Luiza Rangel

The course of severe chronic fatigue syndrome in childhood.

Summary Little has been reported on prognostic indicators in children with chronic fatigue syndrome (CFS). We used interviews with children and parents, a mean of 45.5 months after illness onset, to follow up 25 cases of CFS referred to tertiary paediatric psychiatric clinics. At its worst, the illness had been markedly handicapping (prolonged bed-rest and school absence in two-thirds); mean time out of school was one academic year. Two-thirds, however, had recovered and resumed normal activities—mean duration of illness to recovery/assessment 38 months—and none had developed other medical conditions. Recovery was associated with specific physical triggers to the illness, with start of illness in the autumn school term and with higher socioeconomic status. Severe fatigue states in children can cause serious and longlasting handicap but most children recover.

Psychiatric adjustment in adolescents with a history of chronic fatigue syndrome.

OBJECTIVE To ascertain psychiatric adjustment in youngsters with a history of childhood chronic fatigue syndrome (CFS). METHOD Subjects were 25 children and adolescents with CFS who were seen in tertiary pediatric/psychiatric clinics (mean age 15.6 years, seen a mean of 45.5 months after illness onset; 17 subjects had recovered and 8 were still ill) and 15 healthy matched controls. Youngsters and their parents (usually mothers) were interviewed and completed questionnaires. Instruments used included the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS), the Child Behavior Checklist (CBCL), and the Harter Self-Esteem Questionnaire. RESULTS At assessment, psychiatric disorders (mainly anxiety and depressive disorders) were present in half the subjects with a history of CFS, a rate significantly higher than in healthy controls. On the CBCL youngsters with a history of CFS had an excess of psychological symptoms and decreased social competence. On the Harter Self-Esteem Questionnaire they reported reduced self-esteem, especially in social competence. Anxiety disorders were significantly more common in recovered subjects than in those with active CFS illness status. CONCLUSIONS Psychiatric disorders were found to be increased in adolescents with a history of severe CFS; CFS may enhance the risk for or share common predisposing factors with anxiety disorders.

Surviving chronic physical illness: psychosocial outcome in adult life

Recent advances in physical treatments have changed the implications of receiving a diagnosis of chronic physical illness in childhood. Individuals with disorders such as diabetes, cystic fibrosis, renal failure, and cancer, who may previously have had a limited life expectancy are now surviving into adulthood. During childhood, chronic physical illness confers an increased risk of emotional and behavioural disorders,1 although the majority of children and families successfully adapt to the diagnosis. The increased likelihood of psychiatric disorder during childhood does not seem to be specific to the diagnostic category beyond those involving brain dysfunction,2 3 but reflects the difficulties inherent in living with a chronic illness. Children at greater risk are those with more severe physical disorder,4 and perhaps those with illnesses carrying a greater degree of life threat.5 The risk also varies with the stage of the illness. Adjustment disorders (emotional and/or behavioural symptoms clearly linked in onset to a stressful event and time limited in manifestation) are probably the most frequent psychiatric sequelae and are particularly common at the time of initial diagnosis and after changes in treatment have occurred. For example, psychological problems were reported in almost 60% of children at the time of starting dialysis. One year later, after stabilisation of their physical condition, the prevalence of disturbance was reduced to 21%.6 Similarly, 36% of 8–13 year olds with newly diagnosed insulin dependent diabetes mellitus developed an adjustment disorder (most commonly dominated by depressive symptoms) within the first three months of diagnosis; 50% had recovered within two months.7 While interest is frequently focused on the physical outcome of this group of children as they progress through adolescence into adult life, much less attention has been given to psychosocial outcome. How are they functioning emotionally and socially after their discharge from …

Annotation: Chronic fatigue syndrome in children and adolescents

BACKGROUND Over the past two decades Chronic Fatigue Syndrome (CFS) of childhood has gained increasing prominence. A number of clinical reports and case-control studies have examined the nature of the disorder, its associations, response to treatment and outcome. METHOD A review of publications on childhood CFS was undertaken and reference to work on adult CFS made. Most studies on childhood CFS have been on markedly affected children attending specialist pediatric clinics and very little is known about the condition as it presents in the community or to general medical services. RESULTS The main symptom is fatigue in association with a variety of physical symptoms and with marked and prolonged functional impairment. CFS is commonly reported as being brought on by acute infections. Co-morbid psychiatric (usually mood) disorders are present in at least a half. Personality problems and health attitudes have been described as possible predisposing and maintaining factors. Clinical reports indicate that family work focused on engagement and on a rehabilitation programme (including graded increasing activity and treatment of psychiatric co-morbidity) can help even the more severely impaired children. Recovery may be expected in over two-thirds. CONCLUSIONS CFS presents as a distinct, markedly impairing disorder of childhood. In its severe form, it is often associated with mood disorders. Further research into milder forms and into the efficacy of different treatment interventions is specially needed.

