Dedra Buchwald

Psychiatric illness in patients with chronic fatigue and those with rheumatoid arthritis

Objectives:To identify psychiatric differences between patients with chronic fatigue and those with rheumatoid arthritis and to investigate whether patients meeting Centers for Disease Control (CDC) criteria for chronic fatigue syndrome (CFS) can be differentiated from patients with chronic fatigue on measures of disability and psychosocial distress.Design:Cross-sectional study comparing 98 patients with chronic fatigue with 31 patients with rheumatoid arthritis on structured psychiatric interviews and patient questionnaires. Nineteen patients meeting CDC criteria for CFS were compared with 79 patients with chronic fatigue not meeting CDC criteria on questionnaires measuring disability and psychosocial distress.Setting:Consecutive patients with chronic fatigue were selected from a chronic fatigue clinic at the University of Washington, and 31 consecutive patients with rheumatoid arthritis were sampled from a private rheumatology practice.Main results:Patients with chronic fatigue had a significantly higher prevalence of lifetime major depression and somatization disorder than did patients with rheumatoid arthritis. Patients with chronic fatigue also had a significantly higher prevalence of current and lifetime psychiatric diagnoses. Only 19 of 98 patients with chronic fatigue met CDC criteria for CFS. Patients meeting CDC criteria for CFS could not be differentiated from the larger group of patients with chronic fatigue on any study variable.Conclusions:Patients with chronic fatigue have a significantly higher burden of psychiatric illness than do patients with rheumatoid arthritis. The psychiatric illness preceded the development of chronic fatigue in over half the patients. Centers for Disease Control criteria for CFS did not select a subset of chronic fatigue patients who could be differentiated on disability or psychosocial parameters from patients with chronic fatigue who did not meet CDC criteria.

Health-related quality of life in patients with chronic fatigue syndrome. An international study

OBJECTIVEnChronic fatigue syndrome (CFS) has been reported worldwide. Our objectives were to determine if patients from different countries have similar profiles of impairments.nnnMETHODSnHealth-related quality of life (HRQoL) was assessed in 740 CFS patients in the US, 82 in the UK, and 65 in Germany using the eight subscales of the Short-Form General Health Survey (SF-36). To examine the internal structure, factor analyses were performed.nnnRESULTSnOverall, there was a remarkable similarity in HRQoL among all CFS patients, regardless of location. Patients scored two to three standard deviations below normal on six subscales and one standard deviation below normal on the other two subscales. Factor analysis suggested a two-factor model where the same six subscales constitute the first factor and the two others the second factor.nnnCONCLUSIONnHRQoL is poor in CFS patients from three countries. This study is a first step towards conducting further comparative cross-cultural and international studies.

LONGITUDINAL CHANGES ASSOCIATED WITH IMPROVEMENT IN CHRONIC FATIGUE PATIENTS

Tertiary care patients with chronic fatigue were followed for 2.5 years to determine if changes in physical and psychological status were associated with improvements in chronic fatigue, physical functioning, and return to work. Results indicated that improvement in psychological symptoms, DSM-III-R disorders, physical examination signs, and changes in whether the patient continued to meet criteria for chronic fatigue syndrome (CFS) were associated with recovery from fatigue, improved functioning, and return to work. Patients who never met CFS criteria or only met criteria at the initial assessment, reported improved physical functioning. Patients whose psychiatric disorders and physical examination signs were still present at a mean follow-up time of 2.5 years were more likely to have persistent fatigue and work disability. Loss of physical examination signs was a significant independent predictor of improved functioning and return to work. These results suggest that psychiatric status, as well as physical status, are associated with recovery from chronic fatigue.

Work activities of clinician-educators.

In order to make meaningful scholarly contributions, clinicianeducators need protected time. Forty-one clinician-educators at the University of Washington recorded their work activities in 30-minute intervals for 2 weeks. The average work week was 58.7 hours (SD=13.8). The time devoted to scholarship, 7.6 hours (13%), was significantly less than the 20% designated for scholarship in the clinician-educator job description (p<.001); 42% of scholarly work occurred outside the regular work week. At a time when many schools rely on clinician-educators to sustain their clinical and teaching missions, schools should ensure that faculty have adequate time and resources to meet scholarly expectations for promotion.

Peripheral Blood Lymphocytes Express Recombination-Activating Genes 1 and 2 during Epstein-Barr Virus–Induced Infectious Mononucleosis

Implicit in the persistence of Epstein-Barr virus (EBV) in B lymphocytes is the successful circumvention of ongoing cell selection for competence of B cell receptors (BCRs). Because the EBV infection of B cells in vitro induces enzymatic machinery that is responsible for secondary immunoglobulin gene rearrangement, we examined the expression of the recombination-activating genes (RAGs) in peripheral blood mononuclear cells (PBMCs) from 26 patients with infectious mononucleosis (IM). RAG1 and/or RAG2 RNA was detected in PBMCs from 42% of patients with IM but not from healthy control subjects. EBV may usurp the cellular mechanism that diversifies the BCR, to guarantee a level of survival signaling sufficient for its own persistence.

Hypertension in older urban Native-American primary care patients.

OBJECTIVES: To examine hypertension and its management in a population of older urban American Indians and Alaska Natives (AI/ANs).

The Association of Disease Severity, Functional Status, and Medical Utilization with Relationship Satisfaction among Asthma Patients and Their Partners

The association of relationship satisfaction to asthma-related illness factors was examined among 46 couples in which one person had asthma of mild-to-moderate severity. The asthma-related illness factors included measures of disease severity, functional status, and medical utilization. More asthma severity and greater use of asthma medications accounted for 27% of the variance in relationship satisfaction. These results diverge from the general notion that more illness should be associated with more relationship distress. The findings are discussed in the context of the potentially buffering effects of the relationship satisfaction among the couples in the present sample against the stress of a chronic illness.

Frequency and impact of housestaff contact with primary care physicians

To determine how often housestaff notified primary care providers (PCPs) of admissions, whether notification prompted a visit, and whether PCP input impacted care, 210 medical inpatients were asked about their PCPs, and at discharge, housestaff completed a questionnaire on the patient’s PCP, and whether he or she was contacted, came to the hospital, and influenced care. Of 105 patients with a PCP, 74 were contacted and 26 visited their patients. The PCPs spoken with personally more often made hospital visits than those contacted only by message (p<0.0001). PCP input frequently contributed to patient care by providing continuity, clarifying history/diagnosis, managing chronic problems, and elucidating psychosocial/cultural factors. Having a PCP did not influence length of stay or readmission rates.