Talk:Pathophysiology of chronic fatigue syndrome/Archive 1

Archive 1

Article division

This Article has been created from the origonal content of the Main article Chronic fatigue syndrome. It has been recreated in three main sections. Some comment has already been made to the effect that in itself it is already too long at 90 kilobytes, for a wiki article. Comment is sought on a proposal to further subdivide into three seperate articles.

ME/CFS Pathophysiology, Immune system

ME/CFS Pathophysiology, Nervous system

ME/CFS Pathophysiology, Endocrine system

Jagra (talk) 07:53, 19 April 2008 (UTC)

Not sure about those names. Maybe:

ME/CFS immune system pathophysiology

ME/CFS nervous system pathophysiology

ME/CFS endocrine system pathophysiology

Q: How do we handle additional pathophysiologies, such as vascular, liver, et c.? Give them sections in this article which points to the other three? How difficult are the three sections to summarize? -- Strangelv (talk) 17:36, 19 April 2008 (UTC)

Your names are fine, whats wrong with your liver? Each section does include other but extending titles would be problematic? If it gets to be a problem we could add another article called 'Other pathophysiology'. There is a lead already included in each section. Can you link that admin comment on Article length here, thanks Jagra (talk) 02:47, 20 April 2008 (UTC)

Which admin comment?

Liver, from Ramsay86: "A multisystem disease, primarily neurological with variable involvement of liver, cardiac and skeletal muscle, lymphoid and endocrine organs." As for my condition, I'll email you, as the world at large doesn't need to know. -- Strangelv (talk) 03:21, 20 April 2008 (UTC)

Getting confused with 'Mediawiki complains'. We have the systems covered, organs respond to systems. Jagra (talk) 03:50, 20 April 2008 (UTC)

"This page is 88 kilobytes long. It may be appropriate to split this article into smaller, more specific articles. See Wikipedia:Article size." -- Strangelv (talk) 04:08, 20 April 2008 (UTC)

How do we handle additional pathophysiologies, such as vascular, liver? I agree "A multisystem disease, primarily neurological with variable involvement of liver, cardiac and skeletal muscle, lymphoid and endocrine organs." I think the answer seems to lie in finding commonalities among current sucessful treatments ie Heavy metal removal and detox, Thyroid fuction stability, sucessful treatment of IBS-D, succesful treatment of Depression, succesfull adressing of Sjogrens Syndrome etc.

Its like a piture of an object from multiple angles.

ME/CFS immune system pathophysiology

ME/CFS nervous system pathophysiology

ME/CFS endocrine system pathophysiology

Are better names and very good 'Camera Angles'. Just like in a photo from a different angle its Ok to repeat the overlaping infomation, especially the biochemical overlaps. No review of this page will be short. The best overview of the Endocrine system I have ever read is 60 pages long. Quality infomation is paramount.(talk) 14:49, 22 Sept 2008 (UTC) —Preceding unsigned comment added by 124.176.91.50 (talk)

Merger proposal

Pathophysiology and etiology articles are basicly saying the same things. And they are both written like reviews of the primary literature not an encyclopedia. Lets merge and edit. RetroS1mone talk 19:16, 21 September 2008 (UTC)

OK I merged them there is still alot of primary overload to take out! Pls help. RetroS1mone talk 03:17, 27 September 2008 (UTC)

You included in your merge this section at the top, which I have removed. I've never seen anything like that at the talk of a main article, it may have a place on the talk page. I've never seen a case of a mainspace page referring to a talk page and honestly don't think it's of benefit to readers. You may want to put it on this talk page, but I would suggest the best practice might be to simply copy and paste the contents of the other talk page into an archive on this talk page, and throw in a redirect. WLU (t) (c) ^{(rules - simple rules)} 14:17, 7 October 2008 (UTC)

waaay bloated

This is like a review of the medical literature, it should not have every article that ever said something about cfs! And there aren't prizes for making lots of sub headings! I am taking some stuff out like this trivia section, if you want some thing in here work it into the right section THIS WAS FROM ME, RETROS1MONE. THIS WAS FROM THE ANON USER: How can you be sure that the amendments made will enhance the understanding for the reader/CFS sufferer? I feel that the artcle is like a light review of the signifigant medical literature on CFS over the years and that it needs to be more concise, but how do you ensure nothing valuable will be lost in th editing? I think there needs to be more on the effects of a Nitric Oxide imbalance and the ramifications for sufferers. Also there needs to be more ob GI tract disturbances, the Bio Chemocal pathways/chanelopathies of B12,B6,B2,D3,D6,D9 Magnesium and Potassium. Better to have to much acurate detailed infomation than to little. —Preceding unsigned comment added by 124.176.91.50 (talk) 14:28, 22 September 2008 (UTC)

