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Bijlage 1 Er bestaat wel degelijk bewijs voor ME/CVS als 'ziekte' met objectieve afwijkingen. We geven hier voor de duidelijkheid eerst de definitie van ME en vervolgens de korte referenties. Aan het eind staat de volledige lijst referenties. Om geen misverstanden door vertaling te doen ontstaan is de definitie in het Engels opgenomen. Definition of ME (cf. Ramsay 1992) 1. Generalised or localised muscle fatigue after minimal exertion with PROLONGED recovery time. 2. Neurological disturbance, especially of cognitive, autonomic and sensory functions, often accompanied by marked emotional lability and sleep reversal. 3. Variable involvement of cardiac and other bodily systems. 4. An extended relapsing course with a tendency to chronicity. 5. Marked variability of symptoms both within and between episodes. Bron: Ramsay AM. Myalgic encephalomyelitis - then and now. An epidemiological introduction. In: Hyde B, Goldstein J and Levine P, editors. Clinical and scientific basis of myalgic encephalomyelitis/chronic fatigue syndrome. Ottawa: Nightingale Research Foundation, 1992: 81-84. Bewijs van mogelijke ontsteking centraal zenuwstelsel: Buchwald et al 1992 (findings on MRI suggestive of inflammatory process in the CNS) Lloyd et al 1991 (interferon alpha levels in CSF higher than patients with people with noninflammatory neurological disorders but lower than patients with encephalitis and meningitis. Cytokine levels often undetectable but could be because it's a local reaction.) Schwartz et al 1994 (suggestion from SPECT scans of a possible chronic viral encephalitis) Bewijs van encephalopathie: Als hierboven plus: Bakheit et al 1993 (altered secretion of arginine and vasopressin, evidence of hypothalamic dysfunction, see also others e.g. Majeed et al 1995). NB. Changes in cortisol difficult to interpret as researchers have not partialled out effect of stress. Bastein 1992 (neuropsychological findings suggestive of multifocal organic brain syndrome). Cook et al 2001 (MRI scans suggest that abnormalities found may be of functional significance). Costa et al 1995 (SPECT scans showing hypoperfusion in the brain of ME patients) See also Tirelli et al 1998. (PET scans showing hypoperfusion in brainstem in strictly defined CFS plus altered glucose metabolism). Daugherty et al 1991 (MRI findings on homogeneous group revealed abnormalities but no mention of inflammation) DeLuca et al 1993 (cognitive dysfunction, similar to MS, see also others e.g. Sandman et al 1993). Gilliam 1938 (acute ME, increased pressure CSF) Innes, 1970 (acute ME only, evidence of infection in the CSF) Lange et al 2001 (MRI findings show structural changes (increased cerebral ventricular volume? Martin et al 1994 (blood shows persistent infection over years but absence of accompanying inflammatory response, hence reference to stealth virus). Martin and Anderson 1999 (brain biopsy from a patient showed abnormalities but no inflammation, they refer to encephalopathy) Martin and Glass 1995 (data from cats inoculated with virus from ME patient. Brain tissue showed histological changes but a paucity of inflammatory reaction. They refer to viral encephalopathy). McGarry et al 1994 (isolation of enteroviral RNA from brainstem, etc. No mention of inflammation. One of the few published autopsy findings) Natelson, et al. 2005 Abnormalities in cerebrospinal fluid in a subset. Okada et al. 2004 Atrophy in the brain, which authors relate to fatigue. Prasher et al 1991 (ME patients: abnormalities in cognitive evoked potentials e g. N2 and P3. Not replicated in CFS). Ook van belang: Pellew and Miles 1955. Transference of agent from ME patient to monkeys: acute reaction and confirmation of disease. No abnormalities in CNS but lesions in nerve roots (peripheral), i.e. infection and neurological