Vercoulen J H, Swanink C M, Galama J M, Fennis J F, Jongen P J, Hommes O R, van der Meer J W, Bleijenberg G
Department of Medical Psychology, University Hospital Nijmegen, The Netherlands.
J Psychosom Res. 1998 Dec;45(6):507-17. doi: 10.1016/s0022-3999(98)00023-3.
The cause of chronic fatigue syndrome (CFS) is unknown. With respect to factors perpetuating fatigue, on the other hand, a model has been postulated in the literature in which behavioral, cognitive, and affective factors play a role in perpetuating fatigue. In the present study, this hypothesized model was tested on patients with CFS and on fatigued patients with multiple sclerosis (MS). The model was formulated in terms of cause-and-effect relationships and an integral test of this model was performed by the statistical technique, "structural equation modeling," in 51 patients with chronic fatigue syndrome and 50 patients with multiple sclerosis matched for age, gender, and education. Attributing complaints to a somatic cause produced low levels of physical activity, which in turn had a causal effect on fatigue severity. Depression had to be deleted from the model. Sense of control over symptoms and focusing on bodily symptoms each had a direct causal effect on fatigue. The model showed an excellent fit for CFS patients, but was rejected for MS patients. Therefore, a new model for MS patients had to be developed in which sense of control had a causal effect on fatigue. In the MS model, no causal relationship was found between the physical state as measured by the Expanded Disability Status Score (EDSS) and fatigue or functional impairment. The present study shows that cognitive and behavioral factors are involved in the persistence of fatigue. Treatment should be directed at these factors. The processes involved in the subjective experience of fatigue in CFS were different from the processes related to fatigue in MS.
慢性疲劳综合征（CFS）的病因尚不清楚。另一方面，关于使疲劳持续存在的因素，文献中提出了一种模型，其中行为、认知和情感因素在使疲劳持续存在方面发挥作用。在本研究中，对慢性疲劳综合征患者和患有多发性硬化症（MS）的疲劳患者测试了这一假设模型。该模型是根据因果关系制定的，并通过统计技术“结构方程建模”对51例慢性疲劳综合征患者和50例年龄、性别和教育程度相匹配的多发性硬化症患者进行了该模型的整体测试。将症状归因于躯体原因会导致身体活动水平较低，而这反过来又对疲劳严重程度产生因果影响。抑郁必须从模型中删除。对症状的控制感和关注身体症状各自对疲劳有直接的因果影响。该模型对慢性疲劳综合征患者显示出极佳的拟合度，但对多发性硬化症患者被拒绝。因此，必须为多发性硬化症患者开发一种新模型，其中控制感对疲劳有因果影响。在多发性硬化症模型中，通过扩展残疾状态评分（EDSS）测量的身体状态与疲劳或功能损害之间未发现因果关系。本研究表明，认知和行为因素与疲劳的持续存在有关。治疗应针对这些因素。慢性疲劳综合征中疲劳主观体验所涉及的过程与多发性硬化症中与疲劳相关的过程不同。