Wikipedia has a manual of style called wp:medmos and it says WP is for general readers not doctors and patietns, it is a general encyclopedia not medical textbook not self diagnosis guide not review of literature. I think all these forks are a mistake and making them say stuf like what amino acid got mutated in a percent of subjects at a norwegian study on RNase L is why I say waaaaaay bloated! RetroS1mone talk 03:13, 23 September 2008 (UTC)

This manual of style is wrong. Wikipedia is not for 'the general reader', but for all readers. That is why we chose to keep general info in the main article, and put more detailed info in subarticles. Guido den Broeder (talk, visit) 08:11, 23 September 2008 (UTC)

The manual of style is wrong because you say it is? Neato! Ok, well welcome back from your ninth retirement, again, or whatever!! RetroS1mone talk 02:49, 24 September 2008 (UTC)

The manual of style is wrong because it contradicts Wikipedia's declared purpose. Note that this part of the mos was not based on any consensus, but the result of an edit by one user. Guido den Broeder (talk, visit) 09:36, 24 November 2008 (UTC)

The manual of style is based from consensus. Wikipedia medical articles are not a medical textbook or for medical advice, they are for general readers. You disagree. You edit warred in May about it, you were blocked, the MOS is still the same. I follow MOS not what is right and "wrong" RetroS1mone talk 23:02, 25 November 2008 (UTC)

Where a guideline conflicts with a policy or a foundation principle you should not follow it. If you do, you create problems for other editors. Guido den Broeder (talk, visit) 01:06, 26 November 2008 (UTC)

So you are saying, Wikipedia should give medical advice and be a medical textbook? RetroS1mone talk 08:18, 26 November 2008 (UTC)

I'm saying nothing at all here about what Wikipedia should do in my opinion. I'm saying something about what the foundation says Wikipedia should do. That is, to spread knowledge freely to everyone, not just 'the general reader' as the MOS currently claims (this was not always so, check its history). Guido den Broeder (talk, visit) 11:47, 26 November 2008 (UTC)

THIS IS WHAT I COPIED OUT

Other immunological and infection findings

• A study published in 1995 found that 3 immunological tests (protein A binding, Raji cell, or C3/C4) best discriminated CFS patients from fatigued controls.

• A study found that while exercise worsened symptoms in CFS patients, it also increased allergen challenge response only in the CFS group, regardless of allergy status.

• A study found that fatigue persists in a significant minority of patients for six months or more after infections, suggesting post-infective fatigue syndrome is a valid illness model for investigating CFS.

• In a study on people who had glandular fever (which is caused by the Epstein-Barr virus), no difference was found between the levels of virus in the blood from patients who recovered quickly when compared with those whose fatigue lasted more than six months, although the latter had an altered immune response. The scientists involved believed this suggests CFS can be caused by neurological damage done (during the acute infection phase) to parts of the brain which control perception of fatigue and pain.

• Other bacterial micro-organisms may be associated with CFS, a veterinary surgeon and his co-worker handling CFS animal cases associated with Staphylococcus spp. Bacteremia, contracted the illness and their CFS was diagnosed to CDC criteria.

OK, RetroS1mone talk 20:41, 21 September 2008 (UTC)

Could you explain why? Guido den Broeder (talk, visit) 11:24, 28 November 2008 (UTC)

discussion of new edit The Cognitive Behavioural Model

A new section was added.

The Cognitive Behavioural Model
Because cognitive behavioural therapy and/or graded exercise therapy are the interventions for which there is the clearest research evidence of benefit, it may be of interest to describe the cognitive behavioural model of chronic fatigue syndrome. The cognitive behavioural model distinguishes between Precipitating Factors and Perpetuating Factors. Distress (Wessely et al., 1996; Moss-Morris & Spence, 2006) lower levels of fitness and bed rest (White et al., 2001), previous history of mood disorders and stressful life events (White et al., 2001) are all associated with development of chronic fatigue. For the purposes of treatment, the focus is on perpetuating factors. Exercise is associated with increased energy levels in a wide range of conditions. Rest, and in particular bed rest, is associated with muscle wasting. It is therefore plausible that the avoidance of exercise and bed rest are perpetuating factors as are beliefs that exercise is harmful. Beliefs that exercise is harmful and avoidance of exercise are have been observed in adolescents with chronic fatigue syntrome and their parents. Among adults with CFS it was observed that "Patients believed that they could partially control the symptoms by reducing activity but felt helpless to influence the physical disease process and hence the course of the illness" This, combined with the effectiveness of treatment aimed at beliefs and consequent behaviour suggests that belief and behaviour may be important influences on long term prognosis and recovery.

