Evaluation of chronic fatigue syndrome, depression, anxiety and somatization disorder individuals with a primary diagnosis of fibromyalgia

Yıl 2025, Cilt: 8 Sayı: 4, 686 - 691, 30.07.2025

Canan Emiroğlu , Nesrin Dilbaz

https://doi.org/10.32322/jhsm.1689609

Öz

Aims: Currently, fibromyalgia (FM) is still diagnosed solely on clinical grounds, as no serologic, imaging, or histologic markers are available. Chronic fatigue syndrome (CFS) shares many similarities with FM. The implication of similar etiological factors and mechanisms, the overlap in symptoms and signs, and the high prevalence of psychiatric disorders such as anxiety, depression, panic attacks, and somatization disorder in both conditions have led to suggestions that they may represent different manifestations of the same disease. The primary objective of this investigation was to assess the prevalence of comorbid psychiatric conditions ‘including depression, anxiety, and somatization disorder’ as well as CFS, among individuals diagnosed with FM, and to explore potential overlaps in their clinical presentation.
Methods: In this prospective, cross-sectional study, the prime MD scale was applied to 60 patients diagnosed with FM to investigate their overlap with psychiatric diagnoses. In addition, patients were evaluated according to the Fukuda Classification System to determine whether they could be diagnosed with CFS.
Results: The incidence rate of anxiety disorder was 33.3% and the incidence rate of somatoform disorder was 83.4%. Major depression was detected in 10 patients (16.7%) and dysthymia in 16 patients. Eight out of 60 patients (13.3%) did not have any psychiatric disorders, while the remaining 52 patients had at least one disorder or more than one disorder. Although 50 of 60 patients (83.3%) complained of fatigue, only 8 (13.3%) patients were diagnosed by meeting sufficient criteria for CFS.
Conclusion: Although FM and CFS are not the same clinical entity, they appear to be two conditions with overlapping symptoms, particularly psychiatric ones, which frequently coexist. The prevalence of psychiatric symptoms and diagnoses was notably higher among individuals who met the diagnostic criteria for both FM and CFS.  Further research is needed to refine and evaluate the diagnostic criteria for both conditions.

Anahtar Kelimeler

Fibromyalgia , fatigue , depression , anxiety , somatoform disorders

Etik Beyan

Since, this article was written using data from the thesis written before 2006, there is no ethics committee approval document, but there is an official document from the Ministry of Health showing that the thesis was duly carried out. Thank you for your time and assistance.

Primer fibromiyalji tanısı olan bireylerde kronik yorgunluk sendromu, depresyon, anksiyete ve somatizasyon bozukluğunun değerlendirilmesi

Öz

Giriş: Kronik yaygın ağrı, dünya genelinde yetişkinlerin %10 ila %15'ini etkilemektedir ve bunların çoğunda fibromiyalji (FM) bulunmaktadır. FM genel popülasyonda oldukça yaygın bir sendromdur ve bel ağrısı ve osteoartritten sonra üçüncü en yaygın kas-iskelet sistemi rahatsızlığıdır. Günümüzde, serolojik, görüntüleme veya histolojik belirteçler mevcut olmadığından, FM tanısı hala sadece klinik olarak konulmaktadır. Kronik Yorgunluk Sendromu birçok açıdan PFS'ye benzemektedir. Etiyolojilerinde benzer faktör ve mekanizmaların suçlanması, aynı semptom ve bulguların birlikte görülmesi ve her iki hastalıkta da anksiyete, depresyon, panik atak ve somatizasyon bozukluğu gibi psikiyatrik bozuklukların yüksek prevalansı, bu iki durumun aynı hastalığın farklı tezahürleri olabileceği iddialarına yol açmıştır.
Amaç: Bu araştırmanın amacı, PFS tanısı almış kişilerde kronik yorgunluk sendromu (KYS) ile birlikte depresyon, anksiyete ve somatizasyon bozukluğu gibi komorbid psikiyatrik durumların yaygınlığını değerlendirmek ve klinik sunumdaki potansiyel örtüşmeyi incelemektir.
Materyal ve metod: Bu prospektif, kesitsel çalışmada, psikiyatrik tanılarla örtüşmelerini araştırmak için PFS tanısı alan 60 hastaya Prime MD ölçeği uygulanmıştır. Ayrıca, hastalar KFS tanısı alıp alamayacaklarını belirlemek için Fukuda Sınıflandırma Sistemine göre değerlendirilmiştir.
Bulgular: Anksiyete bozukluğu görülme oranı %33,3 ve somatoform bozukluk görülme oranı %83,4 idi. Majör depresyon 10 hastada (%16.7) ve distimi 16 hastada saptandı. 60 hastanın sekizinde (%13,3) herhangi bir psikiyatrik bozukluk bulunmazken, geri kalan 52 hastada en az bir veya birden fazla bozukluk vardı. 60 hastanın 50'si (%83,3) yorgunluktan şikayetçi olmasına rağmen, sadece 8 (%13,3) hasta KYS için yeterli kriterleri karşılayarak tanı almıştır.
Sonuç: PFS ve KYS aynı klinik antite olmamakla birlikte, benzer semptomların örtüştüğü iki klinik durum gibi görünmektedir, özellikle psikiyatrik semptomlar ve durumlar sıklıkla bir arada bulunmaktadır. Psikiyatrik belirti ve tanıların yaygınlığının, özellikle hem PFS hem de KYS tanı kriterlerini karşılayan bireyler arasında yüksek olduğu görülmüştür.

