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As the COVID-19 pandemic continues to hit in repeated spreading waves, the population worldwide continues to be under stressful lockdowns and quarantine and getting more dependent on Information and Communication Technology (ICT). Evidence is needed to identify the mental health impact of quarantine on loneliness and Problematic Internet Use (PIU) and find the significant risk factors. This study explores the association of loneliness, internet addiction and related factors such as the number of hours spent online, and the quality of the relationship of people spending the quarantine with on well-being using the Internet addiction scale, UCL loneliness short scale, and WHO-5 measure. The data from a sample of 613 adults from the Middle East were analyzed through SPSS using correlation and regression. The results showed an association between loneliness, internet addiction and low well-being; the number of hours spent online was negatively correlated with well-being, and the quality of the relationship with people spending the quarantine was positively associated with well-being. The results confirm the negative consequences of internet addiction, loneliness and spending long hours online on well-being during quarantine, and the importance of the quality of the relationship with whom one is spending quarantine in supporting well-being.

Cargo handling is an operation, which requires a high level of performance from the officer of the watch (OOW). This study aimed to investigate the effect of different shift schedules on sleep quality, cognitive performance, and sleepiness of 139 OOWs on oil tankers with 4on–8off shifts, during the first shift of cargo handling. Sleep quality (Pittsburgh Sleep Quality Index (PSQI)), level of sleepiness (the Karolinska Sleepiness Scale (KSS)), Psychomotor Vigilance Task (PVT), and Arrow Flanker task performance were examined. The results showed that OOWs with (00:00–04:00, 12:00–16:00) and (04:00–08:00, 16:00–20:00) shifts had impaired cognitive performance and higher sleepiness during the cargo handling operation, and they also experienced impaired sleep quality. The results demonstrated that the circadian rhythm and homeostatic sleep drive have a greater impact on cognitive performance and sleepiness than time on shifts. These results suggest that allocating rest hours immediately before the cargo handling operation may reduce the risk of fatigue.

Background: The MUSIC study is testing the impact of inhaled corticosteroid (ICS) and bronchodilator (LABA/LAMA) treatment on the upper and lower airway microbiome in patients with COPD (NCT02972476). Patients receiving ICS at baseline withdrew therapy for one month, followed by randomization to 3 different ICS regimes or combined LABA/LAMA for 3 months. Here we report rates of patients experiencing exacerbations during the withdrawal period Methods: Multicentre randomized controlled trial. Patients were aged >=40 years, current or exsmokers, FEV1/FVC Results: 122 patients were enrolled from 6 study sites. 52.5% of patients were male, mean age 67 years (standard deviation(SD) 8.1), and mean post-bronchodilator FEV1 54.9% predicted (SD 20.7). 48 patients had blood eosinophil counts 300cells/ul (18.0%). 57 patients experienced an exacerbation or adverse event leading to withdrawal during month 1., Rates of failure ranged from 42-69% with no differences between sites (p=0.52). Failure rates were 56.3% in low, 46.2% in moderate, 45.5% in high eosinophil groups (p=0.54). Failure rates were significantly higher in patients with FEV1 50% (41.8%), (odds ratio 2.23 95% CI 1.06 – 4.67,p=0.034). Conclusion: We found a high failure rate during 1 month switch to LABA/LAMA, particularly in patients with severe and very severe lung function impairment.

Results from a small study into the efficacy of a Multi-Convergent Therapy intervention for patients with Chronic Fatigue Syndrome (CFS) had proved encouraging at the post-therapy and six-month follow-up time points. It was, however, important to re-evaluate these findings over a longer period. Eleven patients who had completed the original therapy trial responded to a follow-up call (91.7% response rate). Subjective data was returned by between 9 and 11 of the participants and 7 completed the objective measures. Participants in the current study completed a similar set of outcome measures as those used to assess treatment success previously. These data suggested that patients attending the therapy continued to show improvements in functioning, had lower levels of fatigue and disability, improved sleep quality and levels of activity and lower symptom scores at a three-year follow-up. The long-term efficacy for this treatment is suggested by these results. Multi-convergent therapy is indicated as a promising approach to the rehabilitation of CFS patients.

The current study examined a large cohort of untreated Chronic Fatigue Syndrome patients at initial assessment and at specific time points over a three-year period. Methods used in previous studies to assess patient health, were validated and used to assess recovery and improvement. Possible predictors of outcome would then be identified by assessing improvements in health status at specific follow-up points. The illness was also assessed in terms of recovery and improvement by using health related and psychosocial measures together with the aetiology of the illness. These were further used to investigate possible mechanisms influencing or predicting recovery or improvement. Two-hundred and twenty-six patients completed wide ranging questionnaires at initial assessment and again six and eighteen months and three years later. A current state of health score was used to measure recovery over time and analyses conducted to investigate the relationship between this and other health related measures. Regression analyses were conducted to assess predictors of improvement and recovery. Spontaneous recovery rates in the untreated patient at three-year follow-up were low (6%). The data suggested, however, that illness length, symptom severity and health status have an important role in recovery. Although there was no evidence to suggest an association between illness onset type and subsequent recovery or psychopathology scores at initial assessment and recovery, regression analyses did indicate that levels of anxiety, cognitive difficulties and social support at initial assessment predict a positive outcome. The state of health measure was validated as a method of accurately assessed the health status of patients and was used as an indicator of improvement and recovery within this group. Spontaneous recovery in the patient group was associated with several factors measured at initial assessment. However, further studies are necessary to more fully identify the factors which affect recovery or improvement and to investigate the exact nature of the mechanisms involved. The present study shows that spontaneous recovery of CFS patients is rare. Treatment or management is essential, and the efficacy of different approaches must be assessed.

Background: Concerns have been expressed regarding the potential for caffeinated energy drinks to nega- tively affect mental health, and particularly so in young consumers at whom they are often targeted. The prod- ucts are frequently marketed with declarations of increasing mental and physical energy, providing a short- term boost to mood and performance. Although a certain amount of evidence has accumulated to substantiate some of these claims, the chronic effects of energy drinks on mental health also need to be addressed. Methods: To review the relevant literature, PubMed and PsycINFO were searched for all peer-reviewed ar- ticles published in English that addressed associations between energy drink use and mental health outcomes. Case reports were also considered, though empirical studies investigating acute mood effects were excluded as a review of such articles had recently been published. Fifty-six articles were retrieved: 20 of these (along with eight more identified through other means) were included in the current review, and, because the ma- jority addressed aspects of stress, anxiety, and depression, particular focus was placed on these outcomes. Results: Though a number of null findings (and one negative relationship) were observed, the majority of studies examined reported positive associations between energy drink consumption and symptoms of men- tal health problems.\ud Conclusions: Though the findings imply that energy drink use may increase the risk of undesirable mental health outcomes, the majority of research examined utilized cross-sectional designs. In most cases, it was therefore not possible to determine causation or direction of effect. For this reason, longitudinal and inter- vention studies are required to increase our understanding of the nature of the relationships observed.

