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Chronic Fatigue Syndrome: HELP
Articles by Katharine A. Rimes
Based on 27 articles published since 2010
(Why 27 articles?)
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Between 2010 and 2020, K. Rimes wrote the following 27 articles about Fatigue Syndrome, Chronic.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Review A review of the predisposing, precipitating and perpetuating factors in Chronic Fatigue Syndrome in children and adolescents. 2014

Lievesley, Kate / Rimes, Katharine A / Chalder, Trudie. ·Chronic Fatigue Research and Treatment Unit, South London and Maudsley NHS Trust, 1st Floor, Mapother House, De Crespigny Park, Denmark Hill, London SE5 8AZ, UK. · Institute of Psychiatry, Kings College London, De Crespigny Park, Denmark Hill, London SE5 8AF, UK. · Chronic Fatigue Research and Treatment Unit, South London and Maudsley NHS Trust, 1st Floor, Mapother House, De Crespigny Park, Denmark Hill, London SE5 8AZ, UK; Academic Department of Psychological Medicine, 3rd Floor, Weston Education Centre, King's College London, Cutcombe Road, London SE5 9RJ, UK. Electronic address: Trudie.Chalder@kcl.ac.uk. ·Clin Psychol Rev · Pubmed #24632047.

ABSTRACT: Chronic Fatigue Syndrome (CFS) is a condition characterised by severe mental and physical fatigue coupled with profound disability. The purpose of this review was to investigate psychological, social and physiological factors associated with fatigue and disability in CFS in children and adolescents. The review aimed to gain an overview of the strength of evidence for the relationship between these different factors and CFS in young people. Seventy-nine studies met the inclusion criteria and were included in the review. A narrative synthesis of these studies was conducted. The strongest and most consistent finding was that rates of psychiatric co-morbidity, predominantly anxiety and depressive disorders, were higher in young people with CFS compared to healthy controls or illness control groups. Studies suggested that many children and adolescents with CFS reported that their illness began with an infection and there was some objective and prospective evidence to support this. Preliminary evidence suggested a link between CFS and a family history of CFS, high expectations from both the parent and child, personality traits such as conscientiousness and physical illness attributions. The evidence was limited by methodological problems. Few studies were prospective in nature and future research should address this. Clinical implications of the findings are discussed and a hypothesised model of the factors associated with CFS in children and adolescents is presented.

2 Article Assessing functioning in adolescents with chronic fatigue syndrome: psychometric properties and factor structure of the School and Social Adjustment Scale and the Physical Functioning Subscale of the SF36. 2020

Loades, M E / Vitoratou, S / Rimes, K A / Chalder, T. ·Department of Psychology, University of Bath, Bath, UK. · Bristol Medical School, University of Bristol, Bristol, UK. · Psychometrics & Measurement Lab, Department of Biostatistics and Health Informatics, King's College London, London, UK. · King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK. · South London & Maudsley NHS Trust, Beckenham, UK. ·Behav Cogn Psychother · Pubmed #32234097.

ABSTRACT: BACKGROUND: Chronic fatigue syndrome (CFS) has a major impact on functioning. However, no validated measures of functioning for this population exist. AIMS: We aimed to establish the psychometric properties of the 5-item School and Social Adjustment Scale (SSAS) and the 10-item Physical Functioning Subscale of the SF-36 in adolescents with CFS. METHOD: Measures were completed by adolescents with CFS (n = 121). RESULTS: For the Physical Functioning Subscale, a 2-factor solution provided a close fit to the data. Internal consistency was satisfactory. For the SSAS, a 1-factor solution provided an adequate fit to the data. The internal consistency was satisfactory. Inter-item and item-total correlations did not indicate any problematic items and functioning scores were moderately correlated with other measures of disability, providing evidence of construct validity. CONCLUSION: Both measures were found to be reliable and valid and provide brief measures for assessing these important outcomes. The Physical Functioning Subscale can be used as two subscales in adolescents with CFS.

3 Article Psychometric properties of the Cognitive and Behavioural Responses Questionnaire (CBRQ) in adolescents with chronic fatigue syndrome. 2020

Loades, M E / Vitoratou, S / Rimes, K A / Ali, S / Chalder, T. ·Department of Psychology, University of Bath, Bath, UK. · Bristol Medical School, University of Bristol, Bristol, UK. · Psychometrics & Measurement Lab, Department of Biostatistics and Health Informatics, King's College London, London, UK. · King's College London, London, UK. · South London and Maudsley NHS Trust, Beckenham, UK. ·Behav Cogn Psychother · Pubmed #31113527.

ABSTRACT: BACKGROUND: To better understand the maintenance of chronic fatigue syndrome (CFS), a valid and reliable measure of cognitive and behavioural responses to symptoms is required. Such a measure could also assess beliefs and coping behaviours in the context of fatigue in other somatic conditions. AIMS: We aimed to establish the psychometric properties of both the Cognitive and Behavioural Responses Questionnaire (CBRQ) and its shortened version (CBRQ-S) in adolescents with CFS. METHOD: The full questionnaire was completed by a clinical cohort of adolescents (n = 121) presenting to specialist CFS units in the UK. RESULTS: Both the CBRQ and CBRQ-S had good internal consistency. The CBRQ scores were strongly associated with depression, anxiety, school and social functioning, but weakly associated with fatigue and physical functioning, providing evidence of validity. CONCLUSION: Both the 40-item and the 18-item versions of the CBRQ were found to be reliable and valid in adolescents with CFS. To minimize unnecessary burden, the 18-item version is favoured. Using this assessment tool in future studies, including intervention studies, may help to better target interventions during clinical practice and improve outcomes.