damage but no inflammation and not in CNS. Biddle 1992 (Review notes UBOs on MRI scans suggestive of enlarged Virchow-Robin spaces, possibly due to infiltration by lymphocytes? This is interesting but not evidence). Kommentaar: There is strong evidence for persistent infection or damage from infection in the CNS but little direct evidence of an inflammatory process in the brain and spinal cord after the acute phase. Some evidence that the virus is neurotropic but that it evades the immune system, thus no (normal) inflammatory response. Is that why it persists? The paucity of findings in the CSF argues against inflammation, as do the negative reports from the autopsies. The symptoms reported by most patients since 1960 do not support the involvement of inflammation of the spinal cord. They do, however, support the concept that ME is a disease of the brain and muscles. Voor additionele informatie zie: http://freespace.virgin.net/david.axford/me/me.htm Referenties: 1. Behan, WMH, More, IAR and Behan, PO. Mitochondrial abnormalities in the postviral fatigue syndrome. Acta Neuropathologica, 1991, 83, 61-65. (About 80% of patients with ME have abnormalities in the mitochondria, again signs of pathology). 2. Bowles, NE., Bayston, TA., Zhang, H-Y., Doyle, D., Lane, RJM., Cunningham, L and Archard, LC. Persistence of enterovirus RNA in muscle biopsy samples suggests that some cases of chronic fatigue syndrome result from a previous, inflammatory viral myopathy. Journal of Medicine, 1993, 24, 145-160 (see also later reports by Lane et al. A recurring theme). 3. Costa DC, Gacinovic S, Tannock C and Brostoff J. Brain stem SPET studies in normals, M.E./CFS and depression. Nuclear Medicine Communications 1994; 15: 252-253. 4. Costa DC, Tannock C and Brostoff J. Brainstem perfusion is impaired in patients with chronic fatigue syndrome. Quarterly Journal of Medicine 1995; 88: 767-773 (SPECT scan results, hard to reconcile with suggestions of illness for secondary gain, attention etc). 5. Cunningham L, Bowles NE, Lane RJM, Dubowitz V and Archard LC. Persistence of enteroviral RNA in chronic fatigue syndrome is associated with the abnormal production of equal amounts of positive and negative strands of enteroviral RNA. Journal of General Virology 1990; 71: 1399- 1402. (Paper suggesting the enterovirus in ME may have mutated to avoid detection by the immune system). 6. Daugherty SA, Henry BE, Peterson DL, Swarts RL, Bastein S and Thomas S. Chronic fatigue syndrome in Northern Nevada. Reviews of Infectious Diseases 1991; 13 Suppl 1: S39-44. (Early report on one of the more famous outbreaks) 7. Douche-Aourik, F., Berlier, W., Feasson, L., Bourlet, T., Harrath, R., Omar, S., Grattard, F., Denis, C and Pozzetto, B. Detection of enterovirus in human skeletal muscle from patients with chronic inflammatory muscle disease or fibromyalgia and healthy subjects. Journal of Medical Virology, 2003, 71, 540-547. (Study linking subset of cases with enteroviruses). 8. Durndell A. Second report to Health and Safety Committee on post viral syndrome or myalgic encephalomyelitis at Glasgow College. August 1989. (Report on an epidemic). 9. English, TL. Skeptical of skeptics. Journal of the American Medical Association 1991; 265: 964. (The view of a doctor with ME.) See also; Fleming C. The glass cage. British Medical Journal 1994; 308: 797. 10. Freeman, R and Komaroff, AL. Does the chronic fatigue syndrome involve the autonomic nervous system? American Journal of Medicine, 1997, 102, 4, 357-364 (Symptoms indicative of autonomic nervous system dysfunction are not related to psychiatric disorder and can not be fully explained by deconditioning.) 11. Friedberg F and Krupp LB. A comparison of cognitive-behavioral treatment for chronic fatigue syndrome and primary depression. Clinical Infectious Diseases 1994; 18 Suppl 1: S105-S110. (Paper showing CBT is useful for patients with comorbid depression but otherwise disappointing. See also Lloyd et al below). 