Baseline Cortisol Levels Predict Treatment Outcomes in Chronic Fatigue Syndrome Nonpharmacologic Clinical Trial

Jason, Leonard A.; Torres-Harding, Susan; Maher, Kevin; Reynolds, Nadia; Brown, Molly; Sorenson, Matthew; Donalek, Julie; Corradi, Karina; Fletcher, Mary A; Lu, Tony V.

doi:10.3109/10573320802092039

Cited by 7 publications

(8 citation statements)

References 22 publications

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“…The results are consistent with findings reported by Jason et al (2007). In a study of four non-pharmacological interventions (including CBT), they found that those with abnormal cortisol at baseline did not improve over time, while those with normal baseline cortisol recorded positive outcomes on a number of immunological and self-report measures (cortisol levels were considered abnormal if they continued to rise, were flat, or were at abnormally low over time).…”

supporting

confidence: 88%

Letter to the Editor: Stratification using biological factors should be performed in more CFS studies

Kindlon¹

2009

Psychol. Med.

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supporting

confidence: 88%

Letter to the Editor: Stratification using biological factors should be performed in more CFS studies

Kindlon¹

2009

Psychol. Med.

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“…In support of this proposition, Jason et al [51] found that those with the most severe immune baseline characteristics tended to be non-improvers within non-pharmacologic interventions. Jason et al [52] also found that patients with CFS with normal baseline cortisol evidenced improvements on a number of immunologic and self-report measures, whereas patients most impaired on hypothalamic-pituitary-adrenal (HPA) functioning at baseline were least able to improve when provided rehabilitation interventions. If those with a more severe illness, such as having NDS and ME, are mixed with those with CF and those with exclusionary illnesses, it might be more difficult to determine therapeutic outcomes for clinical studies.…”

Section: Discussionmentioning

confidence: 99%

Case definitions integrating empiric and consensus perspectives

Jason

McManimen

Sunnquist

et al. 2016

Fatigue: Biomedicine, Health & Behavior

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Background There has been considerable controversy regarding how to name and define the illnesses known as myalgic encephalomyelitis (ME) and chronic fatigue syndrome (CFS). The IOM report has proposed a new clinical criteria and name for this illness, but aspects of these recommendations have been scrutinized by patients and scientists. Purpose It is possible that both empiric and consensus approaches could be used to help settle some of these diagnostic challenges. Using patient samples collected in the United States, Great Britain, and Norway (N=556), the current study attempted to categorize patients using more general as well as more restricted case definitions. Results Overall, the outcomes suggest that there might be four groupings of patients, with the broadest category involving those with chronic fatigue (N=62), defined by 6 or more months of fatigue which can be cannot be explained by medical or psychiatric conditions. A second category involves those patients that have chronic fatigue that can be explained by a medical or psychiatric condition (N=47). A third category involves more specific criteria that have been posited both by the IOM report, a Canadian Clinical Case criteria, a ME-ICC criteria and a more empiric approach. These efforts have specified domains of substantial reductions of activity, post-exertional malaise, neurocognitive impairment, and sleep dysfunction (N=346). Patients with these characteristics were more functionally impaired than those meeting just chronic fatigue criteria, p < .05. Finally, those meeting even more restrictive ME criteria proposed by Ramsay, identified a smaller and even more impaired group, p < .05. Discussion The advantages of using such empirical and consensus approaches to develop reliable classification and diagnostic efforts are discussed.

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“…In other words, nonresponders were more likely to have hypocortisolism than responders. Similarly, Jason et al 65 found that abnormal salivary cortisol profiles were predictive of a poorer response to nonpharmaco logical treatment, although the biological abnormalities were not welldefined. Finally, the interaction of the HPA axis with other systems, such as immune dysfunction and neurochemical alterations, is beyond the scope of this article, although it is highly likely that such interactions are of importance in explaining the effect and implications of hypo cortisolism in CFS.…”

Section: Clinical Relevance Of Hpa Axis Changesmentioning

confidence: 96%

Hypothalamic–pituitary–adrenal axis dysfunction in chronic fatigue syndrome

Papadopoulos¹,

Cleare²

2011

Nat Rev Endocrinol

226

153

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The weight of current evidence supports the presence of the following factors related to hypothalamic-pituitary-adrenal (HPA) axis dysfunction in patients with chronic fatigue syndrome (CFS): mild hypocortisolism; attenuated diurnal variation of cortisol; enhanced negative feedback to the HPA axis; and blunted HPA axis responsiveness. Furthermore, HPA axis changes seem clinically relevant, as they are associated with worse symptoms and/or disability and with poorer outcomes to standard treatments for CFS. Regarding etiology, women with CFS are more likely to have reduced cortisol levels. Studies published in the past 8 years provide further support for a multifactorial model in which several factors interact to moderate HPA axis changes. In particular, low activity levels, depression and early-life stress appear to reduce cortisol levels, whereas the use of psychotropic medication can increase cortisol. Addressing these factors-for example, with cognitive behavioral therapy-can increase cortisol levels and is probably the first-line approach for correcting HPA axis dysfunction at present, as steroid replacement is not recommended. Given what is now a fairly consistent pattern of findings for the type of HPA axis changes found in CFS, we recommend that future work focuses on improving our understanding of the cause and relevance of these observed changes.

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Baseline Cortisol Levels Predict Treatment Outcomes in Chronic Fatigue Syndrome Nonpharmacologic Clinical Trial

Cited by 7 publications

References 22 publications

Letter to the Editor: Stratification using biological factors should be performed in more CFS studies

Letter to the Editor: Stratification using biological factors should be performed in more CFS studies

Case definitions integrating empiric and consensus perspectives

Hypothalamic–pituitary–adrenal axis dysfunction in chronic fatigue syndrome

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