Background: Police are exposed to a wide range of stressors and this is especially true in developing countries such as Jamaica. Exposure to psychosocial stressors and use of maladaptive coping styles can result in mental ill-health. \ud \ud Aims: To examine the relationship between work characteristics, coping and mental health in Jamaican police officers and to test whether work characteristics are indirectly associated with mental health outcomes through perceived job stress and job satisfaction. \ud \ud Methods: Police officers from the Jamaican police force completed a questionnaire using a cross-sectional design. We analysed the data using hierarchical regression. \ud \ud Results: The study group consisted of 134 police officers; the response rate was 94%. Negative work characteristics, lower levels of positive work factors and work support and emotion-focused coping styles were associated with increased levels of depression (F(8, 125) = 7.465, P < 0.001). Subjective feelings of anxiety were positively associated with negative work characteristics and emotion-focused coping (F(8, 125) = 7.586, P < 0.001). The relationship between work characteristics and mental health outcomes was mediated by perceived stress. Job satisfaction mediated the relationship between positive work characteristics and depression. \ud \ud Conclusions: Stress management and intervention programmes should address modifiable work conditions, monitor stress levels and reduce maladaptive coping.

Background Despite rescheduling of cannabis to Schedule 2 and amendments to the law permitting legal availability of cannabis for the treatment of medical conditions, access to cannabis for medical use remains challenging for patients in the United Kingdom (UK). Recreational use is widespread despite laws stating users can be sentenced to prison for up to 5 years for possession. Objective The aim of the study was to develop a model for a legal cannabis market in the UK building upon the results of a preceding study in which a UK population sample determined that pharmacies are the most suitable primary legal vendor of cannabis as opposed to regulated shops or the black market. Methods An online survey was developed using Qualtrics software and advertised via the Multidisciplinary Association for Psychedelic Studies’ Facebook, Twitter and Instagram social media accounts and monthly newsletter. Results Three hundred and ninety seven individuals, a majority having used cannabis at least once, consented to participate in the study. The participants concluded that there is enough evidence for cannabis to be prescribed to treat a range of medical conditions. In addition to pharmacies providing cannabis to patients with a prescription, a majority of participants supported cannabis being sold in pharmacies for harm reduction purposes and allowing access to medicinal cannabis in cases where supporting evidence is insufficient to merit a prescription. Participants supported greater integration between dispensing pharmacies and mental health services. Overall, the participants did not oppose a consultation or screening for potential cannabis users prior to obtaining access from licensed vendors. UK participants were supportive of the concept of a cannabis card, which users can present to licensed vendors such as pharmacies, with specific recommendations (such as strains relevant to a patient’s medical condition) being coded into the card. A majority of participants supported the existence of shisha-type bars for the purchase and onsite consumption of cannabis and determined that such vendors should not be part of a pharmacy chain of stores or regulated by pharmacy regulators. The participants generally preferred that laws regarding public consumption are in line with existing smoking legislation. Participants determined that it should be legally permitted to grow cannabis at home for personal medical and non-medical purposes but not to sell for profit. Conclusion The results are suggestive of a regulatory system that medical and non-medical cannabis users can use which aims to maximise therapeutic applications, minimise harms and respect individual liberty.

Background Recreational drug use is a major cause of disease, injury, physical and mental impairment and death in developed countries such as the United Kingdom and the United States. Alcohol, tobacco, cannabis, 3,4-methylenedioxymethamphetamine (MDMA) and psilocybe mushrooms are recreational drugs with capacity to cause harm. Cannabis, MDMA and psilocybin have reported therapeutic applications. Objectives The primary purpose of this study was to determine which of the three types of vendor (pharmacy, shop and the black market) are perceived to be the most suitable for selling the substances discussed according to a general population sample. Methods A sample of 105 UK nationals was selected for the survey. Participants were presented information regarding reported relative dangers of alcohol, tobacco, cannabis, MDMA and psilocybin and potential therapeutic applications. Participants were then asked to review harm reduction strategies. Results It was found that participants concluded that pharmacists with available NHS support from GPs and mental health workers are the most suitable vendors of cannabis, MDMA and psilocybin as opposed to regulated shops or the black market (p Conclusions The data suggest that the university-educated participants are supportive of treating recreational drug use as a health issue with GPs, mental health workers and pharmacists taking on roles.

Background: Previous research has suggested that chronic fatigue syndrome (CFS) patients report more upper respiratory tract illnesses (URTIs) than controls. Aims: The present study aimed to replicate and extend this research. Method: A prospective study of the incidence of URTIs was conducted. This was similar to previous work involving diary studies but also included objective measures of illness severity (e.g. nasal secretion; sub-lingual temperature) and infection (virus isolation from nasal swabs and antibody changes). Fifty-seven patients with CFS, diagnosed according to the 1994 CDC criteria, were recruited randomly from a volunteer panel compiled of patients who had attended the Cardiff CFS outpatient clinic. A further 57 individuals without CFS were recruited from a general population research panel. Results: The results confirmed that CFS patients report more upper respiratory virus infections and the virological results showed that this was not due to a reporting bias but reflected greater susceptibility to infection. Conclusions: This increased susceptibility to infection in the CFS group can account for the increased reporting of URTIs found in this and previous studies.

The behavioral effects of chewing gum have been studied for over 80 years and much of the research has been concerned with increases in alertness and attention. Another line of research has addressed the issue of whether chewing gum reduces stress. This topic has been studied in the laboratory, in epidemiological studies and real-life interventions. Relevance for patients: The present article briefly reviews the area and makes the case for dissemination of the findings with the aim of reducing stress in the general population and patient groups.

Research has shown that chewing gum improves attention, although the mechanism for this effect remains unclear. This study investigated the effects and after-effects of chewing gum on vigilance, mood, heart rate and EEG. Participants completed a vigilance task four times; at baseline, with or without chewing gum, and twice post-chewing. EEG alpha and beta power at left frontal and temporal lobes, subjective mood and heart rate were assessed. Chewing gum quickened reaction time and increased the rate of correct target detections, although correct detections fell during the second post-chewing task. Chewing gum heightened heart rate, but only during chewing. Gum also increased beta power at F7 and T3 immediately post-chewing, but not following the post-chewing tasks. The findings show that chewing gum affects several different indicators of alertness.

