Psychology / (M.A.(Clinical Psycholoy)

This Thesis reports a full scale study of cognition and mood in Chronic Fatigue Syndrome (CFS) longitudinally during recovery. Previous studies fail to cover the scope of this study and/or fail to define adequately the syndrome for subject selection. 47 CFS patients were compared with 41 normal and 26 Crohns/colitis controls in a longitudinal study of cognitive performance and depression/anxiety scores. CFS patients performed significantly worse than controls on many of the cognitive tests at first testing. Small but significant differences between CFS and normal controls were found on memory tests (Logical Memory, Word Recognition and, more significantly, Rey Complex Figure) but Crohns/colitis patients scored similarly to CFS, suggesting that this might relate to a general problem such as attention. Much larger and more significant differences between CFS and both control groups were found on tests involving a psychornotor component (e. g. Reaction Time, Finger Tapping and Digit Symbol). CFS patients' performance improved over time (above practise) on word recognition, Stroop (colours), Reaction Time (Movement) and Digit Symbol. CFS patients were significantly more depressed/anxious than the control groups and scored higher on Middlesex Health Questionnaire (Psychiatric). Depression/anxiety did not diminish significantly by second testing. Differences on depression scores accounted for some of the differences in cognitive test performance, in particular Word Fluency and Stroop; however, significant differences remained after ANCOVA removed depression: significant differences remained on Logical Memory, Word Recognition, Digit Symbol, Finger Tapping and Reaction Time. It was concluded that CFS patients were slowed on psychornotor tasks and that this was only partly accountable by depression as suggested by depressed score. CFS patients performed slightly worse on some other tests possibly dependant upon the task demand. Digit Symbol, Reaction Time, and Finger Tapping seemed to be most sensitive to CFS. Brain damage was not necessarily indicated by the results: differences in psychornotor performance could be caused by difficulties in the transmission of instructions to the muscle or slowness in the nerves and muscles themselves. CFS patients' performance significantly improved on a number of tests over time, and did not significantly deteriorate on any test; therefore, the trend of CFS patients' test performance overall was to get better not worse over time.

Chronic Fatigue Syndrome (CFS) is a debilitating condition in which severe, ongoing fatigue is the most prominent of a complex of somatic, psychological and neuropsychological symptoms. The aetiology of CFS remains uncertain and, to date, efforts to distinguish a clear pathophysiological profile for the disorder have been unsuccessful. Current evidence suggests that, rather than being a discrete disease entity with a single cause, CFS is a clinical condition resulting from the interaction of a number of pathophysiological factors, including acute infections, stress and psychiatric disorder. Recently, there has been some interest in the proposition that disordered circadian time-keeping may contribute to the development and/or course of the illness. The rationale for the investigation of circadian factors in CFS is based on the fact that disorders known to be associated with circadian dysregulation, such as jet lag and shiftwork related syndromes have a high degree of symptomatological overlap with CFS. Also, the presence of circadian disturbance could account, in part, for other phenomenological aspects of CFS, including the high rates of comorbid affective disturbance, and the reports of low-level immune dyregulation among sufferers. While several recent studies have produced some evidence of chronobiological dysregulation in CFS patients, much work remains before conclusions can be drawn about the presence, nature and clinical significance of circadian disturbance in CFS. This thesis describes a series of studies that were designed to systematically investigate: 1. whether CFS is associated with a state of circadian dysregulation, and 2. whether circadian dysregulation contributes significantly to the symptomatology of CFS. The first of the 5 studies reported here compared the circadian patterns of sleep-activity of CFS sufferers with those of healthy controls. Results indicated that CFS patients' sleep-activity cycles were significantly phase delayed compared to controls, and that some aspects of their circadian profiles of sleep-activity were related to some measures of sleep-disturbance and well-being. Studies 2 and 3 investigated the relationship between rhythms of sleep-wake and core temperature in CFS patients and healthy controls. The major finding from these studies was that sleep-wake and core temperature rhythms appear to be less effectively synchronised. Further evidence was collected that suggested that there was a relationship between circadian parameters and symptom measures in the CFS group. While this indicated that circadian dysregulation is linked in some way to the symptoms of CFS, assessment of the actual clinical significance of circadian disturbances required the use of a prospective methodology. The final two studies, therefore, report on a placebo-controlled trial of clinical interventions that were designed to restore circadian integrity to CFS patients, in order to see whether this would lead to a reduction in symptom number or severity. Results indicated that, although patients experienced improvements across a range of measures of symptoms and functional capacity, these were small in magnitude, of unlikely clinical significance, and no greater, in general, to improvements reported by patients who underwent placebo treatment. These results, along with those of the earlier studies, are discussed with respect to their implications regarding the presence and significance of circadian dysregulation. It is concluded that, while they provide evidence that CFS is associated with a degree of both internal and external circadian desynchrony, these findings suggest that circadian dysregulation is likely to be only a peripheral, contributor to the processes that generate and maintain the symptom complex. These findings are discussed with respect to how they contribute to our overall understanding of this multi-dimensional condition, and the implications they have for the continuing effort to investigate the causes and treatment of CFS.

