Abstract: . . .  reproducible evidence of increased rates of comorbid depression, the aetiology remains obscure. 1 Similarly, despite numerous tantalising hypotheses of pathogenesis, including immunological, neuroendocrine and metabolic disturbances, all remain unproven. 1 On the positive side, the criteria for diagnosis are well accepted internationally, 2 and have been the subject of recent refinements to improve reliability. 3 The disorder is well recognised, and about 0.5% of patients attending general practice are identified as having CFS. 4 What, then, of treatment for a disorder with so . . .
. . .  stronger risk factors for thrombosis than anticardiolipin antibodies in the antiphospholipid antibody syndrome: a systematic review of the literature. Blood 2003; 101: 1827-1832. 6. Schulman S, Svenungsson E, Granqvist S, et al. Anticardiolipin antibodies predict early recurrence of thromboembolism and death among patients with venous thromboembolism following anticoagulant therapy. Am J Med 1998; 104: 332-338. 7. Health Insurance Commission. Medicare Benefits Schedule (MBS) item statistics reports. MBS statistics 20022003. Available at: www.hic.gov.au/statistics/ dyn_mbs/forms/mbs_tab4.shtml (accessed Feb 2004). 8. Khamashta MA, Cuadrado MJ, Loizou S, et . . .
. . .  1992; 117: 303-308. 10. Palareti G, Leali N, Coccheri S, et al. Bleeding complications of oral anticoagu- lant treatment: an inception-cohort, prospective collaborative study (ISCOAT). Lancet 1996; 348: 423-428. 11. Crowther MA, Ginsberg JS, Julian J, et al. A comparison of two intensities of warfarin for the prevention of recurrent thrombosis in patients with the antiphos- pholipid antibody syndrome. N Engl J Med 2003; 349: 1133-1138. ? Graded physical exercise is no panacea, but is beneficial M UCH REMAINS UNKNOWN ABOUT the enigmatic clinical disorder chronic fatigue syndrome (CFS). Apart from clear evidence implicating certain . . .
. . .  physical activity, patients may reach the conclusion that it is best to avoid exercise. Thus, patients may develop an understandable cognitive attribu- tion that exercise is harmful in the short term (as symptoms are worsened) and detrimental in the longer term. This leads to altered behaviour in the form of reduced physical activity with consequent deconditioning. Similarly, as sleep typically takes on a characteristic unrefreshing quality, and fatigue is dominant in the symptom complex, patients may consider that increased sleep holds promise for symptom relief and for rapid recovery. This attribution commonly leads to a behavioural pattern of phase-shifted sleep . . .
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