Chronic fatigue syndrome: Harvey and Wessely's (bio)psychosocial model versus a bio(psychosocial) model based on inflammatory and oxidative and nitrosative stress pathways

BMC Medicine

Correspondence

Frank NM Twisk¹  Michael Maes² 

[1] ME-de-patiënten Foundation, Limmen, The Netherlands;Maes Clinics @ TRIA, Piyavate Hospital, Bangkok, Thailand;

关键词: Irritable Bowel Syndrome;    Chronic Fatigue Syndrome;    Cognitive Behavioural Therapy;    Immune Disorder;    Mycoplasma Infection;   

DOI  :  10.1186/1741-7015-8-35

 received in 2009-12-04, accepted in 2010-06-15,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundIn a recently published paper, Harvey and Wessely put forward a 'biopsychosocial' explanatory model for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), which is proposed to be applicable to (chronic) fatigue even when apparent medical causes are present.MethodsHere, we review the model proposed by Harvey and Wessely, which is the rationale for behaviourally oriented interventions, such as cognitive behaviour therapy (CBT) and graded exercise therapy (GET), and compare this model with a biological model, in which inflammatory, immune, oxidative and nitrosative (IO&NS) pathways are key elements.DiscussionAlthough human and animal studies have established that the pathophysiology of ME/CFS includes IO&NS pathways, these abnormalities are not included in the model proposed by Harvey and Wessely. Activation of IO&NS pathways is known to induce fatigue and somatic (F&S) symptoms and can be induced or maintained by viral and bacterial infections, physical and psychosocial stressors, or organic disorders such as (auto)immune disorders. Studies have shown that ME/CFS and major depression are both clinical manifestations of shared IO&NS pathways, and that both disorders can be discriminated by specific symptoms and unshared or differentiating pathways. Interventions with CBT/GET are potentially harmful for many patients with ME/CFS, since the underlying pathophysiological abnormalities may be intensified by physical stressors.ConclusionsIn contrast to Harvey and Wessely's (bio)psychosocial model for ME/CFS a bio(psychosocial) model based upon IO&NS abnormalities is likely more appropriate to this complex disorder. In clinical practice, we suggest physicians should also explore the IO&NS pathophysiology by applying laboratory tests that examine the pathways involved.

【 授权许可】

CC BY   
© Maes and Twisk; licensee BioMed Central Ltd. 2010