Network Analysis of Symptoms Co-Occurrence in Chronic Fatigue Syndrome

Kujawski, Sławomir; Słomko, Joanna; Newton, Julia L.; Eaton-Fitch, Natalie; Staines, Donald; Marshall‐Gradisnik, Sonya; Zalewski, Paweł

doi:10.3390/ijerph182010736

Cited by 8 publications

(4 citation statements)

References 42 publications

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“…There are certain limitations of the present study. Our sample was relatively small in comparison with other network analysis studies; however, recent studies show a tendency to accept smaller samples in studies approaching this methodology (34)(35)(36)(37). The lack of a double-blind randomized clinical trial design can be perceived as another limitation.…”

Section: Limitationsmentioning

confidence: 94%

Baseline depressive symptoms as predictors of efficacy and tolerability of the treatment with duloxetine: a network analysis approach

et al. 2023

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IntroductionDepression is considered one of the most prevalent and burdensome mental disorders. Only 50–60% of patients respond to first-line treatment. Individuals with depression might benefit from personalized treatment, tailored to the individual needs of the patient. In this study, we aimed to explore the baseline characteristics of depressive symptoms associated with a good response to duloxetine treatment using a network analysis. Additionally, the relationship between baseline psychopathological symptoms and treatment tolerability was assessed.MethodsThe sample of 88 drug–free patients with active depressive episode, who started monotherapy with increasing doses of duloxetine were evaluated. The Hamilton Depression Rating Scale (HAM-D) was used to assess depression severity and the UKU side effect rating scale to monitor adverse drug reactions (ADRs). A network analysis that explored interactions of specific baseline depression symptoms, treatment efficacy and tolerability was performed.ResultsThe node representing duloxetine treatment efficacy was directly connected to the nodes representing the first HAM-D item (“depressed mood”) (edge weight = 0.191) and duloxetine dose (edge weight = 0.144). The node representing ADRs was directly connected to only one node representing the baseline score of the HAM-D anxiety (psychic) item (edge weight = 0.263).DiscussionOur findings indicate that individuals with depression presenting greater levels of depressed mood and lower levels of anxiety symptoms might better respond to the treatment with duloxetine in terms of efficacy and tolerability.

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Section: Limitationsmentioning

confidence: 94%

Baseline depressive symptoms as predictors of efficacy and tolerability of the treatment with duloxetine: a network analysis approach

et al. 2023

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“…While the DePaul Symptom Questionnaire (DSQ) has provided the field with a validated tool for assessing PEM,19 21 24 the instrument uses lengthy recall periods and was not designed to capture PEM in real time. Other retrospective questionnaires have been used to capture PEM symptom breadth, severity and duration, including the Patient-Reported Outcomes Measurement Information System, Short Form 36 Health Survey Questionnaire, Chronic Fatigue Questionnaire and Fatigue Impact Scale 21 25 26. These instruments use lengthy temporal intervals in symptom assessment (7 days, 30 days, 6 months) that are unsuitable for measuring moment-to-moment change.…”

Section: Introductionmentioning

confidence: 99%

Mixed methods system for the assessment of post-exertional malaise in myalgic encephalomyelitis/chronic fatigue syndrome: an exploratory study

Stussman,

Calco,

Norato

et al. 2024

BMJ Neurol Open

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BackgroundA central feature of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is post-exertional malaise (PEM), which is an acute worsening of symptoms after a physical, emotional and/or mental exertion. Dynamic measures of PEM have historically included scaled questionnaires, which have not been validated in ME/CFS. To enhance our understanding of PEM and how best to measure it, we conducted semistructured qualitative interviews (QIs) at the same intervals as visual analogue scale (VAS) measures after a cardiopulmonary exercise test (CPET).MethodsTen ME/CFS and nine healthy volunteers participated in a CPET. For each volunteer, PEM symptom VAS (12 symptoms) and semistructured QIs were administered at six timepoints over 72 hours before and after a single CPET. QI data were used to plot the severity of PEM at each time point and identify the self-described most bothersome symptom for each ME/CFS volunteer. Performance of QI and VAS data was compared with each other using Spearman correlations.ResultsEach ME/CFS volunteer had a unique PEM experience, with differences noted in the onset, severity, trajectory over time and most bothersome symptom. No healthy volunteers experienced PEM. QI and VAS fatigue data corresponded well an hour prior to exercise (pre-CPET, r=0.7) but poorly at peak PEM (r=0.28) and with the change from pre-CPET to peak (r=0.20). When the most bothersome symptom identified from QIs was used, these correlations improved (r=0.0.77, 0.42. and 0.54, respectively) and reduced the observed VAS scale ceiling effects.ConclusionIn this exploratory study, QIs were able to capture changes in PEM severity and symptom quality over time, even when VAS scales failed to do so. Measurement of PEM can be improved by using a quantitative–qualitative mixed model approach.