Context: It has been shown that stress increases susceptibility to the upper respiratory tract illnesses (URTIs) such as the common cold. Compared to healthy individuals, those with URTIs also report reduced alertness and have slower reaction times. Objective: The present study investigated whether those with an URTI who had been exposed to stressful events showed greater impairments than either individuals without a cold or those with an illness and low stress exposure. Methods: A prospective cohort study was conducted. The volunteers (360 young adults) were recruited when healthy and completed questionnaires measuring negative life events, personality and health-related behaviours. They also rated their alertness and performed a simple reaction task. If volunteers developed an upper respiratory illness they returned to the laboratory and completed a symptom check list and had nasal secretion and sub-lingual temperature recorded. They also completed a questionnaire measuring recent daily hassles. Alertness and simple reaction time were also recorded again. Those who did not develop a cold were recalled as controls 12 weeks after the start of the study. Analyses of covariance were carried out comparing colds/no colds and high/low stress groups. Baseline measures were included as covariates. Results: 356 participants completed the study. 120 developed URTIs and 236 were re-tested as controls. The frequency and severity of daily hassles were associated with symptom severity. Alertness was reduced and simple reaction time was slower in the URTIs group and the high stress/ill group showed the biggest impairments. These effects remained significant when health related behaviours and personality were covaried. The difference between the high and low stress URTI groups did not reflect symptom severity. Interpretation: The behavioural impairments induced by the common cold are greater when the person has been exposed to stressful events.

Both workload and fatigue impair performance, and a high workload can lead to an increase in fatigue. This paper reports on two studies regarding workload and fatigue, and their impact on performance. Study 1 examined the risk factors for fatigue and the outcomes of it in relation to the rail industry. The results showed that workload is one of several predictors of fatigue. In Study 2 an online test integrating a single-item subjective measure and objective cognitive tests was used to examine the association between workload, fatigue and performance. Workload was found to be a factor that increased fatigue, which then resulted in a change in performance.

Two diary studies were conducted to examine the effects of stress and consumption of breakfast on the incidence and severity of upper respiratory tract illnesses. Both studies showed that negative life events were associated with the occurrence of URTIs. Breakfast consumption and consumption of breakfast cereal were also associated with illness incidence and severity. The effects of stress and breakfast consumption were found to be independent. Further research is now required to elucidate the mechanisms underlying the beneficial effects of breakfast cereal consumption on the occurrence of upper respiratory tract illnesses.

Background Previous research has shown that the severity of symptoms of urinary incontinence impacts on quality of life and wellbeing. The aim of this article is to investigate the relationship between female urinary incontinence and mental wellbeing. This involved analyses comparing those with UI and those without to determine whether any differences in wellbeing were modified by demographic factors, specific wellbeing domain, or exercise and frequency of sex. Following this, further analyses compared sub-groups of those with UI (based on the impact of the UI) to determine which characteristics were important in influencing wellbeing. Methods An internet survey of women with UI, aged between 45 and 60 years, has been previously reported and this article reports secondary analyses of that data. A sample from 4 countries: the UK, France, Germany and the USA. Two thousand four hundred three women completed the survey, 1203 with UI and 1200 who did not report UI. The main outcome measures were the scores from the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS). Results The results showed that lower wellbeing is observed in UI. This effect is observed in all aspects of wellbeing and most sub-groups of UI sufferers. Lifestyle influences wellbeing and those with UI who exercise less frequently or have sex infrequently are especially likely to report lower wellbeing. Wellbeing decreases as a function of the indirect measures of severity of UI and reductions in HRQol. Again, these changes reflect all aspects of wellbeing measured by WEMWBS. Conclusions The results show that women with UI, aged 45–60 years, report lower wellbeing. This effect was not modified by demographic factors and was apparent in most of the domains measured by the WEMWBS. The reduced wellbeing was related to the impact of the UI on behaviour, embarrassment associated with it, and frequency of leakage.

Hollingworth described chewing gum as ‘a technique of relaxation’. Recent research has examined this issue and there is evidence that chewing gum can prevent the adverse effects of acute stress. There are also plausible biological mechanisms that could explain such effects. It is now important to examine chewing gum and chronic stress and the present study involved a survey of this topic. The survey covered the ‘stress process’, collecting data on exposure to stressful events, levels of perceived stress and health outcomes. Frequency of chewing gum was also recorded. Potential confounding factors (demographics, personality and health-related behaviours) were also recorded. The web-based survey was completed by a community sample of 2,248 full-time workers (68% female. Mean age: 35 years, range 18–74 years). Sixty-one per cent of the sample were gum chewers. The results showed that chewing gum was associated with lower levels of perceived stress (both at work and life in general). Gum chewers were also less likely to be depressed and to have seen their doctor for high blood pressure or high cholesterol. Chewing gum was associated with lower levels of alcohol consumption and with cigarette smoking. Gum chewers were also more likely to be neurotic extraverts. Those who chewed gum were also more likely to be exposed to negative factors at work. Logistic regression analyses showed that the effects of chewing gum on stress and health remained significant when these confounding factors were controlled for. These results suggest that chewing gum may be a simple way of preventing stress and the negative health outcomes that are often associated with it. Intervention studies are now required and the mechanisms underlying the effects reported here need further investigation

Rationale: Recent research suggests that chewing gum may increase alertness and lead to changes in cognitive performance. The present study examined effects of chewing gum on these functions within the context of a single study. Objectives: This study had four main aims. The first was to examine whether chewing gum improved learning and memory of information in a story. The second aim was to determine whether chewing gum improved test performance on a validated intellectual task (the Alice Heim task). A third aim was to determine whether chewing gum improved performance on short memory tasks (immediate and delayed recall of a list of words, delayed recognition memory, retrieval from semantic memory, and a working memory task). The final aim was to determine whether chewing gum improved mood (alertness, calm and hedonic tone). Subjects and methods: A cross-over design was used with gum and no-gum sessions being on consecutive weeks. In each week, volunteers attended for two sessions, two days apart. The first session assessed mood, immediate recall of information from a story and performance on short memory tasks. The second session assessed mood, delayed recall of information from a story and performance of an intelligence test (the Alice Heim test). Results: There were no significant effects of chewing gum on any aspect of recall of the story. Chewing gum improved the accuracy of performing the Alice Heim test which confirms the benefits of gum on test performance seen in an earlier study. Chewing gum had no significant effect on the short memory tasks. Chewing gum increased alertness at the end of the test session in both parts of the study. This effect was in the region of a 10% increase and was highly significant (P < 0.001). Conclusions: The results of this study showed that chewing gum increases alertness. In contrast, no significant effects of chewing gum were observed in the memory tasks. Intellectual performance was improved in the gum condition. Overall, the results suggest further research on the alerting effects of chewing gum and possible improved test performance in these situations.