12. Fukuda, K., Straus, SE., Hickie, I., Sharpe, MC., Dobbins, JG., Komaroff, A and the International Chronic Fatigue Syndrome Study Group. The chronic fatigue syndrome: a comprehensive approach to its definition and study. Annals of Internal Medicine, 1994, 121, 953-959. (Latest American diagnostic criteria for CFS). 13. Gilliam AG. Epidemiological study of an epidemic, diagnosed as poliomyelitis, occurring among the personnel of the Los Angeles County General Hospital during the Summer of 1934. Public Health Bulletin, US Treasury Dept. No. 240. Washington: United States Government Printing Office 1938. (First major report, linking ME with enteroviruses. Long before the internet)). 14. Henderson D and Shekolov A. Epidemic neuromyasthenia – clinical syndrome? New England Journal of Medicine 1959; 260: 814-818. (Reports on cases before groups and the internet). 15. Ho-Yen Do and McNamara I. General practitioners' experience of the chronic fatigue syndrome. British Journal of General Practice 1991; 41: 324-326. (Good on prevalence) 16. Innes SBG. Encephalomyelitis resembling benign myalgic encephalomyelitis. Lancet 1970; 1: 969-971. (Evidence of infection in CSF of four patients with ME, before support groups and the internet.) 17. Kennedy, G., Spence, V., Underwood, C and Belch JJF. Increased neutrophil apoptosis in chronic fatigue syndrome. Journal of Clinical Pathology, 2004, 57, 8, 891-893. (Recent paper on ME with findings consistent with immune activation or ongoing pathology). 18. Komaroff, AL., Fagioli, LR., Doolittle, TH., Gandek, B., Gleit, MA., Guerriero, RT., Kornish, J., Ware, NC., Ware, JE and Bates, DW. Health status in patients with chronic fatigue syndrome and in general population and disease comparison groups. American Journal of Medicine, 1996, 101, 3, 281-290. (This shows that the level of disability associated with CFS is higher than that documented in several medically-ill groups. There is more to CFS than fatigue). 19. Johnson, SK., DeLuca, J and Natelson, BH. Assessing somatisation disorder in the chronic fatigue syndrome. Psychosomatic Medicine, 1996, 58, 50-57. (Excellent article on somatization and CFS). 20. Landay AL, Jessop C, Lennette ET and Levy JA. Chronic fatigue syndrome: clinical condition associated with immune activation. Lancet 1991; 338: 707-712. (Useful paper in a high-impact journal, linking CFS with immune activation). 21. Lane RJM, Burgess AP, Flint J, Riccio M and Archard LC. Exercise responses and psychiatric disorder in chronic fatigue syndrome. British Medical Journal 1995; 311: 544-545. 22. Lane, RJM., Barrett, MC., Woodrow, D., Moss, J., Fletcher, R and Archard, LC. Muscle fibre characteristics and lactate responses to exercise in chronic fatigue syndrome. Journal of Neurology, Neurosurgery and Psychiatry, 1998, 64, 3, 362-367. 23. Lane, RJM., Soteriou, BA., Zhang, H and Archard, LC. Enterovirus related metabolic myopathy: a postviral fatigue syndrome. Journal of Neurology, Neurosurgery and Psychiatry, 2003, 74, 1382-1386 24. Lerner, AM., Zervos, M., Dworkin, HJ., Chang, CH., Fitzgerald, T., Goldstein, J et al. New cardiomyopathy: pilot study of intravenous ganciclovir in a subset of the chronic fatigue syndrome. Infectious Diseases in Clinical Practice, 1997, 6, 110-117. 25. Levine, S., Eastman, H and Ablashi, DV. Prevalence of IgM and IgG antibody to HHV-6 and HHV-8 and results of plasma PCR to HHV-6 and HHV-7 in a group of CFS patients and healthy donors. Journal of Chronic Fatigue Syndrome, 2001, 9, 1/2, 31-40. (A subgroup may have ongoing infection relating to herpesviruses). 26. Lloyd A, Hickie I, Brockman A, Dwyer JM and Wakefield D. Cytokine levels in serum and cerebrospinal fluid in patients with chronic fatigue syndrome and control subjects. Journal of Infectious Diseases 1991; 164: 1023-1024. 