Mental Health
Resources

 email page    print page

All Topic Reviews
50 Signs of Mental IllnessA Beautiful MindA Beautiful MindA Bright Red ScreamA Casebook of Ethical Challenges in NeuropsychologyA Corner Of The UniverseA Lethal InheritanceA Mood ApartA Research Agenda for DSM-VA Slant of SunA War of NervesAbnormal Psychology in ContextADD-Friendly Ways to Organize Your LifeAddiction Recovery ToolsAdvance Directives in Mental HealthAggression and Antisocial Behavior in Children and AdolescentsAl-JununAlmost a PsychopathAlterations of ConsciousnessAm I Okay?American ManiaAmerican Psychiatric Publishing Textbook of Neuropsychiatry and Clinical NeurosciencesAn American ObsessionAngelheadAnger, Madness, and the DaimonicAnthology of a Crazy LadyApproaching NeverlandAs Nature Made HimAsylumAttention-Deficit Hyperactivity DisorderAttention-Deficit/Hyperactivity DisorderBeing Mentally Ill: A Sociological Theory Betrayal TraumaBetrayed as BoysBetter Than ProzacBetter Than WellBeyond AppearanceBeyond ReasonBinge No MoreBiological UnhappinessBipolar DisorderBipolar DisorderBipolar Disorder DemystifiedBlack-eyed SuzieBlaming the BrainBleeding to Ease the PainBluebirdBlueprints Clinical Cases in PsychiatryBody Image, Eating Disorders, and ObesityBorderline Personality DisorderBrain Circuitry and Signaling in PsychiatryBrave New BrainBreakdown of WillBrief Adolescent Therapy Homework PlannerBrief Child Therapy Homework PlannerBrief Therapy Homework PlannerCalm EnergyCassandra's DaughterCaught in the NetChild and Adolescent Treatment for Social Work PracticeChildren Changed by TraumaChronic Fatigue Syndrome (The Facts)Clinical Handbook of Psychological DisordersClinical Manual of Women's Mental HealthCognitive Theories of Mental IllnessCommonsense RebellionCommunity and In-Home Behavioral Health TreatmentComprehending SuicideConcise Guide to Child and Adolescent PsychiatryConquering Post-Traumatic Stress DisorderConscience and ConvenienceConsciousnessConsole and ClassifyContesting PsychiatryCoping With TraumaCopshockCrazy for YouCrazy in AmericaCrazy Like UsCreating HysteriaCritical PsychiatryCruel CompassionCultural Assessment in Clinical PsychiatryCulture and Mental HealthCulture and Psychiatric DiagnosisCultures of NeurastheniaDaddy's GirlsDante's CureDarwinian PsychiatryDaughter of the Queen of ShebaDaughters of MadnessDeinstitutionalization And People With Intellectual DisabilitiesDelivered from DistractionDepression In Later LifeDepression SourcebookDepression-Free for LifeDescriptions and PrescriptionsDestructive Trends in Mental HealthDevil in the DetailsDiagnosis: SchizophreniaDiagnostic and Statistical Manual of Mental Disorders DSM-IV-TRDirty Filthy Love DVDDisorders Of DesireDisrupted LivesDissociative ChildrenDivided MindsDr. Andrew Weil's Guide to Optimum HealthDr. Weisinger's Anger Work-Out BookDSM-IV SourcebookDSM-IV-TR CasebookDSM-IV-TR in ActionDSM-IV-TR Mental DisordersE-TherapyEccentricsElectroshockEmergencies in Mental Health PracticeEmergency PsychiatryEmotional and Behavioral Problems of Young ChildrenEmotions and LifeEmpowering People with Severe Mental IllnessEssential PsychopharmacologyEssentials of Cas AssessmentEssentials of Wais-III AssessmentEthics and Values in PsychotherapyEthics in Mental Health ResearchEthics in Psychiatric ResearchEthics, Culture, and PsychiatryEverything In Its PlaceFamily Experiences With Mental IllnessFatigue as a Window to the BrainFear of IntimacyFinding Iris ChangFinding Meaning in the Experience of DementiaFlorid StatesFolie a DeuxFor the Love of ItForensic Nursing and Multidisciplinary Care of the Mentally Disordered OffenderFountain HouseFrom Madness to Mental HealthFrom Trauma to TransformationGandhi's WayGender and Its Effects on PsychopathologyGender and Mental HealthGenes, Environment, and PsychopathologyGetting Your Life BackGracefully InsaneGrieving Mental IllnessHandbook of AttachmentHandbook of DepressionHandbook of Self and IdentityHealing