A Constructive Debate With the CDC on the Empirical Case Definition of Chronic Fatigue Syndrome (original) (raw)
Evaluating the Centers for Disease Control's Empirical Chronic Fatigue Syndrome Case Definition
2008
The Centers for Disease Control and Prevention (CDC) recently developed an empirical case definition that specifies criteria and instruments to diagnose chronic fatigue syndrome (CFS) in order to bring more methodological rigor to the current CFS case definition. The present study investigated this new definition with 27 participants with a diagnosis of CFS and 37 participants with a diagnosis of a Major Depressive Disorder. Participants completed questionnaires measuring disability, fatigue, and symptoms. Findings indicated that 38% of those with a diagnosis of a Major Depressive Disorder were misclassified as having CFS using the new CDC definition. Given the CDC's stature and respect in the scientific world, this new definition might be widely used by investigators and clinicians. This might result in the erroneous inclusion of people with primary psychiatric conditions in CFS samples, with detrimental consequences for the interpretation of epidemiologic, etiologic, and treatment efficacy findings for people with CFS.
Sensitivity and Specificity of the CDC Empirical Chronic Fatigue Syndrome Case Definition
Psychology, 2010
In an effort to bring more standardization to the chronic fatigue syndrome (CFS) Fukuda et al. case definition [1], the Centers for Disease Control and Prevention (CDC) has developed an empirical case definition [2] that specifies criteria and instruments to diagnose CFS. The present study investigated the sensitivity and specificity of this CFS empirical case definition with diagnosed individuals with CFS from a community based study that were compared to non-CFS cases. All participants completed questionnaires measuring disability (Medical Outcome Survey Short-Form-36) [3], fatigue (the Multidimensional Fatigue Inventory) [4], and symptoms (CDC Symptom Inventory) [5]. Findings of the present study indicated sensitivity and specificity problems with the CDC empirical CFS case definition.
A population-based study of the clinical course of chronic fatigue syndrome
Health and quality of life outcomes, 2003
Chronic fatigue syndrome (CFS) presents a challenge for patients, health care providers, and health insurance groups because of its incapacitating nature, unknown cause, and poorly understood prognosis. We conducted a longitudinal population-based study to characterize the clinical course of CFS. Sixty-five CFS subjects were identified from a random-digit-dialing survey of Wichita, Kansas residents and followed for up to 3 years. We evaluated changes in CFS classification (partial or total remission, alternative medical or psychiatric diagnoses), CFS case-defining criteria, wellness scores, hours of activities and sleep, and treatments used to reduce fatigue. Associations between risk factors and outcomes were determined by use of logistic regression and generalized estimating equations models. Only 20%-33% of the subjects were classified as having CFS at follow-up, 56.9% ever experienced partial or total remission, 10% sustained total remission, and 23.1% received alternative diagn...
CDC Grand Rounds: Chronic Fatigue Syndrome - Advancing Research and Clinical Education
MMWR. Morbidity and mortality weekly report, 2016
Chronic fatigue syndrome (CFS) is a complex and serious illness that is often misunderstood. Experts have noted that the terminology "chronic fatigue syndrome" can trivialize this illness and stigmatize persons who experience its symptoms (1). The name was coined by a group of clinicians convened by CDC in the late 1980s to develop a research case definition for the illness, which, at the time, was called chronic Epstein-Barr virus syndrome. The name CFS was suggested because of the characteristic persistent fatigue experienced by all those affected and the evidence that acute or reactivated Epstein-Barr virus infection was not associated with many cases (2). However, the fatigue in this illness is striking and quite distinct from the common fatigue everyone experiences. A variety of other names have been used, including myalgic encephalomyelitis (ME), ME/CFS, chronic fatigue immune dysfunction, and most recently, systemic exertion intolerance disease (3). The lack of agre...
Nevada Chronic Fatigue Syndrome Consensus Conference
Journal Of Chronic Fatigue Syndrome, 2001
Chronic fatigue syndrome (CFS), a debilitating disorder of unknown etiology, has been the subject of a growing body of literature as information accumulates on the epidemiology, pathogenesis, and disease The authors are the members of the Nevada Consensus Panel.