27. Lloyd AR, Hickie I, Brockman A, Hickie C, Wilson A, Dwyer J and Wakefield, D. Immunologic and psychologic therapy for patients with chronic fatigue syndrome: a doubleblind, placebo-controlled trial. American Journal of Medicine 1993; 94: 197-203. 28. Martin WJ, Zeng LC, Ahmed K and Roy M. Cytomegalovirus-related sequence in an atypical cytopathic virus repeatedly isolated from a patient with chronic fatigue syndrome. American Journal of Pathology 1994; 145: 440-451. 29. Martin, WJ and Anderson, D. Stealth virus epidemic in the Mohave Valley. Pathobiology, 1997, 65, 51-56 (The cultures "have been uniformly positive, yielding unequivocal transmissible cytopathic effect (CPE) in both human-and monkey-derived cell lines... Viral cultures and epidemiological data support human-to-human, and probably human-to-dog transmission of the Mohave stealth virus infection".) 30. McGarry F, Gow J and Behan PO. Enterovirus in the chronic fatigue syndrome. Annals of Internal Medicine 1994; 120; 972-973. (Autopsy report. Viral RNA found in brain, heart and skeletal muscle, not in controls). 31. Natelson, BH., Weaver, SA., Tseng, C-L and Ottenweller, JE. Spinal fluid abnormalities in patients with chronic fatigue syndrome. Clinical and Diagnostic Laboratory Immunology, 2005, 12, 1, 52-55. 32. Paul, L., Wood, L., Behan, WMH and Maclaren, WM. Demonstration of delayed recovery from fatiguing exercise in chronic fatigue syndrome. European Journal of Neurology, 1999, 6, 63-69. (Objective measures. Supports criteria for ME, i.e. delayed recovery of muscle power after exertion). 33. Ramsay AM. Myalgic encephalomyelitis - then and now. An epidemiological introduction. In: Hyde B, Goldstein J and Levine P, editors. Clinical and scientific basis of myalgic encephalomyelitis/chronic fatigue syndrome. Ottawa: Nightingale Research Foundation, 1992: 81-84. (A classic description) 34. Ramsay AM. Myalgic encephalomyelitis and postviral fatigue states. 2nd ed. London: Gower Medical Publishing, 1988. Overig relevant onderzoek: Brain scan research: MRI scans have revealed abnormalities in up to 80% of the patients in one study (Daugherty et al). According to researchers, these defects are probably caused by chronic viral encephalitis. There was a correlation between the areas involved and the symptoms experienced. Abnormalities on SPECT scans provide further objective evidence of CNS dysfunction. Studies published to date show patterns of reduced blood flow which are markedly different from those documented in major depression (Costa et al). Moreover, the number of defects are correlated with clinical status (e.g. Schwartz et al). Buchwald, D., Cheyne, PR., Peterson, DL., Henry, B., Wormsley, SB., Geiger, A., Ablashi, DV., Salahuddin, SZ., Saxinger, C., Biddle, R., Kikinis, R., Jolesz, FA., Folks, T., Balachandran, N., Peter, JB., Gallo, RC and Komaroff, AL. A chronic illness characterised by fatigue, neurologic and immunologic disorders, and active Human Herpes Type 6 infection. Annals of Internal Medicine, 1992, 116, 2, 103-113. Chaudhuri, A., Condon, BR., Gow, JW., Brennan, D and Hadley, DM. Proton magnetic resonance spectroscopy of basal ganglia in chronic fatigue syndrome. Neuroreport, 2003, 14, 2, 225-228. Cook, DB., Lange, G., DeLuca, J and Natelson BH. Relationship of brain MRI abnormalities and physical functional status in chronic fatigue syndrome. International Journal of Neuroscience, 2001, 107, 1-2, 1-6. Costa, DC., Tannock, C and Brostoff, J. Brainstem perfusion is impaired in patients with chronic fatigue syndrome. Quarterly Journal of Medicine, 1995, 88, 767-773. Daugherty, SA., Henry, BE., Peterson, DL., Swarts, RL., Bastein, S and Thomas, RS. Chronic fatigue syndrome in Northern Nevada. Reviews of Infectious Diseases, 1991, 13, Suppl. 