#54 Reports on: HPA response, Stealth virus in cats, CBT
CFS-NEWS Electronic Newsletter
H H H HH H H H H H
H HHHHH HHHHHH HHHH H H H HHHH H H H HHHHHH
H H H H HHH H H H H H
HHHHHH H HHHHHH H HH HHHHHH HHHHH HHHHHH
Chronic Fatigue Syndrome Electronic Newsletter
--------------------------------------------------------------------
No. 54 January 31, 1996 Washington DC
--------------------------------------------------------------------
REPORTS ON HPA RESPONSE, STEALTH VIRUS IN CATS, CBT
CONTENTS
>>>1. Neuroendocrine response is distinct in CFS
>>>2. Stealth virus infects cats
>>>3. Study on cognitive behavioral therapy
>>>4. Two kinds of CFS?
>>>5. Muscle dysfunction found
>>>6. Reviews of CFS research
>>>7. High DHEA levels suggest treatment for some cases of chronic
fatigue
>>>8. Ampligen company renews activity
-------------------------------------------------------------------
>>>1. Neuroendocrine response is distinct in CFS
A London study has found that certain hormone responses in CFS
patients are the opposite of those in people who are depressed. This
confirms the landmark cortisol study done by Demitrack and Straus, et
al. in 1991. In the current study by Cleare et al., 10 non-depressed
CFS patients were compared to 15 subjects with major depression and
25 healthy controls with regard to prolactin and cortisol responses.
The results were significantly different for each group. These
results further suggest an organic basis for CFS, and support the
theory that the underlying disease mechanism in CFS involves a
dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis, a
control center in the brain which governs a wide array of bodily
functions. This study was published as:
Cleare AJ, Bearn J, Allain T, McGregor N, Wessely S, Murray R,
O'Keane V: Contrasting neuroendocrine responses in depression and
chronic fatigue syndrome. Journal of Affective Disorders
1995;35:283-289.
-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-
>>>2. Stealth virus infects cats
The Stealth virus which might be linked to CFS has been shown to
infect cats and cause an illness in them, according to a study by W.
John Martin and R. Tom Glass recently published in Pathobiology. "A
simian cytomegalovirus-related stealth virus, isolated from a patient
with the chronic fatigue syndrome, induced an acute neurological
illness when inoculated into cats."
Within a few weeks of inoculation with the virus, the five cats in
the study showed swollen lymph nodes, lowered body temperature,
hypersensitivity to light, and many other symptoms, as well as
behavioral changes including reclusiveness, loss of playfulness, and
irritability. A single control cat inoculated with an uninfected
culture did not show these symptoms. "Histological examination of
the virus-inoculated cats revealed widespread, although subtle,
cellular changes throughout many tissues including the brain." The
authors further speculate that cats might "possibly [be] involved in
human to animal disease transmission."
The citation for the published article is:
Martin WJ, Glass RT. Acute encephalopathy induced in cats with a
stealth virus isolated from a patient with chronic fatigue
syndrome. Pathobiology 1995;63:115-118.
This article's text can also be found on the world wide web at
http://www.usc.edu/hsc/medicine/virus/Cat.html
-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-
>>>3. Study on cognitive behavioral therapy
[In the following report, the terms "CFS" and "M.E." ( = myalgic
encephalomyelitis) are used interchangeably.)
British psychiatrists have reported success with their controversial
application of "cognitive behavioral therapy" (CBT) for CFS, in a
study just published in the British Medical Journal. The study has
gained much media attention in Britain and is being widely discussed.
The published study
The Oxford team lead by Dr. Michael Sharpe developed a program where
patients are actively supported and are counseled about coping
strategies, and are led to pursue increased activity. The
researchers believe that a major reason for continued illness is
physical deconditioning, exacerbated by patients' "inappropriate"
avoidance of activity. The study shows that the patients in the
program who received CBT in addition to regular medical care fared
better than those who received medical care alone.
The paper describes how 30 patients were given CBT in the form of
weekly counseling sessions over four months, in addition to medical
care, whereas a control group of 30 were given only ordinary medical
care with no CBT. Patients in the study were referred from an
outpatient clinic, and the researchers write that they likely did not
see the more chronic cases that may be in the care of medical
specialists. Patients on average began with a Karnofsky disability
score of about 70 (able to care for self, but unable to work or carry
on other normal activities), and at the end of 12 months 22 of the 30
showed a score of at least 80 (normal activity but requiring effort;
signs and symptoms of disease are more than minor).
Sharpe et al. write that CBT is based on the idea that CFS is
perpetuated not only by pathophysiological processes but also by
"inaccurate and unhelpful beliefs, ineffective coping behavior,
negative mood states [and] social problems". The CBT program, given
in addition to regular medical care, involves weekly treatment
sessions in which patients are "encouraged to question a simple
disease explanation of the illness and to consider the role of
psychological and social factors. They were also invited to
evaluate the effect of gradual and consistent increases in activity
and to try strategies other than avoidance. Additional components of
the treatment included strategies to reduce excessive perfectionism
and self criticism and an active problem solving approach to
interpersonal and occupational difficulties.... we think that the
main reason that the therapy used in this study was both acceptable
to patients and effective was its emphasis on re-evaluating patients'
illness beliefs by means of a collaborative rather than an
adversarial approach."
