Elsevier

Medicine

Volume 36, Issue 9, September 2008, Pages 452-454
Medicine

Psychiatric aspects of general medicine
Chronic fatigue syndrome

https://doi.org/10.1016/j.mpmed.2008.06.007Get rights and content

Abstract

Fatigue is a common symptom. When it is chronic, disabling and unexplained by another condition, a diagnosis of chronic fatigue syndrome (CFS) may be appropriate. There is no known simple cause for CFS, but there is evidence for multiple contributing factors. Illness perpetuating factors include inactivity, a fear of making oneself worse and belief that the illness is permanent, and depression. Management should be directed to the perpetuating factors relevant to the particular patient. Much can be achieved by education and gentle encouragement back to normal activity. If specialist management is required, graded exercise therapy (GET) or cognitive–behavioural therapy (CBT) are of proven value.

Section snippets

Epidemiology

The population prevalence of CFS as defined above is less than 1% and it is much more common in women.7

Aetiology

There is no known simple cause for CFS, but there is evidence for multiple contributing factors (biological, psychological and social).8, 9 These factors are usefully divided into predisposing, precipitating and perpetuating (Table 1).

Diagnosis

Medical diagnoses associated with fatigue (Table 2) – whilst it is important to seek evidence of underlying medical conditions, these are found in only a minority of those patients who present with predominant fatigue.

Psychiatric diagnoses associated with fatigue (Table 2) – fatigue is a symptom of many psychiatric disorders, particularly depression and anxiety and these are the main differential diagnoses. Psychiatric diagnoses equivalent to CFS are neurasthenia (ICD-10; persistent and

Management

Management can usually be achieved in primary care or as an outpatient. Admission is occasionally required for very disabled patients. The patient may need to be seen on a number of occasions to cover the essential steps outlined below.10

Explanation and education – ensure it is clear that you accept the reality of the patient’s symptoms and that you do not think they are imagined or ‘all in the mind’ Then to agree the formulation and management plan to address the identified perpetuating

Prognosis

The prognosis of untreated CFS is poor; only 10% of patients recover over 2–4 years.15 However about two-thirds improve with CBT and graded-exercise therapy. Poor pre-morbid functioning or a strong belief that activity is harmful predict a poor response to treatment. Much can be done to help patients with CFS but it is important to accept that some patients will remain ill despite your efforts.

Practice points

  • Ensure it is clear to the patient that you are taking their symptoms seriously

  • Look

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