Summary The aim of this study was to investigate the relationship between psychological stress and negative mood and the recurrence of herpes simplex (HSV1). A range of standard, baseline measures of health and psychological well-being were collected from 20 participants who suffered from HSV1 recurrences (with a history of recent recurrence) and 18 matched controls. Longitudinal data was collected over a 16-week period using weekly diaries. Participants recorded weekly levels of psy- chological stress, negative mood, negative events and hassles and kept a weekly health record documenting the recurrence of HSV1 and the incidence of other infectious illness. The longitudi- nal relationship between stress, negative mood and recurrence of HSV was assessed. Participants who suffered from frequent HSV1 recurrences were signifi cantly higher on stand- ard measures of stress and negative mood than those who only suffered occasional or no recur- rences. Furthermore, there was a longitudinal relationship between high levels of perceived stress and the recurrence of HSV1. It was concluded that those suffering from frequent reactivation of HSV1 may be more vulner- able to the effect of stress on immune function and, in this study, higher levels of psychological stress were associated with the subsequent reactivation of HSV1. Copyright © 2008 John Wiley & Sons, Ltd.

Rationale Recent research has shown that even small doses (

Objectives:- This study investigated the efficacy of a rehabilitation technique for the treatment of chronic fatigue syndrome that was developed by a physiotherapist. Data collected retrospectively from a pilot study indicated that patients benefited from this multiconvergent approach, so further assessments were warranted. Design:- Treatment efficacy was assessed by comparing the primary and secondary outcome measures of patients attending multiconvergent therapy (MCT) with those of patients attending relaxation therapy and a group of non-intervention controls. Setting:- The active treatment took place at a clinic within the physiotherapy outpatient unit. Relaxation therapy and all assessments were conducted at the psychology unit. Participants:- Thirty-five participants, fitting the Centers for Disease Control and Prevention criteria for chronic fatigue syndrome, were recruited from two outpatient clinics and an existing patient panel. Intervention:- Patients were assigned to either MCT (n = 12) or relaxation therapy (n = 14). Nine participants who received general medical care were used as a comparison group. Main outcome measures:- The Karnofsky performance scale was used as the primary outcome measure of function. Secondary outcome measures assessing overall improvement in patient condition, fatigue and disability levels were also administered. Results:- A significant percentage of the patients attending the MCT sessions showed improvement in the primary outcome score used to measure the success of the treatment (MCT = 83%, relaxation = 21%, controls = 0; P < 0.001). A significant percentage of this group also reported improvement in their overall condition (MCT = 92%, relaxation = 64%, controls = 22%; P < 0.001), lower fatigue levels (MCT = 83%, relaxation = 57%, controls = 11%; P < 0.001) and lower levels of disability (MCT = 75%, relaxation = 43%, controls = 11%; P = 0.032) immediately post-therapy. In addition, these improvements were maintained at 6-month follow-up. Conclusions:- Outcomes from this small preliminary study were encouraging. The multiconvergent approach produced significant improvements for standardised primary and secondary outcome measures. Further research is required to examine the efficacy of this approach over time, and its effectiveness on a larger scale within the primary healthcare setting using additional therapists trained in the technique.

Background Occupational fatigue is relatively common within the general population and has been linked to reduced performance, injury and longer term ill-health. Despite growing acknowledgement of this problem in the maritime sector, little research has been conducted into the risk factors, prevalence and consequences of seafarers' fatigue. Aims To examine the prevalence of fatigue among seafarers, identify potential risk factors and assess possible links with poor performance and ill-health. Methods Cross-sectional questionnaire survey of seafarers working in the offshore oil support, short-sea and deep-sea shipping industries. A number of tools were used including the fatigue subscale of the profile of fatigue-related symptoms, the Cognitive Failures Questionnaire, the General Health Questionnaire and the SF36 General Health scale. Results In all, 1855 questionnaires were completed giving an overall response rate of 20%. Fatigue symptoms were associated with a range of occupational and environmental factors, many unique to seafaring. Reporting a greater number of risk factors was associated with greater fatigue [e.g. OR = 2.53 (1.90–3.35) for those with three or four risk factors and OR = 9.54 (6.95–13.09) for those with five or more risk factors]. There was also a strong link between fatigue and poorer cognitive and health outcomes, with fatigue the most important of a number of risk factors, accounting for 10–14% of the variance. Conclusions Seafarers' fatigue could impact on safety within the industry and may be linked to longer term individual ill-health. It can only be addressed by considering how multiple factors combine to contribute to fatigue. Key words

Objectives. Previous research has found that chronic fatigue syndrome (CFS) patients report increased susceptibility to upper respiratory tract illnesses (URTIs) when compared with healthy volunteers. This study aimed to replicate and extend this research by investigating the role of psychological distress (stress and negative mood) in the recurrence of URTIs in CFS patients as well as its role in the recurrence of CFS symptoms. Design. A 15-week diary study. Methods. Measures of psychological stress, negative mood, recurrence of URTIs and symptoms were recorded each week for a 15-week period. CFS patients (N = 21), who had been assessed and diagnosed according to the Oxford criteria, were recruited from the Cardiff Chronic Fatigue Clinic and compared with a matched group of healthy controls (N = 18). Frequency of occurrence of infectious illness and the relationship between psychological stress/negative mood and occurrence of illness were assessed. Results. CFS patients reported more URTIs than the controls. Stress scores (and negative mood) were significantly higher in the week prior to the occurrence of URTIs than in weeks when no subsequent illness occurred. High levels of psychological stress also preceded the severity of reported symptoms of fatigue in the CFS group. Conclusions. CFS patients reported more frequent URTIs than healthy controls and these recurrences were preceded by high levels of psychological stress. High levels of stress were also associated with greater subsequent fatigue. Possible explanations of these results are discussed.

