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Chronic Fatigue Syndrome
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Severe disabling fatigue lasting >6/12 - not medically explained also musculo-skeletal pain, sleep disturbance, impaired concentration, headaches prevalence 0.2-2.6% Criteria - as above but ... UK (Oxford) - stresses mental fatigue US (CDC) - stresses physical fatigue (implying underlying infective cause) and unrelieved by rest Exclusions - other active / suspected disease, psychosis, complicated depression (not just major) anorexia, dementia, substance abuse, DD Depression - low mood most of the time>2/52 - check mental state exam Physical - check for anaemia, thyroid, diabetes Coeliac - tired, diarrhoea, wt loss, 10% rash - dermatitis herpetiformis Addisons - tired, wt loss, hypoT, Na, glc, hyperK, neutropenia Tests Urinalysis, U/E, Cr FBC ferritin LFT T4 TSH Ca, Creatinine Kinase Glc ESR / CRP Coeliac autoantibodies, Gluten screening - if bowel Sx Good prognosis - esp in primary care Unlikely to develop other problems by 12/12 Mx - bio-psycho-social approach antidepressants - don't usually help (unless also depressed - but start carefully as may be more sensitive) - nor do vitamins or evening primrose oil prolonged rest - adverse long term outcome graded exercsize - 30 mins per day walk / swim - improves general functioning CBT - often helps
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Psychiatry