This should be a subclass under Nervous system factors, Behavioral. Source^[1} is a lesser source compared to the reviews in the main article on CBT. Chronic fatigue and chronic fatigue syndrome are lumped together in this material. Sources^[2] and ^[3] appear to not mention CFS/ME. There are some bold assumptions scattered between references that appear to be WP:OR or unsourced. These issues need to be addressed. Ward20 (talk) 00:20, 27 December 2008 (UTC)

While I think that it might be useful to add a section on the cognitive behavioural model, I agree with Ward20 that this isn't the best way to do it. Some of the references added have nothing to do with CFS, and there is a lot of WP:Synth here. My suggestion would be to stick to the references which actually discuss the cognitive behavioural model and add a summary of it. --sciencewatcher (talk) 01:49, 27 December 2008 (UTC)

Ooo sorry i just restored i thought it was a good start with some ok references but if you do not like pls revert! Thx, RetroS1mone talk 05:47, 29 December 2008 (UTC)

I've just rewritten it with proper references, sticking to the facts. See what you think. You can see the referenced text in google books for free. --sciencewatcher (talk) 01:05, 30 December 2008 (UTC)

Other Hypotheses - needs trimmed?

The "other hypotheses" section seems to have an awful lot of very speculative stuff, and should probably be trimmed. One example is the Martin Pall research, which has a long paragraph and 4 refs (all from Pall), and seems to be mostly speculative and probably WP:Fringe. One of the refs talks about MCS, which is not a recognised illness (and research shows that MCS patients are not in fact sensitive to chemicals). Lassesen has already removed one of the Pall refs from the main article for this reason, and I also reworded a sentence that was talking about MCS. At the very least we should trim the Pall stuff down to a sentence and maybe one reference. I'm not sure how it should be done, but if anyone wants to attempt it or has any ideas, please go ahead. --sciencewatcher (talk) 23:14, 8 January 2009 (UTC)

62.69.36.*'s changes

There are a lot of problems with your changes. First of all you are inserting text that is unsupported by any references and that appears to be your POV. Here are a few examples:

"CFS is not depression, although there are a few shared symptoms between CFS and clinical depression" - not true, the refs show more than "a few shared symptoms".

"a rate not incomparable to that found in multiple sclerosis" - you need a ref for this.

"It should be noted that if these "vicious circles" were extant, all patients would progress to a permanently bed-bound state, which is far from the case."

"or may simply mean some CFS cases may manifest earlier than commonly recognised with seemingly unconnected prodromal symptoms"

"Additionally, the weight of evidence for a pathophysiological disease state in at least a CFS subgroup contradicts these theories."

"Despite that this psychosomatic construct is managed with the same response, and that no other serious organic disease is routinely, widely treated by cognitive therapy, its proponents claim that this is not an "

"(with the presumptive corollary that they are not) "

"which may be a predisposing factor for CFS".

I think you should revert or at least fix all of your changes except for the cardiac section which is mostly ok, but you will also need to fix the references in that section so that they follow the same format as the other refs. I would also suggest you get a username rather than logging in from a dynamic ip. --sciencewatcher (talk) 19:01, 25 February 2009 (UTC)

Essential fatty acids

Can someone put a pmid # or a better ref on, "A review of CFS treatments compared two studies of essential fatty acids, concluding that there is insufficient evidence to recommend it as a treatment for CFS.Chronic fatigue syndrome - Musculoskeletal disorders - BMJ Clinical Evidence" It appears to be PMID 10650029 is that correct? Thanks.Ward20 (talk) 04:41, 26 February 2009 (UTC)

This ref is used in treatment article. Last time I checked it wasn't on pubmed. It is an updated version of PMID 10650029. Let me know if you need the full text. --sciencewatcher (talk) 15:23, 26 February 2009 (UTC)

Inappropriate removal of MEDRS text

RetroS1mone had removed MEDRS information (06 July 2009 [1]) which RobinHood restored (06 July 2009 [2], but RetroS1mone then reverted that (08 July 2009 - [3]) so I readded/reworded it (08 July 2009 - [4] but forgot to put in an edit summary. These are similar studies (large national birth cohorts) with conflicting results. - Tekaphor (TALK) 12:47, 8 July 2009 (UTC)

OK, I hope every person will stop deleting medrs like stevie nic did at chronic fatigue syndrome. RetroS1mone talk 22:40, 8 July 2009 (UTC)

Jargon Issue

In regards to the recent reversion of my header edits, it was done in good faith, and I will thank RetroS1mone to assume so. Specifically, the recently added tag said there was too much jargon, so I simplified the header. Yes, I removed the MUS reference, but only because it seemed redundant in light of the "unknown etiology" phrasing. --Rob (talk) 01:59, 10 July 2009 (UTC)

Medically unexplained symptoms links to an article that explains more. Please do not remove it. How is it, "no cause has been proven" is jargon or conteroversial? That is what every review says. Thx. RetroS1mone talk 02:08, 10 July 2009 (UTC)

I didn't remove "no cause has been proven", I simply reworded it ("cause...unknown") to make it more brief and encyclopedic by including it in the first sentence. It seems kind of silly for you to be reverting edits removing jargon when you were the one who put the tag there in the first place.