The paper's journal citation is as follows:
Sharpe M, Hawson K, Simkin S, Surawy C, Hackmann A, Klimes I,
Petro T, Warrell D, Seagrott V. Cognitive behaviour therapy for
the chronic fatigue syndrome; a randomised control trial. BMJ
1996;312:22-6.
Media play
Dr. Simon Wessely wrote a report about this paper in the London Times
in which he hailed the CBT study as an important success which
signaled that "a return to relatively normal functioning is possible
for the majority" of all patients. Wessely stated that the usual
"injunctions to do nothing" as a supposed treatment for CFS have
serious biochemical, metabolic and psychological consequences that
are detrimental to health. However, cognitive behavior therapy "is
based on a very simple idea -- that regardless of what starts an
illness, which in this case might be glandular fever, stress, or an
unknown cause, something else may be the reason why people fail to
recover. It is also pragmatic -- therapist and patient work together
in experiments to see what actually helps." Wessely concludes by
decrying both extremes of "it's all in the head" and "[it must be] a
simple virus" as being "ill-informed and unhelpful", and he commends
CBT as a promising treatment.
Other media attention in Britain was considerably coarse. An example
is the play that this news received in the London Daily Express.
Their article began with the headline "ME's Mainly in the Mind: Study
reveals yuppie flu can be cured by positive thinking", and continued
with: "Sufferers of yuppie flu can beat the crippling illness with
the power of positive thinking. British researchers have found that
the secret of overcoming ME is mostly in the mind. Thousands of
patients treated with psychotherapy, together with basic medical
care, felt better after a year, a study reveals today...."
Critical response
Dr. Charles Shepherd, writing on behalf of the M.E. Association of
Britain, stated in a letter published in the Times that while the
Sharpe study showed only 10 per cent improvement in disability rating
for patients, two other studies of CBT showed no improvement for ME
patients at all above what general medical care achieves. In a
letter submitted to the British Medical Journal, Shepherd states
additional criticisms. Some alternative therapies such as
homeopathy, he writes, are as successful as the Sharpe CBT program.
Sharpe's control group received no medical care from a professional
team experienced in managing M.E., whereas in an Australian study of
CBT, both the primary subjects and the controls received expert
medical care from the research team, and both groups showed similar
improvement. In addition, Shepherd writes, the data in Sharpe's
paper indicate a high proportion of psychiatric co-morbidity in the
particular sample in the study, and therefore, he suggests, perhaps
CBT is helping those conditions rather being helpful to the M.E.
CFS-NEWS will follow the discussion of this topic in future editions.
[Thanks to "Reeves, on the Internet", and to Dr. Shepherd, for
assistance with this report.]
-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-
>>>4. Two kinds of CFS?
Researchers in Sydney, Australia have distinguished two different
subgroups within CFS by applying a complex analysis to data on 565
patients. If confirmed by other studies, this finding may help
improve future CFS research. See:
Hickie I, Lloyd A, Hadzi-Pavlovic D, Parker G, Bird K, Wakefield
D. Can the chronic fatigue syndrome be defined by distinct
clinical features? Psychol Med 1995;25:925-935.
-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-
>>>5. Muscle dysfunction found
A study of 96 CFS patients has found an impaired muscle energy
metabolism that is not readily explained by physical inactivity or by
psychiatric disorder, further supporting the idea that CFS is a
distinct illness. The study examined all subjects for lactate and
heart rate response during exercise, and further examined a subgroup
of 43 patients for possible psychiatric disorder. See:
Lane R, Burgess A, Flint J, Riccio M, Archard L. Exercise
responses and psychiatric disorder in chronic fatigue syndrome.
BMJ 1995;311:544-5.
-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-
>>>6. Reviews of CFS research
A general and broad review of CFS issues and medical literature is
discussed in a 35-page article by Robin McKenzie and Stephen Straus
of the National Institutes of Health (NIH). The review discusses the
history of the illness, definition, clinical evaluation of patients,
associated medical illnesses (fibromyalgia, sleep disorders,
infectious diseases, endocrine abnormalities, psychiatric illness),
treatment and prognosis. There are 91 references. See: Robin
McKenzie and Stephen Straus. Chronic Fatigue Syndrome. Advances in
Internal Medicine 40:119-153.
A review of viral research that appears in the latest Journal of
Chronic Fatigue Syndrome includes a discussion of herpesviruses
(EBV, HHV-6, HHV-7), Stealth, enteroviruses (Coxsackie B),
retroviruses (HTLV-II-like), Spuma viruses, Hepatitis C, and
retrovirus-like particles. The 20-page article has 63 references.
See: Ablashi DV, et al.: Viruses and Chronic Fatigue Syndrome:
Current Status. JCFS 1995 1(2):3-22.