the SplitHerbs for the MindHidden SelvesHigh RiskHope and DespairHow Clients Make Therapy WorkHow People ChangeHow to Become a SchizophrenicHow We Think About DementiaHughes' Outline of Modern PsychiatryHumanizing MadnessHysterical MenHystoriesI Hate You-Don't Leave MeI Never Promised You a Rose GardenI Thought I Could FlyI'm CrazyImagining RobertImpulse Control DisordersIn Others' EyesIn Two MindsInsanityIntegrated Behavioral Health CareIntegrative MedicineIntegrative Mental Health CareIntuitionJust CheckingKarl JaspersKissing DoorknobsKundalini Yoga Meditation for Complex Psychiatric DisordersLaw and the BrainLaw, Liberty, and PsychiatryLegal and Ethical Aspects of HealthcareLiberatory PsychiatryLife at the BottomLife at the Texas State Lunatic Asylum, 1857-1997Life Is Not a Game of PerfectLithium for MedeaLiving Outside Mental IllnessLiving with AnxietyLiving With SchizophreniaLiving with SchizophreniaLiving Without Depression and Manic DepressionLost in the MirrorLove's ExecutionerLoving Someone With Bipolar DisorderMad in AmericaMad TravelersMad, Bad and SadMadhouseMadnessMadness at HomeMadness in Buenos AiresManaged Care ContractingMandated Reporting of Suspected Child AbuseManic Depression and CreativityMary BarnesMasters of the MindMeasuring PsychopathologyMedia MadnessMedicine As MinistryMelancholy And the Care of the SoulMemory, Brain, and BeliefMental HealthMental Health At The CrossroadsMental Health Issues in Lesbian, Gay, Bisexual, and Transgender Communities Mental Health MattersMental Health Policy in BritainMental Health Policy in BritainMental Health Professionals, Minorities and the PoorMental IllnessMental Illness and Your TownMental Illness, Medicine and LawMental SlaveryMindfulness in Plain EnglishModels of MadnessMothers Who Kill Their ChildrenMozart's Brain and the Fighter PilotMultifamily Groups in the Treatment of Severe Psychiatric DisordersMuses, Madmen, and ProphetsMyths of ChildhoodNapkin NotesNeural MisfireNew Hope For People With Bipolar DisorderNight Falls FastNo Enemies WithinNolaNormalNot CrazyNovember of the SoulOf Two MindsOn Being Normal and Other DisordersOn Our Own, TogetherOn The Stigma Of Mental IllnessOrigins of Human NatureOut of Its MindOut of the ShadowsOvercoming Compulsive HoardingPathologies of BeliefPathways through PainPersonal Recovery and Mental IllnessPersonality Disorder: Temperament or Trauma?Pillar of SaltPoints of ViewPoppy ShakespearePosttraumatic Stress DisorderPsychiatric Cultures ComparedPsychiatric Diagnosis and ClassificationPsychiatric Genetics and GenomicsPsychiatric Illness in WomenPsychiatrists and Traditional HealersPsychiatryPsychiatry and ReligionPsychiatry in SocietyPsychological Dimensions of the SelfPsychology and the MediaPsychopathia SexualisPsychopathologyPsychopathyPsychotic DepressionQuitting the Nairobi TrioRaising a Moody ChildRapid Cognitive TherapyRebuilding Shattered LivesReclaiming Soul in Health CareReclaiming the SoulRecollection, Testimony, and Lying in Early ChildhoodRecovery from SchizophreniaRecovery in Mental IllnessRedressing the EmperorRelational Mental HealthRemembering TraumaRepressed SpacesResearch Advances in Genetics and GenomicsRestricted AccessRethinking the DSMReviving OpheliaRewarding Specialties for Mental Health CliniciansSaints, Scholars, and Schizophrenics: Mental Illness in Rural IrelandSchizophreniaSchizophrenia RevealedSchizophrenia: A Scientific Delusion?Self-Determination Theory in the ClinicShunnedShynessSigns of SafetySilencing the VoicesSlackjawSocial Cognition and SchizophreniaSocial Inclusion of People with Mental IllnessSoul Murder RevisitedSounds from the Bell JarSpeaking Our MindsSpontaneous HealingStop PretendingStraight Talk about Psychological Testing for KidsStranger Than FictionStreet CrazyStudy Guide to the DSM-IV-TRSurviving Manic DepressionSurviving SchizophreniaSurviving SchizophreniaTaking Charge of ADHD, Revised EditionTaking the Fear Out of ChangingTalking Back