Practice points
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Ensure it is clear to the patient that you are taking their symptoms seriously
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Look
The population prevalence of CFS as defined above is less than 1% and it is much more common in women.7
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).
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 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
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. Ensure it is clear to the patient that you are taking their symptoms seriously LookPractice points