Population Health Metrics, 2016
Background: Multiple case definitions are in use to identify chronic fatigue syndrome (CFS). Even when using the same definition, methods used to apply definitional criteria may affect results. The Centers for Disease Control and Prevention (CDC) conducted two population-based studies estimating CFS prevalence using the 1994 case definition; one relied on direct questions for criteria of fatigue, functional impairment and symptoms (1997 Wichita; Method 1), and the other used subscale score thresholds of standardized questionnaires for criteria (2004 Georgia; Method 2). Compared to previous reports the 2004 CFS prevalence estimate was higher, raising questions about whether changes in the method of operationalizing affected this and illness characteristics. Methods: The follow-up of the Georgia cohort allowed direct comparison of both methods of applying the 1994 case definition. Of 1961 participants (53 % of eligible) who completed the detailed telephone interview, 919 (47 %) were eligible for and 751 (81 %) underwent clinical evaluation including medical/psychiatric evaluations. Data from the 499 individuals with complete data and without exclusionary conditions was available for this analysis. Results: A total of 86 participants were classified as CFS by one or both methods; 44 cases identified by both methods, 15 only identified by Method 1, and 27 only identified by Method 2 (Kappa 0.63; 95 % confidence interval [CI]: 0.53, 0.73 and concordance 91.59 %). The CFS group identified by both methods were more fatigued, had worse functioning, and more symptoms than those identified by only one method. Moderate to severe depression was noted in only one individual who was classified as CFS by both methods. When comparing the CFS groups identified by only one method, those only identified by Method 2 were either similar to or more severely affected in fatigue, function, and symptoms than those only identified by Method 1. Conclusions: The two methods demonstrated substantial concordance. While Method 2 classified more participants as CFS, there was no indication that they were less severely ill or more depressed. The classification differences do not fully explain the prevalence increase noted in the 2004 Georgia study. Use of standardized instruments for the major CFS domains provides advantages for disease stratification and comparing CFS patients to other illnesses.
An examination of the working case definition of chronic fatigue syndrome
The American Journal of Medicine, 1996
PURPOSE: Chronic fatigue syndrome (CFS) currently is defined by a working case definition developed under the leadership of the United States Centers for Disease Control and Prevention (CDC) based on a consensus among experienced clinicians. We analyzed the experience from one large center to examine the adequacy of the case definition.
Prevalence and Incidence of Chronic Fatigue Syndrome in Wichita, Kansas
Archives of Internal Medicine, 2003
Background: Chronic fatigue syndrome (CFS) is a debilitating illness with no known cause or effective therapy. Population-based epidemiologic data on CFS prevalence and incidence are critical to put CFS in a realistic context for public health officials and others responsible for allocating resources and for practicing physicians when examining and caring for patients. Methods: We conducted a random digit-dialing survey and clinical examination to estimate the prevalence of CFS in the general population of Wichita, Kan, and a 1-year follow-up telephone interview and clinical examination to estimate the incidence of CFS. The survey included 33 997 households representing 90 316 residents. This report focuses on 7162 respondents aged 18 to 69 years. Fatigued (n=3528) and randomly selected nonfatigued (n=3634) respondents completed telephone questionnaires concerning fatigue, other symptoms, and medical history. The clinical examination included the Diagnostic Interview Schedule for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, laboratory testing, and a physical examination. Results: The overall weighted point prevalence of CFS, adjusted for nonresponse, was 235 per 100000 persons (95% confidence interval, 142-327 per 100000 persons). The prevalence of CFS was higher among women, 373 per 100000 persons (95% confidence interval, 210-536 per 100000 persons), than among men, 83 per 100000 persons (95% confidence interval, 15-150 per 100 000 persons). Among subjects nonfatigued and fatigued for less than 6 months, the 1-year incidence of CFS was 180 per 100 000 persons (95% confidence interval, 0-466 per 100000 persons). Conclusions: Chronic fatigue syndrome constitutes a major public health problem. Longitudinal follow-up of this cohort will be used to further evaluate the natural history of this illness.
Chronic fatigue syndrome: Labels, meanings and consequences
Journal of Psychosomatic Research, 2011
In this month's issue, we report a survey of members of the Association of British Neurologists, which asked if they viewed chronic fatigue syndrome (CFS) as a neurological condition-84% of respondents did not. This is at odds with current classification in ICD-10. We discuss the difficulties of classifying CFS and myalgic encephalopmeylitis (ME), including historical and sociological factors, the pitfalls of the physical/psychological dichotomy and why classification matters to doctors and patients.
