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Logo of jnnpsycJournal of Neurology, Neurosurgery and PsychiatryCurrent TOCInstructions for authors
J Neurol Neurosurg Psychiatry. Aug 1989; 52(8): 940–948.
PMCID: PMC1031831

Fatigue syndromes: a comparison of chronic "postviral" fatigue with neuromuscular and affective disorders.


Patients (n = 47) presenting to a neurological centre with unexplained chronic "postviral" fatigue (CFS) were studied prospectively. Controls were patients with peripheral fatiguing neuromuscular diseases and inpatients with major depression in a psychiatric hospital. Seventy-two percent of the CFS patients were cases of psychiatric disorder, using criteria that excluded fatigue as a symptom, compared with 36% of the neuromuscular group. There was no difference in subjective complaints of physical fatigue between all groups. Mental fatigue and fatigability was equally common in CFS and affective patients, but only occurred in those neuromuscular patients who were also cases of psychiatric disorder. Overall, the CFS patients more closely resembled the affective than the neuromuscular patients. Attribution of symptoms to physical rather than psychological causes was the principal difference between matched CFS and psychiatric controls. The symptoms of "postviral" fatigue had little ability to discriminate between CFS and affective disorder. The fatigue in CFS appeared central in origin, suggesting it is not primarily a neuromuscular illness. The implications for research and treatment of chronic fatigue are discussed.