As for the MUS reference, if you're really attached to the MUS article which you've been spamming into CFS articles all over the place lately for reasons I don't understand, then by all means, leave it there. I just thought it was highly redundant in light of the unknown pathophisiology phrasing that was there initially. Essentially, the header before I edited it said: "We don't know the pathophsiology of CFS; there are medically unexplained symptoms; we don't know the cause." That's repeating variations on the same theme three times! --Rob (talk) 02:32, 10 July 2009 (UTC)

Herpes and CFS

• PMID 1337559 : Epstein-Barr virus
• PMID 1850541 : EBV again
• PMID 1337558 : Human herpesvirus 6 (HHV-6)

Drive-by sourcing. XP MichaelExe (talk) 03:56, 8 November 2009 (UTC)

Sorry, but what is your point? --sciencewatcher (talk) 16:45, 8 November 2009 (UTC)

They're useful links (all three are reviews, albeit a bit old), if anyone wants to expand the infections section. Also, the XMRV link is not a review, so we'll have to wait for one before including anything on it. MichaelExe (talk) 00:46, 9 November 2009 (UTC)

XMRV is already included in Pathophysiology of chronic fatigue syndrome right here. You may also be interested in the discussion at Talk:Chronic_fatigue_syndrome#Request_for_Comment:_should_XMRV_be_mentioned_in_this_article.3F. Ward20 (talk) 00:58, 9 November 2009 (UTC)

Contradictory evidence

In regards to Sciencewatcher's recent edit, I'm curious where it says that you can't use a lower-quality reference to refute a higher-quality review? In particular, in MEDRS, it specifically states "Individual primary sources should not be cited or juxtaposed so as to "debunk" or contradict the conclusions of reliable secondary sources, unless the primary source itself directly makes such a claim ...". Since the second source does indeed directly refute the first, I believe it should be included to show that the first statement is not without controversy, though appropriate disclaimers may need to be added to present the weight in context. —RobinHood70 ^{(talk • contribs)} 05:48, 26 November 2009 (UTC)

The review PMID 17892624 identified no clinically meaningful risk factors. We give too much weight to a single childhood trauma study, seemingly cherrypicked from a collection of risk factors found in unreplicated small studies. In fact the whole Psych (behavioral through stress) section needs revisiting, since many of the single studies promoted here were excluded from the review. Hamilton, Hatcher, Theorell, Van Houdenouve, etc. Looks like WP:SYN and WP:OR to me. Siding with SandyGeorgia on this one. And what does any of this have to do with Path? Sam Weller (talk) 10:44, 26 November 2009 (UTC)

Silly me, while I don't have access to the full text of that review I naturally assumed that because it was used as a reference for that sentence then the review must support it! Can someone email me a copy of this review?

As for the question of using primary sources to debunk reviews, MEDRS also says 'The use and presentation of primary sources should also respect Wikipedia's policies on undue weight; that is, primary sources favoring a minority opinion should not be aggregated or presented devoid of context in such a way as to undermine proportionate representation of expert opinion in a field'. As far as I can see, this source uses Jason's own definition of CFS, 'CF-psychiatric', i.e. he is basically saying (as far as I can tell), that CFS patients with psychiatric disorders don't really have CFS, which goes against all of the other CFS criteria and essentially means he has a circular argument because he's first taking out all the psychiatric cormorbid patients and then concluding that the patients that are left do not have any psychiatric problems! --sciencewatcher (talk) 16:20, 26 November 2009 (UTC)

Here [5]. Note that it's not a systematic review or metaanalysis. A scoping review is a snapshot of what's out there. Result, as stated in the first paragraph of this article. Sam Weller (talk) 18:55, 26 November 2009 (UTC)

Thanks. It calls itself a 'systematic scoping' review, but as you say they don't find anything useful and we already mention that in the first para. I think we might just need to reword the Jason sentence. Any idea where I can get the fulltext for that one (PMID 11708672)? --sciencewatcher (talk) 20:05, 26 November 2009 (UTC)