to PsychiatryTarnationTeen LoveTelling Is Risky BusinessTelling SecretsThe Age of InsanityThe American Psychiatric Press Textbook of PsychiatryThe American Psychiatric Publishing Textbook Of Child And Adolescent PsychiatryThe Anger WorkbookThe Anorexic SelfThe Behavioral Medicine Treatment PlannerThe Betty Ford Center Book of AnswersThe Bipolar ChildThe Bipolar Disorder Survival GuideThe Body in PsychotherapyThe Borderline Personality Disorder Survival GuideThe Broken MirrorThe Burden of SympathyThe Cambridge Medical Ethics WorkbookThe Case for Pragmatic PsychologyThe Center Cannot HoldThe Chemical Dependence Treatment Documentation SourcebookThe Chemical Dependence Treatment PlannerThe Child and Adolescent Psychotherapy Treatment PlannerThe Clinical Child Documentation SourcebookThe Clinical Documentation SourcebookThe Complete Adult Psychotherapy Treatment PlannerThe Condition of MadnessThe Construction of Power and Authority in PsychiatryThe Couples Psychotherapy Treatment PlannerThe Criminal BrainThe Cultural Context of Health, Illness, and MedicineThe Day the Voices StoppedThe Death of PsychotherapyThe Depression WorkbookThe Difficult-to-Treat Psychiatric PatientThe Early Stages of SchizophreniaThe Employee Assistance Treatment PlannerThe Employee Assistance Treatment PlannerThe Epidemiology of SchizophreniaThe Essential Family Guide to Borderline Personality DisorderThe Essentials of New York Mental Health LawThe Ethical WayThe Evolution of Mental Health LawThe Explosive ChildThe Fall Of An IconThe Fasting GirlThe Forensic Documentation SourcebookThe Forgotten MournersThe Gift of Adult ADDThe Good EaterThe Green ParrotThe Healing Power of PetsThe Heart of AddictionThe Heroic ClientThe Insanity OffenseThe Invisible PlagueThe Last Time I Wore a DressThe Limits of Autobiography The LobotomistThe Madness of Our LivesThe Mark of ShameThe Meaning of AddictionThe Meaning of MindThe Medical AdvisorThe Mind/Mood Pill BookThe Most Solitary of AfflictionsThe Mozart EffectThe Naked Lady Who Stood on Her HeadThe Older Adult Psychotherapy Treatment PlannerThe OutsiderThe Pastoral Counseling Treatment PlannerThe PDR Family Guide to Natural Medicines & Healing TherapiesThe Places That Scare YouThe Plural SelfThe Problem of EvilThe Psychology of Religion and CopingThe Quiet RoomThe Real World Guide to Psychotherapy PracticeThe Right to Refuse Mental Health TreatmentThe Rise of Mental Health NursingThe Roots of the Recovery Movement in PsychiatryThe Savage GirlThe Self-Help SourcebookThe Talking CureThe Trick Is to Keep BreathingThe Unwell BrainThe Virtuous PsychiatristThe Way of TransitionThe Wing of MadnessThe Wisdom in FeelingTheoretical Evolutions in Person-Centered/Experiential TherapyTherapy's DelusionsTheraScribe 3.0 for WindowsThis is Madness TooThoughts Without a ThinkerThrough the Looking GlassTo Have Or To Be?Toxic PsychiatryTransforming MadnessTraumaTraumatic PastsTraumatic Relationships and Serious Mental DisordersTreating Affect PhobiaTreating Chronic and Severe Mental DisordersTreating Self-InjuryTreatment and Rehabilitation of Severe Mental IllnessTreatment Plans and Interventions for Depression and Anxiety DisordersTwinsUnderstanding and Treating Violent Psychiatric PatientsUnderstanding Child MolestersUnderstanding DepressionUnderstanding ParanoiaUnderstanding the Stigma of Mental IllnessUnderstanding Treatment Without ConsentUnholy MadnessUnspeakable Truths and Happy EndingsUsers and Abusers of PsychiatryViolence and Mental DisorderVoices of MadnessVoices of RecoveryVulnerability to PsychopathologyWarning: Psychiatry Can Be Hazardous to Your Mental HealthWashing My Life AwayWhen History Is a NightmareWhen Someone You Love Is BipolarWhen the Body SpeaksWhen Walls Become DoorwaysWitchcrazeWomen and Borderline Personality DisorderWomen and Mental IllnessWomen Who Hurt ThemselvesWomen's Mental HealthWrestling with the AngelYou Must Be DreamingYour Drug May Be Your ProblemYour Miracle Brain

