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Gramont B, Goutte J, Féasson L, Millet G, Hupin D, Cathébras P. [Chronic fatigue: What investigations? And what for?]. Rev Med Interne 2023; 44:662-669. [PMID: 37248110 DOI: 10.1016/j.revmed.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 05/15/2023] [Indexed: 05/31/2023]
Abstract
Chronic fatigue is a frequent complaint, expressed at all levels of the healthcare system. It is perceived as disabling in a high proportion of cases, and internists are frequently called upon to find "the" cause. The etiological diagnostic approach of an unexplained state of fatigue relies on the careful search for more specific clues by questioning and clinical examination. It is necessary to recognize the limited place of complementary examinations apart from the basic biological parameters. Simple rating scales can be useful in the etiological and differential diagnosis of fatigue. Chronic fatigue syndrome (CFS), in the current state of knowledge, cannot be considered as a specific pathological entity distinct from idiopathic chronic fatigue states, and does not have validated biomarkers. It is important to know that a state of chronic asthenia often results from several intricated etiological factors (biological, psychological and social), to be classified as predisposing, precipitating and perpetuating. The metabolic and cardiorespiratory exercise test has a major place in the assessment and management of fatigue, as a prerequisite for personalized retraining or adapted physical activity (APA), which are the treatments of choice for chronic fatigue.
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Affiliation(s)
- B Gramont
- Service de médecine interne, CHU de Saint-Étienne, hôpital Nord, Saint-Étienne, France.
| | - J Goutte
- Service de médecine interne, CHU de Saint-Étienne, hôpital Nord, Saint-Étienne, France
| | - L Féasson
- Service de physiologie clinique et de l'exercice, IRMIS, CHU de Saint-Étienne, université Jean-Monnet, Saint-Étienne, France
| | - G Millet
- STAPS, IRMIS, université Jean-Monnet, Saint-Étienne, France
| | - D Hupin
- Service de physiologie clinique et de l'exercice, IRMIS, CHU de Saint-Étienne, université Jean-Monnet, Saint-Étienne, France
| | - P Cathébras
- Service de médecine interne, CHU de Saint-Étienne, hôpital Nord, Saint-Étienne, France
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Huber F, Beise U. [Not Available]. PRAXIS 2022; 111:581-584. [PMID: 35920006 DOI: 10.1024/1661-8157/a003892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
| | - Uwe Beise
- Verein mediX schweiz, Zürich, Schweiz
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Abstract
Owing to the broad differential diagnoses that can present as fatigue, a rational approach to diagnosis is paramount. Performance of a battery of diagnostic tests is unlikely to assist with diagnosis, highlighting the importance of a thorough history and physical examination. Fatigue can be a sequela of an underlying medical disease or exists as a primary condition. Management of secondary fatigue largely depends on treatment of the underlying condition. There are no FDA-approved medications for primary fatigue, now known as system exertion intolerance disease. Treatment is focused on individualized exercise therapy and cognitive behavioral therapy.
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Affiliation(s)
- Jason C Dukes
- Internal Medicine Department, Eastern Virginia Medical School, 825 Fairfax Avenue, Suite 565, Norfolk, VA 23507, USA.
| | - Matthew Chakan
- Internal Medicine Department, Eastern Virginia Medical School, 825 Fairfax Avenue, Suite 481, Norfolk, VA 23507, USA
| | - Aaron Mills
- Internal Medicine Department, Eastern Virginia Medical School, 825 Fairfax Avenue, Suite 483, Norfolk, VA 23507, USA
| | - Maurice Marcaurd
- Internal Medicine Department, Eastern Virginia Medical School, 825 Fairfax Avenue, Suite 572, Norfolk, VA 23507, USA
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Rai SK, Gupta TP, Kashid M, Shaki O, Chakrabarty BK, Upreti V. Can self-perceived easy fatigability be a predictor of vitamin D deficiency in young Indian women? J Family Med Prim Care 2020; 9:997-1002. [PMID: 32318457 PMCID: PMC7113952 DOI: 10.4103/jfmpc.jfmpc_862_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 01/10/2020] [Accepted: 01/13/2020] [Indexed: 12/25/2022] Open
Abstract
Background Easy fatigability is a common presenting complaint in Indian women who visited primary care hospitals. Many medical conditions like cancer, chronic bronchial asthma, prolonged use of glucocorticosteroid, renal disorder, and hypothyroidism have been associated with low levels of vitamin D. Correction of vitamin D level improves the symptom of fatigue. Whether low vitamin D causes fatigue in otherwise healthy women is the subject of research. Aim This prospective nonrandomized and therapeutic study observed the prevalence of hypovitaminosis D in women with fatigue and the effect of correction of vitamin D level in fatigue-like symptoms. Material and Methods One thousand two hundred adult women, who presented in our primary care hospital with complaints of easy fatigue, otherwise no associated medical illness were included. They completed the fatigue assessment questionnaire (FAQ). Patients with hypovitaminosis D received cholecalciferol (60000 IU) therapy for 5 weeks. Scores of pre- and post-treatment FAQs were noted and compared. Results The prevalence of low vitamin D was noted in 84.8% women who presented with main complaints of fatigue. After the correction of vitamin D level, fatigue symptom scores improved significantly (P < 0.001) in 82.6% of the women in all five-subscale categories of the FAQ. Conclusion We observed a high prevalence of low serum vitamin D level in women who presents with fatigue with no medical illness. A significant improvement was noted in the severity of their fatigue symptoms after the correction of vitamin D levels with cholecalciferol therapy.
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Affiliation(s)
- Sanjay Kumar Rai
- Department of Orthopaedics, 151 Base Hospital, Guwahati, Assam, India
| | - Tej Pratap Gupta
- Department of Orthopaedics, 151 Base Hospital, Guwahati, Assam, India
| | - Manoj Kashid
- Department of Orthopaedics, SMBT Medical Colleges, Igatpuri, Nasik, Maharashtra, India
| | - Omna Shaki
- Department of Trauma and Emergency, 151 Base Hospital, Guwahati, Assam, India
| | | | - Vimal Upreti
- Department of Medicine, 151 Base Hospital, Guwahati, Assam, India
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Beise U, Huber F. [Not Available]. PRAXIS 2018; 107:39-41. [PMID: 29295682 DOI: 10.1024/1661-8157/a002859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Abstract
This paper reviews French concepts of fatigue syn dromes, with a special emphasis on a reputedly unique ly French diagnosis: spasmophilia. Neurasthenia has virtually no place in contemporary French nosology of fatigue states, and chronic fatigue syndrome has not been accepted by all French researchers. The contro versies on neurasthenia and spasmophilia illustrate some of the social uses of diagnostic categories (e.g., legitimation of symptoms) and the ambivalence of physicians toward diagnostic labels based on clinical criteria.