Simon Wessely reviews the epidemiologic literature on CFS, including
topics on: history of CFS, the language of chronic fatigue,
definitions of CFS, epidemiology of chronic fatigue, epidemiologic
data on the prevalence of CFS, the role of psychological disorders,
sex, infection, immune dysfunction, social class, selection bias and
illness behavior, CFS and the spectrum of fatigue, confounding,
public health implications, prognosis, other fatigue syndromes, the
social purpose of CFS, and conclusions. There are 138 references.
See: Wessely S: The Epidemiology of Chronic Fatigue Syndrome.
Epidemiol Rev 1995;17(1):139-151.
-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-
>>>7. High DHEA levels suggest treatment for some with chronic
fatigue
Twenty percent of chronically fatigued females showed high levels of
the androgenic hormone DHEA sulfate in a recent survey, and most of
those showing these high levels responded well to appropriate
treatment, according to a letter by Marshall Goldberg, MD published
in the November edition of the Journal of Clinical Endocrinology and
Metabolism. Goldberg's survey was made on 140 females. The study
did not identify subjects with CFS specifically. See:
Goldberg M. High Androgen Levels in Chronic Fatigue Patients.
JCE&M 1995;80(11):3390-1.
[Thanks to Dr. Marshall Goldberg for assistance with this report.]
-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-
>>>8. Ampligen company renews activity
The company that has been developing the drug Ampligen has changed
its name, and is raising money for further research, and has
authorized research for applications to Hepatitis C to be undertaken
in South Africa.
Ampligen treatments have been shown in previous studies to possibly
benefit CFS patients. A report on a new Ampligen study in Belgium
was presented at the Brussels CFS medical conference last November.
HEM Pharmaceuticals of Philadelphia, the creators of Ampligen, have
changed their name to Hemispherx BioPharma, Inc. They have sold
public shares in their corporation last November, from which they
have raised $16 million, which will be mostly used to complete
previous research and also to develop some new trials. Hemispherx
BioPharma public shares are being traded on the NASDAQ exchange.
In a separate action, Hemispherx BioPharma has licensed SAB-Bioclones
of South Africa to be the exclusive manufacturer of Ampligen for the
continent of Africa. SAB-Bioclones has a specific interest in
researching Ampligen for possible treatments of Hepatitis C. For the
foreseeable future they will be producing Ampligen only for their
research needs.
[Information for this report was obtained from: Hemispherx BioPharma
spokesman Bill Jencks; a CFS Newswire article written by Dan Fylstra;
and a soon-to-published article in the CFIDS Chronicle. To get on
the distribution list for the CFS Newswire, send a command in the
form of SUB CFS-WIRE YourFirstName YourLastName as an e-mail message
to Internet address LIST...@SJUVM.STJOHNS.EDU. For an annual
subscription to the quarterly CFIDS Chronicle, USA residents should
make a check for $35 payable to the CFIDS Association of America and
send by postal mail to P.O. Box 220398, Charlotte, NC 28222-0398. In
Canada send $45, overseas send $60.]
===================================================================
CFS-NEWS (ISSN 1066-8152) is an international newsletter published
and edited by Roger Burns in Washington D.C. It is distributed:
through the "CFS echo" (discussion group) on the Fidonet volunteer
network of BBSs; via the NIHLIST Listserv on Internet; and a USENET
Newsgroup bit.listserv.cfs.newsletter. Back issues are on file on
the Project ENABLE BBS in West Virginia USA at telephone 1-304-759-
0727 in file area 23, and the valuable patient resource file named
CFS-RES.TXT is available there too. Suggestions and contributions
of news may be sent to Roger Burns at Internet CFS-...@LIST.NIH.GOV
or by Fido NetMail to 1:109/432, or at telephone 1-202-966-8738, or
postal address 2800 Quebec St NW, no. 1242, Washington DC 20008 USA,
or post a message to the CFS echo or to the Internet CFS-L group or
to newsgroup alt.med.cfs. Copyright (c) 1996 by Roger Burns. Per-
mission is granted to excerpt this document if the source (CFS-NEWS
Electronic Newsletter) is cited. Permission is also granted to
reproduce the entirety of this document unaltered. This notice does
not diminish the rights of others whose copyrighted material as so
noted may be quoted herein. All trademarks, both marked and not
marked, are the property of their respective owners.
===================================================================
INTERNET users are encouraged to obtain the CFS FAQ file and other
CFS files at the SJUVM file server. Send the command GET CFS FAQ by
Internet e-mail to the address LIST...@SJUVM.STJOHNS.EDU .
Distribution of CFS-NEWS on the Internet is sponsored by the NIH
Computing Utility. However, the content of this independent
newsletter and the accuracy of the sources which it cites are solely
the responsibility of Roger Burns. To subscribe, send the command
SUB CFS-NEWS <your> <name> to the address LIST...@LIST.NIH.GOV .
To get back issues, send GET CFS-NEWS INDEX to that address and
follow the instructions in the file. Web address at the following
URL: http://metro.turnpike.net/C/cfs-news/cfs-news.html
=====================================================================