1. S39-44. Lange, G et al. Quantitative assessment of cerebral ventricular volumes in chronic fatigue syndrome. Applied Neuropsychology, 2001, 8, 1, 23-30. Okada, T., Tanaka, M., Kuratsune, H., Watanabe, Y and Sadato, N. Mechanisms underlying fatigue: a voxel-based morphometric study of chronic fatigue syndrome. BMC Neurology, 2004, 4, 1, 14. Schwartz, RB., Garada, BM., Komaroff, AL., Tice, HM., Gleit, M., Jolesz, FA., Holman, BL. Detection of intracranial abnormalities in patients with chronic fatigue syndrome: comparison of MR imaging and SPECT. American Journal of Roentgenology, 1994, 162, 4, 935-41. Schwartz, RB., Komaroff, AL., Garada, BM., Gleit, M., Doolittle, TH., Bates, DW., Vasile, RG and Holman, B. SPECT imaging of the brain: comparison of findings in patients with chronic fatigue syndromes, AIDS, dementia complex and major unipolar depression. American Journal of Roentgenology, 1994, 162, 4, 943-51. The results on SPECT have been replicated using PET. Tirelli, U., Chierichetti, F., Tavio, M., Simonelli, C., Bianchin, G., Zanco, P and Ferlin, G. Brain positron emission tomography (PET) in chronic fatigue syndrome: preliminary data. American Journal of Medicine, 1998, 105, 3A, 54s-58s. Neuropsychological tests on patients with ME/PVFS and strictly-defined CFS have revealed abnormalities which are consistent with an organic brain disorder (e.g. Daugherty et al). The deficits have been found in both community and hospital samples and they were not the result of psychiatric disorders, such as depression (e.g. Smith, DeLuca et al). Daugherty, SA., Henry, BE., Peterson, DL., Swarts, RL., Bastein, S and Thomas, RS. Chronic fatigue syndrome in Northern Nevada. Reviews of Infectious Diseases, 1991, 13, Suppl. 1. S39-44. Riccio, M., Thompson, C., Wilson, B, Morgan, DJR and Lant, AF. Neuropsychological and psychiatric abnormalities in myalgic encephalomyelitis: A preliminary report. British Journal of Clinical Psychology, 1992, 31, 111-120. Smith, AP. Chronic fatigue syndrome and performance. In AP Smith and D Jones (eds), Handbook of Human Performance, Vol. 2. London: Academic Press. 1992, p. 261-278. Marcel, B., Komaroff, AL., Fagioli, LR., Kornish, RJ and Albert, MS. Cognitive deficits in patients with chronic fatigue syndrome. Biological Psychiatry, 1996, 40, 535-541. DeLuca, J., Johnson, SK., Ellis, SP and Natelson, BH. Cognitive functioning in patients with chronic fatigue syndrome devoid of psychiatric disease. Journal of Neurology, Neurosurgery, and Psychiatry, 1997, 62, 151-155. Scholey, A., McCue, P and Wesnes, KA. A comparison of the cognitive deficits seen in myalgic encephalomyelitis to Alzheimer's Disease. Proceedings of the British Psychological Society, 1999, January, 12. ME/PVFS and strictly-defined CFS are different from fibromyalgia, a rheumatic condition. Bennett, AL., Mayes, DM., Fagioli, LR., Guerriero, R and Komaroff, AL. Somatomedin C (insulin-like growth factor 1) levels in patients with chronic fatigue syndrome. Journal of Psychiatric Research, 1997, 31, 1, 91-96. Wysenbeek, AJ., Shapira, Y and Leibovici, L. Primary fibromyalgia and the chronic fatigue syndrome. Rheumatology International, 1991, 10, 227-230. The fatigue reported by patients with ME/PVFS and strictly-defined CFS is very different from that experienced by the general population. Scores on fatigue scales are more like those of people with M.S. Krupp, LB., Mendelson, WB and Friedman, R. An overview of chronic fatigue syndrome. Journal of Clinical Psychiatry, 1991, 52, 10, 403-410. Ray, C., Weir, WRC., Phillips, S and Cullen, S. Development of a measure of symptoms in chronic fatigue syndrome: the profile of fatigue-related symptoms (PFRS). Psychology and Health, 1992, 7, 27-43. Schwartz, JE., Jandorf, L and Krupp, LB. The measurement of fatigue: a new instrument. Journal