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Can the chronic fatigue syndrome be defined by distinct clinical features?

Published online by Cambridge University Press:  09 July 2009

I. Hickie ,
A. Lloyd ,
D. Hadzi-Pavlovic ,
G. Parker ,
K. Bird  and
D. Wakefield
I. Hickie*
Affiliation:
School of Psychiatry, University of New South Wales; Mood Disorders Unit and Department of Immunopathology, Prince Henry Hospital, Sydney, NSW, Australia
A. Lloyd
Affiliation:
School of Psychiatry, University of New South Wales; Mood Disorders Unit and Department of Immunopathology, Prince Henry Hospital, Sydney, NSW, Australia
D. Hadzi-Pavlovic
Affiliation:
School of Psychiatry, University of New South Wales; Mood Disorders Unit and Department of Immunopathology, Prince Henry Hospital, Sydney, NSW, Australia
G. Parker
Affiliation:
School of Psychiatry, University of New South Wales; Mood Disorders Unit and Department of Immunopathology, Prince Henry Hospital, Sydney, NSW, Australia
K. Bird
Affiliation:
School of Psychiatry, University of New South Wales; Mood Disorders Unit and Department of Immunopathology, Prince Henry Hospital, Sydney, NSW, Australia
D. Wakefield
Affiliation:
School of Psychiatry, University of New South Wales; Mood Disorders Unit and Department of Immunopathology, Prince Henry Hospital, Sydney, NSW, Australia
*
1Address for correspondence: Dr Ian Hickie, The St George Hospital, Academic Department of Psychiatry, 7 Chapel Street, Kogarah, NSM 2217, Australia.
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Synopsis

To determine whether patients diagnosed as having chronic fatigue syndrome (CFS) constitute a clinically homogeneous class, multivariate statistical analyses were used to derive symptom patterns and potential patient subclasses in 565 patients. The notion that patients currently diagnosed as having CFS constitute a single homogeneous class was rejected. An alternative set of clinical subgroups was derived. The validity of these subgroups was assessed by sociodemographic, psychiatric, immunological and illness behaviour variables. A two-class statistical solution was considered most coherent, with patients from the smaller class (27% of the sample) having clinical characteristics suggestive of somatoform disorders. The larger class (73% of sample) presented a more limited combination of fatigue and neuropsychological symptoms, and only moderate disability but remained heterogeneous clinically. The two patient groups differed with regard to duration of illness, spontaneous recovery, severity of current psychological morbidity, utilization of medical services and CD8 T cell subset counts. The distribution of symptoms among patients was not unimodal, supporting the notion that differences between the proposed subclasses were not due simply to differences in symptom severity. This study demonstrated clinical heterogeneity among patients currently diagnosed as CFS, suggesting aetiological heterogeneity. In the absence of discriminative clinical features, current consensus criteria do not necessarily reduce the heterogeneity of patients recruited to CFS research studies.

Type
Original Articles
Information
Psychological Medicine , Volume 25 , Issue 5 , September 1995 , pp. 925 - 935
Copyright
Copyright © Cambridge University Press 1995

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