Anahtar Kelimeler

fibromiyalji , yorgunluk , depresyon , anksiyete

Kaynakça

• Siracusa R, Paola RD, Cuzzocrea S, Impellizzeri D. Fibromyalgia: pathogenesis, mechanisms, diagnosis and treatment options update. Int J Mol Sci. 2021;22(8):3891. doi:10.3390/ijms22083891
• Galvez-Sánchez CM, Duschek S, Reyes Del Paso GA. Psychological impact of fibromyalgia: current perspectives. Psychol Res Behav Manag. 2019;12:117-127. doi:10.2147/PRBM.S178240
• Wolfe F, Häuser W. Fibromyalgia diagnosis and diagnostic criteria. Ann Med. 2011;43(7):495-502. doi:10.3109/07853890.2011.595734
• García Rodríguez DF, Abud Mendoza C. Physiopathology of fibromyalgia. Fisiopatología de la fibromialgia. Reumatol Clin (Engl Ed). 2020;16(3):191-194. doi:10.1016/j.reuma.2020.02.003
• Favretti M, Iannuccelli C, Di Franco M. Pain biomarkers in fibromyalgia syndrome: current understanding and future directions. Int J Mol Sci. 2023;24(13):10443. doi:10.3390/ijms241310443
• Wolfe F, Smythe HA, Yunus MB, et al. The American College of Rheumatology 1990 Criteria for the classification of fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheumatol. 1990;33(2):160-172. doi:10.1002/art.1780330203
• Wolfe F, Clauw DJ, Fitzcharles MA, et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res. 2010;62(5):600-610. doi:10.1002/acr.20140
• Wolfe F, Clauw DJ, Fitzcharles MA, et al. 2016 revisions to the 2010/2011 fibromyalgia diagnostic criteria. Semin Arthritis Rheum. 2016;46(3):319-329. doi:10.1016/j.semarthrit.2016.08.012
• World Health Organization. International Statistical Classification of Diseases and Related Problems. ICD-10. Geneva: WHO; 1992.
• Mckay PG, Martin CR, Walker H, Fleming M. Chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME) and fibromyalgia (FM): the foundation of a relationship. Br J Pain. 2021;15(1):26-39. doi:10.1177/2049463719875164
• Mckay PG, Walker H, Martin CR, Fleming M. Exploratory study into the relationship between the symptoms of chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME) and fibromyalgia (FM) using a quasiexperimental design. BMJ Open. 2021;11(2):e041947. doi:10.1136/bmjopen-2020-041947
• Kleinstäuber M, Schröder A, Daehler S, et al. Aetiological Understanding of fibromyalgia, irritable bowel syndrome, chronic fatigue syndrome and classificatory analogues: a systematic umbrella review. Clin Psychol Eur. 2023;5(3):e11179. doi:10.32872/cpe.11179
• Creed F. Psychiatric disorders and the onset of self-reported fibromyalgia and chronic fatigue syndrome: the lifelines cohort study. Front Psychiatry. 2023;14:1120250. doi:10.3389/fpsyt.2023.1120250
• National Institute for Health and Clinical Excellence 53. Chronic fatigue syndrome/myalgic encephalomyelitis (or encephalopathy): diagnosis and management of CFS/ME in adults and children. London: NICE, 2007.
• Spitzer RL, Williams JB, Kroenke K, et al. Utility of a new procedure for diagnosing mental disorders in primary care: the PRIME-MD 1000 study. JAMA. 1994;272(22):1749-1756. doi:10.1001/jama.1994.03520220043029