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Rimbaut S, Van Gutte C, Van Brabander L, Vanden Bossche L. Chronic fatigue syndrome - an update. Acta Clin Belg 2016; 71:273-280. [PMID: 27362742 DOI: 10.1080/17843286.2016.1196862] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Chronic fatigue syndrome is a widespread condition with a huge impact not only on a patient's life, but also on society as evidenced by substantial losses of productivity, informal costs, and medical expenses. The high prevalence rates (0.2-6.4%) and the low employment rates (27-41%) are responsible for the enormous burden imposed on society, with loss of productivity representing the highest cost. The objective of this review is to systematically review the recent literature on chronic fatigue syndrome/myalgic encephalomyelitis. METHODS The published literature between 1 January 1990 and 1 April 2015 was searched using the MEDLINE, Cochrane Library, and Web of Sciences databases. The reference lists of the selected articles were screened for other relevant articles. RESULTS AND CONCLUSIONS Despite extensive research, none of the proposed etiological factors have shown strong, reproducible scientific evidence. Over the years, the biopsychosocial model integrating many of the proposed hypotheses has been gaining popularity over the biomedical model, where the focus is on one physical cause. Since the etiological mechanism underlying chronic fatigue syndrome is currently unknown, disease-specific treatments do not exist. Various treatments have been investigated but only cognitive behavior therapy (CBT) and graded exercise therapy (GET) have shown moderate effectiveness.
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Roy S, Sherman A, Monari-Sparks MJ, Schweiker O, Hunter K. Correction of Low Vitamin D Improves Fatigue: Effect of Correction of Low Vitamin D in Fatigue Study (EViDiF Study). NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2014; 6:396-402. [PMID: 25210673 PMCID: PMC4158648 DOI: 10.4103/1947-2714.139291] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background: Fatigue is a common presenting complaint of patients in the primary care offices. Low levels of vitamin D have been associated with fatigue in cancer patients. Normalization of vitamin D level improves their fatigue. Whether low vitamin D plays a role in fatigue in medically stable patients is not known. Aims: This prospective non-randomized therapeutic study observed the prevalence of low vitamin D in fatigue and the effect of normalization of vitamin D on fatigue. Material and Methods: One hundred and seventy four adult patients, who presented in our primary care office with fatigue and stable chronic medical conditions,completed fatigue assessment questionnaires. Patients with low vitamin D levels received ergocalciferol therapy for 5 weeks. Scores of pre- and post-treatment fatigue assessment questionnaires were compared. Results: Prevalence of low vitamin D was 77.2% in patients who presented with fatigue. After normalization of vitamin D levels fatigue symptom scores improved significantly (P < 0.001) in all five subscale categories of fatigue assessment questionnaires. Conclusion: The prevalence of low vitamin D is high in patients who present with fatigue and stable chronic medical conditions, if any. Normalization of vitamin D levels with ergocalciferol therapy significantly improves the severity of their fatigue symptoms.
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Affiliation(s)
- Satyajeet Roy
- Department of Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Anthony Sherman
- Department of Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Mary Joan Monari-Sparks
- Department of Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Olga Schweiker
- Department of Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Krystal Hunter
- Cooper Research Institute, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, New Jersey, USA
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Abstract
Fatigue is a common symptom in primary care with many causes ranging from benign to life threatening. Appropriate evaluation and management are guided by the patient's history, which provides valuable clues as to the source of the patient's symptoms. Ultimately a diagnosis may not be identified for many patients presenting with fatigue, and in these patients management is the most challenging. This article offers guidance in the management of patients presenting with fatigue including key aspects of the patient's history of present illness, the building of a differential diagnosis, rational evaluation in a patient with a nondiagnostic history, and management in the setting of a nondiagnostic work-up.
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Affiliation(s)
- Jennifer Wright
- Division of General Internal Medicine, Department of Internal Medicine, General Internal Medicine Centre, University of Washington, Box 354760, 4245 Roosevelt Way Northeast, Seattle, WA 98105, USA.
| | - Kim M O'Connor
- Division of General Internal Medicine, Department of Internal Medicine, General Internal Medicine Centre, University of Washington, Box 354760, 4245 Roosevelt Way Northeast, Seattle, WA 98105, USA
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Kizilbash SJ, Ahrens SP, Bruce BK, Chelimsky G, Driscoll SW, Harbeck-Weber C, Lloyd RM, Mack KJ, Nelson DE, Ninis N, Pianosi PT, Stewart JM, Weiss KE, Fischer PR. Adolescent fatigue, POTS, and recovery: a guide for clinicians. Curr Probl Pediatr Adolesc Health Care 2014; 44:108-33. [PMID: 24819031 PMCID: PMC5819886 DOI: 10.1016/j.cppeds.2013.12.014] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 10/22/2013] [Accepted: 12/13/2013] [Indexed: 12/15/2022]
Abstract
Many teenagers who struggle with chronic fatigue have symptoms suggestive of autonomic dysfunction that may include lightheadedness, headaches, palpitations, nausea, and abdominal pain. Inadequate sleep habits and psychological conditions can contribute to fatigue, as can concurrent medical conditions. One type of autonomic dysfunction, postural orthostatic tachycardia syndrome, is increasingly being identified in adolescents with its constellation of fatigue, orthostatic intolerance, and excessive postural tachycardia (more than 40 beats/min). A family-based approach to care with support from a multidisciplinary team can diagnose, treat, educate, and encourage patients. Full recovery is possible with multi-faceted treatment. The daily treatment plan should consist of increased fluid and salt intake, aerobic exercise, and regular sleep and meal schedules; some medications can be helpful. Psychological support is critical and often includes biobehavioral strategies and cognitive-behavioral therapy to help with symptom management. More intensive recovery plans can be implemented when necessary.