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  • Straus SE. The chronic mononucleosis syndrome. J Infect Dis. 1988 Mar;157(3):405–412. [PubMed]
  • David AS, Wessely S, Pelosi AJ. Postviral fatigue syndrome: time for a new approach. Br Med J (Clin Res Ed) 1988 Mar 5;296(6623):696–699. [PMC free article] [PubMed]
  • Holmes GP, Kaplan JE, Gantz NM, Komaroff AL, Schonberger LB, Straus SE, Jones JF, Dubois RE, Cunningham-Rundles C, Pahwa S, et al. Chronic fatigue syndrome: a working case definition. Ann Intern Med. 1988 Mar;108(3):387–389. [PubMed]
  • Yousef GE, Bell EJ, Mann GF, Murugesan V, Smith DG, McCartney RA, Mowbray JF. Chronic enterovirus infection in patients with postviral fatigue syndrome. Lancet. 1988 Jan 23;1(8578):146–150. [PubMed]
  • Archard LC, Bowles NE, Behan PO, Bell EJ, Doyle D. Postviral fatigue syndrome: persistence of enterovirus RNA in muscle and elevated creatine kinase. J R Soc Med. 1988 Jun;81(6):326–329. [PMC free article] [PubMed]
  • Dawson J. Royal Free disease: perplexity continues. Br Med J (Clin Res Ed) 1987 Feb 7;294(6568):327–328. [PMC free article] [PubMed]
  • Pollack MS, Rich RR. The HLA complex and the pathogenesis of infectious diseases. J Infect Dis. 1985 Jan;151(1):1–8. [PubMed]
  • Hellinger WC, Smith TF, Van Scoy RE, Spitzer PG, Forgacs P, Edson RS. Chronic fatigue syndrome and the diagnostic utility of antibody to Epstein-Barr virus early antigen. JAMA. 1988 Aug 19;260(7):971–973. [PubMed]
  • Kennedy HG. Fatigue and fatigability. Br J Psychiatry. 1988 Jul;153:1–5. [PubMed]
  • Chen MK. The epidemiology of self-perceived fatigue among adults. Prev Med. 1986 Jan;15(1):74–81. [PubMed]
  • Kroenke K, Wood DR, Mangelsdorff AD, Meier NJ, Powell JB. Chronic fatigue in primary care. Prevalence, patient characteristics, and outcome. JAMA. 1988 Aug 19;260(7):929–934. [PubMed]
  • Buchwald D, Sullivan JL, Komaroff AL. Frequency of 'chronic active Epstein-Barr virus infection' in a general medical practice. JAMA. 1987 May 1;257(17):2303–2307. [PubMed]
  • Stokes MJ, Cooper RG, Edwards RH. Normal muscle strength and fatigability in patients with effort syndromes. BMJ. 1988 Oct 22;297(6655):1014–1017. [PMC free article] [PubMed]
  • Greenough A, Wood S, Morley CJ, Davis JA. Pancuronium prevents pneumothoraces in ventilated premature babies who actively expire against positive pressure inflation. Lancet. 1984 Jan 7;1(8367):1–3. [PubMed]
  • Bannister BA. Post-infectious disease syndrome. Postgrad Med J. 1988 Jul;64(753):559–567. [PMC free article] [PubMed]
  • Yonge RP. Magnetic resonance muscle studies: implications for psychiatry. J R Soc Med. 1988 Jun;81(6):322–326. [PMC free article] [PubMed]
  • Byrne E. Idiopathic chronic fatigue and myalgia syndrome (myalgic encephalomyelitis): some thoughts on nomenclature and aetiology. Med J Aust. 1988 Jan 18;148(2):80–82. [PubMed]
  • Byrne E, Trounce I. Chronic fatigue and myalgia syndrome: mitochondrial and glycolytic studies in skeletal muscle. J Neurol Neurosurg Psychiatry. 1987 Jun;50(6):743–746. [PMC free article] [PubMed]
  • Jamal GA, Hansen S. Electrophysiological studies in the post-viral fatigue syndrome. J Neurol Neurosurg Psychiatry. 1985 Jul;48(7):691–694. [PMC free article] [PubMed]
  • Lloyd AR, Hales JP, Gandevia SC. Muscle strength, endurance and recovery in the post-infection fatigue syndrome. J Neurol Neurosurg Psychiatry. 1988 Oct;51(10):1316–1322. [PMC free article] [PubMed]
  • Bell EJ, McCartney RA, Riding MH. Coxsackie B viruses and myalgic encephalomyelitis. J R Soc Med. 1988 Jun;81(6):329–331. [PMC free article] [PubMed]
  • Fegan KG, Behan PO, Bell EJ. Myalgic encephalomyelitis--report of an epidemic. J R Coll Gen Pract. 1983 Jun;33(251):335–337. [PMC free article] [PubMed]
  • Taerk GS, Toner BB, Salit IE, Garfinkel PE, Ozersky S. Depression in patients with neuromyasthenia (benign myalgic encephalomyelitis). Int J Psychiatry Med. 1987;17(1):49–56. [PubMed]
  • Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983 Jun;67(6):361–370. [PubMed]
  • Wittenborn JR, Buhler R. Somatic discomforts among depressed women. Arch Gen Psychiatry. 1979 Apr;36(4):465–471. [PubMed]
  • Snaith RP. The concepts of mild depression. Br J Psychiatry. 1987 Mar;150:387–393. [PubMed]
  • Mayou R, Hawton K. Psychiatric disorder in the general hospital. Br J Psychiatry. 1986 Aug;149:172–190. [PubMed]
  • Wehr TA, Rosenthal NE, Sack DA. Environmental and behavioral influences on affective illness. Acta Psychiatr Scand Suppl. 1988;341:44–52. [PubMed]
  • Manu P, Lane TJ, Matthews DA. The frequency of the chronic fatigue syndrome in patients with symptoms of persistent fatigue. Ann Intern Med. 1988 Oct 1;109(7):554–556. [PubMed]
  • Calder BD, Warnock PJ, McCartney RA, Bell EJ. Coxsackie B viruses and the post-viral syndrome: a prospective study in general practice. J R Coll Gen Pract. 1987 Jan;37(294):11–14. [PMC free article] [PubMed]
  • Wessely S, David A, Butler S, Chalder T. Management of chronic (post-viral) fatigue syndrome. J R Coll Gen Pract. 1989 Jan;39(318):26–29. [PMC free article] [PubMed]
  • HUDSON EH. Endemic syphilis--heir of the syphiloids. Arch Intern Med. 1961 Jul;108:1–4. [PubMed]

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