4 Article Depressive symptoms in adolescents with chronic fatigue syndrome (CFS): Are rates higher than in controls and do depressive symptoms affect outcome? 2019

Loades, Maria Elizabeth / Rimes, Katharine A / Ali, Sheila / Chalder, Trudie. ·1 Department of Psychology, University of Bath, UK. · 2 Bristol Medical School, University of Bristol, UK. · 3 King's College London, UK. · 4 South London and Maudsley NHS Foundation Trust, UK. ·Clin Child Psychol Psychiatry · Pubmed #30945566.

ABSTRACT: INTRODUCTION: Previous research has indicated that co-morbid depression is common in adolescents with chronic fatigue syndrome (CFS). OBJECTIVES: We sought to compare the characteristics of depressive symptoms in adolescents with CFS to those of healthy controls (HCs) and illness controls (adolescents with asthma). DESIGN: Case-control study nested within a prospective clinical cohort. METHODS: A total of 121 adolescents with CFS who attended an initial assessment at two specialist CFS units completed the Children's Depression Inventory (CDI). Their responses were compared to 80 HCs and 27 adolescents with asthma (illness controls). The clinical cohort of adolescents with CFS completed questionnaires at assessment, and those who were seen subsequently for treatment at the CFS unit (68%) completed the measures again at their first treatment session. RESULTS: CFS participants scored significantly higher on all the depression subscales than participants with asthma and HCs. Depression score explained 11% of the variance in subsequent fatigue, but only 1.9% of the variance in physical functioning. Depression score also explained most (68%) of the variance in subsequent depression. CONCLUSION: Depressive symptoms are more prominent in adolescents with CFS than in HCs or illness controls. These symptoms also appear to remain over time during a naturalistic follow-up where no treatment was provided. This highlights the need for further research into depression in CFS, including stratifying treatment outcomes by depression status to determine what is effective at addressing these symptoms.

5 Article Cognitive and behavioural responses to symptoms in adolescents with chronic fatigue syndrome: A case-control study nested within a cohort. 2019

Loades, Maria Elizabeth / Rimes, Katharine / Lievesley, Kate / Ali, Sheila / Chalder, Trudie. ·1 Department of Psychology, University of Bath, UK. · 2 Bristol Medical School, University of Bristol, UK. · 3 King's College London, UK. · 4 South London and Maudsley NHS Foundation Trust, UK. ·Clin Child Psychol Psychiatry · Pubmed #30873864.

ABSTRACT: BACKGROUND: What adolescents think about symptoms and what they do in response could contribute to fatigue maintenance. We compared the cognitive and behavioural responses of adolescents and their parents with chronic fatigue syndrome (CFS; METHOD: Consecutively referred adolescents with CFS were recruited. Questionnaires, completed by adolescents and parents, assessed fatigue, functioning, mood and cognitive and behavioural responses to symptoms. Age-matched adolescents with asthma completed the same questionnaires. Adolescents with CFS completed questionnaires again approximately 3 months later. RESULTS: Adolescents with CFS scored higher on all unhelpful cognitive and behavioural subscales than adolescents with asthma. Parents' cognitions about their child's symptoms were associated with adolescent's own cognitions. Unhelpful cognitive and behavioural responses, particularly, damage beliefs, predicted subsequent fatigue in CFS, and all-or-nothing behaviour, catastrophising and damage beliefs predicted subsequent physical functioning. CONCLUSION: Unhelpful cognitive and behavioural responses to symptoms appear to be particularly prominent in adolescents with CFS. There is some consistency but not a perfect match between cognitive and behavioural responses to symptoms reported by adolescents and their parents. These responses could be contributing to fatigue maintenance and disability.

6 Article Perfectionism and beliefs about emotions in adolescents with chronic fatigue syndrome and their parents: a preliminary investigation in a case control study nested within a cohort. 2019

Loades, Maria E / Rimes, Katharine A / Lievesley, Kate / Ali, Sheila / Chalder, Trudie. ·a Department of Psychology , University of Bath , Bath , UK. · b Department of Psychological Medicine , King's College London, Institute of Psychiatry, Psychology and Neuroscience, Weston Education Centre , London , UK. · c South London & Maudsley NHS Foundation Trust , London , UK. ·Psychol Health · Pubmed #30821511.

ABSTRACT:

7 Article Does fatigue and distress in a clinical cohort of adolescents with chronic fatigue syndrome correlate with fatigue and distress in their parents? 2019

Loades, Maria E / Rimes, Katharine A / Ali, Sheila / Lievesley, Kate / Chalder, Trudie. ·Department of Psychology, University of Bath, Bath, United Kingdom. · School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom. · Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom. · South London and Maudsley NHS Trust, Monks Orchard Road, Beckenham, Kent, BR3 3BX. ·Child Care Health Dev · Pubmed #30342433.

