Diagnosis possible depression ?
Q.I would like to bring to your attention some of the findings we have found here out in Willow Valley. Her fatigue/exaustion is made worse by exersise also after exersise her cognitive function is markedly impaired. In depressed patients they have no change in cognitive function and actually, ususally feel better after exersise. This is one of the key differences between endogenous depression and Chronic Fatigue Syndrome. Dr. Jason presented, at the AACFS conference in San Fransicsco in October 1996, the results of a very well done study of CFS patients and depressed patients and normal controls.He found the CFS patients consistently and reproducibly scored significantly worse on cognitive function, than the normal controls and depressed patients. This was true both shortly after the graded exersise, and the following day. This is consistent with patient reports and corroborates what they are saying.
A.She has calculation difficulties - eg. she can not subtract seriel 7's or 13's for that matter. Depressed patients usually have no difficulty with calculating in their heads. She has spatial disorientation - difficulty gauging distances etc. she also has difficulty finding the right word at times. She has head aches that are worse than any she has had in the past and this finding is not nessesarily typical of primary depression. These headaches could be termed worse than migraine and almost an encephalitis grade headache. She has balance problems with dysequilibrium as noted on an augmented Rhomberg test. She can not maintain her balance 10 seconds with one foot in front of the other with eyes closed. This finding is also not typical of depression. She complains of severe muscle weakness. She has non-restorative, shallow sleep. She has chronic or reoccurent sore throats and flu like symptoms with aches and pains all over the body. She says she feels "spacey" and not able to think, like she is in a fog. She has ringing of her ears and dizziness. She is intolerent to bright lights, they hurt her eyes and she sometimes feels disoriented and confused. She has had abdominal complaints with bloating and gas and cramping abdominal. pains. She has low grade temperatures and night sweats and heart palpitations. She has had outbreaks of herpes and has frequent problems with cystitis or frequent urination. She has had hair loss, chest pains on occasion and mouth sores. She has also found her allergies to things to be much worse lately. She has some difficulty with night vision. Her lab work was interesting for a normal SMAK-20 with slightly low iron at 37 (nl- 40). Her Rheumatiod factor was neg and ANA was neg. CBC was normal except for 15 eosinophiles. Her HHV-6 titers are positive, IgG =1:80 and IgM is neg. Her EBV titers are positive indicating a chronic or reactivated EBV infection. Human herpes virus 6 is a newly recognized virus which infects T-lymphocyte cells. HHV-6 has been identified as an etiologic agent of exanthema subitum and has been associated with chronic fatigue-like illness. She has been to the ER on many occasions for multiple anxiety related reasons including syncope. An intracranial lesion was ruled out by CT scan. CFIDS (Chronic Fatigue and Immunodysfunction Syndrome) is a real diagnosis. I wish there was a better name for it. Many of the patients who have it also suffer from depression and anxiety. This is a secondary problem. There is very good evidence of immune dysfunction including abnormalities in the T-Cells function and decreased Natural Killer Cell Function. There has recently been found an abnormality in the 2'-5'-Rnase synthetase pathway with an upregulation, suggesting a chronic viral illness. Dr. Sudhulnick from Temple University found a novel protien found only in patients with CFS and not in normal controls. Dr. Tan at Scripts Institute found a high percentage of auto antibodies in patients with CFS- about 70% of the time.
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