Related Topics
Fatigue as a Window to the BrainReview - Fatigue as a Window to the Brain
by John DeLuca (Editor)
MIT Press, 2005
Review by Roy Sugarman, Ph.D.
Oct 3rd 2006 (Volume 10, Issue 40)

Some symptoms are so ubiquitous that their inclusion in any diagnosis is too non-specific to be of value, and fatigue is one of those symptoms. A symptom which may equally present in multiple sclerosis, depression, brain injury, or just about anywhere else is difficult to investigate, and given its subjective nature, difficult to quantify objectively. Its effects are equally damning for many physical functions, and cognition is just another one of them complicating the view of the clinician and researcher alike. Not only is fatigue so common, but it is unlikely that the quality or quantity of fatigue is directly related to how severe the underlying condition might be, or how this relates to cognition.

The term "as a window to the brain" indicates that the editor will set his chosen authors to work using fatigue as a way of gaining insight into the processes of the brain. The foreword informs us that whatever fatigue in a specific condition might be, it is predominantly of central origin; hence the most promising approaches to its alleviation are neurobiological if they are anything. By this, it is saying that we are to move away from trying to correlate lesions in the brain with fatigue: rather, we are to set about studying the impairment itself. It is therefore hoped that the book will drive research along to finding the underlying causes, or at least, inform us more fully as to how the brain works.

To this end the book is then divided into 6 parts, the first on the nature of fatigue. Sensibly, there is a starting point in examining the history of research into fatigue, or at least interest in the phenomenon, and its epidemiology. A second chapter serves as an introduction to assessing fatigue, and the third part of this first section is devoted to a chapter on the phenomenon of cognitive fatigue, together with its measurement. Torres-Harding and Jason take on the first part, covering an array of illnesses, including the once present in DSM terms 'neurasthenia' which enjoyed a long time as a popular diagnosis in Russia while disappearing from the DSM III. As with most aspects of humanity where psychiatry will attempt to play a role, while often being shunned, the chapter presents an argument for a biopsychosocial approach, where many sufferers of CFS for instance would deny the need for psychiatry at all. Christodoulou attempts to show how fatigue, like pain, can be a both subjective and objectively measured phenomenon, reviewing the techniques. John DeLuca himself comes into Chapter 3 to tackle the empirical research of inducing mental fatigue via several interventions to simulate and examine the effects on the neural substrate of prolonged activity. This last is not an easy task, as experts such as Lezak make commonsense evaluations of how to approach assessment of cognition where fatigue is an issue, without any real clinical evidence to support her assertions. There is also of course little understanding of the elusive nature of an objective measure of fatigue that would enlighten as to the mechanisms of fatigue. It is clear that the field is still in its infancy, but a start has been made as the pages of references at the end of this chapter suggest.

