Category: Management

Management of chronic fatigue syndrome: case study

Abstract:

1. Chronic fatigue syndrome (CFS) is a complex disorder marked by incapacitating fatigue of uncertain etiology which has resulted in a least a 50% reduction in activity and is of at least 6 months’ duration. 2. Definitive diagnosis can be very challenging. Because no markers objectively identify the presence of CFS, diagnosis depends heavily on the presence of subjective complaints. 3. The current philosophy of CFS management is to use a multidisciplinary approach incorporating these rehabilitation goals: restore a sense of self efficacy and control; gradually increase physical activity; and decrease the restrictions imposed by CFS.

 

Source: Dyck D, Allen S, Barron J, Marchi J, Price BA, Spavor L, Tateishi S. Management of chronic fatigue syndrome: case study. AAOHN J. 1996 Feb;44(2):85-92. http://www.ncbi.nlm.nih.gov/pubmed/8694980

 

Chronic fatigue syndrome: current perspectives on evaluation and management

Abstract:

OBJECTIVE: To describe clinical and laboratory guidelines for assessment and management of patients presenting with chronic fatigue syndrome(CFS).

DATA SOURCES: Relevant international consensus diagnostic criteria and research literature on the epidemiology, pathophysiology, concurrent medical and psychological disturbance and clinical management of CFS.

CONCLUSIONS: Medical and psychiatric morbidity should be carefully assessed and actively treated, while unnecessary laboratory investigations and extravagant treatment regimens should be avoided. No single infective agent has been demonstrated as the cause of CFS, and immunopathological hypotheses remain speculative. The aetiological role of psychological factors is debated, but they do predict prolonged illness. The rate of spontaneous recovery appears to be high. Effective clinical management requires a multidisciplinary approach, with consideration of the medical, psychological and social factors influencing recovery.

Comment in: Chronic fatigue syndrome: is total body potassium important? [Med J Aust. 1996]

 

Source: Hickie IB, Lloyd AR, Wakefield D. Chronic fatigue syndrome: current perspectives on evaluation and management. Med J Aust. 1995 Sep 18;163(6):314-8. http://www.ncbi.nlm.nih.gov/pubmed/7565238

 

The chronically fatigued patient

Abstract:

This article illustrates that the diagnostic evaluation as well as the management of the patient presenting with chronic fatigue can be done in an orderly manner. If a medical illness is the cause of the patient’s fatigue, this is usually evident on initial presentation. A thorough history and complete physical examination, in conjunction with some screening laboratory tests, can rule out most medical causes of fatigue, and any remaining cases declare themselves over the next several visits. If a medical cause is not evident, a further “fishing expedition” is fruitless.

Psychiatric illness, such as depression or generalized anxiety disorder, accounts for another significant proportion of cases of chronic fatigue. As with medical illness, psychiatric illness should be suspected based on history and is not a diagnosis of exclusion. Some patients presenting with chronic fatigue have a history and symptom pattern consistent with the diagnosis of CFS. The cause of this syndrome is controversial and is still unknown. The clinician, however, can offer the patient care in an environment that is respectful of their physical and psychological discomfort and can provide significant symptomatic improvement to the patient.

Lastly, some patients with fatigue do not fit any diagnostic category, including CFS. As with many other common complaints, such as headaches or abdominal pain, although a diagnosis may not be given to the patient, the clinician can do a lot to reassure the patient and assist the patient in living with his or her symptoms. As Solberg eloquently wrote: “[E]valuation of the fatigued patient requires all of a physician’s best attributes–a broad view of disease, psychosocial sensitivity, and a good ongoing relationship with the patient.”

