Health-related quality of life in patients with chronic fatigue syndrome: group cognitive behavioural therapy and graded exercise versus usual treatment. A randomised controlled trial with 1 year of follow-up.

Chronic fatigue syndrome (CFS) produces physical and neurocognitive disability that significantly affects health-related quality of life (HRQL). Multidisciplinary treatment combining graded exercise therapy (GET) cognitive behavioural therapy (CBT) and pharmacological treatment has shown only short-term improvements. To compare the effects on HRQL of (1) multidisciplinary treatment combining CBT, GET, and pharmacological treatment, and (2) usual treatment (exercise counselling and pharmacological treatment) at 12 months of follow-up. Prospective, randomized controlled trial with a follow-up of 12 months after the end of treatment. Patients consecutively diagnosed with CFS (Fukuda criteria) were randomly assigned to intervention (n = 60) or usual treatment (n = 60) groups. HRQL was assessed at baseline and 12 months by the Medical Outcomes Study Short-Form questionnaire (SF-36). Secondary outcomes included functional capacity for activities of daily living measured by the Stanford Health Assessment Questionnaire (HAQ) and comorbidities. At baseline, the two groups were similar, except for lower SF-36 emotional role scores in the intervention group. At 12 months, the intervention did not improve HRQL scores, with worse SF-36 physical function and bodily pain scores in the intervention group. Multidisciplinary treatment was not superior to usual treatment at 12 months in terms of HRQL. The possible benefits of GET as part of multidisciplinary treatment for CFS should be assessed on an individual patient basis.

Relación entre el síndrome de fatiga crónica y el patrón de conducta tipo A / Relationship between chronic fatigue syndrome and type A behaviour

Fundamento y objetivo: Evidenciar la relación entre el patrón de conducta tipo A (PCTA) y el síndrome de fatiga crónica (SFC). Pacientes y método: Para evaluar el PCTA se ha administrado el inventario del JAS (Jenkins Activity Survey ‘cuestionario de actividad de Jenkins’) a 82 pacientes diagnosticados de SFC según los criterios de Fukuda (Centro para el Control y prevención de enfermedades, 1994). Se han comparado las medias de las puntuaciones típicas obtenidas en el JAS de los pacientes con SFC con las medias de las puntuaciones obtenidas en la población general (controles sanos) y en los pacientes con cardiopatía isquémica (controles patológicos). Resultados: Los pacientes con SFC tienen una media de las puntuaciones típicas de 5 puntos por encima de la media de la población general y de 2 puntos por encima de los enfermos de cardiopatía isquémica. Conclusiones: El PCTA es un factor que está relacionado con el SFC. Una alta puntuación en el JAS debería tenerse en cuenta en el abordaje terapéutico de estos enfermos (AU)

Background and objective: To quantify the relationship between Chronic Fatigue Syndrome (CFS) and Type A Behaviour Pattern (TABP) Patients and method: The Jenkins Activity Survey (JAS) was administered to 82 patients diagnosed with CFS to determine the prevalence of TABP. Subjects’ mean z scores on the JAS were compared with those from the general population (healthy controls) and from patients with ischemic cardiopathy (pathologic controls). Results: CFS patients’ mean score on the JAS was 5 points higher than that of the general population (healthy controls) and 2 points higher than that of patients with ischemic cardiopathy. Conclusions: TABP appears to be related with CFS and should be taken into account in the treatment of these patients (AU)

[Relationship between chronic fatigue syndrome and type A behaviour]. / Relación entre el síndrome de fatiga crónica y el patrón de conducta tipo A.

BACKGROUND AND OBJECTIVE: To quantify the relationship between Chronic Fatigue Syndrome (CFS) and Type A Behaviour Pattern (TABP) PATIENTS AND METHOD: The Jenkins Activity Survey (JAS) was administered to 82 patients diagnosed with CFS to determine the prevalence of TABP. Subjects' mean z scores on the JAS were compared with those from the general population (healthy controls) and from patients with ischemic cardiopathy (pathologic controls). RESULTS: CFS patients' mean score on the JAS was 5 points higher than that of the general population (healthy controls) and 2 points higher than that of patients with ischemic cardiopathy. CONCLUSIONS: TABP appears to be related with CFS and should be taken into account in the treatment of these patients.

[Multiple chemical sensitivity: study of 52 cases]. / Sensibilidad química múltiple: análisis de 52 casos.