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Affiliation(s)
- Sarah J Kizilbash
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Shelley P Ahrens
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Barbara K Bruce
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Gisela Chelimsky
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | | | | | - Robin M Lloyd
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Kenneth J Mack
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Dawn E Nelson
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Nelly Ninis
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Paolo T Pianosi
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Julian M Stewart
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Karen E Weiss
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Philip R Fischer
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
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Harvey SB, Wessely S. Chronic fatigue syndrome: identifying zebras amongst the horses. BMC Med 2009; 7:58. [PMID: 19818158 PMCID: PMC2766380 DOI: 10.1186/1741-7015-7-58] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2009] [Accepted: 10/12/2009] [Indexed: 12/04/2022] Open
Abstract
There are currently no investigative tools or physical signs that can confirm or refute the presence of chronic fatigue syndrome (CFS). As a result, clinicians must decide how long to keep looking for alternative explanations for fatigue before settling on a diagnosis of CFS. Too little investigation risks serious or easily treatable causes of fatigue being overlooked, whilst too many increases the risk of iatrogenic harm and reduces the opportunity for early focused treatment. A paper by Jones et al published this month in BMC Medicine may help clinicians in deciding how to undertake such investigations. Their results suggest that if clinicians look for common psychiatric and medical conditions in those complaining of prolonged fatigue, the rate of detection will be higher than previously estimated. The most common co-morbid condition identified was depression, suggesting a simple mental state examination remains the most productive single investigation in any new person presenting with unexplained fatigue. Currently, most diagnostic criteria advice CFS should not be diagnosed when an active medical or psychiatric condition which may explain the fatigue is identified. We discuss a number of recent prospective studies that have provided valuable insights into the aetiology of chronic fatigue and describe a model for understanding chronic fatigue which may be equally relevant regardless of whether or not an apparent medical cause for fatigue can be identified. See the associated research paper by Jones et al: http://www.biomedcentral.com/1741-7015/7/57.
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Affiliation(s)
| | - Simon Wessely
- Institute of Psychiatry, King's College London, London, UK
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Abstract
Fatigue and stress-related illnesses often become diagnoses of exclusion after extensive investigation. 'Tired all the time' is a frequent reason for referral to the endocrine clinic, the implicit question being--is there a subtle endocrine pathology contributing to the patient's symptoms? Often initial assessment suggests not but there are no clear data to address the question of whether overt pathology will develop in the future. This study observed outcomes after five years in 101 consecutive and unselected referrals to secondary care for 'fatigue?cause', where initial assessment did not suggest treatable endocrine pathology. The findings suggest that the clinical diagnosis of fatigue, based on history and tests to exclude anaemia, hypothyroidism and diabetes, is secure: these patients do not subsequently demonstrate excess morbidity and mortality, and their presenting symptoms are not early features of significant endocrine pathology.
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Affiliation(s)
- Kate M Evans
- Department of Endocrinology and Metabolism, Peninsula Medical School, Plymouth and Derriford Hospital, Plymouth.
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Segal B, Thomas W, Rogers T, Leon JM, Hughes P, Patel D, Patel K, Novitzke J, Rohrer M, Gopalakrishnan R, Myers S, Nazmul-Hossain A, Emamian E, Huang A, Rhodus N, Moser K. Prevalence, severity, and predictors of fatigue in subjects with primary Sjögren's syndrome. ACTA ACUST UNITED AC 2009; 59:1780-7. [PMID: 19035421 DOI: 10.1002/art.24311] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To investigate the relationship of fatigue severity to other clinical features in primary Sjögren's syndrome (SS) and to identify factors contributing to the physical and mental aspects of fatigue. METHODS We identified 94 subjects who met the American-European Consensus Group criteria for the classification of primary SS. Fatigue was assessed with a visual analog scale, the Fatigue Severity Scale (FSS), and the Profile of Fatigue (ProF). Associations with fatigue were compared using multivariate regression. RESULTS Abnormal fatigue, defined as an FSS score >or=4, was present in 67% of the subjects. Pain, helplessness, and depression were the strongest predictors of fatigue according to the FSS and the somatic fatigue domain of the ProF (ProF-S), both with and without adjustment for physiologic and serologic characteristics. Depression was associated with higher levels of fatigue; however, the majority of subjects with abnormal fatigue were not depressed. Anti-Ro/SSA-positive subjects were no more likely to report fatigue than seronegative subjects. The regression models explained 62% of the variance in FSS and 78% of the variance in ProF-S scores. Mental fatigue was correlated with depression and helplessness, but the model predicted only 54% of the variance in mental fatigue scores. CONCLUSION Psychosocial variables are determinants of fatigue, but only partially account for it. Although fatigue is associated with depression, depression is not the primary cause of fatigue in primary SS. Investigation of the pathophysiologic correlates of physical and mental aspects of fatigue is needed to guide the development of more effective interventions.
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Pae CU, Lim HK, Han C, Patkar AA, Steffens DC, Masand PS, Lee C. Fatigue as a core symptom in major depressive disorder: overview and the role of bupropion. Expert Rev Neurother 2007; 7:1251-1263. [DOI: 10.1586/14737175.7.10.1251] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Manu P, Lane TJ, Matthews DA. Chronic fatigue and chronic fatigue syndrome: clinical epidemiology and aetiological classification. CIBA FOUNDATION SYMPOSIUM 2007; 173:23-31; discussion 31-42. [PMID: 8491100 DOI: 10.1002/9780470514382.ch3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
To determine the medical and psychiatric diagnoses that have an aetiological role in chronic fatigue we conducted a prospective study of 405 (65% women) patients who presented for evaluation with this chief complaint to an academic medical centre. The average age was 38.1 years and the average duration of fatigue at entry in the study was 6.9 years. All patients were given comprehensive physical and laboratory evaluations and were administered a highly structured psychiatric interview. Psychiatric diagnoses explaining the chronic fatigue were identified in 74% of patients and physical disorders were diagnosed in 7% of patients. The most common psychiatric conditions in this series were major depression, diagnosed in 58% of patients, panic disorder, diagnosed in 14% of patients, and somatization disorder, diagnosed in 10% of patients. Primary sleep disorders, diagnosed in 2% patients, and chronic infections, confirmed in 1.6% patients, explained the majority of cases whose chronic fatigue was attributed to a physical disorder. Thirty per cent of patients met the criteria used to define the chronic fatigue syndrome (CFS). Compared with age- and gender-matched control subjects with chronic fatigue, CFS patients had a similarly high prevalence of current psychiatric disorders (78% versus 82%), but were significantly more likely to have somatization disorder (28% versus 5%) and to attribute their illness to a viral infection (70% versus 33%). We conclude that most patients with a chief complaint of chronic fatigue, including those exhibiting the features of CFS, suffer from standard mood, anxiety and/or somatoform disorders. Careful research is still needed to determine whether CFS is a distinct entity or a variant of these psychiatric illness.
