Perceived fatigue and energy are independent unipolar states: Supporting evidence.
Perceived fatigue and energy are independent unipolar states: Supporting evidence.
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DOI：
10.1016/j.mehy.2018.02.014
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发表时间：
2018-04
影响因子：
4.7
通讯作者：
O'Connor PJ
中科院分区：
文献类型：
--
作者：
Loy BD;Cameron MH;O'Connor PJ
持续性疲劳是一个常见的问题（占美国人口的20%-45%），在患有癌症、抑郁症、纤维肌痛、心力衰竭、睡眠呼吸暂停和多发性硬化症等疾病的人群中患病率和严重程度更高。FDA批准的疲劳治疗方法很少，而且对于如何测量疲劳存在很大分歧，研究中使用了250多种仪器。许多仪器将疲劳定义为“缺乏能量”，因此将能量和疲劳状态视为单一双极连续体上的对立物。在本文中，我们假设能量和疲劳是不同的感知状态，应该使用单独的单极量表进行测量，具有不同的机制，并且应该使用量身定制的疗法来治疗缺陷。探索性和验证性因素分析研究都发现了能量和疲劳的独立性。包括行为药理学和运动科学在内的各个领域的实验经常发现能量的变化而不是疲劳，反之亦然。如果能量和疲劳是独立的假设是正确的，那么可能有不同的机制驱动能量和疲劳的变化。能量可以通过多巴胺和去甲肾上腺素的传递和结合增加。疲劳可增加脑血清素和炎性细胞因子和组胺结合减少。这个假设可以通过一个实验来检验，这个实验试图同时产生高的能量和疲劳等级（例如使用两种药物，使用随机、双盲、安慰剂对照设计），这将提供强有力的证据来反对双相连续体的普遍观点。如果假设是正确的，使用双极器械的既往文献将是有限的，并且将需要对低能量和疲劳加重作为单独条件的患病率、机制和治疗进行研究。在不久的将来，使用单极测量工具测量能量和疲劳可能会提高我们对这些状态的理解并改善治疗效果。
Persistent fatigue is a common problem (∼20-45% of U.S. population), with higher prevalence and severity in people with medical conditions such as cancer, depression, fibromyalgia, heart failure, sleep apnea and multiple sclerosis. There are few FDA-approved treatments for fatigue and great disagreement on how to measure fatigue, with over 250 instruments used in research. Many instruments define fatigue as “a lack of energy”, thus viewing energy and fatigue states as opposites on a single bipolar continuum. In this paper, we hypothesize that energy and fatigue are distinct perceptual states, should be measured using separate unipolar scales, have different mechanisms, and deficits should be treated using tailored therapies. Energy and fatigue independence has been found in both exploratory and confirmatory factor analysis studies. Experiments in various fields, including behavioral pharmacology and exercise science, often find changes in energy and not fatigue, or vice versa. If the hypothesis that energy and fatigue are independent is correct, there are likely different mechanisms that drive energy and fatigue changes. Energy could be increased by elevated dopamine and norepinephrine transmission and binding. Fatigue could be increased by elevated brain serotonin and inflammatory cytokines and reduced histamine binding. The hypothesis could be tested by an experiment that attempts to produce simultaneously high ratings of energy and fatigue (such as with two drugs using a randomized, double-blind, placebo-controlled design), which would offer strong evidence against the common viewpoint of a bipolar continuum. If the hypothesis is correct, prior literature using bipolar instruments will be limited, and research on the prevalence, mechanisms, and treatment of low energy and elevated fatigue as separate conditions will be needed. In the immediate future, measuring both energy and fatigue using unipolar measurement tools may improve our understanding of these states and improve therapeutic outcomes.
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