ABSTRACT: OBJECTIVES: Previous studies have found that parents of children with chronic fatigue syndrome (CFS) are more fatigued, and mothers are more distressed than healthy controls. Managing the disabling symptoms of CFS can result in disruption and burden for the family. Most research has focused on mothers. This study sought to further explore the associations between adolescent fatigue and distress and parental fatigue and distress, as well as family functioning, including both mothers and fathers. DESIGN: Cross-sectional study of a clinical cohort of consecutive attenders at a specialist chronic fatigue unit. METHODS: Questionnaires were completed by adolescents (N = 115, age 11-18) with a confirmed diagnosis of CFS and their mothers (N = 100) and fathers (N = 65). RESULTS: Maternal fatigue was significantly correlated with maternal distress, but not with adolescent fatigue, depression, anxiety, or functioning. This pattern held true for paternal fatigue. Maternal and paternal anxiety and depression were significantly correlated with family functioning. Paternal and maternal distress were correlated with each other. Mothers and fathers tended to have a consistent view of family functioning. Family functioning, specifically being overwhelmed by difficulties and scoring lower on strengths and adaptability, was positively associated with adolescent depression. Unexpectedly, higher levels of adolescent fatigue and poorer physical functioning were associated with better family functioning as rated by the mother. CONCLUSIONS: Parents of adolescents with fatigue scored near to or within normative range for non-clinical samples on distress, fatigue, and family functioning. Parental distress may contribute to or result from poorer family functioning. Family functioning, particularly building strengths and adaptability, may be clinically important in CFS, as well as attending to parental (particularly paternal) distress in families where adolescents are low in mood.

8 Article Illness beliefs of adolescents with CFS and their parents: the perceived causes of illness and beliefs about recovery. 2018

Loades, Maria E / Rimes, Katharine A / Lievesley, Kate / Ali, Sheila / Chalder, Trudie. ·Department of Psychology, University of Bath, Bath, BA2 7AY, UK, Phone: +(44) 01225 385249. · School of Social and Community Medicine, University of Bristol, Bristol, UK. · Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park SE5 8AF, London, UK. · South London and Maudsley NHS Foundation Trust, London, UK. · Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Weston Education Centre, Cutcombe Road, London, SE5 9RJ, UK. · South London and Maudsley NHS Foundation Trust, Monks Orchard Road, Beckenham, Kent, BR3 3BX, UK. ·Int J Adolesc Med Health · Pubmed #30118437.

ABSTRACT: -- No abstract --

9 Article The presence of co-morbid mental health problems in a cohort of adolescents with chronic fatigue syndrome. 2018

Loades, Maria Elizabeth / Rimes, Katharine A / Ali, Sheila / Lievesley, Kate / Chalder, Trudie. ·1 Department of Psychology, University of Bath, UK. · 2 School of Social and Community Medicine, University of Bristol, UK. · 3 Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK. · 4 South London and Maudsley NHS Foundation Trust, UK. ·Clin Child Psychol Psychiatry · Pubmed #29096528.

ABSTRACT: OBJECTIVE: To report on the prevalence of mental health disorders in adolescents with chronic fatigue syndrome (CFS) and to compare the diagnoses identified by a brief clinician-administered psychiatric interview with self-report screening questionnaires. DESIGN: Cross-sectional study. SETTING: Consecutive attenders to specialist CFS clinics in the United Kingdom. PATIENTS: N = 52 adolescents, age 12-18 years with CFS. MEASURES: Self-report questionnaires and a brief structured psychiatric diagnostic interview, administered by a researcher. RESULTS: On the psychiatric interview, 34.6% met a diagnosis of major depressive disorder and 28.8% had an anxiety disorder. Of these, 15% had co-morbid anxiety and depression. Those with a depression diagnosis reported significantly greater interference on the school and social adjustment scale. They also scored significantly higher on trait anxiety, but not on state anxiety. There were no differences between those who had an anxiety disorder and those who did not on fatigue, disability or depressive symptoms. Children's Depression Inventory (CDI) score was associated with a depression diagnosis on the psychiatric interview. However, neither the state nor the trait subscale of the State-Trait Anxiety Inventory (STAI) was associated with an anxiety diagnosis. CONCLUSION: Clinicians should assess for the presence of anxiety and depressive disorders in adolescents with CFS using a validated psychiatric interview. Treatment should be flexible enough to accommodate fatigue, depression and anxiety. Transdiagnostic approaches may suit this purpose. Goals should include pleasurable activities particularly for those who are depressed.

10 Article Stress vulnerability in adolescents with chronic fatigue syndrome: experimental study investigating heart rate variability and skin conductance responses. 2017

Rimes, Katharine A / Lievesley, Kate / Chalder, Trudie. ·Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. ·J Child Psychol Psychiatry · Pubmed #28276066.

ABSTRACT: BACKGROUND: Stress vulnerability has been implicated in adolescent chronic fatigue syndrome (CFS), but has rarely been investigated directly. This study compared psychological and physiological responses to a laboratory social performance task in adolescents with CFS with chronic illness (asthma) and healthy control groups. METHODS: Adolescents with CFS (n = 60), adolescents with asthma (n = 31) and healthy adolescents (n = 78) completed questionnaires before and after a social performance task. Skin conductance responses (SCR; mean SCR and Max-Min) and heart rate variability (low frequency/high frequency; LF/HF and root mean square difference of successive RR intervals; RMSSD) was measured before, during and after the task. RESULTS: Baseline heart rate variability (HRV) (RMSSD) was significantly lower in the CFS and Asthma groups than the HC. During the speech, the CFS and Asthma groups had higher HRV (LF/HF) than the HC, adjusting for baseline LF/HF. Although the asthma group showed a subsequent reduction in HRV during recovery, the CFS group did not. Similarly, during recovery after the task, the CFS group showed a continued increase in skin conductance (Min-Max), unlike the Asthma and HC groups. Compared to control groups, adolescents with CFS expected to find the task more difficult, were more anxious beforehand and afterwards, rated it as more difficult, evaluated their performance more negatively and had lower observer ratings of performance. Parents of adolescents with CFS expected that their child would perform less well in the task than parents of control participants. CONCLUSIONS: Adolescents with CFS showed autonomic nervous system responses that are consistent with chronic stress vulnerability, difficulty coping with acute stress and slower recovery after acute stress. Self-report measures also indicated greater trait, pre- and posttask anxiety in the CFS group.