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Affiliation(s)
- P Manu
- Department of Medicine, University of Connecticut School of Medicine, University of Connecticut Health Center, Farmington 06032
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Mechanic D. Chronic fatigue syndrome and the treatment process. CIBA FOUNDATION SYMPOSIUM 2007; 173:318-27; discussion 327-41. [PMID: 8491105 DOI: 10.1002/9780470514382.ch18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Fatigue is a common complaint in general practice and is often associated with psychiatric and psychosocial problems and demoralization. Although the Centers for Disease Control definition of chronic fatigue syndrome (CFS) excludes pre-existing psychiatric illness, common psychosocial problems short of a clinical disorder (such as irritability, difficulty in thinking, inability to concentrate, depression and sleep disturbance) overlap with the criteria for CFS. Psychological states can affect the course of CFS or become confused in the patient's and doctor's mind with the course of infection. The core dilemma in practice is how aggressively to pursue a possible basis for CFS when it persists in the absence of an identifiable external cause. Possibilities for exploration are numerous and potentially expensive. In practice, the persistence of doctors depends on the patient's illness behaviour, on financial and organizational factors, and on the culture of medical care and practice styles. It is essential to differentiate the appropriate management of CFS from scientific study where intensive investigation may be warranted. In practice doctors should proceed in a manner that conveys concern, supports function, and avoids dysfunctional illness behaviour and inadvertent legitimization and reinforcement of disability.
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Affiliation(s)
- D Mechanic
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ 08903
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Katon WJ, Walker EA. The relationship of chronic fatigue to psychiatric illness in community, primary care and tertiary care samples. CIBA FOUNDATION SYMPOSIUM 2007; 173:193-204; discussion 204-11. [PMID: 8491098 DOI: 10.1002/9780470514382.ch12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
This paper reviews the psychiatric disorders associated with the symptom of fatigue in community, primary care and tertiary care samples. In each of these subsamples, studies using structured psychiatric interviews and operational diagnostic criteria are compared and contrasted. In summary, in community, primary care and tertiary care populations, there was a high association between the symptom of fatigue and affective and anxiety disorders. The prevalence rates of affective illness went up linearly in patients with fatigue as one moved from community to primary care and tertiary populations. The fact that fatigue is a common symptom in the community and is associated with significantly higher medical utilization when associated with affective and anxiety disorders may explain the increased association between this symptom and affective illness in primary and tertiary care.
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Affiliation(s)
- W J Katon
- Department of Psychiatry and Behavioral Sciences, University of Washington Medical School, Seattle 98195
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Abstract
Sporadic and chronic fatigue are common, but an underlying etiology is identified in only up to 10% of cases. Under-reporting makes fatigue's prevalence unknown. Some estimate up to 50% of elders suffer from mild fatigue. Causes vary, but prevailing theory links most fatigue as a secondary consequence to illness and medication. Fatigue is prominently linked to sleep disorders, depression, heart disease, Parkinson's disease, anemia, and cancer. Fatigue and its consequences should be assessed routinely. Empiric treatment is the norm, focusing on managing fatigue, and, when possible, selecting agents with fewer side effects. Exercise, diet, and promoting good sleep hygiene have beneficial effects in symptom management.
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Affiliation(s)
- Jeannette Y Wick
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
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Du Toit C, Locke S. An audit of clinically relevant abnormal laboratory parameters investigating athletes with persistent symptoms of fatigue. J Sci Med Sport 2007; 10:351-5. [PMID: 17337243 DOI: 10.1016/j.jsams.2007.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2006] [Revised: 12/14/2006] [Accepted: 01/08/2007] [Indexed: 11/16/2022]
Abstract
The aim of this audit was to assess the yield of a selection of laboratory tests as part of the clinical assessment of the fatigued athlete. Clinical charts and blood test results of fifty consecutive athletes who presented with the primary complaint of fatigue were retrospectively reviewed. Blood tests results reviewed were: haematology (haemoglobin, red cell count, mean cell volume, mean cell haemoglobin content, platelets, white cell count, differential white cell count); erythrocyte sedimentation rate; serum biochemistry (urea, creatinine, electrolytes, urate, glucose, liver function tests, albumin, globulin); blood iron status (serum iron, total iron binding capacity, percent transferring saturation, and ferritin concentration); thyroid stimulating hormone; and immune measures (Epstein-Barr virus serology, cytomegalovirus serology). We identified only 3 abnormal results that contributed to the diagnosis of medical disease as a cause for fatigue. Laboratory testing identified 2 fatigued female athletes with serum ferritin concentration between 15 microg L(-1) and 20 microg L(-1) plus two of the other criteria of iron concentration (serum iron <10 micromol L(-1), iron binding capacity > 68 micromol L(-1), or transferrin saturation <15%). We concluded that the yield from a selection of blood tests investigating fatigued athletes was low. Future study is needed to further define the role of laboratory testing and to study whether low iron stores in the absence of anaemia is related to symptoms in fatigued athletes.
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Affiliation(s)
- Jacques Cornuz
- Department of Community Medicine and Public Health, University Outpatient Clinic, and University Hospital, Lausanne, Switzerland
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Fallon KE. Clinical utility of blood tests in elite athletes with short term fatigue. Br J Sports Med 2006; 40:541-4; discussion 544. [PMID: 16547143 PMCID: PMC2465092 DOI: 10.1136/bjsm.2006.026617] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To determine, in a population of elite athletes at their initial presentation with tiredness or fatigue, whether a set of haematological and biochemical investigations enhances the diagnostic process over and above the information gained from clinical history and examination. METHODS A sequential series of 50 elite athletes were studied at the initial consultation for a primary complaint of fatigue, tiredness, or a synonym thereof. A standardised clinical history, physical examination, and series of haematological and biochemical test were performed. The effects of the results of the blood tests on the diagnosis made after the clinical history and examination were examined. RESULTS In only one case did the test results lead to an alteration in diagnosis. Physical examination did not provide any findings that would not have been suspected from the history, except for a number of incidental findings not relevant to the presenting symptom. DISCUSSION In cases of short term fatigue in elite athletes, a thorough clinical history is mandatory. Physical examination is unlikely to reveal any findings not suspected from the history. Routine ordering of a panel of blood tests at the initial consultation should be discouraged. Unless specifically indicated by the history and examination, investigations are not required at the initial consultation.