• https://tez.yok.gov.tr/UlusalTezMerkezi/tezDetay.jsp?id=XYroDf5DJwKGb3w8G5WykQ&no=XYroDf5DJwKGb3w8G5WykQ (Accessed on 11.03.2024.)
• Fukuda K, Straus SE, Hickie I, Sharpe MC, Dobbins JG, Komaroff A. The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group. Ann Intern Med. 1994;121(12):953-959. doi:10.7326/0003-4819-121-12-199412150-00009
• Van Dyne A, Moy J, Wash K, et al. Health, psychological and demographic predictors of depression in people with fibromyalgia and osteoarthritis. Int J Environ Res Public Health. 2022;19(6)3413. doi:10.3390/ijerph19063413
• Henao-Pérez M, López-Medina DC, Arboleda A, Bedoya Monsalve S, Zea JA. Patients with fibromyalgia, depression, and/or anxiety and sex differences. Am J Mens Health. 2022;16(4):15579883221110351. doi:10.1177/15579883221110351
• Kleykamp BA, Ferguson MC, McNicol E, et al. The prevalence of psychiatric and chronic pain comorbidities in fibromyalgia: an ACTTION systematic review. Semin Arthritis Rheum. 2021;51(1):166-174. doi:10.1016/j.semarthrit.2020.10.006
• Løge-Hagen JS, Sæle A, Juhl C, Bech P, Stenager E, Mellentin AI. Prevalence of depressive disorder among patients with fibromyalgia: systematic review and meta-analysis. J Affect Disord. 2019;245:1098-1105. doi:10.1016/j.jad.2018.12.001
• Häuser W, Fitzcharles MA. Facts and myths pertaining to fibromyalgia. Dialogues Clin Neurosci. 2018;20(1):53-62. doi:10.31887/DCNS.2018.20.1/whauser
• Chang MH, Hsu JW, Huang KL, et al. Bidirectional association between depression and fibromyalgia syndrome: a nationwide longitudinal study. J Pain. 2015;16(9):895-902. doi:10.1016/j.jpain.2015.06.004
• Natelson BH. Myalgic encephalomyelitis/chronic fatigue syndrome and fibromyalgia: definitions, similarities, and differences. Clin Ther. 2019;41(4):612-618. doi:10.1016/j.clinthera.2018.12.016
• Creed F. Psychiatric disorders and the onset of self-reported fibromyalgia and chronic fatigue syndrome: the lifelines cohort study. Front Psychiatry. 2023;14:1120250. doi:10.3389/fpsyt.2023.1120250
• Otero E, Gálvez I, Ortega E, Hinchado MD. Influence of chronic fatigue syndrome codiagnosis on the relationship between perceived and objective psychoneuro-immunoendocrine disorders in women with fibromyalgia. Biomedicines. 2023;11(5):1488. doi:10.3390/biomedicines11051488
• Nepotchatykh E, Caraus I, Elremaly W, et al. Circulating microRNA expression signatures accurately discriminate myalgic encephalomyelitis from fibromyalgia and comorbid conditions. Sci Rep. 2023;13(1):1896. doi:10.1038/s41598-023-28955-9
• Tsamou M, Kremers FAC, Samaritakis KA, Roggen EL. Identifying microRNAs possibly implicated in myalgic encephalomyelitis/chronic fatigue syndrome and fibromyalgia: a review. Int J Mol Sci. 2024;25(17):9551. doi:10.3390/ijms25179551
• Schutzer SE, Liu T, Tsai CF, et al. Myalgic encephalomyelitis/chronic fatigue syndrome and fibromyalgia are indistinguishable by their cerebrospinal fluid proteomes. Ann Med. 2023;55(1):2208372. doi:10.1080/07853890.2023.2208372