11 Article Chronic Fatigue Syndrome: Cognitive, Behavioural and Emotional Processing Vulnerability Factors. 2017

Brooks, Samantha K / Chalder, Trudie / Rimes, Katharine A. ·Department of Psychological Medicine,King's College London,Institute of Psychiatry,Weston Education Centre,Cutcombe Road,London SE5 9RJ. · King's College London,Institute of Psychiatry,Psychology and Neuroscience,Department of Psychology,Henry Wellcome Building,De Crespigny Park,London SE5 8AF. ·Behav Cogn Psychother · Pubmed #28098051.

ABSTRACT: BACKGROUND: Cognitive-behavioural models of chronic fatigue syndrome (CFS) suggest that personality factors such as perfectionism and high moral standards may contribute to the development of CFS. AIMS: To investigate cognitive, behavioural and emotional processing risk factors for CFS. METHOD: CFS patients (n = 67) at a UK specialist clinic completed questionnaires about psychological characteristics both currently and retrospectively (6 months pre-CFS onset). Responses were compared with those of healthy individuals (n = 73) who rated their current characteristics. Forty-four relatives retrospectively rated the pre-morbid psychological characteristics of the CFS participants. RESULTS: CFS patients showed similar levels of current perfectionism to controls, though higher pre-morbid perfectionism. CFS patients showed greater self-sacrificial beliefs and more unhelpful beliefs about experiencing and expressing negative emotions, both currently but more markedly prior to onset. In the 6 months pre-illness onset, CFS patients showed more disruption to their primary goal and greater general stress than controls. Ratings of pre-morbid psychological characteristics by relatives were consistent with patients' self-reports. The extent of overinvestment in one goal was significantly associated with fatigue. CONCLUSIONS: Perfectionism, self-sacrificial tendencies, unhelpful beliefs about emotions, and perceived stress may be present to a greater extent pre-morbidly in CFS patients compared with healthy individuals.

12 Article Fatigue in an adult attention deficit hyperactivity disorder population: A trans-diagnostic approach. 2017

Rogers, Denise C / Dittner, Antonia J / Rimes, Katharine A / Chalder, Trudie. ·King's College London, King's Health Partners, (formerly Behavioural and Developmental Psychiatry Clinical Academic Group, Maudsley Adult ADHD Service, South London and Maudsley NHS Foundation Trust), London, UK. · King's College London, King's Health Partners, Psychological Medicine Clinical Academic Group, Chronic Fatigue Research and Treatment Unit (formerly Behavioural and Developmental Psychiatry Clinical Academic Group, Maudsley Adult ADHD Service), South London and Maudsley NHS Foundation Trust, London, UK. · Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's Health Partners, King's College London, UK. · Department of Psychological Medicine, King's College London, Weston Education Centre, London, UK. ·Br J Clin Psychol · Pubmed #27918087.

ABSTRACT: OBJECTIVES: Trans-diagnostic approaches suggest that key cognitive and behavioural processes maintain symptoms across a wide range of mental health disorders. Fatigue is a common clinical feature of attention deficit hyperactivity disorder (ADHD) in adulthood; however, empirical data supporting its prevalence are lacking. This study aimed to collate outcomes from outpatient services to (1) investigate the prevalence of fatigue in adults with ADHD, (2) examine symptoms of ADHD in adults with chronic fatigue syndrome (CFS), and (3) consider secondary clinical characteristics common to both disorder groups. METHODS: Measures of self-reported fatigue were compared across groups of adults with ADHD (N = 243), CFS (N = 86), and healthy controls (HC) (N = 211) using a between-subjects cross-sectional design. Groups were also compared on secondary clinical measures of functional impairment, mood, anxiety, sleep, self-efficacy, and their beliefs about the acceptability of expressing emotions. RESULTS: The ADHD group were significantly more fatigued than HC with 62% meeting criteria for fatigue caseness. ADHD symptoms were significantly greater in the CFS group than in HC. ADHD and CFS groups did not differ significantly on measures of functional impairment, mood, and self-efficacy. No significant differences were detected on measures of anxiety when items relating to physical restlessness were removed from the analysis. CONCLUSIONS: Adults with ADHD experience greater fatigue than HC. Adults with CFS and ADHD share many trans-diagnostic clinical characteristics, including difficulties with low mood, anxiety, and reduced self-efficacy, which impact upon their overall functioning. Further research is required to investigate extraneous factors mediating fatigue severity in these clinical groups. PRACTITIONER POINTS: Fatigue is a common clinical feature of attention deficit hyperactivity disorder (ADHD) in adulthood. Evidence-based interventions for chronic fatigue syndrome could be adapted to address fatigue in ADHD in adults.

13 Article Emotional suppression in chronic fatigue syndrome: Experimental study. 2016

Rimes, Katharine A / Ashcroft, Joanna / Bryan, Lauren / Chalder, Trudie. ·Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London. ·Health Psychol · Pubmed #27183308.