Summary of Public Policy and Chronic Fatigue Syndrome: A Perspective
Clinical Infectious Diseases, 1994
Chronic fatigue syndrome (CFS) is a challenge for patients as well as their families, caregivers, and the health care teams who treat them. This clinical syndrome of unknown etiology and unclear pathogenesis, with no consistent objective physicalor laboratory findings, produces symptoms that result in significant physical, cognitive, and emotional dysfunction. Individuals and organizations responsible for developing and implementing social and health care policies find that these characteristics of CFS cause difficulties in the administration of limited private and public resources. Thus, the problems in establishing the presence of disease and objectively defining its functional impact, the lack of effective treatment, and a poor understanding of the natural history and prognosis of this syndrome leave policymakers with little basis for assessing the needs of patients with CFS in the context of other health care priorities. All these difficulties are occurring at a time when resources available for health care are being closely scrutinized. The scope and impact of CFS are not clearly understood. Epidemiological studies from the United States presented at this conference place the minimum number of affected individuals at "-'30,000-50,000. It is highly likely that a much larger number of individuals are partially or intermittently impaired. Because CFS affects the productivity of both the patient and the patient's caregiver, its social impact is significant. This paper is a synthesis of the comments made by the authors and the participants at the Public Policy Session of the First International Chronic Fatigue Syndrome Conference in Albany, New York, in 1992. These ideas may provide a focus for future research in the area of public health and, it is hoped, will produce action in the arena of social policy. Epidemiological and Biomedical Research Policy decisions relating to CFS should be based on an accurate body of knowledge. This body of knowledge will accumulate from data generated by rigorously performed studies. These studies should strive to confirm or refute testable hypotheses by use ofwell-described, reproducible meth
A Community-Based Study of Chronic Fatigue Syndrome
Archives of Internal Medicine, 1999
Background: Most previous estimates of the prevalence of chronic fatigue syndrome (CFS) have derived largely from treated populations, and have been biased by differential access to health care treatment linked with sex, ethnic identification, and socioeconomic status. Objective: To assess the point prevalence of CFS in an ethnically diverse random community sample. Design and Participants: A sample of 28 673 adults in Chicago, Ill, was screened by telephone, and those with CFS-like symptoms were medically evaluated. Main Outcome Measures and Analyses: Selfreport questionnaires, psychiatric evaluations, and complete medical examinations with laboratory testing were used to diagnose patients with CFS. Univariate and multivariate statistical techniques were used to delineate the overall rate of CFS in this population, and its relative prevalence was subcategorized by sex, ethnic identification, age, and socioeconomic status. Results: There was a 65.1% completion rate for the telephone interviews during the first phase of the study. Findings indicated that CFS occurs in about 0.42% (95% confidence interval, 0.29%-0.56%) of this random community-based sample. The highest levels of CFS were consistently found among women, minority groups, and persons with lower levels of education and occupational status. Conclusions: Chronic fatigue syndrome is a common chronic health condition, especially for women, occurring across ethnic groups. Earlier findings suggesting that CFS is a syndrome primarily affecting white, middleclass patients were not supported by our findings.
General Hospital Psychiatry, 1997
Chronic fatigue and chronic fatigue syndrome (CFS) have become increasingly recognized as a common clinical problem, yet one that physicians often find difficult to manage. In this review we suggest a practical, pragmatic, evidence-based approach to the assessment and initial management of the patient whose presentation suggests this diagnosis. The basic principles are simple and for each aspect of management we point out both potential pitfalls and strategies to overcome them. The first, and most important task is to develop mutual trust and collaboration. The second is to complete an adequate assessment, the aim of which is either to make a diagnosis of CFS or to identify an alternative cause for the patient's symptoms. The history is most important and should include a detailed account of the symptoms, the associated disability, the choice of coping strategies, and importantly, the patient's own understanding of his/her illness. The assessment of possible comorbid psychiatric disorders such as depression or anxiety is mandatory. When the physician is satisfied that no alternative physical or psychiatric disorder can be found to explain symptoms, we suggest that a firm and positive diagnosis of CFS be made. The treatment of CFS requires that the patient is given a positive explanation of the cause of his symptoms, emphasizing the distinction among factors that may have predisposed them to develop the illness (lifestyle, work stress, personality), triggered the illness (viral infection, life events) and perpetuated the illness (cerebral dysfunction, sleep disorder, depression, inconsistent activity, and misunderstanding of the illness and fear of making it worse). Interventions are then aimed to overcoming these illness-perpetuating factors. The role of antidepressants remains uncertain but may be tried on a pragmatic basis. Other medications should be avoided. The only treatment strategies of proven efficacy are cognitive behavioral ones. The most important starting point is to promote a consistent pattern of activity, rest, and sleep, followed by a gradual return to normal activity; ongoing review of any ‘catastrophic’ misinterpretation of symptoms and the problem solving of current life difficulties. We regard chronic fatigue syndrome as important not only because it represents potentially treatable disability and suffering but also because it provides an example for the positive management of medically unexplained illness in general.
Extracts from "Clinical Evidence": Chronic fatigue syndrome
BMJ, 2000
Background Definition Chronic fatigue syndrome is characterised by severe, disabling fatigue and other symptoms, including musculoskeletal pain, sleep disturbance, impaired concentration, and headaches. Two widely Interventions Beneficial: Exercise Cognitive behavioural therapy Unknown effectiveness: Corticosteroids Antidepressants Dietary supplements Oral nicotinamide adenine dinucleotide (NADH)
Australian and New Zealand Journal of Psychiatry, 2009
Objective: The validity of the diagnosis of chronic fatigue syndrome and related chronic fatigue states remains controversial, particularly in psychiatry. This project utilized international epidemiological and clinical research data to test construct validity across diagnostic categories, health-care settings and countries. Relevant demographic, symptom and diagnostic data were obtained from 33 studies in 21 countries. The subjects had fatigue lasting 1–6 months (prolonged fatigue), or >6 months (chronic fatigue), or met diagnostic criteria for chronic fatigue syndrome. Method: Common symptom domains were derived by factor analytic techniques. Mean scores on each symptom factor were compared across diagnostic categories, health-care settings and countries. Results: Data were obtained on 37 724 subjects (n = 20 845 female, 57%), including from population-based studies (n = 15 749, 42%), studies in primary care (n = 19 472, 52%), and secondary or specialist tertiary referral clini...