of Psychosomatic Research, 1993, 37, 7, 753-762. The fatigue is not due to a lack of motivation or effort. Lloyd, A, Gandevia, S. and Hales, J. Muscle performance, voluntary activation, twitch properties and perceived effort in normal subjects and patients with chronic fatigue syndrome. Brain, 1991, 114, 85-98. Recent evidence indicates that most patients with CFS do not spend the whole of the daytime resting. A number of coping strategies are used, some of which are associated with a positive outcome (e.g. Saltzstein et al). Packer, TL., Foster, DM and Brouwer, B. Fatigue and activity patterns of people with chronic fatigue syndrome. The Occupational Therapy Journal of Research, 1997, 17, 3, 186-199. Knussen, C and Lee, D. Chronic fatigue syndrome: symptoms, appraisal and ways of coping. British Journal of Health Psychology, 1998, 3, 111-121. Lovell, DM. Chronic fatigue syndrome among overseas development workers: a qualitative study. Journal of Travel Medicine, 1999, 6, 16-23. Saltzstein, BJ., Wyshak, G., Hubbuch, JT and Perry, JC. A naturalistic study of the chronic fatigue syndrome among women in primary care. General Hospital Psychiatry, 1998, 20, 5, 307-316. Patients with CFS are no different from other medically ill groups in terms of personality. Johnson, SK., Lange, G., Tiersky, L., DeLuca, J and Natelson, BH. Health-related personality variables in chronic fatigue syndrome and multiple sclerosis. Journal of Chronic Fatigue Syndrome, 2001, 8, 3/4, 41-52. Trigwell, P et al. 'Abnormal' illness behaviour in chronic fatigue syndrome and multiple sclerosis. BMJ, 1995, 311, 15-18. Longitudinal studies using appropriate measures have shown that physical attributions do not affect outcome (e.g. Lawrie et al). Moreover, research on patients with ME indicated that a belief in a biological cause was not associated with avoidance behaviour or poor mental health. Lawrie, SM., Manders, DN., Geddes, JR and Pelosi, AJ. A population-based incidence study of chronic fatigue. Psychological Medicine, 1997, 27, 343-353. Ray, C., Jefferies, S and Weir, WRC. Coping and other predictors of outcome in chronic fatigue syndrome: A 1-year follow-up. Journal of Psychosomatic Research, 1997, 43, 4, 405415. Deale, A., Chalder, T and Wessely, S. Illness beliefs and treatment outcome in chronic fatigue syndrome. Journal of Psychosomatic Research, 1998, 45, 1, 77-83. Heijmans, MJWM. Coping and adaptive outcome in chronic fatigue syndrome: importance of illness cognitions. Journal of Psychosomatic Research, 1998, 45, 1, 39-51. Fear of exercise does not lead to a major reduction in activity levels (Sisto et al, Van der Werf et al). There is no evidence for the phobic avoidance of activity amongst the majority of patients with CFS, or support for the view that deconditioning plays a major role in the perpetuation of fatigue (Bazelmans et al, Sargent et al). Sisto, SA., Tapp, WN., LaManca, JJ., Ling, W., Korn, LR., Nelson, AJ and Natelson, BH. Physical activity before and after exercise in women with chronic fatigue syndrome. Quarterly Journal of Medicine, 1998, 91, 7, 465-473. Van der Werf, SP., Prins, JB., Vercoulen, JHMM., van der Meer, JWM and Bleijenberg, G. Identifying physical activity patterns in chronic fatigue syndrome using actigraphic assessment. Journal of Psychosomatic Research, 2000, 49, 5, 373-379. Bazelmans E, Bleijenberg, G., van der Meer, JWM and Folgering, H. Is physical deconditioning a perpetuating factor in chronic fatigue syndrome? A controlled study on maximal exercise performance and relations with fatigue, impairment and physical activity. Psychological Medicine, 2001, 31, 107-114. Sargent., C, Scroop, GC., Nemeth, PM., Burnet, RB and Buckley JD. Maximal oxygen uptake and lactate metabolism are normal in chronic fatigue syndrome. Medicine and Science in Sports and Exercise, 2002, 34, 1, 