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Affiliation(s)
- K E Fallon
- Australian Institute of Sport, Sports Medicine, PO Box 176, Belconnen, Canberra 2616, Australia.
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Abstract
Fatigue is a common symptom in patients with neurologic disease. Mechanisms of fatigue are still incompletely understood. In this paper, we review recent studies of fatigue in common neurologic conditions and discuss therapeutic interventions. In particular, the role of therapeutic exercise is examined in both health and disease.
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Affiliation(s)
- Robert G Miller
- Department of Neurosciences, California Pacific Medical Center, 2324 Sacramento Street, #111 San Francisco, CA 94115, USA.
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Wiesmüller GA, Ebel H, Hornberg C, Kwan O, Friel J. Are syndromes in environmental medicine variants of somatoform disorders? Med Hypotheses 2003; 61:419-30. [PMID: 13679005 DOI: 10.1016/s0306-9877(03)00185-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
To date, relatively little is known about the etiology, pathophysiology, diagnosis, therapy, prevention and prognosis of environment-related syndromes like multiple chemical sensitivity (MCS), idiopathic environmental intolerance (IEI), sick building syndrome (SBS), chronic fatigue syndrome (CFS), candida syndrome (CS) and burnout syndrome (BS). Part of the reason is that these syndromes have not been clearly defined and classified in scientific categories distinct from each other, and that they show clinical similarities to classified somatoform disorders. Furthermore, there are at least three possible explanations for the existence of these syndromes: (1) The syndromes may result from the interaction of environmental factors, individual susceptibility and psychological factors (i.e., how they are perceived and seen by the patient); (2) they may reflect socially and culturally accepted methods of expressing distress; and/or (3) they may be iatrogenic. Despite all the uncertainties in evaluation of environmental syndromes, physicians have the duty to take the affected person's problems seriously. A comprehensive systematic classification which better accounts for these complex clinical manifestations is long overdue. Until these syndromes are well defined, the terms used for them should definitely not be applied to connote a specific disease process.
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Affiliation(s)
- G A Wiesmüller
- Institute of Hygiene and Environmental Medicine, University Hospital Aachen, Aachen, Germany
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Hyams KC. The investigation of chronic fatigue syndrome: a case-study of the limitations of inductive inferences and non-falsifiable hypotheses in medical research. Med Hypotheses 2003; 60:760-6. [PMID: 12710915 DOI: 10.1016/s0306-9877(03)00062-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Karl Popper's argument that deductive logic and falsifiable hypotheses are necessary for the growth of scientific knowledge has been controversial. One approach to assess the relevance of his ideas to medical science has been to evaluate examples of successful research. Another approach is to analyze an unsuccessful investigation. The inconclusive search for a unique 'chronic fatigue syndrome' offers a well-documented case-study for this analysis. Over the past 130 years, numerous studies have provided clinical and epidemiological data, which have supported competing hypotheses about the etiology of chronic fatigue. However, few hypotheses have been refuted because it has not been possible to establish objective standards of inquiry for a subjective symptom like fatigue. As a result, intensive research efforts have not converged on correct explanations by eliminating erroneous ideas. This unsuccessful investigation illustrates how non-falsifiable hypotheses are insufficient to advance medical knowledge, even when there is an abundance of empirical data.
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Affiliation(s)
- Kenneth C Hyams
- Department of Veterans Affairs, Office of Public Health and Environmental Hazards, Washington, DC, USA.
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Barron DF, Cohen BA, Geraghty MT, Violand R, Rowe PC. Joint hypermobility is more common in children with chronic fatigue syndrome than in healthy controls. J Pediatr 2002; 141:421-5. [PMID: 12219066 DOI: 10.1067/mpd.2002.127496] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To determine whether children with chronic fatigue syndrome (CFS) have a higher prevalence of joint hypermobility than gender-matched controls. STUDY DESIGN Matched case-control study comparing the Beighton joint hypermobility scores in 58 consecutive children with CFS (incident cases) with 58 otherwise healthy controls referred to a dermatology clinic for evaluation of common skin problems. A second group of 58 patients previously diagnosed with CFS (prevalent cases) was matched by gender to the incident cases to evaluate temporal changes in referral patterns. RESULTS Of the 58 patients in each group, 71% were female. The median Beighton scores were higher in incident CFS cases than in healthy controls (4 vs 1, P <.001). More incident CFS cases had Beighton scores >/=4 (consistent with joint hypermobility), 60% versus 24%, P <.0001. Incident and prevalent CFS cases had similar Beighton scores. The odds ratio for hypermobility in all patients with CFS versus healthy controls was 3.5 (P <.001; 95% CI, 1.6-7.5). CONCLUSIONS Joint hypermobility is more common in patients with CFS than in otherwise healthy children with common skin disorders. The etiologic significance of the observed association remains to be defined.
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Affiliation(s)
- Diana F Barron
- Department of Pediatrics, and the McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21287, USA
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McCauley LA, Joos SK, Barkhuizen A, Shuell T, Tyree WA, Bourdette DN. Chronic fatigue in a population-based study of Gulf War veterans. ARCHIVES OF ENVIRONMENTAL HEALTH 2002; 57:340-8. [PMID: 12530602 DOI: 10.1080/00039890209601419] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Fatigue has been associated with illness in veterans of the Gulf War; however, few studies have confirmed self-reported fatigue by using clinical evaluation, and symptomatic veterans have not been evaluated with established criteria for Chronic Fatigue Syndrome (CFS). The authors describe the frequency and clinical characteristics of CFS in a sample of veterans residing in the northwestern United States. The sample was selected randomly from U.S. Department of Defense databases of troops deployed to southwest Asia during the Gulf War. The selected individuals were invited to participate in a clinical case-control study of unexplained illness. Of 799 survey respondents eligible for clinical evaluation, 178 had fatigue symptoms. Of the 130 veterans who were evaluated clinically, 103 had unexplained fatigue, and 44 veterans met the 1994 U.S. Centers for Disease Control criteria for CFS. In this population, the authors estimated a minimum prevalence of any unexplained fatigue to be 5.1%, and of CFS to be 2.2%. The estimated prevalence was greater among females than among males. Cases were similar to healthy controls, as determined by laboratory tests and physical findings. In comparison to several clinical studies of CFS patients, the authors of this study found a lower proportion of veterans who reported a sudden onset of symptoms (19%) vs. a gradual onset (50%). Although it has previously been suggested that veterans of the Gulf War suffer from higher rates of chronic fatigue than the general population, the study results described herein--on the basis of clinical examination of a population-based sample of veterans-actually indicate that an increased rate may indeed exist. Gulf War veterans with unexplained fatigue should be encouraged to seek treatment so that the impact of these symptoms on overall quality of life can be reduced.
