Implementing evidence-based psychiatry: whose responsibility?
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Biomedical subjects
Publications and source records attributed to M C Sharpe.
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The complexities of the chronic fatigue syndrome and the methodologic problems associated with its study indicate the need for a comprehensive, systematic, and integrated approach to the evaluation, classification, and study of persons with this condition and other fatiguing illnesses. We propose a conceptual framework and a set of guidelines that provide such an approach. Our guidelines include recommendations for the clinical evaluation of fatigued persons, a revised case definition of the chronic fatigue syndrome, and a strategy for subgrouping fatigued persons in formal investigations.
Patients currently suffering or recently recovered from chronic fatigue syndrome (CFS) were compared with each other and with a group of well-matched controls in a study of diurnal variation in levels of perceived mental and physical energy and positive and negative affect. Patients who were currently ill showed diurnal variation in patterns of energy, with maximum levels being recorded between 10.00 h and 12.00 h which were significantly higher (P < 0.05) than energy levels recorded on rising or retiring. This pattern was similar to the controls but average energy levels at each time point were lower (P < 0.05) among the ill patients. Recovered patients showed the same pattern, with mean energy levels falling between those of the ill patients and controls. Similar diurnal patterns were found for perceptions of positive, though not negative affect. Correlations between physical and mental energy and between both of these energy variables and positive affect were high (r = 0.75 to 0.85) in both controls and CFS patients. However, correlations with negative affect were low (eg r = -0.10) and non-significant. Total scores on the Hospital Anxiety and Depression Scale (HAD) were significantly higher (P < 0.05) among patients who were still ill than those who had recovered. Scores on the HAD Depression (but not Anxiety) subscale were also significantly higher among those who were still ill (P < 0.01). These findings may be of value in facilitating programmes of cognitive-behavioural modification intended to aid the recovery of patients with CFS.
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The effects of intravenous infusion of Asp1. Ile5-angiotensin II on blood pressure, plasma vasopressin, ACTH and 11-hydroxycorticosteroid levels and on plasma renin activity were studied in five trained, conscious dogs. The dogs were prepared with bilateral carotid loops. Infusion of angiotensin II at rates of 5, 10, and 20 ng/kg.min raised its plasma concentration from 23 +/- 7 to 48 +/- 8, 125 +/- 8, and 187 +/- 21 pg/ml, respectively. The lowest rate of infusion was mildly pressor, the two higher rates more so. All rates of infusion promptly increased vasopressin levels and depressed renin levels. The two higher rates also stimulated ACTH, although with a latency of 30-45 min. Since the rates of infusion of angiotensin II employed produced plasma levels within the physiological range, it is suggested that peripherally generated angiotensin II may play an important role in the regulation of vasopressin, and ACTH secretion.