On to part two, which section approaches the many conditions in which fatigue might emerge as a criterion or sequel. Krupp and the aforementioned Christodoulou with Schombert added on, look at Multiple Sclerosis, which rightfully occupies pole position in such a section. Clinical aspects are evaluated in terms of pathophysiology, immune system dysregulation, CNS mechanisms and impaired nerve conduction as well as neuroendocrine and neurotransmitter dysregulation. The relationship with the ANS is however not straightforward, together with the co-factors of simply reduced energy, and others such as pain, sleep problems, mood disorders, medication and so on. Fatigue after stroke is handled by Stulemeijer, Fasotti and Bleijenberg in the next chapter, a neglected condition in this regard and like pain after stroke, it can be disabling and hard to treat, from either focal or widespread lesions. Fatigue after brain injury is next, with Elovic, Dobrovic and Fellus in the writer's chair, with perhaps almost 50% reporting this as a burden and obstacle to rehabilitation and return to normal psychosocial existence. Again a quote from Lezak is brushed aside, this time in terms of the necessity for a definition of fatigue in these authors' eyes. Fatigue here is not full remedied by sleep or rest, and is multifactorial and multidimensional in its origins and effects. A putative attempt is made here to rationalize all of this, and again psychiatric and endocrine input is mooted, as with other agencies of fatigue in the biochemistry of the brain and body. About a page is devoted to a discussion of the cognitive effects, in a linear way, as certainly using cognitive skills is depleted by limited energy, and in its turn depleting of energy resources, leading to further interference.

Given another chapter is devoted to treatment of fatigue, the authors don't go much further, a cop-out as there is only a single chapter in Section Five covering everything. Fellus emerges again in the next chapter, with Rashidzada as partner this time, to discuss fatigue in other conditions. As with pain, a distinction is made between central and peripheral fatigue, which makes sense. A great insertion here is to look at early or mild dementia, Alzheimer's, Parkinson's, post-Lyme encephalopathy, and a bit of a discussion on the basal ganglia too. A most interesting, small chapter.

Part three is likely to be the most contentious section, with its focus on psychiatric conditions. This includes CFS, which may anger some, with its focus on perception of effort, both mental and physical. As noted earlier, fatigue has become a non-disease in DSM terms, which many regard as a pity, given high levels of it in both normal and ill populations, returning to the days prior to 1870 when fatigue was ignored. When neurasthenia became favored after that, with no less than von Krafft-Ebing coming to the platform on it, together with Kraepelin, Freud and Janet joining the club later on, a hundred years of opinion followed. And so DSM II may have been described as 'brainless', its third version would be described as 'mindless' in dumping neurasthenia, the most diagnosed condition in Russia, and finally our present version decried as 'witless' by some wags, so the authors end with a small addendum on treatment. Its enough to send one to the barricades, if it were to end there, but Johnson and DeLuca take over with CFS and the brain, drawing on the definitions of Holmes et al in 1988 and Fukuda et al in 1994. The authors keep to both sides of the psychiatric-organic street in this chapter, referring to neuropsychological performance as not illuminating on the subjective complaints, which appear unrelated to depression or fatigue levels. Neuroimaging studies show varying degrees of punctate high signal intensity of the white matter, in some studies cerebral, in others subcortical and periventricular, or in fact nothing. In terms of functional neuroimaging, lateral frontal cortex, lateral temporal cortex and basal ganglia were promising origin sites, with perhaps the medical temporal lobes involved as well. Brainstem hypoperfusion is noted in other studies, with thalamus, basal ganglia and frontal areas involved in still more studies as well. More specifically, the right thalamus, pallidum and putamen may be involved. Together with other studies, the review speculates that the perception of effort might be skewed in such cases, but the heterogeneity of the CFS group is too wide to allow for localization to be exact. The HPA axis comes under scrutiny in a similar way. The literature quoted overall in this chapter is extensive. Overall, it appears that sufferers may over-recruit cortex in response to challenge, and thus fatigue.

Johnson returns without her partner this time, in reviewing the most essential chapter in such a section, looking at depression. Straight away she introduces gender as a variable, as it should be, given the epidemiology of depression, CFS and so on. White matter hyperintensity again looms, as it did in CFS. The cytokines are studied briefly, as well as genetics. It is a very short, very limited chapter, and the editors should have demanded more than its ten pages plus references, but it is about the same length as other chapters.

Allen and Escobar take on somatization, the last and most brief chapter. I guess in a book that purports to be a window on the brain, via fatigue, the emphasis is not on the psychiatric.