BACKGROUND AND OBJECTIVE: Multiple chemical sensitivity (MCS) is characterized by a loss of tolerance to various environmental chemicals. The objective of this study was to describe patients with MCS seen in our hospital. PATIENTS AND METHOD: Patients consecutively seen by the Toxicology and Chronic Fatigue Units who presented symptoms of MCS were included. The diagnosis was clinical. All patients completed the Quick Environmental Exposure and Sensitivity Inventory (QEESI) questionnaire. RESULTS: Fifty-two patients were included. The average age (standard deviation) was 47.2 (7.6) years, and 46 (88%) were females. The origin of the syndrome was related to occupational exposure to various chemical agents in 31 cases (59.6%), including occupational accidents in 14 patients (fumigation of the workplace with insecticides). In 20 patients (38.5%), the syndrome could not be associated with any toxic exposure and was considered a manifestation of chronic fatigue syndrome. The QEESI showed mean scores of 72.9 (18.6) on the chemical inhalant intolerance scale, 45.5 (20.6) on the other intolerances scale, 69.8 (20.6) on the symptom severity scale, 4.4 (1.8) on the masking index and 66.6 (21.7) on the life impact scale. All patients were followed up for a minimum of 12 months, and during this period they remained stable with no deaths. CONCLUSIONS: MCS normally affects middle-aged women. It is frequently triggered by exposure to chemical agents, especially insecticides. An association with chronic fatigue syndrome is common. The prognosis is good but the patients' quality of life is seriously affected.

Sensibilidad química múltiple: análisis de 52 casos / Multiple chemical sensitivity: study of 52 cases

Fundamento y objetivo: La sensibilidad química múltiple (SQM) se caracteriza por la pérdida de tolerancia a la presencia en el medio ambiente de agentes químicos diversos. El objetivo de este trabajo es describir las características clínicas de una serie de pacientes con SQM atendidos en nuestro hospital. Pacientes y método: Se ha evaluado a los pacientes atendidos en las Unidades de Toxicología y de Fatiga Crónica que presentaban síntomas de SQM. El diagnóstico fue clínico. Todos ellos completaron el cuestionario QEESI (Quick Environmental Exposure and Sensitivity Inventory). Resultados: Se ha incluido a 52 pacientes, con una edad media (desviación estándar) de 47,2 (7,6) años; 46 eran mujeres (88%). El origen del síndrome pudo relacionarse con una exposición laboral a productos químicos en 31 pacientes (59,6%) y en 14 de ellos fue una fumigación con insecticidas en el lugar de trabajo. En 20 casos (38,5%) el síndrome no pudo relacionarse con ninguna exposición tóxica y constituía una manifestación más de un síndrome de fatiga crónica. En el cuestionario QEESI obtuvieron una media de 72,9 (18,6) puntos en la escala de exposición inhalatoria; 45,5 (20,6) en la de exposición no inhalatoria; 69,8 (20,6) en la de gravedad de los síntomas; 4,4 (1,8) en la de identificación de la exposición, y 66,6 (21,7) en la de repercusión sobre las actividades de la vida diaria. Todos los casos fueron controlados durante un mínimo de 12 meses, período durante el cual permanecieron estables y no se registró ningún fallecimiento. Conclusiones: La SQM incide habitualmente en mujeres de mediana edad. En general se desencadena por una exposición a productos químicos y muy en particular a insecticidas. La asociación con el síndrome de fatiga crónica es frecuente. El pronóstico vital es bueno, pero se reduce considerablemente la calidad de vida de los pacientes

Background and objective: Multiple chemical sensitivity (MCS) is characterized by a loss of tolerance to various environmental chemicals. The objective of this study was to describe patients with MCS seen in our hospital. Patients and method: Patients consecutively seen by the Toxicology and Chronic Fatigue Units who presented symptoms of MCS were included. The diagnosis was clinical. All patients completed the Quick Environmental Exposure and Sensitivity Inventory (QEESI) questionnaire. Results: Fifty-two patients were included. The average age (standard deviation) was 47.2 (7.6) years, and 46 (88%) were females. The origin of the syndrome was related to occupational exposure to various chemical agents in 31 cases (59.6%), including occupational accidents in 14 patients (fumigation of the workplace with insecticides). In 20 patients (38.5%), the syndrome could not be associated with any toxic exposure and was considered a manifestation of chronic fatigue syndrome. The QEESI showed mean scores of 72.9 (18.6) on the chemical inhalant intolerance scale, 45.5 (20.6) on the other intolerances scale, 69.8 (20.6) on the symptom severity scale, 4.4 (1.8) on the masking index and 66.6 (21.7) on the life impact scale. All patients were followed up for a minimum of 12 months, and during this period they remained stable with no deaths. Conclusions: MCS normally affects middle-aged women. It is frequently triggered by exposure to chemical agents, especially insecticides. An association with chronic fatigue syndrome is common. The prognosis is good but the patients' quality of life is seriously affected