ABSTRACT: OBJECTIVE: Emotional processing differences in chronic fatigue syndrome (CFS) have been reported but have rarely been investigated experimentally. This study used self-report, observer ratings, and electrodermal responses to test hypotheses about emotion suppression and autonomic reactivity. METHODS: Eighty adults with CFS and 80 healthy controls (HC) watched a distressing film clip. Half of each group were instructed to suppress their emotions and half were told to express their feelings as they wished. Their reactions were filmed and rated by independent observers. Electrodermal activity (skin conductance response) was used as a measure of sympathetic nervous system arousal. RESULTS: CFS participants reported higher anxiety and sadness than the HC, both before and after the film. However, observers rated the CFS group as having lower emotional expression than HC in both emotional suppression and expression choice conditions. Beliefs about the unacceptability of negative emotions were associated with greater self-reported suppression. Electrodermal responses were greater in the CFS group than HC participants. Higher skin conductance responses were associated with larger posttask increases in fatigue in the CFS participants but not in the HC. CONCLUSIONS: CFS participants had lower observer-rated emotional expression than HC, despite greater distress and higher autonomic arousal. This may have implications for their ability to access social support at times of stress. As the degree of autonomic arousal was associated with short-term increases in fatigue in the CFS participants, this requires further investigation as a contributory factor for this condition. (PsycINFO Database Record

14 Article Maternal and childhood psychological factors predict chronic disabling fatigue at age 13 years. 2015

Collin, Simon M / Tilling, Kate / Joinson, Carol / Rimes, Katharine A / Pearson, Rebecca M / Hughes, Rachael A / Sterne, Jonathan A C / Crawley, Esther. ·School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom; Centre for Child and Adolescent Health, University of Bristol, Bristol, United Kingdom. Electronic address: simon.collin@bristol.ac.uk. · School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom. · School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom; Centre for Child and Adolescent Health, University of Bristol, Bristol, United Kingdom. · Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom. ·J Adolesc Health · Pubmed #25448612.

ABSTRACT: PURPOSE: To investigate whether premorbid maternal and childhood psychological problems are risk factors for chronic disabling fatigue at age 13 years among children in the Avon Longitudinal Study of Parents and Children birth cohort. METHODS: Chronic disabling fatigue was defined as fatigue of at least 3-month, and up to 5-year, duration that prevented school attendance or hobbies/sport/leisure activities, and for which other causes were not identified. Maternal psychological factors were symptoms of anxiety and depression assessed up to eight times between pregnancy and age 6 years. We investigated critical periods for maternal effects and effects of paternal depression at three time points. Child psychological factors included internalizing and externalizing problems and upsetting life events occurring at age 7-8 years. RESULTS: Of 5,657 children, 110 (1.9%) had chronic disabling fatigue at age 13 years. Maternal anxiety (adjusted odds ratio [AOR], 1.19; 95% confidence interval [CI], 1.09-1.31 per episode), maternal depression (AOR, 1.24; CI, 1.11-1.39 per episode), child psychological problems (AOR, 1.19; CI, 1.00-1.41 per problem), and upsetting events (AOR, 1.22; CI, .99-1.58 per event) were associated with chronic disabling fatigue. Associations of child psychological problems and upsetting events were attenuated (AOR, 1.12; CI, .93-1.33 per problem; AOR, 1.19; CI, .94-1.52 per event) after further adjusting for maternal anxiety and depression. CONCLUSIONS: Pediatricians need to be aware that children whose mothers experience anxiety and/or depression between pregnancy and child's age 6 years have an increased risk of developing chronic disabling fatigue in early adolescence. Conversely, clinicians need to be alert to fatigue in children whose mothers have longstanding anxiety and depression. These findings suggest the importance of family-based approaches to treatment.

15 Article Cortisol output in adolescents with chronic fatigue syndrome: pilot study on the comparison with healthy adolescents and change after cognitive behavioural guided self-help treatment. 2014

Rimes, Katharine A / Papadopoulos, Andrew S / Cleare, Anthony J / Chalder, Trudie. ·King's College London, Institute of Psychiatry, London, UK. Electronic address: Katharine.Rimes@kcl.ac.uk. · King's College London, Institute of Psychiatry, London, UK. ·J Psychosom Res · Pubmed #25260861.

ABSTRACT: OBJECTIVE: This study examined cortisol in adolescents with chronic fatigue syndrome (CFS) compared to healthy adolescents and changes in cortisol after cognitive behavioural guided self-help treatment. Exploratory analyses investigated the association between cortisol output and psychological variables. METHODS: Salivary cortisol was measured upon awakening, at 15, 30, 45 and 60 min afterwards and at 12 noon, 4:00 p.m. and 8:00 p.m., in adolescents with CFS and healthy controls (HC). Groups were matched for age, gender, menarche status, menstrual cycle and awakening time. Twenty-four adolescents with CFS provided saliva samples six months after treatment. The main outcome measure was total salivary output over the day, calculated by area under the curve (AUC). The salivary awakening response was also assessed. RESULTS: Cortisol output over the day was significantly lower in the CFS group (n=46) than in healthy controls (n=33). Within the CFS group, lower daily cortisol output was associated with higher self-reported perfectionist striving and prosocial behaviour. There were no significant group differences in the awakening response (n=47 CFS versus n=34 HC). After treatment, adolescents with CFS (n=21) showed a significant increase in daily cortisol output, up to normal levels. CONCLUSION: The reduced daily cortisol output in adolescents with CFS is in line with adult findings. Associations between reduced cortisol output and two psychological variables-perfectionism and prosocial behaviour-are consistent with cognitive behavioural models of chronic fatigue syndrome. The mild hypocortisolism is reversible; cortisol output had returned to healthy adolescent levels by six months after cognitive behavioural guided self-help treatment.

16 Article Competences required for the delivery of high and low-intensity cognitive behavioural interventions for chronic fatigue, chronic fatigue syndrome/ME and irritable bowel syndrome. 2014

Rimes, Katharine A / Wingrove, Janet / Moss-Morris, Rona / Chalder, Trudie. ·King's College London,Institute of Psychiatry,UK. · South London and Maudsley NHS Foundation Hospital Trust,London,UK. ·Behav Cogn Psychother · Pubmed #24832606.

