1/5. Chronic fatigue syndrome: assessing symptoms and activity level.Current approaches to the diagnosis and assessment of Chronic fatigue syndrome (CFS) rely primarily on scales that measure only the occurrence of various symptoms related to CFS. Such approaches do not provide information on either the severity of symptoms or on fluctuations in symptom severity and activity level that occur over time. As a result, these measures do not reflect the complexities and the interrelations among symptoms. By obscuring the fluctuating nature of CFS and its high variability, current assessment procedures may prevent health care professionals from understanding the complexities of this disease. The present study provides two CFS case studies to illustrate the advantages of using self-reporting rating scales in combination with a device used to measure the frequency and intensity of activity. The implications of this assessment system, which captures the symptom dynamics and variability involved in CFS, are discussed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/5. Building bridges between body and mind: The analysis of an adolescent with paralyzing chronic pain.This paper describes the evaluation, initial psychotherapy and subsequent psychoanalysis of an adolescent who presented with a severe psychosomatic process involving total body pain and profound fatigue. The author details the complex and multifaceted nature of the psychosomatic process as it unfolded in the treatment. The psychosomatic problem was not a single entity, but rather was comprised of diverse interwoven elements such as somatization, conversion on pre-oedipal and oedipal levels, conflicts over aggression, sexuality, identity, masochism, secondary gain, anaclitic depression, internalized self-other interactions with a depressed mother and transgenerational transmission of trauma. The author uses the case material to discuss technical approaches to problems that often arise in the analytic treatment of patients with complicated chronic pain and fatigue as the primary complaints. Such approaches include respecting the mind-body split as a primary defense, speaking the language of the body along with the language of the mind and developing the verbal sphere around the non-verbal symptoms. The author emphasizes that complicated chronic pain problems are common and can be helped by psychoanalysis as long as the unique and complex features are understood and reflected in the technical approach.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/5. depression and chronic fatigue. Indications for psychiatric consultation.Symptoms of fatigue and the fatigue syndrome itself are familiar complaints heard by nonpsychiatric physicians in the general hospital. The nature of these complaints is often diffuse and frequently conceals atypical psychiatric disorders. In the general hospital setting, consultation psychiatry, which functions as the interface between psychiatry and these medical practitioners, is ideally situated to assist in the assessment and management of these patients. This article reviews the methods of approach that psychiatric consultants can use to assist their nonpsychiatric colleagues in identification and referral for problems involving fatigue. In addition, a brief review of diagnosis, management, and treatment of such patients is given.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/5. A psychodynamic view of the chronic fatigue syndrome. The role of object relations in etiology and treatment.The chronic fatigue syndrome (CFS) is a constellation of physical and psychological symptoms including incapacitating fatigue associated with a marked reduction in activity. Although the etiology of CFS is unclear, reports in the literature suggest the presence of both physical and psychological dysfunction in this patient population. These findings have led to a debate between those who consider CFS to be primarily organic in origin and those who view CFS as a primary psychiatric disorder characterized by somatic preoccupations. This debate led the authors to develop a working model for CFS designed to integrate the psychological and physiological findings, based on the hypothesis that early object relations have an etiologic relationship to CFS. This hypothesis then formed the rationale for a psychoanalytic treatment approach which will be described. There are no published case reports describing psychoanalytic psychotherapy as a primary treatment modality for this patient population. The current paper attempts to fill a void. Two case reports of long-term (> 18 months), intensive (2-3 times per week) psychoanalytic psychotherapy with CFS patients referred by infectious disease specialists at a university teaching hospital will be presented. The following aspects of the treatment will be highlighted: 1) the unique opportunity afforded by this treatment to view the nature of CFS, namely, the intimate relationship over time of fatigue symptoms to disturbances in object relationships, particularly within the transference; (2) the improvement in symptoms when this relationship is seen and understood by the patient; (3) the importance of the patient-therapist bond as a facilitating medium for clinical improvement; (4) the challenges involved in treating CFS patients with psychotherapy.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/5. Missing the meaning and provoking resistance; a case of myalgic encephalomyelitis.BACKGROUND. The interaction between a clinician and a patient who put his problems down to myalgic encephalomyelitis is described. Despite attempting a patient-centred approach, the doctor acted on his own understanding of the meaning of this diagnosis without gaining proper insight into what it meant for the patient. This failure not only led to damaged rapport, it may have contributed to delayed recovery. OBJECTIVES. The unsatisfactory nature of this encounter led the clinician to consider more effective consulting techniques. methods AND RESULTS. A hypothetical interaction is constructed in which the clinician uses reflective listening statements to understand the patient's true meaning of this self-diagnosis. CONCLUSIONS. Despite well intentioned attempts to be patient-centered through widening the consultation beyond the biomedical to include personal and contextual factors, clinicians may still end up imposing their own medical meaning on patient's words. Damaged rapport is a signal that another track could be more fruitful and reflective listening is one strategy which enables clinicians to check that they fully understand the patient's meaning. Provoking resistance by following strategies which are not appropriate for the patient might then be avoided.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |