Thesis (M.Psych.Clin.) - University of Queensland, [2004]. / Includes bibliography.

Chronic Fatigue Syndrome (CFS) is a chronic disabling condition characterised by persistent physical and mental fatigue, and a variety of somatic, psychological and neurological symptoms. The aetiology of CFS is unknown and the cause of the illness remains controversial. Cognitive-behavioural therapy (CBT) is a non-pharmacological treatment approach that has been shown to be effective in treating patients with CFS. It is based on a model that hypothesises that certain maladaptive thoughts and dysfunctional beliefs may contribute to self-defeating behaviour that perpetuates symptoms and disability, and thereby impedes recovery. The main aim of this study was to critically examine the cognitive-behavioural approach of CFS outlined by Sharpe, Chalder, Palmer & Wessely (1997) by conducting three in-depth case studies. An additional aim was to present a full cognitive developmental case conceptualisation of CFS based on the theories of Leahy (1996) and Young (1994). This case study evaluated the effectiveness of a CBT treatment programme in a 48-year-old Caucasian woman diagnosed with CFS for three years. The treatment consisted of sixteen sessions of CBT and was evaluated both quantitatively and qualitatively. On the basis of this study, a set of core maladaptive schema in the area of disconnection and rejection was identified. In addition, it was found that specific compensatory schemas had developed to offset the core maladaptive schemas and that this compensatory strategy played an important role in maintaining the condition. The results also showed a significant decline in fatigue coupled with a moderate decline in functional disability and depression. A one-month follow-up interview revealed evidence of a substantial consolidation of therapeutic gains in that the improvements observed at the end of the treatment were sustained. Finally, the feasibility of incorporating a cognitive-developmental and/or schema-focused model into the standard CBT treatment model is discussed and the case study method as a research toll is evaluated in light of the findings.

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.

Recently there has been increased interest in chronic fatigue syndrome (CFS), a syndrome of nonspecific symptoms and unknown etiology. The relationship between cardiovascular reflex function, fatigue, and depression in CFS was examined. Findings were as follows: First, there was no evidence of abnormal cardiovascular reflex function in the CFS group. Second, the CFS group had significantly higher systolic and diastolic blood pressure than the control group. Third, the CFS group scored higher on psychological measures of depression, fatigue, and confusion than the control group; the control group scored higher on a measure of vigor than the CFS group. Finally, the CFS group reported more CFS-related symptoms, but some members of the control group did endorse symptoms on a CFS symptom checklist. The possibility that increased peripheral resistance accounts for the elevated blood pressure in the CFS group, and the merits of exploring the role of interleukin-1 and other hormones or "hormone-like" substances in the etiology or maintenance of CFS symptomatology are discussed.

This mini-dissertation was submitted in partial compliance with the requirements for the Master's Degree in Technology: 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). / M

Fibromyalgia Syndrome (FMS) and Chronic Fatigue Immune Dysfunction Syndrome (CFIDS) are primarily womens syndromes. Both syndromes are highly contested within the biomedical and scientific communities and within the general population. Because there is no apparent cause for the syndromes and no available treatment, women living with FMS and/or CFIDS must live with difficult and disabling symptoms. <p>This research also analyzes the metaphors used in the scientific and biomedical literature to describe the same symptoms as listed above. A comparison is drawn between this analysis and that focused on the womens use of metaphors. It is found that although many of the metaphors are the same, they differ in discursive employment. Environmental metaphors, along with metaphors of fracture, harm and productivity are used by the research participants with a very different intent than how the same metaphors are used in the biomedical literature. The women used the metaphors to reveal the ways in which their symptoms are influenced by the social and cultural forces in their everyday lives. The biomedical and scientific use of metaphors reinforced the highly contested view that the symptoms are influenced more by individual psychological and emotional deficiencies than by broader structural forces.

Fibromyalgia Syndrome (FMS) and Chronic Fatigue Immune Dysfunction Syndrome (CFIDS) are primarily womens syndromes. Both syndromes are highly contested within the biomedical and scientific communities and within the general population. Because there is no apparent cause for the syndromes and no available treatment, women living with FMS and/or CFIDS must live with difficult and disabling symptoms. <p>This research also analyzes the metaphors used in the scientific and biomedical literature to describe the same symptoms as listed above. A comparison is drawn between this analysis and that focused on the womens use of metaphors. It is found that although many of the metaphors are the same, they differ in discursive employment. Environmental metaphors, along with metaphors of fracture, harm and productivity are used by the research participants with a very different intent than how the same metaphors are used in the biomedical literature. The women used the metaphors to reveal the ways in which their symptoms are influenced by the social and cultural forces in their everyday lives. The biomedical and scientific use of metaphors reinforced the highly contested view that the symptoms are influenced more by individual psychological and emotional deficiencies than by broader structural forces.

Chronic fatigue syndrome (CFS) is an illness of unknown origin. Although its reality and nature remain in dispute, people in crucial social roles have taken positions that stigmatize or legitimize the condition. And most sufferers remain convinced that CFS is a real, physical illness. This study examined stigma and legitimation in CFS through semi-structured interviews with doctors (N = 15), insurers (N = 16), significant others (N = 23), and sufferers (N = 43). The findings confirm that CFS is stigmatized by characterizing it as a psychological disorder or a form of malingering. But they also show that the duration of the illness and associated disability are sources of stigma not previously identified with CFS. Furthermore, in the absence of biomedical findings, social judgments about sufferers' credibility became a major factor in legitimizing the illness. / By studying stigmatization and legitimation together, it became possible to identify how shifts occurred from one position to the other. By studying doctors, insurers, and significant others, it became evident that five common elements across their different social locations were influencing their views about the illness and its effect on their personal and professional lives or occupational contexts. In turn, these perspectives and effects shaped their reactions to sufferers. / Individual and social factors were found to be implicated in sufferers' illness convictions. On a personal level, persistent or recurrent severe somatic symptoms, functional deterioration, and self evaluations led sufferers to conclude they were physically sick At a social level, these beliefs were sustained by intermittent reinforcement from sympathetic doctors, support group members, and selected medical literature. Finally this study showed the personal and social costs associated with both stigmatizing and legitimizing CFS.

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