ABSTRACT: BACKGROUND: Cognitive behavioural interventions are effective in the treatment of chronic fatigue, chronic fatigue syndrome (sometimes known as ME or CFS/ME) and irritable bowel syndrome (IBS). Such interventions are increasingly being provided not only in specialist settings but in primary care settings such as Improving Access to Psychological Therapies (IAPT) services. There are no existing competences for the delivery of "low-intensity" or "high-intensity" cognitive behavioural interventions for these conditions. AIMS: To develop "high-intensity" and "low-intensity" competences for cognitive behavioural interventions for chronic fatigue, CFS/ME and IBS. METHOD: The initial draft drew on a variety of sources including treatment manuals and other information from randomized controlled trials. Therapists with experience in providing cognitive behavioural interventions for CF, CFS/ME and IBS in research and clinical settings were consulted on the initial draft competences and their suggestions for minor amendments were incorporated into the final versions. RESULTS: Feedback from experienced therapists was positive. Therapists providing low intensity interventions reported that the competences were also helpful in highlighting training needs. CONCLUSIONS: These sets of competences should facilitate the training and supervision of therapists providing cognitive behavioural interventions for chronic fatigue, CFS/ME and IBS. The competences are available online (see table of contents for this issue: http://journals.cambridge.org/jid_BCP) or on request from the first author.

17 Article Mechanisms of change underlying the efficacy of cognitive behaviour therapy for chronic fatigue syndrome in a specialist clinic: a mediation analysis. 2014

Stahl, D / Rimes, K A / Chalder, T. ·Department of Biostatistics, Institute of Psychiatry, King's College London, UK. · Department of Psychology, University of Bath, UK. · Department of Psychological Medicine, Institute of Psychiatry, King's College London, UK. ·Psychol Med · Pubmed #23931831.

ABSTRACT: BACKGROUND: Several randomized controlled trials (RCTs) have shown that cognitive behavioural psychotherapy (CBT) is an efficacious treatment for chronic fatigue syndrome (CFS). However, little is known about the mechanisms by which the treatment has its effect. The aim of this study was to investigate potential mechanisms of change underlying the efficacy of CBT for CFS. We applied path analysis and introduce novel model comparison approaches to assess a theoretical CBT model that suggests that fearful cognitions will mediate the relationship between avoidance behaviour and illness outcomes (fatigue and social adjustment). METHOD: Data from 389 patients with CFS who received CBT in a specialist service in the UK were collected at baseline, at discharge from treatment, and at 3-, 6- and 12-month follow-ups. Path analyses were used to assess possible mediating effects. Model selection using information criteria was used to compare support for competing mediational models. RESULTS: Path analyses were consistent with the hypothesized model in which fear avoidance beliefs at the 3-month follow-up partially mediate the relationship between avoidance behaviour at discharge and fatigue and social adjustment respectively at 6 months. CONCLUSIONS: The results strengthen the validity of a theoretical model of CBT by confirming the role of cognitive and behavioural factors in CFS.

18 Article Depression in paediatric chronic fatigue syndrome. 2013

Bould, Helen / Collin, Simon M / Lewis, Glyn / Rimes, Katharine / Crawley, Esther. ·School of Social and Community Medicine, University of Bristol, Bristol, UK. ·Arch Dis Child · Pubmed #23619200.

ABSTRACT: OBJECTIVE: To describe the prevalence of depression in children with chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME) and investigate the relationship between depression in CFS/ME and clinical symptoms such as fatigue, disability, pain and school attendance. DESIGN: Cross-sectional survey data using the Hospital Anxiety and Depression Scale (HADS) collected at assessment. SETTING: Specialist paediatric CFS/ME service in the South West. PATIENTS: Children aged 12-18 years with CFS/ME. MAIN OUTCOME MEASURE: Depression was defined as scoring >9 on the HADS depression scale. RESULTS: 542 subjects had complete data for the HADS and 29% (156/542) (95% CI 25% to 33%) had depression. In a univariable analysis, female sex, poorer school attendance, and higher levels of fatigue, disability, pain, and anxiety were associated with higher odds of depression. Age of child and duration of illness were not associated with depression. In a multivariable analysis, the factors most strongly associated with depression were disability, with higher scores on the physical function subscale of the 36 item Short Form (SF-36). CONCLUSIONS: Depression is commonly comorbid with CFS/ME, much more common than in the general population, and is associated with markers of disease severity. It is important to screen for, identify and treat depression in this population.

19 Article Treatment outcome in adults with chronic fatigue syndrome: a prospective study in England based on the CFS/ME National Outcomes Database. 2013

Crawley, E / Collin, S M / White, P D / Rimes, K / Sterne, J A C / May, M T / Anonymous1970754. ·Centre for Child & Adolescent Health, School of Social & Community Medicine, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK. esther.crawley@bristol.ac.uk ·QJM · Pubmed #23538643.