Thesis (Ph. D.)--University of Sydney, 2004. / Title from title screen (viewed 5 May 2008). Includes questionnaires, interview guides, consent form, participant information sheet. Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the Dept. of Clinical Nursing, Faculty of Nursing. Includes bibliographical references. Also available in print form.

Psychology / (M.A.(Clinical Psycholoy)

M.A. (Psychology) / Please refer to full text to view abstract

D.Litt. et Phil. / The goal of this study was to determine the impact of cognitive behavioural therapy on people who meet the international diagnostic criteria for CFS, by specifically looking at symptoms and health behaviour. Whereas CFS was originally only studied from a medical perspective, recent years have seen an increased interest from psychologists. Initially the debate centered around whether CFS was a medical or psychiatric illness, but with the development of health psychology as a recognised field of its own, the focus shifted to the investigation of how medical and psychological factors work together to create the symptomatology of CFS. The approach adopted by the research team was that CFS was a biopsychosocial illness and that biological factors such as genetic predisposition, psychological factors such as cognitions and emotions and social factors such as the pressures of families and society work together to establish the health of a person. The study thus set out to gather information regarding all of these aspects in order to add to the current body of knowledge. As previous research efforts had been critisised regarding the validity of the diagnosis of the CFS patients included in their samples, an important challenge that was faced by the researcher was to establish that all the research group participants did meet with the diagnostic criteria. It also had to be ensured that their symptoms could not be accounted for by any other medical illness that was listed as an exclusion criteria for CFS. In order to achieve this patients who had not already had the necessary medical tests done, were requested to do so. The therapeutic intervention was based on cognitive behavioural principles which had been proven to be effective in the treatment of other illnesses that had a biological as well as psychological , aspect to it, for example anxiety, fibromyalgia and chronic pain. The aspects that were addressed had been found by previous researchers to be of great importance in a therapeutic intervention for CFS. These aspects included illness beliefs, information regarding CFS, locus of control and coping mechanisms, avoidance, activity levels, negative and dysfunctional thoughts, social support, lifestyle changes, stress management, sleep, exercise and personality factors. The specific techniques that were included in the intervention were self monitoring, monitoring and modifying of dysfunctional thoughts, goal setting, relaxation and systematic desensitisation. The research group consisted of 37 patients who met the internationally accepted diagnostic criteria for CFS. The control group was a contrast group of comparable size, which included only people who were free from psychological disorders and medical illnesses. The research group participated in a cognitive behavioural intervention, which was designed around the needs of each individual. They therapy was conducted at a community clinic at Rand Afrikaans University between February 1995 and October 1995. Pretests were completed upon commencement of the therapy and the posttests upon termination of the therapy. The control group completed their pre- and posttests at the average interval of the research group pre- and posttests. In order to make a multi-dimensional assessment of the impact of the cognitive behavioural intervention on CFS, various instruments were ulitised. The first instrument was a biographical questionnaire, which recorded the name, sex, age, income group, highest formal qualification, type of work, etcetera. The second questionnaire was an adapted version of the Support and Service Utilisation Schedule, which was employed to control for the other medical and therapeutic interventions that patients participated in, for example the medication taken, alternative medical practitioners visited and sources of support. The participants were asked to maintain their use of these services that they had been using for a long period and to not embark on any new therapies and treatments while they were partaking in the cognitive behavioural intervention.