The aim of the current study was to evaluate the services offered by Action for ME to sufferers of Chronic Fatigue Syndrome using measures developed and validated in previous research. Preliminary studies had suggested that clients attending rehabilitation residential courses were benefiting from the service. A further, more in-depth evaluation process with a greater number of health-related outcome measures was warranted. In addition, assessment was widened to include other services offered to sufferers of the illness. Data relating to the usefulness and success of the services (rated by the clients) were also collected. Data from client volunteers were collected at baseline (that is, before intervention) and approximately six months later. Quantitative comparative analyses were conducted using within-group comparisons to assess any improvements in scores at six-month follow-up from baseline. Fifty-six participants completed wide-ranging questionnaires assessing illness history, psychopathology, psychosocial factors and health and well-being. Data relating to improvements in illness status and acceptability of treatment were also collected by means of global outcome measures. Both the counselling and residential groups showed improvements in many areas assessed at follow-up. Most importantly, improvements were indicated in areas such as fatigue and the levels of disability suffered by patients. In addition, there were significant improvements in ratings of mood, anxiety, depression and physical symptoms. Overall, clients reported satisfaction with the care received and most found the services useful. All of the participants who completed the evaluation stated that they would recommend Action for ME services to fellow sufferers. The outcome of the current study is encouraging. The data presented provides evidence of the high level of support and advice Action for ME offers to sufferers of this illness. Furthermore, measurable improvements in scores relating to illness status were accompanied by improvements in mental health and psychosocial variables in the patient group.

Aims: Stress, anxiety, and depression are alarmingly common in the general population, can be extremely debilitating, and are a huge cost to public health services. Understanding risk factors associated with such conditions may therefore be useful in helping devise intervention strategies. Though much research has been conducted in the adult population, relatively few studies have investigated these problems in adolescents from the UK. This is a gap in the literature that the current paper aims to address.\ud Study Design: The current research utilised a cross-sectional design.\ud Place and Duration of Study: Data were collected from three secondary schools in Cornwall, UK, in June 2013.\ud Methodology: Data from the Cornish Academies Project were used to investigate links between demographic and lifestyle variables and single item measures of stress, anxiety, and depression. The sample included 2307 secondary school children aged 11-17 (48.5% male, 51.5% female) from the South West of England.\ud Results: A number of risk factors were identified, including female gender, low sleep hours, and belonging to a higher school year. In addition to this, the effects of stress anxiety, and depression on school attendance, Key Stage 3/Key Stage 4 English and maths attainment, and the occurrence of behavioural sanctions were investigated. After demographic and lifestyle covariates had been controlled for, high stress was found to predict the occurrence of behavioural sanctions, and high depression was associated with below average English and maths attainment.\ud Conclusion: Though the findings presented are informative in themselves, the identification of correlates of mental health problems in this demographic group may also be of benefit to future studies that utilise multivariate approaches to data analysis.

Recent evidence has indicated that chewing gum can enhance attention, as well as promoting well-being and work performance. Four studies (two experiments and two intervention studies) examined the robustness of and mechanisms for these effects. Study 1 investigated the acute effect of gum on mood in the absence of task performance. Study 2 examined the effect of rate and force of chewing on mood and attention performance. Study 3 assessed the effects of chewing gum during one working day on well-being and performance, as well as postwork mood and cognitive performance. In Study 4, performance and well-being were reported throughout the workday and at the end of the day, and heart rate and cortisol were measured. Under experimental conditions, gum was associated with higher alertness regardless of whether performance tasks were completed and altered sustained attention. Rate of chewing and subjective force of chewing did not alter mood but had some limited effects on attention. Chewing gum during the workday was associated with higher productivity and fewer cognitive problems, raised cortisol levels in the morning, and did not affect heart rate. The results emphasise that chewing gum can attenuate reductions in alertness, suggesting that chewing gum enhances worker performance.

Objectives: Multi Convergent Therapy combines approaches such as Cognitive Behaviour Therapy and Graded Exercise Therapy in an holistic treatment of Chronic Fatigue Syndrome. Initial follow-up data showed that patients were benefiting from this individualised form of therapy. The objective of the present study was to evaluate this Multi Convergent approach, developed at a specialised Chronic Fatigue Syndrome Outpatient clinic in Cardiff, and compare it to Relaxation Therapy and control groups using multiple outcome measures. Design: Thirty-five participants fitting the Centre for Disease Control criteria for Chronic Fatigue Syndrome were recruited from two outpatient clinics and members of our existing patient panel. Patients were assigned to Multi Convergent Therapy (N=12), Relaxation Therapy (N=14) or recruited as controls (N=9). Methods: Each patient completed a battery of mood and performance tasks along with comprehensive set of questionnaires at baseline, post-treatment and at six-month follow-up. These measures had been validated in previous studies on untreated patients and matched healthy controls. Results: Patients attending the Multi Convergent Therapy clinic showed statistically significant improvements in many of our measures. Most importantly we have produced data indicating that Multi Convergent Therapy provides improvements in objective measures of psychomotor performance and cognition. Discussion: The outcomes of this small study are encouraging. Multi Convergent Therapy has not only produced results indicating significant improvements in standardised questionnaire based measures but also in objective cognitive performance tasks. The next step would be to assess Multi Convergent Therapy at the primary medical care level, with a greater number of patients to further evaluate its efficacy as a treatment for Chronic Fatigue Syndrome.

Background Studies of the impact of antidepressant use on cognitive performance have frequently been carried out among the elderly or on healthy volunteers. Comparatively little research has considered their impact on a relatively young, working population, particularly within the context of everyday life. Aims To examine any association between SSRI use and cognitive performance, mood and human error at work. Methods SSRI users and controls completed a battery of laboratory based computer tasks measuring mood and cognitive function pre- and post-work at the start and end of a working week. They also completed daily diaries reporting their work performance. Results SSRI use was associated with memory impairment: specifically poorer episodic, though not working or semantic memory. Effects of SSRI use on recognition memory seemed to vary according to the underlying psychopathology, while effects on delayed recall were most pronounced among those whose symptoms had not (yet) resolved. There were no detrimental effects on psychomotor speed, attention, mood or perceived human error at work. Conclusions The findings lend support to the SSRIs comparative safety, even among workers, particularly as the symptoms of the underlying psychopathology are successfully addressed. Possible memory impairments may, however, be found in those taking SSRIs. Copyright © 2005 John Wiley & Sons, Ltd.

Background: The Demand Control Model (DCM) and the Effort - Reward Imbalance Model (ERI) offer putative explanations of the relationship between stressful working conditions, job strain, and psychological and physical ill health. Aims: The aims of this study are to: (a) compare the predictive powers of the two models for explaining perceived job stress and mental distress amongst workers as a whole, (b) identify whether a model which combines dimensions of the DCM and ERI might have more predictive power than either of them separately, and (c) ascertain whether the models make distinct contributions to explaining stress at work in specific occupational settings. Methods: Statistical analysis was carried out on data collected from a cross-sectional postal survey of a random sample (n=7,069), of the adult population in an urban area in Southern England. The analysis focused on the 4,135 respondents who were in paid employment. Results: There was little support for combining the models as the combined model was dominated by the predictive power of dimensions from the ERI. However, the results also showed that the models or dimensions of the models made distinct contributions to explaining perceived work stress in different types of occupation. Conclusions: There is little evidence to support a combined model of work characteristics. The ERI appears to be the stronger of the two models although the DCM has explanatory value for specific occupations.