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Affiliation(s)
- Linda A McCauley
- Center for Research on Occupational and Environmental Toxicology, Oregon Health & Science University Portland, Oregon 97201, USA.
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Jason LA, Taylor RR, Kennedy CL, Song S, Johnson D, Torres S. Chronic fatigue syndrome: occupation, medical utilization, and subtypes in a community-based sample. J Nerv Ment Dis 2000; 188:568-76. [PMID: 11009329 DOI: 10.1097/00005053-200009000-00002] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Most studies of chronic fatigue syndrome (CFS) have been based on patients recruited from primary or tertiary care settings. Patients from such settings might not be typical of patients in the general population. The present investigation involved examining individuals with CFS from a community-based study. A random sample of 18,675 respondents in Chicago was first interviewed by telephone. A group of individuals with chronic fatigue accompanied by at least four minor symptoms associated with CFS were given medical and psychiatric examinations. From this sample, a physician review group diagnosed individuals with CFS. Those diagnosed with CFS were subclassified based on a variety of categories, including duration of illness, mode of illness onset, and presence or absence of a stressful life event directly preceding onset. In addition, we examined medical utilization among those diagnosed with CFS, as well as whether individuals with CFS were disproportionately represented in health care professions. Important differences emerged on measures of sociodemographics, symptoms, and functional disability. The implications of these findings and others are discussed.
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Affiliation(s)
- L A Jason
- Department of Psychology, DePaul University, Chicago, Illinois 60614, USA
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Chronic fatigue syndrome: an allergic entity? Curr Opin Otolaryngol Head Neck Surg 2000. [DOI: 10.1097/00020840-200006000-00024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Steele L, Dobbins JG, Fukuda K, Reyes M, Randall B, Koppelman M, Reeves WC. The epidemiology of chronic fatigue in San Francisco. Am J Med 1998; 105:83S-90S. [PMID: 9790487 DOI: 10.1016/s0002-9343(98)00158-2] [Citation(s) in RCA: 122] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Despite considerable research on chronic fatigue syndrome (CFS) and conditions associated with unexplained chronic fatigue (CF), little is known about their prevalence and demographic distribution in the population. The present study describes the epidemiology and characteristics of self-reported CF and related conditions in a diverse urban community. The study used a cross-sectional telephone screening survey of households in San Francisco, followed by interviews with fatigued and nonfatigued residents. Respondents who appeared to meet case definition criteria for CFS, based on self-reported fatigue characteristics, symptoms, and medical history, were classified as CFS-like cases. Subjects who reported idiopathic chronic fatigue (ICF) that did not meet CFS criteria were classified as ICF-like cases. Screening interviews were completed for 8,004 households, providing fatigue and demographic information for 16,970 residents. Unexplained CF was extremely rare among household residents <18 years of age, but was reported by 2% of adult respondents. A total of 33 adults (0.2% of the study population) were classified as CFS-like cases and 259 (1.8%) as ICF-like cases. Neither condition clustered within households. CFS- and ICF-like illnesses were most prevalent among women and persons with annual household incomes below $40,000, and least prevalent among Asians. The prevalence of CFS-like illness was elevated among African Americans, Native Americans, and persons engaged in clerical occupations. Although CFS-like cases were more severely ill than those with ICF-like illness, a similar symptom pattern was observed in both groups. In conclusion, conditions associated with unexplained CF occur in all sociodemographic groups but appear to be most prevalent among women, persons with lower income, and some racial minorities.
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Affiliation(s)
- L Steele
- Viral Exanthems and Herpesvirus Branch, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA
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Wessely S. The epidemiology of chronic fatigue syndrome. EPIDEMIOLOGIA E PSICHIATRIA SOCIALE 1998; 7:10-24. [PMID: 9658678 DOI: 10.1017/s1121189x00007089] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Abstract
We evaluated 4 women with chronic fatigue and myalgias. Two had proximal weakness. All had elevated serum creatine kinase levels, but none was diagnosed with myopathy until electrodiagnostic studies revealed myotonic or complex repetitive discharges predominantly in paraspinal muscles. Histopathology of paraspinal muscles revealed vacuolar myopathies with glycogen storage; biochemical assays revealed phosphorylase deficiency in 1. Since vacuolar myopathies may affect paraspinal muscles more than limb muscles, electromyographic and histopathologic studies of paraspinal muscles may be required for diagnosis.
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Affiliation(s)
- J T Petrella
- Department of Neurology, University of Pittsburgh School of Medicine, Presbyterian University Hospital, PA 15213, USA
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Wessely S, Chalder T, Hirsch S, Wallace P, Wright D. The prevalence and morbidity of chronic fatigue and chronic fatigue syndrome: a prospective primary care study. Am J Public Health 1997; 87:1449-55. [PMID: 9314795 PMCID: PMC1380968 DOI: 10.2105/ajph.87.9.1449] [Citation(s) in RCA: 264] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES This study examined the prevalence and public health impact of chronic fatigue and chronic fatigue syndrome in primary care patients in England. METHODS There were 2376 subjects, aged 18 through 45 years. Of 214 subjects who fulfilled criteria for chronic fatigue, 185 (86%) were interviewed in the case-control study. Measures included chronic fatigue, psychological morbidity, depression, anxiety, somatic symptoms, symptoms of chronic fatigue syndrome, functional impairment, and psychiatric disorder. RESULTS The point prevalence of chronic fatigue was 11.3%, falling to 4.1% if comorbid psychological disorders were excluded. The point prevalence of chronic fatigue syndrome was 2.6%, falling to 0.5% if comorbid psychological disorders were excluded. Rates did not vary by social class. After adjustment for psychological disorder, being female was modestly associated with chronic fatigue. Functional impairment was profound and was associated with psychological disorder. CONCLUSIONS Both chronic fatigue and chronic fatigue syndrome are common in primary care patients and represent a considerable public health burden. Selection bias may account for previous suggestions of a link with higher socioeconomic status.
