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Title: Fatigue and inflammation : a psychoneuroimmunological approach o chronic fatigue
Author: Russell, Alice Elizabeth
ISNI:       0000 0004 6347 7068
Awarding Body: King's College London
Current Institution: King's College London (University of London)
Date of Award: 2017
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Chronic Fatigue Syndrome (CFS) is characterised by severe fatigue, endured for at least six months, together with symptoms including impaired cognitive function, sleep disturbance, and musculoskeletal pain. The pathogenesis is still unknown, resulting in a lack of treatment options and the stigmatization of patients. Both psychological and biological factors have been implicated in the development of CFS. To date, evidence has come largely from cross-sectional studies, and there have been a paucity of longitudinal studies. The aim of this study was to explore interferon-alpha (IFN-α) induced persistent fatigue as a proxy model of CFS. IFN-α is an immunotherapy for chronic Hepatitis C Virus (HCV) infection. It induces a range of side effects including fatigue, which in some patients persists post-treatment. This model allows for the identification of risk factors and monitoring of biological and behavioural changes from the perspective of the trigger, to determine factors relevant to the persistence of fatigue after the original stimulus is no longer present. Fifty-five patients undergoing IFN-α treatment for chronic HCV were assessed at baseline, during treatment, and six-months post-treatment. Clinical, inflammatory and cortisol measures were obtained. Fifty-four CFS patients and 57 healthy volunteers completed the same measures at a one-off assessment, which were compared with post-treatment measures from HCV persistent and resolved fatigue patients. IFN-α induced persistent fatigue was associated with an exaggerated response to IFN-α, with increased fatigue, depressive symptoms, and perceived stress, a greater decline in health status, and higher inflammation. This higher symptomatology during treatment put these patients at a disadvantage for their subsequent recovery. Neither IFN-α induced persistent fatigue nor CFS was associated with continued peripheral inflammation, emphasising the importance of the response to the initial trigger. Future studies are needed to elucidate the mechanisms behind the exaggerated response, and the ‘conversion’ to chronic illness in the absence of peripheral immune activation.
Supervisor: Pariante, Carmine Maria ; Zunszain, Patricia Ana Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available