Rationale Evidence for the behavioural effects of caffeine is prevalent in the literature. It is associated with increased subjective alertness, improved reaction time and enhanced encoding of new information. However, there is an on-going debate as to whether such changes are in fact improvements or merely a reversal of the negative effects of caffeine withdrawal. Using participants who had consumed their normal daily quota of caffeine this study alleviated this potential confound as all participants were not withdrawn at the time of testing. Objectives To determine whether caffeine influenced the mood and performance of non-withdrawn volunteers. Methods Sixty eight volunteers, all of whom were regular caffeine consumers, consumed their normal amount of caffeine over the course of the day. Baseline measures of mood and performance were then carried out followed by double-blind administration of caffeine (2 mg/kg) or placebo. The test battery was repeated again 30 min after ingestion of the drink. Results Our findings showed improvements comparable to previous research. Mood was improved and performance on a number of cognitive measures was improved. The findings are discussed in relation to both noradrenergic and cholinergic neurotransmitter systems. Conclusions This study provided evidence against the argument that behavioural changes due to caffeine are merely the reversal of negative withdrawal effects.

A literature review was carried out to establish the extent of the literature on interventions for psychological distress and post-traumatic stress disorder in emergency ambulance personnel. A total of 292 articles were identified. Of these, 10 were relevant to this review. The primary intervention used with this population was critical incident stress debriefing, although there was some debate in the literature about the effectiveness of this intervention and the quality of the research conducted. More high quality research is needed on critical incident stress debriefing before being confident of its effectiveness.

Rationale: Psychotropic medication may impair psychomotor and cognitive function, and so increase accident susceptibility. However, few studies examine any association in the framework of other demographic, health and occupational factors. Objectives: To examine the relationship between sleeping tablets and antidepressants, and accidents, minor injuries and cognitive failures. Methods: Postal questionnaire study of 3111 individuals who participated in an earlier phase of the Bristol Stress and Health Study. Results: Sleeping tablet use was associated with accidents, minor injuries and cognitive failures both at work and outside work. Antidepressant use was associated with accidents and cognitive failures both at work and outside work. Adjusting for health, demographic and occupational factors explained many of these associations, but sleeping tablet use was independently associated with accidents (both at work and outside work), and antidepressant use with cognitive failures (outside work). Conclusions: Antidepressant and sleeping tablet use were apparently associated with accidents, minor injuries and cognitive failures. Although most of the associations could be accounted for by other factors the results suggested links between sleeping tablet use and accidents, and between antidepressant use and cognitive failures.

Research suggests that chewing gum may be associated with reduced stress, depression and a reduced likelihood of having high cholesterol and blood pressure. The present study aimed to replicate these findings and extend them by examining dose–response. A web-based survey was completed by a sample of 388 workers from public sector organisations (68.5% female; mean age: 42 years, range 17–64 years). The results showed that chewing gum was associated in a linear dose–response manner with lower levels of perceived stress (both at work and life in general), anxiety and depression. Occasional gum chewers also reported a reduced risk of high cholesterol and blood pressure. Intervention studies are now required to extend these findings, and the mechanisms underlying the effects reported here need further investigation

Measurement of disability in rheumatoid arthritis is often used to support treatment decisions and outcome assessments, but is used without reference to the impact of disability on individual patients.To develop and validate a scale to measure individual values for functions, which is used to weight the level of an individual patient's functional loss and thus calculate the personal impact of disability.In four linked studies, first the phraseology for values was explored to develop a stem question for the value scale couched in terms patients understand (face validity). Then short and long versions of the value scale were compared (content validity) and tests of internal consistency and short term reliability undertaken (criterion validity). Finally, the value scale was examined for long term reliability and agreement with expected variables (criterion and construct validity), after which personal impact scores were calculated and their construct validity examined.Patients understand the concept of values, and a positively phrased stem question was developed for the value scale, for which a short version was reasonably equivalent to a long version. The value scale was reliable over one week (96% changed by1 point) with positive interitem correlation. Reasonable six and 12 month reliability was shown (52% changed by0.5 points), and the value scale was independent of disability and clinical, psychological, personality, and social support variables. Personal impact scores were then calculated by using the value scores to weight disability scores. Impact scores varied widely between patients of similar disability. Personal impact for disability showed convergent validity with dissatisfaction with disability, perceived increase in disability, increased disease activity, worse psychological status, low social support, and time trade off for disability. It discriminated between patients with low and high dissatisfaction with disability, life satisfaction, depression, pain, and helplessness.This individualised personal impact scale should lend meaning to disability scores, improving the interpretation of clinical and research data.

Residential rehabilitation courses in self-directed illness management offer a potentially useful patient-centered and multidis-ciplinary therapeutic option for Chronic Fatigue Syndrome. A retrospective survey of the data from the courses run by Westcare UK between 1995 and 1998 was undertaken to give a preliminary evaluation of outcomes and acceptability. The outcome results, for 49 participants, show improvements, at 12 months, on the Fatigue and Emotional Distress subscales of the PFRS. (Fatigue: before course: mean 3.66, s.d. 1.14; 12 months later: mean 3.11, s.d. 1.57; F(l,48) = 11.19 p < 0.005. Emotional distress: before course: mean 2.53, s.d. 1.46; 12 months later: mean 2.04, s.d. 1.39; F(l, 48) = 5.96 p < 0.01.) Participants also reported a high level of general satisfaction with the course: 89.4% gave a rating of five or six, out of six. These results describe both long and short-term benefits, and support the continued use of these courses and the implementation of a further more rigorous Study.

This article reviews previous research on the scale of perceived stress at work and describes results from the 'Bristol Stress and Health at Work' study (Smith et al, 2000a, 2000b). This study had three main aims: first, to determine the scale of perceived stress at work in a random population sample; secondly, to distinguish the effects of stress at work from those of stress in life as a whole; and, finally, to determine whether objective measures of health status and performance efficiency were related to reports of stress at work. These objectives were investigated by conducting an epidemiological survey of 17,000 randomly selected people from the Bristol electoral register, a follow-up survey 12 months later and detailed investigation of a cohort from the original sample. The results revealed that approximately 20 per cent of the sample reported very high or extremely high levels of stress at work. This effect was reliable over time, related to potentially stressful working conditions and associated with impaired physical and mental health. The effects of stress at work could not be attributed to life stress or negative affectivity. The cohort study also suggested that high levels of stress at work may influence physiology and mental performance. The prevalence rate obtained in this study suggests that five million workers in the UK may have very high levels of stress at work.