Personality in adolescents with chronic fatigue syndrome.

Abstract Our aim was to study the presence of personality traits and disorder in adolescents with Chronic Fatigue Syndrome (CFS). Personality was then compared to other measures of functioning such as presence of psychiatric disorder and rating on the Child Behavior Checklist 4–18 (CBCL) and in relation to CFS outcome. Twenty-five adolescents with CFS followed-up after contacts with tertiary paediatric/psychiatric clinics were compared with 15 matched healthy controls. Interviews and questionnaires from parents and youngsters included Personality Assessment Schedule (PAS), Kiddie-SADS Psychiatric Interview, Child Behavior Checklist. CFS subjects were significantly more likely than controls to have personality difficulty or disorder. Personality features significantly more common amongst them were conscientiousness, vulnerability, worthlessness and emotional lability. There was a nonsignificant association between personality disorder and worse CFS outcome. Personality difficulty or disorder was significantly associated with psychological symptoms and decreased social competence on the CBCL but it was distinguishable from episodic psychiatric disorder. Personality difficulty and disorder are increased in adolescents with a history of CFS. Personality disorder may be linked to poor CFS outcome.

Family Health and Characteristics in Chronic Fatigue Syndrome, Juvenile Rheumatoid Arthritis, and Emotional Disorders of Childhood

OBJECTIVE To compare family health and characteristics in children with chronic fatigue syndrome (CFS), in juvenile rheumatoid arthritis (JRA), and emotional disorders. METHOD Parents of 28 children and adolescents aged 11 to 18 years with CFS, 30 with JRA, and 27 with emotional disorders (i.e., anxiety and/or depressive disorders) were recruited from specialty clinical settings and completed interviews and questionnaires assessing family health problems, parental mental distress, illness attitudes, and family burden of illness. RESULTS Parents of children with CFS were significantly more likely than those of children with JRA to report a history of CFS-like illness, high levels of mental distress, and a tendency to experience functional impairment in response to physical symptoms. Families of children with CFS were characterized by significantly greater emotional involvement and reported greater family burden related to the childs illness in comparison with families of children with JRA. CONCLUSIONS CFS in childhood and adolescence is associated with higher levels of parental CFS-like illness, mental distress, emotional involvement, and family illness burden than those observed in association with JRA, a chronic pediatric physical illness.

Chronic fatigue syndrome of childhood. Comparative study with emotional disorders.

To examine clinical specificity in chronic fatigue syndrome (CFS) of childhood, by comparing clinical features in childhood CFS and in emotional disorders (ED). 28 children with CFS; 27 with ED. History of disorder; K-SADS psychiatric interviews; self-esteem and physical symptoms questionnaires; premorbid history, behavioural and personality assessments. There were high levels of comorbid emotional disorders in children with CFS, and the two groups were comparable on selfesteem, but CFS children endorsed more fatigue and other somatic symptoms. The two groups were comparable on age at illness onset, but parents of children with CSF reported more biological illness precipitants,more pre-morbid recurrent medical problems and infections. The CFS group had fewer pre-morbid psychological problems and less psychiatric comorbidity than the ED group. There is considerable clinical overlap between CFS and ED of childhood, but there are also differences in clinical presentation between these disorders.

Chronic fatigue syndrome: updates on paediatric and psychological management

l Fatigue as the principal symptom l A definite onset and not life long l Severe and disabling fatigue affecting physical and mental functioning l The fatigue should have been present for a minimum of 6 months, during which it was present for more than 50% of the time l Other symptoms could be associated to the main symptom of fatigue, such as myalgia. joint pains, headache, and sleep disturbance l Some patients should be excluded from the definition. They include: a) patients with established medical conditions known to produce chronic fatigue b) patients with a current diagnosis of schizophrenia, substance abuse, manic depressive illness, eating disorders and organic brain syndrome.