Impacts of Fatigue on Development Flashcards
Define
Pathological fatigue
Prolonged or chronic exhaustion typically lasting > 3 months, where the precise cause is unclear, or can be multi-factorial in etiology. Highly-debilitating with major effects on daily functioning, and not relieved by rest. Primarily affects clinically disordered populations and is perceived as abnormal, unusual or excessive
What is the best diagnositic tools for CFS?
Canadian Consensus Criteria
What was not found to influence objective measures of sleep in a CFS study, but influences subjective measures?
Psychological factors like anxiety
Definition
a delayed and significant exacerbation of ME/CFS symptoms that always follows physical activity and often follows cognitive activity
Post-exertional malaise
Definition
A normal universal acute experience lasting less than 3 months involving overall exhaustion and depletion of energy that has cognitive or physical manifestations, with a clearly identifiable cause. Minor effects on daily functioning, usually relieved by rest
Non-pathological fatigue
What are the implications for development and for clinical management of the cognitive outcomes of adolescents with CFS?
- Certain MRI methods may be limited in identifying differences in brain functioning between CFS patients and controls
- Longer illness duration may lead to greater impacts on brain functioning in CFS or impacts more noticable as the brain matures over time
- Although CFS patients may show a similar ‘fatigue response’ to their healthy peers in response to mental exercise, they may be starting from a lower threshold from which to access cognitive resources when mental effort is required
- Clinicians and school staff need to consider this when assessing and educating CFS adolescent patients
Who wrote this study?
Study Objectives: Little is known about the type and severity of sleep disturbances in the pediatric chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) population, compared with healthy adolescents. Using a range of objective and subjective measures, the aim of this study was to investigate sleep quality, the relationship between objective and subjective measures of sleep quality, and their associations with anxiety in adolescents with CFS/ME compared with healthy controls. Methods: Twenty-one adolescents with CFS/ME aged 13 to 18 years (mean age 15.57 ± 1.40), and 145 healthy adolescents aged 13 to 18 years (mean age 16.2 ± 1.00) wore actigraphy watches continuously for 2 weeks to collect a number of objective sleep variables. The Pittsburgh Sleep Quality Index was used to obtain a subjective measure of sleep quality. Anxiety was measured by the Spence Children’s Anxiety scale. Results: On average over the 2-week period, adolescents with CFS/ME were found to have (1) significantly longer objective sleep onset latency, time in bed, total sleep time, and a later rise time (all P < .005), and (2) significantly poorer subjective sleep quality (P < .001), compared with healthy adolescents. The CFS/ME patient group displayed higher levels of anxiety (P < .05), and in both groups, higher levels of anxiety were significantly related to poorer subjective sleep quality (P < .001). Conclusions: This study provides objective and subjective evidence of sleep disturbance in adolescents with CFS/ME compared with healthy adolescent controls
Josev et al. (2017)
What are the implications for development and for clinical management for the results of school functioning in CFS kids?
- CFS may lead to poorer school functioning which can put adolescents at heightened risk for long-term maladjustment across a range of developmental areas
- If risk factors or domain known, we can begin to target key developmental domains to minimise the impact of poorer school functioning
- Liaison between health professionals and school staff important for identifying students at risk, and providing help/strategies on individual basis
What are the causes and contributions of fatigue?
- Biological
- Impaired transmission between CNS and PNS
- Impaired neuromuscular transmission
- Medical conditions
- Cancer, multiple sclerosis, Type II diabetes
- Medications
- Antihistamines
- Lifestyle
- Diet, exercise, sleep, alcohol/substance use
Over 70% of people with CFS had what prior to onset?
Viral infection
What has been hypothesised to cause underlying cognitive difficulties in CFS?
Central nervous system deficits
What are the issues with defining fatigue?
- Subjective
- Lack of clear definition
- Difficult to differentiate from other constructs
- No objective gold standard for measuring fatigue
What are the impacts of fatigue?
- Physical
- Sleep problems, muscle/joint pain
- Cognitive
- Memory and concentration deficits
- Psychological and emotional
- Mental health problems
- Functional
- Impairment in daily functioning and quality of life
- Developmental
- Impact on schooling, educational and occupational attainment, career prospects, development of life skills, socialisation and social skills
What are the implications for development and for clinical management of the sleep disturbances caused by CFS?
- Sleep an important research focus and treatment target for paediatric CFS
- Clinicians should ensure specific questionaling about sleep, and assess sleep problems on an individual basis per patient
- Sleep hygiene and habits in all adolescents
- Mood management in all adolescents
What are the hallmark features of CFS?
Chronic fatigue (> 3 months)
Significant functional impairment
Sleep disturbance
Post-exertional malaise
Pain
How do adolescents with CFS differ to those that don’t in the following areas:
- Response to cognitive exertion
- Subjective failure
- Overall cognitive performance
Adolescents with CFS showed a similar response to cognitive exertion compared with healthy peers but they showed greater subjective failute and poorer cognitive performance overall