BACKGROUND Although many disability questionnaires measure fact very efficiently, they do not allow for consideration of the relevance of that disability to the patient. Data suggest that professionals misinterpret the relevance of disability for the patient and thus, also, the outcome of treatment. OBJECTIVES Firstly, to examine agreement on levels of importance for the items on a validated disability scale (Health Assessment Questionnaire (HAQ) and Modified HAQ (MHAQ)), within groups of patients with rheumatoid arthritis, health professionals, and controls. Secondly, to see if functional items important to patients are included in the HAQ, and whether the HAQ items are important to patients. METHODS 25 patients with RA, 25 rheumatology health professionals, and 25 healthy controls were asked to rate the importance of the HAQ (20 items) and MHAQ (eight domains). Before seeing the HAQ, patients were asked to generate items of function important to them. RESULTS Only a slight-fair agreement within each group was found for the level of importance of the HAQ and MHAQ, and also within any combination of the groups (κ values

Objectives. First, to determine whether chronic fatigue syndrome (CFS) patients report increased susceptibility to upper respiratory tract illnesses (URTIs) compared with healthy volunteers. Second, to determine whether symptom severity and use of medication is greater in CFS patients. Finally, to assess the impact of the URTIs on the subsequent clinical state of the patients. Design. A 10-week diary study. Methods. The frequency and severity of URTIs were recorded over a 10-week period by CFS patients (N = 62) and healthy controls (N = 44). The patients were selected according to the Oxford criteria and had previously been assessed at the Cardiff Chronic Fatigue Clinic. One group of patients and controls carried out the diary study from October to December, and another group from January to March. At the end of each of the 10-week periods the volunteers completed standard questionnaires about the frequency and severity of symptoms of colds and influenza and their general clinical condition. Results. CFS patients reported more cold and influenza illnesses than the controls. The patients also reported greater symptom severity and use of medication for the URTIs; these differences were still observed when trait anxiety was covaried. There was little evidence of the URTIs leading to longer term changes in the primary symptoms of CFS. Conclusions. CFS patients report more URTIs, greater symptom severity and greater use of medication for these illnesses than healthy controls. Further studies are now necessary to determine whether these results reflect greater susceptibility to infection or differences in symptom reporting. The present findings also suggest that acute infections do not play a major role in the pathogenesis of CFS.

An experiment was carried out to examine the effects of 40 mg of caffeine given in different drinks (coffee, water, tea, cola) on mood and performance. One hundred and forty-four volunteers were randomly assigned to one of the groups formed by combining the caffeine/placebo and drinks conditions. Following a baseline session measuring mood and different aspects of performance, the volunteers were given their drink and then carried out another test session 1 h later. Administration of the caffeine/placebo was double-blind. The results showed that those given caffeine reported greater alertness and anxiety at the end of the test session, as well as improved performance on choice reaction time tasks involving focused attention and categoric search, a semantic memory task and a delayed recognition memory task. The effect of the caffeine was not modified by the nature of the drink in which it was given. Overall, these results show that a dose of caffeine typical of the level found in commercial products can improve alertness and performance efficiency.

A double-blind placebo controlled trial was carried out to examine the effects of supplementation with anti-oxidant vitamins on mental performance in the elderly. The participants were assigned to either placebo or vitamin groups and assessed at 4, 8 and 12 months. Blood samples were taken to determine vitamin levels at these times. The results showed little effect of supplementation on mental performance and few associations between plasma levels of the vitamins and mental functioning. These results are in contrast to results from assessment of mood, intelligence and cognitive failure which demonstrated beneficial effects of increased levels of vitamin C.

This study examined the effects of breakfast cereal and caffeinated coffee on working memory, attention, mood, and cardiovascular function. One hundred and forty-four volunteers (72 male, 72 female, mean age 21 years) were assigned to one of the groups formed by combining breakfast (cereal versus no breakfast) and caffeine (caffeinated versus decaffeinated coffee) conditions. The volunteers completed a baseline session between 0800 and 0845 h. The breakfast/caffeine administration took place between 0845 and 0915 h. They then completed another test session (starting at 0945) and had a coffee break at 1045, followed by a final session starting at 1145. The results showed that those who consumed breakfast cereal had a more positive mood at the start of the test sessions, performed better on a spatial memory task, and felt calmer at the end of the test session than those in the no breakfast condition. Ingestion of caffeine had no effect on initial mood or working memory, but it did improve encoding of new information and counteracted the fatigue that developed over the test session. Caffeine increased blood pressure and pulse rate, whereas breakfast cereal consumption only had an effect on pulse. Overall, these results confirm previous findings on the effects of breakfast and caffeine, and demonstrate distinct profiles for two common examples of early-morning food and drink, breakfast cereal and caffeinated coffee.

Abstract The present study examined whether volunteers with common colds showed impairments in objective and subjective indicators of alertness. All the volunteers (N = 81) were tested when healthy to provide baseline data for mood, simple and choice reaction time tasks, and an anti-saccadic eye movement task. When subjects developed a cold (N = 17) they returned to the laboratory and repeated the procedure. Volunteers (N = 64) who remained healthy over a 10-week period were recalled as controls. The results showed that those with colds felt significantly less alert and had significantly slower simple and choice reaction times and eye movements. This extends earlier research and shows that electrophysiological measures may also be of use in assessing the behavioral changes induced by upper respiratory tract illnesses.

The present study examined the effects of anti-oxidant vitamin supplementation on mood and cognitive functioning in 205 volunteers (110 females, 95 males; age range: 60-80 years). In this randomised, double-blind, placebo-controlled study, the volunteers received either anti-oxidant supplementation (daily dosage 12mg/d β-carotene, 400 mg/d α-tocopherol and 500mg/d ascorbic acid) or placebo. The volunteers were followed up for 12 months. Vitamin levels were assessed from plasma samples. The primary outcome measures were subjective mood, self-reported cognitive failures, and measures of intelligence. These were measured at 4, 8 and 12 months. There were very few significant differences between the placebo and vitamin groups. Analysis of the effects of changes in vitamin levels on mood and cognition revealed significant effects of changes in vitamin C but not the other anti-oxidants. Increases in vitamin C were associated at 12 months with more positive mood, greater improvements in global assessments of intellectual functioning and a reduction in everyday errors of memory, attention and action. These effects were greatest for those volunteers who had a more negative mood and lower levels of cognitive function at baseline. Overall, results support earlier findings based on examination of dietary intake.

