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Am J Psychiatry 1996; 153:1050-1059
Copyright © 1996 by American Psychiatric Association
Psychological symptoms, somatic symptoms, and psychiatric disorder in chronic fatigue and chronic fatigue syndrome: a prospective study in the primary care setting
S Wessely, T Chalder, S Hirsch, P Wallace and D Wright
Department of Psychological Medicine, King's College School of Medicine and Dentistry, London.
OBJECTIVE: This study assessed relationships among psychological symptoms,
past and current psychiatric disorder, functional impairment, somatic
symptoms, chronic fatigue, and chronic fatigue syndrome. METHOD: A
prospective cohort study was followed by a nested case- control study. The
subjects, aged 18-45 years, had been in primary care for either clinical
viral infections or a range of other problems. Questionnaire measures of
fatigue and psychological symptoms were completed by 1,985 subjects 6
months later; 214 subjects with chronic fatigue were then compared with 214
matched subjects without fatigue. Assessments were made with
questionnaires, interviews, and medical records of fatigue, somatic
symptoms, psychiatric disorder, and functional impairment. RESULTS:
Subjects with chronic fatigue were at greater risk than those without
chronic fatigue for current psychiatric disorder assessed by standardized
interview (60% versus 19%) or by questionnaire (71% versus 31%). Chronic
fatigue subjects were more likely to have received psychotropic medication
or experienced psychiatric disorder in the past. There was a trend for
previous psychiatric disorder to be associated with comorbid rather than
noncomorbid chronic fatigue. Most subjects with chronic fatigue syndrome
also had current psychiatric disorder when assessed by interview (75%) or
questionnaire (78%). Both the prevalence and incidence of chronic fatigue
syndrome were associated with measures of previous psychiatric disorder.
The number of symptoms suggested as characteristics of chronic fatigue
syndrome was closely related to the total number of somatic symptoms and to
measures of psychiatric disorder. Only postexertion malaise, muscle
weakness, and myalgia were significantly more likely to be observed in
chronic fatigue syndrome than in chronic fatigue. CONCLUSIONS: Most
subjects with chronic fatigue or chronic fatigue syndrome in primary care
also meet criteria for a current psychiatric disorder. Both chronic fatigue
and chronic fatigue syndrome are associated with previous psychiatric
disorder, partly explained by high rates of current psychiatric disorder.
The symptoms thought to represent a specific process in chronic fatigue
syndrome may be related to the joint experience of somatic and
psychological distress.
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