Sciencewatcher, there is a distinction between comorbid psychiatric and primary psychiatric. Where does it say that Jason uses his own definition of CFS? And most CFS definitions specifically exclude people with any condition which can primarily explain the fatigue, including psychiatric. "CF-psychiatric" means fatigue explainable by primary psychiatric disorder, so it does not go "against all of the other CFS criteria". In Jason et al's study comparing CDC-1994 criteria to Canadian-2003 criteria, it states that "... the Canadian group (47.8%) had lower rates of current psychiatric diagnoses than those in the CF-psychiatric group (87.9%) ... and directionally lower rates than those in the CFS group (75.0%)", so somehow I doubt that Jason generally believes "CFS patients with psychiatric disorders don't really have CFS", neither is he engaging in the circular "first taking out all the psychiatric cormorbid patients and then concluding that the patients that are left do not have any psychiatric problems" . - Tekaphor (TALK) 02:17, 27 November 2009 (UTC)

PS - Note that the less than 100% figure (87.9%) for current psychiatric diagnoses in the "CF-psychiatric" group is because previous (primary) psychiatric disorder can be exclusionary if it was relatively recent ... "the Canadian group (78.3%) had lower rates of lifetime psychiatric diagnoses than those in the CF-psychiatric group (100%) ... and directionally lower rates than the CFS group (83.3%)". - Tekaphor (TALK) 03:10, 27 November 2009 (UTC)

The 1994 CDC criteria doesn't exclude patients with psychiatric diagnoses, but the 1988 one did. So it looks like Jason is using the older criteria for his CFS group, and his CF-psychiatric patients would be considered to have CFS under CDC-1994. Is that correct? --sciencewatcher (talk) 15:46, 27 November 2009 (UTC)

Some psychiatric conditions are exclusionary while others are not, although the CDC-1994 criteria is not as exclusionary as I thought. Exclusionary conditions include: "Any past or current diagnosis of a major depressive disorder with psychotic or melancholic features; bipolar affective disorders; schizophrenia of any subtype; delusional disorders of any subtype; dementias of any subtype; anorexia nervosa; or bulimia nervosa." Non-exclusionary conditions include: "Any condition defined primarily by symptoms that cannot be confirmed by diagnostic laboratory tests, including fibromyalgia, anxiety disorders, somatoform disorders, nonpsychotic or nonmelancholic depression, neurasthenia, and multiple chemical sensitivity disorder."

However, it isn't clear exactly how exclusionary the CDC-1988 criteria is.[6] While it does mention ruling out "chronic psychiatric disease, either newly diagnosed or by history (such as endogenous depression; hysterical personality disorder; anxiety neurosis; schizophrenia; or chronic use of major tranquilizers, lithium, or antidepressive medications)", measuring psychiatric symptoms and diagnosing psychiatric illness is somewhat arbitrary, and "depression" is still listed as an example of a neuropsychological complaint (which are included as "minor" criteria).

Another study by Jason et al (comparing 1988 and 1994) [7], concluded that "The 1988 criteria, compared to the 1994 criteria, appeared to select a group of participants with more symptomatology and functional impairment, but these groups did not significantly differ in psychiatric comorbidity." I have not seen the full-text of PMID 11708672, but in the "Canadian-2003 vs CDC-1994" study of Jason et al I previously mentioned, it describes the "CF-psychiatric" group as "with a psychiatric explanation for their chronic fatiguing illness ... [eg 19/33] individuals were diagnosed with melancholic depression ... psychiatric conditions were diagnosed using the Structured Clinical Interview for the DSM-IV (SCID)".

_Tekaphor (TALK) 16:44, 27 November 2009 (UTC)

Not 100% sure if this is all the full-text of PMID 11708672, but this link appears to provide more than the abstract. - Tekaphor (TALK) 17:19, 27 November 2009 (UTC)

Thanks. That gives more, but not the full text. Anyway, I see you are right - it is Fukuda who arbitrarily (IMO) excludes patients with melancholic depression but not depression. I have just rewritten the sentence to more accurately reflect the conclusions in the abstract. --sciencewatcher (talk) 17:30, 27 November 2009 (UTC)

Abnormal Fluctuations in Vitamin E Found in CFS

Here is an interesting new finding regarding metabolic abnormalities in CFS:

Abnormal fluctuations in vitamin E levels are linked to flare ups and remissions in CFS —Preceding unsigned comment added by Drgao (talk • contribs) 15:51, 23 August 2010 (UTC)

Interesting. You might want to add a sentence to the Oxidative stress section.--sciencewatcher (talk) 16:28, 23 August 2010 (UTC)