Previous research has shown that cessation of caffeine consumption may be associated with a distinct withdrawal syndrome, typified by an increase in headaches. Recent research suggests that low to moderate consumers of caffeine may report an increase in headaches if they perceive caffeine to have been withdrawn regardless of whether it has been or not. The present study provides additional support for the role of subjective perceptions in the caffeine withdrawal syndrome. Forty-three low caffeine consumers recorded the incidence of headaches when drinking caffeinated or decaffeinated beverages. When caffeine was withdrawn the incidence of headaches increased but this effect was only significant in those individuals who could discriminate whether they were consuming caffeinated or decaffeinated beverages. This result suggests a major role of subjective perceptions and expectancies in the caffeine withdrawal syndrome, a view that contrasts with the notion that a significant proportion of caffeine consumers are physically dependent upon caffeine.

Previous research has shown that both experimentally-induced and naturally occurring upper respiratory tract illnesses (URTIs) influence mood and mental functioning. None of the previous studies of naturally occurring colds has conducted appropriate virological assays to determine the nature of the infecting agent. This is an essential methodological step in studies of malaise associated with URTIs. The aim of this research was to investigate the effects of naturally occurring colds on mood and objective measures of performance. This was done by first conducting a cross-sectional comparison of 37 healthy people and 158 volunteers with colds and then a longitudinal study in which 100 volunteers developed colds and 87 remained healthy. Virological techniques were used to identify infecting agents and comparisons made across the different groups. The results showed that having a cold was associated with reduced alertness and slowed reaction times. These effects were observed both for colds where the infecting virus was identified and those where it was not. Similar effects were obtained for both rhinovirus and coronavirus colds. One may conclude that upper respiratory tract illnesses lead to a reduction in subjective alertness and impaired psychomotor functioning. This was true for both illnesses where the infecting agent was identified and for those clinical illnesses where no virus was detected. It is now important to identify the mechanisms linking infection and illness with the behavioural changes. Similarly, the impact of these effects on real-life activities such as driving needs examining. Finally, methods of treatment need to be developed which not only treat the local symptoms of the illnesses but remove the negative mood and the performance impairments. © 1998 Elsevier Science Ltd. All rights reserved.

This study examined the effects of smoking and smoking deprivation on the articulatory loop of working memory. Forty subjects (20 smokers and 20 non-smokers) performed tasks involving serial recall of letters on two occasions 1 week apart. In each test one part was conducted with articulatory suppression and the other without it. The smokers completed one test following 12 h of smoking deprivation, and the other after smoking a cigarette. The order of suppression/non-suppression conditions and the order of smoking and smoking deprivation were balanced across subjects. The results showed that deprived smokers performed significantly worse than both smoking smokers and non-smokers in the task without suppression. Although all the subjects performed significantly worse whilst under articulatory suppression, smoking status was not found to influence performance here. These results imply that smoking has the effect of returning the smoker to a comparable level of performance to that seen in non-smokers, and suggest that smoking abstinence has a negative effect when performance involves the articulatory loop.

An experiment was conducted to examine the effects of caffeine and noise on mood, mental performance and cardiovascular function. One hundred and six young adults (mean age 21·2 years) took part in the study. Subjects were assigned to one of six groups formed by combining noise/quiet and drink (caffeinated coffee, decaffeinated coffee and fruit juice) conditions. Subjects were familiarized with the tasks and then completed a pre-drink baseline session (conducted in the quiet). Subjects were then given either caffeinated coffee (1·5 mg/kg caffeine), decaffeinated coffee or fruit juice. Following consumption of the drink subjects were re-tested 1 h later, either in noise (75 dBA conglomerate noise, consisting of speech, music and machinery noise) or in quiet. The subjects exposed to noise felt more anxious and showed an increase in blood pressure. Their performance of a cognitive vigilance task also declined over time. There were no significant main effects of caffeine, although simple reaction time was quickest in the caffeinated coffee group. Caffeine did not modify the effects of noise on mood, cardiovascular functioning or sustained attention. Indeed, the only interaction between drinks and noise was found in recall and recognition memory tasks, with the caffeine/noise group having better memory performance than the decaffeinated/noise subjects. Overall, the results show that low levels of caffeine do not increase the behavioural and physiological changes observed in a stressful situation.

Despite the large number of studies on caffeine and attention, interpretation is often difficult because of methodological weaknesses. In the present study, use of a small battery of tests with four key outcome measures, combined with an appropriate sample size, addresses many of these problems. This methodology was used to examine whether effects of caffeine (a dose of 2 mg/kg) could be explained in terms of reversal of the effects of caffeine withdrawal. This was achieved by examining effects in non-consumers ( N = 35), who could not be withdrawn, and also in a group of consumers ( N = 35) who had undergone withdrawal for a week and no longer reported symptoms of withdrawal. The results showed no effect of short-term withdrawal on the performance measures, even though subjective reports showed an increase in symptoms after withdrawal. In contrast, the caffeine challenge carried out on Day 8 showed that ingestion of caffeine was associated with faster simple reaction time, fewer long responses, greater detection of targets in the cognitive vigilance task, and faster encoding of new information. These results suggest that it is important to continue to investigate mechanisms underlying these effects of caffeine and to further evaluate the practical implications of such effects.

BackgroundDifferent definitions of chronic fatigue syndrome (CFS) have different psychiatric exclusion criteria and this affects the type and frequency of associated psychiatric morbidity found. The operational criteria for neuraesthenia in ICD–10 vary in this and other respects from the Centers for Disease Control and Prevention (CDC) criteria for CFS. Neuraesthenia and associated psychiatric morbidity in CDC-defined CFS are evaluated.MethodCFS subjects and controls were interviewed with the Schedule for the Clinical Assessment of Neuropsychiatry (SCAN). The computerised scoring program for SCAN (CATEG05) facilitates the assignment of operational definitions according to DSM–III–R and ICD–10. Subjects were re-interviewed with SCAN an average of 11 months later. No specific treatments or interventions were given during this period.ResultsThe majority of subjects fulfilled ICD–10 operational criteria for neuraesthenia and had two and a half times the rate of psychiatric morbidity as the healthy comparison group according to the CATEG05 Index of Definition (ID). Approximately 80% of subjects fulfilled both DSM–III–R and ICD–10 criteria for sleep disorders. There was a significant fall in the number of subjects fulfilling criteria for depression and anxiety disorders and a significant increase in the number of subjects with no diagnosis for DSM–III–R criteria over time. There were no significant changes over time for any diagnosis according to ICD–10 criteria or for overall levels of psychopathology as reflected in CATEG05 ID levels.ConclusionsThe ICD–10 ‘neuraesthenia’ definition identifies almost all subjects with CDC-defined CFS. Fifty per cent of CFS subjects also had depressive or anxiety disorders, some categories of which remit spontaneously over time.