirements for practinioners of group therapy in therapeutic milieus

In order to assess the need to formulate training requirements for practitioners of group therapy in therapeutic milieus attached to the Cape Provincial Hospital service , the organization, theoretical framework and functioning of these therapeutic milieus have been cutline. The group therapy component of the therapeutic milieu programmes and the present training provider to all four psyct1iatric disciplines from whose ranks the co-therapists of the therapy groups nrc dravm have been examined . Within this framework an assessment of the need to provide bath improved training and some consider able training in common for the four psychiatric disciplines involved has been made. Evidence from U1e writer's observations reached during thrills' years or supervision of psychic social work students' group therapy in the therapeutic milieus together with examples from the students I process records has been cited to support the conclusion that these needs do exist. The training requirements have been analysed into four components: the theory, experiential group attcnd~1ce, group therapy practice, supervision. The formulation of a training programme embracing these components is advocated . It is concluded that the training programme 3hould to a great extent be applicable to co-therapists from the different psychiatric disciplines. Finally, a number of proposals as to hm-1 improved c1:1d common training programmes can be evaluated and implemented · have been outlined

Tracking daily fatigue fluctuations in multiple sclerosis : ecological momentary assessment provides unique insights

The preparation of this manuscript was supported by a UK Economic and Social Research Council (ESRC) PhD studentship (ES/1026266/1) awarded to DP. The study was funded by the Psychology Unit at the University of Southampton. The authors declare that they have no conflict of interest. The authors thank all participants of this study. Open access via Springer Compact Agreement.Peer reviewedPublisher PD

Mitigating dilemmas in postgraduate researcher mental health and well-being project implementation: critical reflections from three former implementers.

Purpose: This paper aims to present the critical reflections of three women implementers formerly working in projects that seek to support the mental health and well-being (MHW) of postgraduate researchers (PGRs), which has become a recent focus for UK researchers and policymakers. The paper offers an experience-based perspective on tensions in PGR-MHW project implementation by providing personal accounts of several social dilemmas the authors encountered. From reflecting on experiences, the authors derived recommendations for mitigating such dilemmas when designing and delivering future projects. Design/methodology/approach: First, the experiences of dilemmas as female project implementers of PGR-MHW projects were recalled, listed and discussed and identified broad overarching themes. Second, one dilemma for each of the three themes was fleshed out according to the ones that carried meaning for how the role was personally experienced. Third, what the accounts of dilemmas meant for project implementation and outcomes was analyzed. Then the findings to existing literature where similar tensions were identified were linked, including how these could be mitigated. Findings: The dilemmas experienced as implementers in PGR-MHW projects fit among three interconnected themes: identity, values, and motivations and relationships. It was showed that, although they may be hard to see, the dilemmas presented in this paper impede project’s success, outcomes for PGRs and implementers’ well-being. Mitigating such dilemmas when designing, funding, implementing and evaluating future projects is not straightforward, and the findings in this article open avenues to tackle this problem. Originality/value: Focusing on reflections of female implementers, the paper provides an original perspective on PGR-MHW project evaluation. Using reflective writing as a research tool allowed us to identify overlooked dilemmas in project implementation. Honest and critical accounts of implementers’ experiences revealed important lessons such as different framings of project success, the intersection between the personal and the professional and individual responsibilities in project networks

A pilot randomised controlled trial of an internet-based cognitive behavioural therapy self-management programme (MS Invigor8) for multiple sclerosis fatigue

The majority of people affected by Multiple Sclerosis (PaMS) experience severe and disabling fatigue. MS Fatigue is poorly understood and most existing treatments have limited effectiveness. However, a recent randomised controlled trial (RCT) showed that cognitive-behaviour therapy with a clinical psychologist was effective in reducing MS fatigue severity and impact. The current study developed an Internet-based version of this intervention to make it available to a wider group of PaMS and conducted preliminary investigations of its efficacy, feasibility and cost-effectiveness in a pilot RCT. The ‘MS Invigor8’ website was developed using agile design and substantial input from PaMS. The programme includes eight online tailored and interactive sessions along with homework tasks, intended to be accessed weekly. In the pilot trial, 40 patients were randomised to MS Invigor8 (n=23) or standard care (n=17). The MS Invigor8 group accessed sessions over 8-10 weeks and received up to three 30-50 minute telephone support sessions. Participants completed online questionnaires assessing fatigue, mood and quality of life at baseline and 10 weeks follow-up. Large between group treatment effects were found for the primary outcomes of fatigue severity (d=1.19) and impact (d =1.22). The MS Invigor8 group also reported significantly greater improvements in anxiety and depression. Analysis suggested that the intervention may be cost-effective. Qualitative feedback suggested that participants considered this treatment approach acceptable and helpful. Technical website problems negatively affected some users’ experiences and need to be resolved. Given the promising results a larger RCT with longer term follow-up is warranted. <br/

Barriers to reporting non-motor symptoms to health-care providers in people with Parkinson's