ABSTRACT: BACKGROUND: Chronic fatigue syndrome (CFS) is relatively common and disabling. Over 8000 patients attend adult services each year, yet little is known about the outcome of patients attending NHS services. AIM: Investigate the outcome of patients with CFS and what factors predict outcome. DESIGN: Longitudinal patient cohort. METHODS: We used data from six CFS/ME (myalgic encephalomyelitis) specialist services to measure changes in fatigue (Chalder Fatigue Scale), physical function (SF-36), anxiety and depression (Hospital Anxiety and Depression Scale) and pain (visual analogue pain rating scale) between clinical assessment and 8-20 months of follow-up. We used multivariable linear regression to investigate baseline factors associated with outcomes at follow-up. RESULTS: Baseline data obtained at clinical assessment were available for 1643 patients, of whom 834 (51%) had complete follow-up data. There were improvements in fatigue [mean difference from assessment to outcome: -6.8; 95% confidence interval (CI) -7.4 to -6.2; P < 0.001]; physical function (4.4; 95% CI 3.0-5.8; P < 0.001), anxiety (-0.6; 95% CI -0.9 to -0.3; P < 0.001), depression (-1.6; 95% CI -1.9 to -1.4; P < 0.001) and pain (-5.3; 95% CI -7.0 to -3.6; P < 0.001). Worse fatigue, physical function and pain at clinical assessment predicted a worse outcome for fatigue at follow-up. Older age, increased pain and physical function at assessment were associated with poorer physical function at follow-up. CONCLUSION: Patients who attend NHS specialist CFS/ME services can expect similar improvements in fatigue, anxiety and depression to participants receiving cognitive behavioural therapy and graded exercise therapy in a recent trial, but are likely to experience less improvement in physical function. Outcomes were predicted by fatigue, disability and pain at assessment.

20 Article Mindfulness-based cognitive therapy for people with chronic fatigue syndrome still experiencing excessive fatigue after cognitive behaviour therapy: a pilot randomized study. 2013

Rimes, Katharine A / Wingrove, Janet. ·University of Bath, Department of Psychology, Claverton Down, Bath, UK. K.A.Rimes@bath.ac.uk ·Clin Psychol Psychother · Pubmed #21983916.

ABSTRACT: KEY PRACTITIONER MESSAGE: Only about 30% of people with chronic fatigue syndrome (CFS) recover after cognitive behaviour therapy (CBT); thus, methods for improving treatment outcomes are needed. This is the first pilot randomized study to demonstrate that a mindfulness-based intervention was associated with reduced fatigue and other benefits for people with CFS who were still experiencing excessive fatigue after a course of CBT. Levels of acceptability, engagement in the intervention and rated helpfulness were high. A larger-scale randomized controlled trial is required.

21 Article Family-focused cognitive behaviour therapy versus psycho-education for adolescents with chronic fatigue syndrome: long-term follow-up of an RCT. 2012

Lloyd, Samantha / Chalder, Trudie / Rimes, Katharine A. ·Department of Psychological Medicine, Institute of Psychiatry, King's College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK. Samantha.lloyd@kcl.ac.uk ·Behav Res Ther · Pubmed #22985998.

ABSTRACT: The aim of this study was to investigate the long term efficacy of family-focused cognitive behaviour therapy (CBT) compared with psycho-education in improving school attendance and other secondary outcomes in adolescents with chronic fatigue syndrome (CFS). A 24 month follow-up of a randomised controlled trial was carried out. Participants received either 13 one-hour sessions of family-focused CBT or four one-hour sessions of psycho-education. Forty-four participants took part in the follow-up study. The proportion of participants reporting at least 70% school attendance (the primary outcome) at 24 months was 90% in CBT group and 84% in psycho-education group; the difference between the groups was not statistically significant (OR = 1.29, p = 0.80). The proportion of adolescents who had recovered in the family-focused CBT group was 79% compared with 64% in the psycho-education, according to a definition including fatigue and school attendance. This difference was not statistically significant (Fisher's exact test, p = 0.34). Family-focused CBT was associated with significantly better emotional and behavioural adjustment at 24 month follow-up compared to psycho-education, as reported by both adolescents (F = 6.49, p = 0.02) and parents (F = 4.52, P = 0.04). Impairment significantly decreased in both groups between six and 24 month follow-ups, with no significant group difference in improvement over this period. Gains previously observed for other secondary outcomes at six month follow-up were maintained at 24 month follow-up with no further significant improvement or group differences in improvement. In conclusion, gains achieved by adolescents with CFS who had undertaken family-focused CBT and psycho-education generally continued or were maintained at two-year follow-up. The exception was that family-focused CBT was associated with maintained improvements in emotional and behavioural difficulties whereas psycho-education was associated with deterioration in these outcomes between six and 24-month follow-up.

22 Article Telephone-based guided self-help for adolescents with chronic fatigue syndrome: A non-randomised cohort study. 2012

Lloyd, Samantha / Chalder, Trudie / Sallis, Hannah M / Rimes, Katharine A. ·Department of Psychological Medicine, Institute of Psychiatry, King's College London, Weston Education Centre, Cutcombe Road, London, UK. Samantha.lloyd@kcl.ac.uk ·Behav Res Ther · Pubmed #22459729.

ABSTRACT: The aim of this study was to gain preliminary evidence about the efficacy of a new telephone-based guided self-help intervention, based on cognitive-behavioural principles, which aimed to reduce fatigue and improve school attendance in adolescents with chronic fatigue syndrome (CFS). A non-randomised cohort design was used, with a two-month baseline period. Sixty-three 11-18 year-old participants recruited from a specialist CFS unit received the intervention. Participants received six half-hour fortnightly telephone sessions and two follow-up sessions. Fatigue and school attendance were the main outcomes and the main time point for assessing outcome was 6 months post-treatment. Using multi-level modelling, a significant decrease in fatigue was found between pre-treatment and 6 month follow-up, treatment effect estimate = - 5.68 (-7.63, -3.72), a large effect size (Cohen's d = 0.79). The decrease in fatigue between pre and post-treatment was significantly larger than between baseline and pre-treatment. A significant increase in school attendance was found between pre-treatment and 6 month follow-up, effect estimate = 1.38 (0.76, 2.00), a medium effect size (d = -0.48). univariate logistic regression found baseline perfectionism to be associated with better [corrected] school attendance at six-month follow-up. In conclusion, telephone-based guided self-help is an acceptable minimal intervention which is efficacious in reducing fatigue in adolescents with CFS.