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Affiliation(s)
- S Wessely
- Department of Psychological Medicine, King's College School of Medicine and Dentistry, London, England
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Abstract
Haemochromatosis was first recognized as a disease entity over a century ago and its hereditary nature recognized over 60 years ago. However it was only in late 1996 that the haemochromatosis gene was cloned and a single C282Y mutation confirmed as being the cause of all HLA-linked iron overload in Caucasian populations. Haemochromatosis is common, occurring in approximately 1 in 300 people in Caucasian populations, and untreated can cause serious morbidity and early death. However, the disease remains much underdiagnosed for reasons such as lack of awareness of the disease, the presence of normal liver function tests and the lack or non-specific nature of symptoms. A commercially available DNA-based test for the haemochromatosis gene is likely to be available in the near future but its place in the diagnosis and management of the disorder is not yet clear. Assessment of body iron stores by measurement of serum ferritin and transferrin saturation, hepatic iron stores and hepatic architecture by liver biopsy will remain important in the future. The haemochromatosis mutation itself has as yet no known influence on morbidity other than via iron loading and organ failure, in particular, hepatic cirrhosis. Thus, diagnosing patients before the development of hepatic cirrhosis is crucial because iron depletion by venesection treatment before the development of cirrhosis results in a normal life expectancy.
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Affiliation(s)
- D K George
- Joint Liver Program, Queensland Institute of Medical Research, Brisbane, Australia
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Sharpe M, Chalder T, Palmer I, Wessely S. Chronic fatigue syndrome. A practical guide to assessment and management. Gen Hosp Psychiatry 1997; 19:185-99. [PMID: 9218987 DOI: 10.1016/s0163-8343(97)80315-5] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Chronic fatigue and chronic fatigue syndrome (CFS) have become increasingly recognized as a common clinical problem, yet one that physicians often find difficult to manage. In this review we suggest a practical, pragmatic, evidence-based approach to the assessment and initial management of the patient whose presentation suggests this diagnosis. The basic principles are simple and for each aspect of management we point out both potential pitfalls and strategies to overcome them. The first, and most important task is to develop mutual trust and collaboration. The second is to complete an adequate assessment, the aim of which is either to make a diagnosis of CFS or to identify an alternative cause for the patient's symptoms. The history is most important and should include a detailed account of the symptoms, the associated disability, the choice of coping strategies, and importantly, the patient's own understanding of his/her illness. The assessment of possible comorbid psychiatric disorders such as depression or anxiety is mandatory. When the physician is satisfied that no alternative physical or psychiatric disorder can be found to explain symptoms, we suggest that a firm and positive diagnosis of CFS be made. The treatment of CFS requires that the patient is given a positive explanation of the cause of his symptoms, emphasizing the distinction among factors that may have predisposed them to develop the illness (lifestyle, work stress, personality), triggered the illness (viral infection, life events) and perpetuated the illness (cerebral dysfunction, sleep disorder, depression, inconsistent activity, and misunderstanding of the illness and fear of making it worse). Interventions are then aimed to overcoming these illness-perpetuating factors. The role of antidepressants remains uncertain but may be tried on a pragmatic basis. Other medications should be avoided. The only treatment strategies of proven efficacy are cognitive behavioral ones. The most important starting point is to promote a consistent pattern of activity, rest, and sleep, followed by a gradual return to normal activity; ongoing review of any 'catastrophic' misinterpretation of symptoms and the problem solving of current life difficulties. We regard chronic fatigue syndrome as important not only because it represents potentially treatable disability and suffering but also because it provides an example for the positive management of medically unexplained illness in general.
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Abstract
To determine the prevalence of chronic fatigue syndrome (CFS) criteria in other forms of unexplained chronic fatigue, 297 consecutive outpatients under the age of 40 from a general medicine practice were studied. After excluding the three with chronic fatigue syndrome, the remaining 294 individuals were divided into those with unexplained chronic fatigue (64 patients) those without (the remaining 230 patients). Chronic fatigue syndrome criteria noted to be significantly more common in those with unexplained fatigue compared to those without include: fever, painful adenopathy, muscle weakness, myalgia, headache, migratory arthralgia, neuropsychologic symptoms, and sleep disorder. Like chronic fatigue syndrome, unexplained chronic fatigue often started suddenly. I conclude that the CFS criteria are noted more commonly than expected in other forms of unexplained chronic fatigue.
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Affiliation(s)
- A C Chester
- Georgetown University Medical Center, Washington D.C., USA
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Abstract
Chronic fatigue syndrome (CFS) is a medically unexplained illness characterized by chronic, disabling fatigue, impaired concentration, muscle pain, and other somatic symptoms. The conceptual difficulties associated with all medically unexplained illnesses contribute to the controversy surrounding CFS, which has centered around whether it is best regarded as a medical or as a psychiatric condition. Clinically, such an approach is not helpful, and current research suggests that both pathophysiologic changes and psychosocial factors are important. Pragmatic management based on a detailed assessment of the individual is outlined.
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Affiliation(s)
- M Sharpe
- Department of Psychiatry, University of Oxford, United Kingdom
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Abstract
The prevalence of fatigue as a presenting complaint and as a symptom is evaluated in French general practice patients. The data for a sample of 3784 persons 18-64 years-of-age who were seen by 367 general practitioners were examined for fatigue as a presenting complaint, diagnosis, and reported symptoms of persistent fatigue. Gender, age, and socio-professional category were considered as potential risk correlates. At least one of the symptoms of persistent fatigue was reported by 41.2% of the patients, but only 7.6% had presented with fatigue to the doctor. Women reported more symptoms of fatigue than men, but they were only slightly more likely to present with, or be diagnosed with fatigue; women were more frequently diagnosed with depression. There was a strong relationship between the symptoms of depression as measured by the Center for Epidemiologic Studies-Depression Scale (CES-D) and fatigue, but fatigue was neither sensitive nor specific for the diagnosis of depression. Age and fatigue as a presenting complaint and diagnosis were strongly associated for men. After adjusting for sex and age, we found that lower social classes were less likely to be diagnosed as fatigued, though they were more likely to report symptoms of fatigue.
