Depression and somatization in the chronic fatigue syndrome

Article Abstract:

Chronic fatigue syndrome (CFS), proposed as a clinical entity in 1988, must be diagnosed according to strict criteria. Its major characteristic is chronic, debilitating fatigue unexplainable by other diagnoses, which must be systematically ruled out. One important factor that should be investigated is the patient's personal and family history of psychiatric disease. CFS is associated with psychiatric illness and any other disorders must first be ruled out. To learn more about the prevalence of CFS in a group of patients whose chief complaint was chronic fatigue, a prospective study of 200 patients was performed using modified diagnostic criteria from the Centers for Disease Control. The patients underwent complete medical examinations, including a structured psychiatric interview with the Diagnostic Interview Schedule. Laboratory tests were performed. The two major criteria for diagnosing CFS are the new onset of persistent debilitating fatigue that causes the patient to reduce daily activity by more than 50 percent for at least six months, and the absence of other conditions that could produce such fatigue. Sixty patients met these criteria; each was matched for age and sex to another patient from the remaining 140 subjects (controls) so that comparisons could be carried out. Those with CFS reported greater disability than controls and were less likely to be employed. Current psychiatric disorders were present in 82 percent of the CFS patients and 83 percent of the controls. The proportions of patients in the two groups with active mood disorders and preexisting psychiatric disorders were also similar. Those with CFS were more likely to have somatization disorder (diagnosed based on the frequency of 35 somatic symptoms) than controls, and to believe that their illness had a physical cause. CFS patients often had functional problems, as well, many of which had predated the diagnosis of CFS by many years. The results show that people with CFS have a high rate of psychiatric disorders and that the syndrome cannot be distinguished from mood and anxiety disorders (other common causes of fatigue) without psychiatric evaluation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Chronic fatigue syndrome

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Hereditary angioedema: its diagnostic and management perspectives

Article Abstract:

Angioedema is characterized by the development of urticaria, or hives, and edematous areas in the skin, mucous membranes and abdominal organs. This condition may result from an allergic reaction to food, drugs, bee stings, molds, or from a physical reaction of the skin to cold temperature, exercise, light, or pressure. The hereditary form of angioedema, familial angioedema, results from the deficiency of complement component C1 esterase inhibitor (C1EI), a factor that normally prevents the activity of the first component of complement, C1. (Complement is a system of proteins that affects immune activities and other biologic functions.) Because C1EI deficiency results in increased levels of proteins that affect the vascular system, attacks of hereditary angioedema may be complicated by disabling swelling of the skin, life-threatening blockage of the upper airways (anaphylaxis), and severe uncontrolled contraction and pain of the gastrointestinal tract. The levels of another complement component, C4, are measured to screen for hereditary angioedema. Decreased levels of C4 during symptomatic attacks should be followed by measurement of C1EI levels. A laboratory test for C1EI is necessary to confirm the diagnosis of familial angioedema. A correct diagnosis prevents potentially fatal consequences, such as blockage of the upper airway or unnecessary abdominal surgery. Preventive therapy can be started to avoid complications associated with trauma or injury. Long-term therapy with androgen (male) hormones can diminish or eliminate symptoms in patients with persistent and disabling attacks of angioedema. (Consumer Summary produced by Reliance Medical Information, Inc.)

Drug therapy, Genetic aspects, Angioneurotic edema

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Functional laryngeal obstruction: a somatization disorder

Article Abstract:

Periodic blockage of the upper airway may be caused by allergic reactions, recurrent infections, tumors and spasms of the larynx, and inherited angioedema, which is the development of hives and accumulation of fluid within the skin. Previous cases have been described in which patients had recurrent stridor, or harsh sounds, during breathing with upper airway blockage of unknown cause. This disorder has been called factitious asthma, Munchausen's stridor, and emotional laryngeal wheezing. A case is described of a 30-year-old woman with intermittent stridor or wheezing, who was diagnosed as having asthma. She was treated with anti-asthmatic drugs including corticosteroids for almost two years. More detailed examination of the upper airway did not indicate an organic cause, but provided more information about the mechanism of this disorder. This abnormality may be due to impaired function of the vocal cords, and associated with psychosocial stress. It may be treated by speech therapy and psychiatric counselling. The prevalence of psychosomatic airway disorder is not known, but it may be more common than originally believed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abnormalities, Causes of, Stridor, Larynx

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