23 Article The role of acceptance in chronic fatigue syndrome. 2011

Brooks, Samantha K / Rimes, Katharine A / Chalder, Trudie. ·Department of Psychological Medicine, King's College London, UK. ·J Psychosom Res · Pubmed #22118384.

ABSTRACT: OBJECTIVE: In this paper we consider the role that acceptance plays in fatigue and physical and social functioning. We predicted that lack of acceptance would be positively correlated with fatigue and impairment in functioning; that there would be a significant relationship between perfectionism and acceptance; and cognitive behavioural therapy (CBT) would increase acceptance. METHODS: Two hundred and fifty nine patients with chronic fatigue syndrome (CFS) completed questionnaires measuring fatigue, physical functioning, work and social adjustment, lack of acceptance, perfectionism and depression. Ninety consecutive attenders received a course of CBT and completed further questionnaires at discharge and 3months post-treatment. Correlations and multiple hierarchical regressions were used to determine relationships between acceptance, perfectionism and clinical outcome variables. RESULTS: At baseline, lack of acceptance was the key factor associated with impaired physical functioning and work and social adjustment. Lack of acceptance and doubts about actions were associated with fatigue in a multiple regression analysis. At discharge and follow-up patients showed significantly increased acceptance, as well as reduced Concern over Mistakes, less fatigue and impairment of physical functioning, and improved work and social adjustment. CONCLUSION: This is the first study to our knowledge which shows a change in acceptance after CBT and a relationship between acceptance and perfectionism. Acceptance may be an important factor to consider within treatments for CFS.

24 Article Emotional expression, self-silencing, and distress tolerance in anorexia nervosa and chronic fatigue syndrome. 2011

Hambrook, David / Oldershaw, Anna / Rimes, Katharine / Schmidt, Ulrike / Tchanturia, Kate / Treasure, Janet / Richards, Selwyn / Chalder, Trudie. ·Division of Psychological Medicine and Psychiatry, Section of Eating Disorders, King's College London, Institute of Psychiatry, UK. ·Br J Clin Psychol · Pubmed #21810109.

ABSTRACT: OBJECTIVES. Difficulties in processing emotional states are implicated in the aetiology and maintenance of diverse health conditions, including anorexia nervosa (AN) and chronic fatigue syndrome (CFS). This study sought to explore distress tolerance, self-silencing, and beliefs regarding the experience and expression of emotions in individuals diagnosed with AN and CFS. These conditions were chosen for this study because their clinical presentation is characterized by physical symptoms, yet cognitive behavioural models suggest that emotional processing difficulties contribute to the aetiology and maintenance of both. DESIGN. A between-subjects cross-sectional design was employed. METHODS. Forty people with AN, 45 with CFS, and 48 healthy controls (HCs) completed the Distress Tolerance Scale (DTS), Silencing the Self Scale (STSS), Beliefs about Emotions Scale (BES), and measures of clinical symptomatology. RESULTS. Initial group comparisons found that both AN and CFS participants scored higher than HCs on a subscale measuring difficulties in distress tolerance. AN and CFS participants were also more likely to judge themselves by external standards, endorse statements reflecting a tendency to put the needs of others before themselves, and present an outwardly socially compliant image of themselves whilst feeling hostile within. Relative to HCs, AN participants reported more maladaptive beliefs regarding the experience of having negative thoughts and feelings and revealing these emotions to others, with CFS participants showing a non-significant trend in the same direction. After controlling for differences in age, anxiety, and depression the only significant difference to remain was that observed for the STSS care as self-sacrifice subscale. More maladaptive beliefs about the experience and expression of emotions were associated with greater degree of eating disorder symptomatology in the AN group. CONCLUSIONS. Differences in emotional processing are present in AN and CFS compared to HCs, with some disorder-specific variation, and may be associated with greater clinical symptomatology. These findings support current explanatory models of both AN and CFS, and suggest that emotional processing should be addressed in the assessment and treatment of individuals with these illnesses.

25 Article Emotion recognition and emotional theory of mind in chronic fatigue syndrome. 2011

Oldershaw, A / Hambrook, D / Rimes, K A / Tchanturia, K / Treasure, J / Richards, S / Schmidt, U / Chalder, T. ·Section of Eating Disorders, Division of Psychological Medicine and Psychiatry, Institute of Psychiatry, King's College London, London, UK. anna.oldershaw@kcl.ac.uk ·Psychol Health · Pubmed #21598185.

ABSTRACT: BACKGROUND: Difficulties with social function have been reported in chronic fatigue syndrome (CFS), but underpinning factors are unknown. Emotion recognition, theory of mind (inference of another's mental state) and 'emotional' theory of mind (eToM) (inference of another's emotional state) are important social abilities, facilitating understanding of others. This study examined emotion recognition and eToM in CFS patients and their relationship to self-reported social function. METHODS: CFS patients (n = 45) and healthy controls (HCs; n = 50) completed tasks assessing emotion recognition, basic or advanced eToM (for self and other) and a self-report measure of social function. RESULTS: CFS participants were poorer than HCs at recognising emotion states in the faces of others and at inferring their own emotions. Lower scores on these tasks were associated with poorer self-reported daily and social function. CFS patients demonstrated good eToM and performance on these tasks did not relate to the level of social function. CONCLUSIONS: CFS patients do not have poor eToM, nor does eToM appear to be associated with social functioning in CFS. However, this group of patients experience difficulties in emotion recognition and inferring emotions in themselves and this may impact upon social function.

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