Abstract:
BACKGROUND: Chronic fatigue syndrome (CFS) is a complex syndrome with a psychiatric comorbidity of 70-80%. A psychiatric interview is necessary in order to exclude psychiatric illness and to identify psychiatric comorbidity. Studies have demonstrated that in general medical practice and in the non-psychiatric specialist practice, physicians tend to underdiagnose psychopathology in patients with CFS. There are many questions unanswered about the treatment of CFS Aim: Typical issues for the psychiatric practice are reviewed: psychiatric comorbidity, dysregulation of the PHA-axis and the treatment of CFS.
CONCLUSIONS: Depression, somatization, sleeping disorders and anxiety disorders are the most important psychopathological symptoms found in CFS patients. CFS should not be regarded as a masked (somatoform) depression. Although the results from neuroendocrinological studies assessing the hypothalamic-pituitary-adrenal axis (HPA-axis) are inconsistent, they suggest that there is a subgroup of CFS patients suffering from a discrete dysregulation of the HPA-axis resulting in basal hypocortisolaemia. These findings, however, do not reveal a causal relationship. Antidepressants do not seem to have a positive influence on the symptom of fatigue, but appear to be beneficial in alleviating the symptoms of depression and social functioning. Cognitive behaviour therapy and graded exercise show a significant improvement on fatigue and other symptoms and are the only treatments available for CFS patients.
Source: Van Duyse A, Mariman A, Poppe C, Michielsen W, Rubens R. Chronic fatigue syndrome in the psychiatric practice. Acta Neuropsychiatr. 2002 Jun;14(3):127-33. doi: 10.1034/j.1601-5215.2002.140306.x. http://www.ncbi.nlm.nih.gov/pubmed/26984154