51-56. Graded exercise, where activity is increased according to a plan irrespective of symptoms, is not appropriate for all patients with CFS (Friedberg and Krupp, Jason et al). Indeed, overexertion can lead to relapse (eg Lapp). Although cognitive behavioural therapy is not superior to counselling for CFS in general (Ridsdale et al), it may be helpful for a subgroup, for example, those who are particularly anxious and depressed, those with inadequate coping strategies or where activity levels are largely determined by a fear of symptom flare-ups. Follow-up studies suggest that improvements are often limited and transient (e.g. Akagi et al). There are no follow-up studies indicating benefits for those with somatic symptoms (cf. Deale et al). Akagi, H., Klimas, I and Bass, C. Cognitive behavioral therapy for chronic fatigue syndrome in a general hospital - feasible and effective. General Hospital Psychiatry, 2001, 23, 254-260. Deale, A., Husain, K., Chalder, T and Wessely, S. Long-term outcome of cognitive behavior therapy versus relaxation therapy for chronic fatigue syndrome: a 5 year follow-up study. American Journal of Psychiatry, 2001, 158, 2038-2042. Friedberg, F and Krupp, LB. A comparison of cognitive behavioral treatment for chronic fatigue syndrome and primary depression. Clinical Infectious Diseases, 1994, 18, (Suppl.1), S105-S110. Jason, LA., Richman, JA., Friedberg, F., Wagner, L., Taylor, R and Jordan, KM. Politics, science, and the emergence of a new disease. The case of chronic fatigue syndrome. American Psychologist, 1997, 52, 9, 973-983. Lloyd, AR., Hickie, I., Brockman, A., Hickie, C., Wilson, A., Dwyer, J and Wakefield, D. Immunologic and psychologic therapy for patients with chronic fatigue syndrome: a doubleblind, placebo-controlled trial. American Journal of Medicine, 1993, 94, 197-203. Lapp, C. Exercise limits in chronic fatigue syndrome. American Journal of Medicine, 1997, 103, 83-84. Ridsdale, L., Godfrey, E., Chalder, T., Seed, P., King, M., Wallace, P and Wessely, S. Chronic fatigue in general practice: is counselling as good as cognitive behaviour therapy? A UK randomised trial. British Journal of General Practice, 2001, 51, 462, 19-24. Difference between CFS and chronic fatigue: Darbishire, L., Ridsdale, L and Seed, PT. Distinguishing patients with chronic fatigue syndrome: a diagnostic study in UK primary care. British Journal of General Practice, 2003, 53, 441-445. Evengard, B., Jonzon, E., Sandberg, A., Theorell, T and Lindh, G. Differences between patients with chronic fatigue syndrome and with chronic fatigue at an infectious disease clinic in Stockholm, Sweden. Psychiatry and Clinical Neurosciences, 2003, 57, 4, 361-368. Evidence of an abnormal immunological response following exertion. Sorensen B, Streib JE, Strand M, Make B, Giclas PC, Fleshner M, and Jones JF. Complement activation in a model of chronic fatigue syndrome. Journal of Allergy and Clinical Immunology, 2003, 112, 2, 397-403. (Like Paul et al, and others, this suggests that exercise may not be indicated for all with CFS. Normally, people do not have this reaction to exertion.) Animals (ME or ME-like illness in animals who tend not to become ill to gain attention, etc): Pellew RAA and Miles JATR. Further investigations on a disease resembling poliomyelitis seen in Adelaide. Medical Journal of Australia, 1955, 42, 480-482. Ricketts SW, Young A, Mowbray JF, Yousef GE and Wood J. Equine fatigue syndrome. Veterinary Record 1992; 131: 58-59. Martin, WJ and Glass, RT. Acute encephalopathy induced in cats with a stealth virus isolated from a patient with chronic fatigue syndrome. Pathobiology 1995, 63, 115-118. (Work on this virus may not seem relevant but see also Lerner et al.) Ricketts SW, Young A, Mowbray JF, Yousef GE and Wood J. Equine fatigue syndrome. Veterinary Record 1992; 131: 58-59.