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Affiliation(s)
- R Fuhrer
- Institut National de la Santé et de la Recherche Médicale (INSERM Unité 360), France
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Vercoulen JH, Swanink CM, Fennis JF, Galama JM, van der Meer JW, Bleijenberg G. Dimensional assessment of chronic fatigue syndrome. J Psychosom Res 1994; 38:383-92. [PMID: 7965927 DOI: 10.1016/0022-3999(94)90099-x] [Citation(s) in RCA: 851] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The absence of laboratory tests and clear criteria to identify homogeneous (sub)groups in patients presenting with unexplained fatigue, and to assess clinical status and disability in these patients, calls for further assessment methods. In the present study, a multi-dimensional approach to the assessment of chronic fatigue syndrome (CFS) is evaluated. Two-hundred and ninety-eight patients with CFS completed a set of postal questionnaires that assessed the behavioural, emotional, social, and cognitive aspects of CFS. By means of statistical analyses nine relatively independent dimensions of CFS were identified along which CFS-assessment and CFS-research can be directed. These dimensions were named: psychological well-being, functional impairment in daily life, sleep disturbances, avoidance of physical activity, neuropsychological impairment, causal attributions related to the complaints, social functioning, self-efficacy expectations, and subjective experience of the personal situation. A description of the study sample on these dimensions is presented.
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Affiliation(s)
- J H Vercoulen
- Department of Medical Psychology, University Hospital, Nijmegen, The Netherlands
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Makela EH. Understanding chronic fatigue syndrome. AMERICAN PHARMACY 1994; NS34:45-54; quiz 55-6. [PMID: 8209832 DOI: 10.1016/s0160-3450(15)30459-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Affiliation(s)
- J Bearn
- Bethlem Royal Hospital, London, UK
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Abstract
In brief When active patients relate brief chronic fatigue, three basic questions must be answered: Is there an underlying medical or psychiatric disorder? Could the fatigue be from overtraining or a sleep disturbance? Does the patient have chronic fatigue syndrome or the far more common idiopathic chronic fatigue? Answers may come from sensitive history-taking and targeted physical and laboratory exams. And the patient must play an active role in treatment, which includes reassurance, stress relief, and regular exercise.
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Abstract
The term "chronic fatigue syndrome" (CFS) applies to a condition of unknown aetiology characterized clinically by an association of subjective symptoms, the most constant being an invalidating tiredness. The diagnostic criteria in current use do not permit to isolate an homogeneous subgroup among patients consulting for chronic asthenia. In the present state of research no infectious or immunological cause has been demonstrated conclusively, although a persistent enterovirus or herpesvirus type 6 infection or a state of chronic immune activation seem to play a role in some cases. Patients who fulfill the criteria of CFS present with psychiatric overmorbidity, essentially depressive, and in 50% of the cases with the mental disorders preceding CFS. The various theoretical models linking CFS to psychopathology are discussed, and finally the syndrome is regarded as a social construction reproducing or renovating the neurasthenia of the late 19th century. There is no specific treatment of CFS, but antidepressants, cognitive-behavioural therapy and perhaps certain immuno-modulators can be useful. The future lines of research should endeavour to isolate a subgroup of patients with prolonged asthenia after a recognized episode of infection and to identify the immunological, psychological and behavioral characteristics of this particular group as well as their reciprocal interactions.
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Affiliation(s)
- P Cathébras
- Service de Médecine Interne, Hôpital Nord, Saint-Etienne
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Elnicki DM, Shockcor WT, Brick JE, Beynon D. Evaluating the complaint of fatigue in primary care: diagnoses and outcomes. Am J Med 1992; 93:303-6. [PMID: 1524082 DOI: 10.1016/0002-9343(92)90237-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE This case series describes associated diagnoses and prognoses of persistent fatigue in a community-based, primary care population. PATIENTS AND METHODS All patients presenting to a private practice internist with a chief complaint of fatigue of more than 1 month's duration were prospectively evaluated with clinically directed examination and diagnostic testing. Patients were excluded if they had a previously diagnosed illness associated with fatigue. Fatigue was attributed to newly established diagnoses or medication use based on explicit criteria. Change in the state of each patient's fatigue was measured 6 months after entry. RESULTS Fifty-two consecutive patients entered the study. The diagnoses associated with fatigue were a medical disorder in 25 patients, depression in 10 patients, and no definitive diagnosis in 18 patients. The mean cost of diagnostic testing was $131. At 6 months, 37 of 52 patients (72%) reported improvement in or resolution of their fatigue. CONCLUSION In a primary care setting, many patients presenting with persistent fatigue have an associated, treatable disease that can be determined using a cost-effective, clinically directed approach. Most will experience an improvement in their fatigue.
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Affiliation(s)
- D M Elnicki
- Section of General Internal Medicine, West Virginia University School of Medicine, Morgantown 26506
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Sharpe M, Hawton K, Seagroatt V, Pasvol G. Follow up of patients presenting with fatigue to an infectious diseases clinic. BMJ (CLINICAL RESEARCH ED.) 1992; 305:147-52. [PMID: 1515828 PMCID: PMC1883193 DOI: 10.1136/bmj.305.6846.147] [Citation(s) in RCA: 118] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To determine the symptomatic and functional status during follow up of patients referred to hospital with unexplained fatigue and to identify patient variables associated with persistent functional impairment. DESIGN Follow up by postal questionnaire six weeks to four years (median 1 year) after initial clinical assessment of patients referred to hospital during 1984-8. SETTING Infectious diseases outpatient clinic in a teaching hospital. PATIENTS 200 consecutive patients with fatigue of uncertain cause for at least six weeks; 177 fulfilled the inclusion criteria. MAIN OUTCOME MEASURES Findings at initial assessment; current symptoms, beliefs about the cause of illness, coping behaviours emotional disorder, social variables including membership of self help organizations, and degrees of recovery and functional impairment from questionnaire responses. RESULTS 144 (81%) patients returned completed questionnaires. Initial assessment did not indicate the cause of fatigue, other than preceding infection. The proportion of patients with functional impairment was significantly smaller with longer follow up (33% (11/33) at two to four years, 73% (29/40) at six weeks to six months; chi 2 for trend = 12.5, df = 1; p less than 0.05). Functional impairment was significantly associated with belief in a viral cause of the illness (odds ratio = 3.9; 95% confidence interval 1.5 to 9.9), limiting exercise (3.2; 1.5 to 6.6), avoiding alcohol (4.5; 1.8 to 11.3), changing or leaving employment (3.1; 1.4 to 6.9), belonging to a self help organization (7.8; 2.5 to 23.9), and current emotional disorder (4.4; 2.0 to 9.3). CONCLUSIONS Short term prognosis for recovery of function was poor but improved with time. Most patients had made a functional recovery by two years after initial clinic attendance. Impaired functioning was more likely with certain patient characteristics. Prospective studies are required to clarify whether these associations are the consequences of a more disabling illness or indicate factors contributing to impaired function.
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Affiliation(s)
- M Sharpe
- Department of Psychiatry, University of Oxford
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