Thesis (M.Tech.: Homoeopathy)-Dept. of Homoeopathy, Durban Institute of Technology, 2005 xxvii, 153 p. / Chronic fatigue syndrome (CFS) remains a medically unexplained syndrome, with differing aetiological models, case definitions and treatment recommendations (Ranjith, 2005:13). Sharpe & Wessely (1997:179) state that the current case definition for CFS has assumed acceptance as representing nothing more than a working definition of a clinical problem, pending further understanding. CFS has subsequently become the focus of much research and debate (Wessely, Hotopf & Sharpe, 1999:13). Notwithstanding, the definition in terms of diagnostic criteria is adequate in meeting the needs of research studies (Rutherford, 2003). Anecdotal reports, espousing the effectiveness of homoeopathic treatment of CFS, points to the use of the similimum. (Bailey, 1995:189; De Schepper, 2001:6-7; Hardy, 2005:8-10). However, the limited research available on the subject suggests that more research needs to be conducted in this regard (Wessely, Hotopf & Sharpe, 1999:371; Walach, 2004:210-211). This double-blind placebo-controlled study was conducted to determine the effectiveness of homoeopathic similimum treatment in chronic fatigue syndrome (CFS).

Chronic Fatigue Syndrome or myalgic encephalopathy (CFS/ME) has a negative impact on a child and their parents. It is not known what the impact is for the siblings of children with CFS/ME. Nine siblings participated in semi-structured interviews. Siblings identified a number of negative impacts to their family and to themselves, as well as describing some protective family factors. These findings have implications for current practice in CFS/ME paediatric services.

Chronic Fatigue Syndrome (CFS) is a contested condition that generates scepticism and occupies a marginalised position within medical and social contexts. The thesis examines the illness experiences, and specifically the experiences of self, for people affected with CFS. Using qualitative inquiry, a substantive theory related to the process of self-renewal and adaptation associated with CFS is explicated. The theory encompasses the trajectory of CFS from onset to chronicity, and in exceptional instances, recovery. Illness narratives were derived from in-depth, semi-structured interviews of 19 adults, including 16 people affected with, and 3 people recovered from, CFS. Data was coded and analysed using a grounded theory approach. Analysis generated two parallel narratives that defined the illness experience of CFS: the narrative of the illness biographies and the narrative of self, specifically the struggling and diminished self seeking renewal. The illness biographies encompassed the stories of symptoms and their explanations, the encounters that ensued and their contentious milieu. The narrative of self was the primary narrative. It articulated the negative consequences to self and personhood associated with CFS, named the Violation of Self, and the consequent efforts of participants to decrease the struggle and violation by use of the Guardian Response and the Reconstructing Response. The Guardian Response provided protection and self-reclamation. The Reconstructing Response fostered self-renewal and meaning. The two narratives were bridged by the threats of CFS. That is, the illness biographies were accompanied by threats of disruption related to chronic illness, and by threats of invalidation that arose from CFS as a contested condition. In turn, these threats provided the catalyst to the violation and responses as described in the narrative of self. Under different conditions the relative strengths of violation, guardianship or reconstruction fluctuated, and it was these fluctuations that presented the participants with the ongoing struggle of CFS.