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“…While the recently developed DePaul Symptom Questionnaire (DSQ) has provided the field a validated tool for assessing PEM in ME/CFS patients (17,19,27), the instrument uses lengthy recall periods and was not designed to capture PEM in real time. A variety of other retrospective questionnaires have been used to capture PEM symptom breadth, severity, and duration, such as the Patient-Reported Outcomes Measurement Information System (PROMIS), Short Form 36 Health Survey Questionnaire (SF-36), Chronic Fatigue Questionnaire (CFQ), and Fatigue Impact Scale (FIS) (19,28,29). Many of these instruments use lengthy temporal intervals in symptom assessment, such as seven days, thirty days, or six months, and thus are unsuitable for measuring moment-to-moment changes in PEM.…”

Section: Introductionmentioning

confidence: 99%

A Mixed Methods System for the Assessment of Post Exertional Malaise in Encephalomyelitis/Chronic Fatigue Syndrome

Stussman

Calco

Norato

et al. 2023

Preprint

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Background: A central feature of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is post exertional malaise (PEM), which is an acute worsening of symptoms after a physical, emotional and/or mental exertion. PEM is also a feature of Long COVID. Dynamic measures of PEM have historically included scaled questionnaires which have not been validated in ME/CFS. To enhance our understanding of PEM and how best to measure it, we conducted semi-structured qualitative interviews (QIs) at the same intervals as Visual Analog Scale (VAS) measures after a Cardiopulmonary Exercise Test (CPET). Methods: Ten ME/CFS and nine healthy volunteers participated in a CPET. For each participant, PEM symptom VAS (7 symptoms) and semi-structured QIs were administered at six timepoints over 72 hours before and after a single CPET. QI data were used to plot the severity of PEM at each time point and identify the self-described most bothersome symptom for each patient. QI data were used to determine the symptom trajectory and peak of PEM. Performance of QI and VAS data were compared to each other using Spearman correlations. Results: QIs documented that each ME/CFS volunteer had a unique PEM experience, with differences noted in the onset, severity, trajectory over time, and most bothersome symptom. No healthy volunteers experienced PEM. Scaled QI data were able to identify PEM peaks and trajectories, even when VAS scales were unable to do so due to known ceiling and floor effects. QI and VAS fatigue data corresponded well prior to exercise (baseline, r=0.7) but poorly at peak PEM (r=0.28) and with the change from baseline to peak (r=0.20). When the most bothersome symptom identified from QIs was used, these correlations improved (r=.0.77, 0.42. and 0.54 respectively) and reduced the observed VAS scale ceiling and floor effects. Conclusion: QIs were able to capture changes in PEM severity and symptom quality over time in all the ME/CFS volunteers, even when VAS scales failed to do so. Information collected from QIs also improved the performance of VAS. Measurement of PEM can be improved by using a quantitative-qualitative mixed model approach. Keywords: Myalgic Encephalomyelitis, Chronic Fatigue Syndrome, Post Exertional Malaise, Cardiopulmonary Exercise Test; Measurement

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Network Analysis of Symptoms Co-Occurrence in Chronic Fatigue Syndrome

Cited by 8 publications

References 42 publications

Baseline depressive symptoms as predictors of efficacy and tolerability of the treatment with duloxetine: a network analysis approach

Baseline depressive symptoms as predictors of efficacy and tolerability of the treatment with duloxetine: a network analysis approach

Mixed methods system for the assessment of post-exertional malaise in myalgic encephalomyelitis/chronic fatigue syndrome: an exploratory study

A Mixed Methods System for the Assessment of Post Exertional Malaise in Encephalomyelitis/Chronic Fatigue Syndrome

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