Section four examines the general medical conditions of HIV, lupus, cancer, heart disease, and so on. The HIV chapter from Dufour, Dube and Breitbart is thorough and long enough although two pages shorter than the depression chapter, but somehow more fulfilling. Duntley discusses aspects of sleep, fatigue versus sleepiness, and fatigue and the brain focused on the role of sleep, in a chapter almost without headings. Sleepiness and fatigue are separate entities, perhaps even from a pharmacological viewpoint. It is a tight, excellent chapter with strong standpoints taken in evaluating the literature. Siegel and Schneiderman discuss cardiac issues, and both sickness behavior and the acute-phase response, coming back to the cytokines as Johnson did, and the value of anti-inflammatory medications. Lupus and related autoimmune disorders take up on that inflammatory theme, Kozora in the writer's box, with an intense look at measurement and mechanisms of fatigue here, and a very wide look at other conditions that contribute putatively to fatigue in Lupus sufferers. Again, as in earlier in the book, there is a move towards a biopsychosocial approach as a model for fatigue in Lupus. A small section deals with treatment, as small as elsewhere.

Jacobsen and Donovan approach breast cancer using studies on women who are treated for it via radiotherapy and/or chemotherapy, as well as autologous bone marrow transplant. Fatigue is studied closely with cognitive effects, something not all chapters do despite the tone of the book. Complaints again are much more closely with fatigue, more so than with performance on cognitive tasks, as was the case with CFS and mild brain injury again. Two pages of unanswered questions provide fertile ground for further study, especially with regard to toxicity.

Klimas, Fletcher, Maher and Lawrence band together in search of answers to the perplexing question of psychoneuroimmunology, and the connections to fatigue. Again, as before, the sickness behavior, fatigue and immune system of the sufferer are compared and contrasted.

The most potentially useful section, given the paucity of evidence in other chapters, is Section five that tackles the treatment of the conditions that have gone before. Lange, Cook and Natelson review the impact of fatigue on rehabilitation, but their single chapter is all there is in Section five. Behavioral treatments, pharmacological interventions, exercise training, and the relation of outcomes on fatigue are reviewed, with all three recommended in combination, with a view to avoiding the trap of a sedentary response.

DeLuca winds up with a summary chapter that sets out to once again define fatigue, and separate it into primary mechanisms, and the other, secondary mechanisms including deconditioning, anxiety, stress and depression, effects of medication and impact of sleep hygiene. As with any such attempt, and as before in this book, this separation may be spurious, as one may lead to the other in any order, as a circular system may do in any condition.

As a book on the subject, DeLuca's collection stands out pretty much alone, without competition, and it certainly does what it sets out to do, which is penetrate the phenomenology of fatigue, and peer through such a window into the brain. How the brain is defined here is not stated, as for many, such as my colleagues in Neuroscience, the brain is not just inside the cranium, but bounded by a wide spectrum of associated mechanisms in ANS, CNS, endocrine, lymph and blood that connect the whole body as one mechanism. This perhaps narrow focus of the DeLuca approach leads to some artificial boundary creation such as one sees in the final summation, but it doesn't detract much from the usefulness of the book to anyone in the social, psycho, neuro, or related sciences. There is not much to be gained in terms of understanding exactly how fatigue demonstrates the mechanisms of brain or mind, given the dissociation between subjective and objectively measured complaints in regard to cognitive fall-off. However, the book comes close enough to advance our knowledge in this tricky subject, which perhaps has no peer apart from pain as a phenomenon. Perhaps DeLuca will provide such a text.

 

2006 Roy Sugarrman

 Roy Sugarman, PhD, Conjoint Senior Lecturer in Psychiatry, University of New South Wales, A-Dir of Psychology, Royal Rehab Centre Sydney, Australia


Share

Welcome to MHN's unique book review site Metapsychology. We feature over 7900 in-depth reviews of a wide range of books and DVDs written by our reviewers from many backgrounds and perspectives. We update our front page weekly and add more than thirty new reviews each month. Our editor is Christian Perring, PhD. To contact him, use one of the forms available here.

Can't remember our URL? Access our reviews directly via 'metapsychology.net'


Metapsychology Online reviewers normally receive gratis review copies of the items they review.
Metapsychology Online receives a commission from Amazon.com for purchases through this site, which helps us send review copies to reviewers. Please support us by making your Amazon.com purchases through our Amazon links. We thank you for your support!


Join our e-mail list!: Metapsychology New Review Announcements: Sent out monthly, these announcements list our recent reviews. To subscribe, click here.

Interested in becoming a book reviewer for Metapsychology? Currently, we especially need thoughtful reviewers for books in fiction, self-help and popular psychology. To apply, write to our editor.

Metapsychology Online Reviews

Promote your Page too

Metapsychology Online Reviews
ISSN 1931-5716