Background: Non-motor symptoms (NMS) are common in Parkinson's disease (PD) and cause significant distress. A high rate of non-declaration of NMS by patients to healthcare providers (HCP) means that many NMS remain untreated. Current understanding of the factors preventing disclosure of NMS to HCPs is limited. The present study aimed to i) further assess the prevalence of NMS and associated distress, ii) establish current rates of NMS reporting across a range of sources, and iii) explore overall and any symptom specific barriers to help-seeking for NMS. Methods: 358 PD patients completed a cross-sectional survey of NMS severity, reporting and barriers to help-seeking. A series of Generalised Estimating Equations were used to determine whether barriers were symptom specific. Results: A mean of 10.5 NMS were reported by each patient. Rates of non-reporting of NMS ranged from 15 to 72% of those experiencing distressing symptoms. The most commonly reported barriers to help-seeking were acceptance of symptoms; lack of awareness that a symptom was associated with PD, and belief that no effective treatments were available. Symptom specific barriers were found for sexual dysfunction (embarrassment), unexplained pain and urinary problems (belief about lack of treatment availability). Conclusion: A diverse range of barriers prevent PD patients reporting NMS to HCPs and these barriers differ between NMS. The study provides the foundations for developing interventions to increase reporting by targeting individual NMS. Increasing rates of help-seeking for NMS by patients to their Parkinson's healthcare providers will increase appropriate clinical care which may improve quality of life and well-being

Multiple challenges for people after transitioning to secondary progressive multiple sclerosis: a qualitative study

Objectives Transitioning to secondary progressive multiple sclerosis (SPMS) is demanding for both patients and healthcare professionals. The particular challenges and the ways patients cope are poorly understood. The present study examines what challenges people face when diagnosed with SPMS by exploring experiences of people who have transitioned recently (up to 5 years). Design Semistructured qualitative interviews at two time points a year apart. Interviews were analysed using inductive thematic analysis. Setting UK. Participants We interviewed 21 people at baseline and 17 participated in the follow-up interviews. Results The majority of participants reported expecting to transition to SPMS, and the diagnosis did not make much difference to them. Participants described increasing emotional and physical challenges after transitioning to SPMS and between the first and second interviews. Planning, using distractions and maintaining social roles helped participants cope with the increased challenges. The same coping strategies were used between the two interviews. Participants felt there was not much left to do regarding the management of their symptoms. A key theme was the sense of abandonment from healthcare services after transitioning to SPMS. Conclusions After transitioning to SPMS, people are faced with multiple challenges. Participants described a lack of directions for symptoms management and lack of support from the healthcare system. An integrated multidisciplinary healthcare approach is crucial at the progressive stage of the disease to alleviate feelings of helplessness and promote symptom management

Galactic dynamos with captured magnetic flux and an accretion flow

We examine the behaviour of an axisymmetric galactic dynamo model with a radial accretion flow in the disc. We also introduce a vertical magnetic flux through the galactic midplane, to simulate the presence of a large scale magnetic field trapped by the galaxy when forming. The trapped vertical flux is conserved and advected towards the disc centre by the radial flow. We confirm that accretion flows of magnitude several km/s through a significant part of the galactic disc can markedly inhibit dynamo action. Moreover, advection of the vertical flux in general results in mixed parity galactic fields. However, the effect is nonlinear and non-additive -- global magnetic field energies are usually significantly smaller that the sum of purely dynamo generated and purely advected field energies. For large inflow speeds, a form of `semi-dynamo' action may occur. We apply our results to the accumulation and redistribution, by a radial inflow, of a vertical magnetic flux captured by the Galactic disc. Taking representative values, it appears difficult to obtain mean vertical fields near the centre of the Milky Way that are much in excess of 10 microgauss, largely because the galactic dynamo and turbulent magnetic diffusion modify the external magnetic field before it can reach the disc centre.Comment: 18 pages, 12 figures, LaTE

Parents' expressed emotion and mood, rather than their physical disability are associated with adolescent adjustment. A longitudinal study of families with a parent with multiple sclerosis

Objective. This study investigated the impact of the severity of parental multiple sclerosis, parents’ expressed emotion and psychological well-being on offspring’s psychological difficulties. Design: A longitudinal study including baseline and 6-month follow-up data collected from parents and children. Subjects: Adolescents (n=75), their parents with multiple sclerosis (n=56) and the partner without multiple sclerosis (n=40) Main measures: Parents completed the Hospital Anxiety and Depression Scale and the Five Minutes Speech Sample, a standardised interview of expressed emotion towards their child. Parents with multiple sclerosis also completed the Expanded Disability Status Scale, a measure of illness severity. Adolescents completed the Strength and Difficulties Questionnaire, a self-report measure of psychological difficulties. Results: Higher depression scores of the parents with multiple sclerosis at baseline correlated with increased adolescents’ internalising symptoms at 6-month follow-up (γdep=0.31, p=.004). Higher expressed emotion scores of parents with multiple sclerosis at baseline were associated with increased adolescent externalising symptoms at 6-month follow-up (γEE=4.35, p=.052). There was no direct effect of severity, duration or type of multiple sclerosis on adolescents’ adjustment at baseline or follow-up. Conclusions: Emotional distress and expressed emotion in parents with multiple sclerosis, rather than the severity and type of multiple sclerosis had an impact on adolescents’ psychological difficulties