Fatigue in psychosis, 2021, Poole-Wright, Chalder et al

Dear Editor,

Fatigue may be defined as ‘tiredness or exhaustion as a result of mental or physical exertion’ (Dittner et al., 2004). Few studies have examined rates of fatigue among those with psychotic disorders. One Australian exception found that nearly 60% of 93 inpatients were fatigued (Waters et al., 2013). Another genome-wide association study found a significant association between tiredness phenotypic scores and polygenic profile scores for schizophrenia and bipolar disorder among 108,976 UK Biobank participants (Deary et al., 2018).

Factors associated with fatigue in psychosis are also relatively unexplored although a link with depression has been found. A ‘loss of energy/tiredness’ was a significant symptom among those with major depressive disorder and bipolar disorder (Serretti et al., 2004), while 55% of sub-syndromal depressed individuals with schizophrenia reported a ‘lack of energy’ (Zisook et al., 2006). Other factors associated with tiredness include obesity and, among those with psychotic disorders, poor physical functioning (Strassnig et al., 2014) and lower physical fitness (Vancampfort et al., 2011). Although the associations between fitness, obesity and fatigue have not been widely investigated, an association between poorer health and higher fatigue was elicited (Waters et al., 2013).

Paywall, https://www.sciencedirect.com/science/article/abs/pii/S0920996421002449

 

Being in hospital is exhausting for anyone in a reasonably normal frame of mind so 60% seems a remarkably low figure, but then by definition people with psychosis are not in a normal frame of mind and it is difficult to know how to interpret anything they say about themselves.

So I think it might be hard to conclude much.

 

I agree but I'm sure that won't stop Chalder and her colleagues forming all sorts of conclusions.

 

Uh, no. That would exclude fatigue that is present without any physical or mental exertion, as say during an infectious illness or as a result of a drug. Or, you know, even chronic fatigue, the symptom. What nonsense is this? Is there seriously zero editorial or review process involved in this field?

When words mean nothing. This is just a word salad.

 

Not to mention that hospitalized psychosis patients are probably on antipsychotic drugs, perhaps the most common side effect of such being drowsiness.

 

"Rates"? The key is the severity.

I've had a few friends who have had schizophrenia, their tiredness/lack of energy was mostly caused by a lack of sleep or medication side effects (or undiagnosed cancer causing a major hormone imbalance)...

 

So is the fatigue a factor in the development of the psychosis, or is the psychosis resulting in the development of fatigue? Or both? Or neither?

 

It may be. But did they tell the patients that it was? Or did they assume the patients had read Dittner?
Psychotic patients in hospitals mostly watch telly or sit around doing nothing much so any tired ness would be unlikely to be a result of exertion.

 

There's also the possibility of patients with psychosis having fatigue from an additional health problem but it being put down to their mental health condition and not investigated through the sheer diagnostic laziness of their doctors.

 

If you went into the records office of the hospital you would get at least 60% saying they felt fatigue. It is a normal human feeling.

It is a consequence of disease too, but it is made up of different components. The sheer effort of doing things when you are disabled, sleep problems, side effects of medication and so on. There should be a word for the inherent fatigue due to the disease but the ones doing the research are quite happy to package it all together.

Frankly, it is a complicated side issue in most diseases, cure the disease, cure the fatigue.

 

Is there anyone in a hospital who isn't fatigued?

Even when you're just visiting time seems to pass differently in hospitals. Long before I had ME I found spending time in hospitals tiring even though I wasn't sick.

The staff will all tell you they're knackered & usually they're so busy that's understandable.

The patients, well presumably they're sick as they're patients and as others have mentioned before fatigue is one of the most common symptoms there is.

You could just as easily investigate fatigue as a reaction to the hospital environment itself -
- sometime very bright environment
- it smells "funny"
- wherever you need to go it's always a hike
- it's a socially weird environment - a lot of strange people in quite close proximity, wearing clothes they normally wouldn't wear in public, having all their routines dictated by the "system" and nursing staff etc.

Hospitals are not restful places.