 

Source: Epstein KR. The chronically fatigued patient. Med Clin North Am. 1995 Mar;79(2):315-27. http://www.ncbi.nlm.nih.gov/pubmed/7877393

 

Chronic fatigue syndrome. 1: Etiology and pathogenesis

Abstract:

Chronic fatigue syndrome (CFS) is a disorder of unknown etiology characterized by debilitating fatigue and other somatic and neuropsychiatric symptoms. A range of heterogeneous clinical and laboratory findings have been reported in patients with CFS. Various theories have been proposed to explain the underlying pathophysiologic processes but none has been proved.

Research findings of immunologic dysfunction and neuroendocrine changes suggest the possible dysregulation of interactions between the nervous system and the immune system. Without a clear understanding of its etiopathogenesis, CFS has no definitive treatment.

Management approaches have been necessarily speculative, and they have evolved separately in a number of medical and nonmedical disciplines. The results of several controlled treatment studies have been inconclusive. An accurate case definition identifying homogeneous subtypes of CFS is needed. The integration of medical and psychologic treatment modalities and the use of both biologic and psychologic markers to evaluate treatment response will enhance future treatment strategies.

 

Source: Farrar DJ, Locke SE, Kantrowitz FG. Chronic fatigue syndrome. 1: Etiology and pathogenesis. Behav Med. 1995 Spring;21(1):5-16. http://www.ncbi.nlm.nih.gov/pubmed/7579775

 

The treatment of chronic fatigue syndrome: science and speculation

Abstract:

The chronic fatigue syndrome (CFS) is a heterogeneous disorder characterized by fatigue, neuropsychiatric symptoms, and various other somatic complaints. Treatment studies to date reflect both the diversity of medical disciplines involved in the management of patients with CFS and the multiple pathophysiologic mechanisms proposed.

There have been few attempts to study integrated treatment programs, and although several controlled studies have been reported, no treatment has been shown clearly to result in long-term benefit in the majority of patients. Good clinical care integrating medical and psychologic concepts, together with symptomatic management, may prevent significant secondary impairment in the majority of patients.

Future treatment studies should examine differential response rates for possible subtypes of the disorder (eg, documented viral onset, concurrent clinical depression), evaluate the extent of any synergistic effects between therapies (ie, medical and psychologic), and employ a wide range of biologic and psychologic parameters as markers of treatment response.

 

Source: Wilson A, Hickie I, Lloyd A, Wakefield D. The treatment of chronic fatigue syndrome: science and speculation. Am J Med. 1994 Jun;96(6):544-50. http://www.ncbi.nlm.nih.gov/pubmed/8017453

 

Ways of coping with chronic fatigue syndrome: development of an illness management questionnaire

Abstract:

Chronic fatigue syndrome (CFS) is a disorder of uncertain aetiology, and there is uncertainty also about the appropriate way in which patients should manage the illness. An illness management questionnaire (IMQ) was designed to assess coping in CFS. This was completed by 207 patients, in parallel with the COPE scales (a general measure of coping that can be applied situationally), and measures of functional impairment, anxiety and depression.

The IMQ yielded four factors: maintaining activity, accommodating to the illness, focusing on symptoms and information-seeking. Scales based upon these factors together predicted 26, 27 and 22% of the variance in functional impairment, anxiety and depression, respectively, and each scale had significant relationships with relevant scales of the COPE, supporting the interpretation of the factors. It is suggested that the IMQ may be employed to relate ways of coping to outcomes in CFS, and to assess coping as a mediator of change in cognitive-behavioural interventions.

 

Source: Ray C, Weir W, Stewart D, Miller P, Hyde G. Ways of coping with chronic fatigue syndrome: development of an illness management questionnaire. Soc Sci Med. 1993 Aug;37(3):385-91. http://www.ncbi.nlm.nih.gov/pubmed/8356486

 

Service delivery for people with chronic fatigue syndrome: a pilot action research study

Abstract:

Chronic fatigue syndrome (CFS) is a symptom complex which while mild in some cases is severely debilitating in others. Long-term ill health leads to greater use of resources but in the case of long-term CFS the anecdotal evidence suggested a low compliance with the available options and a high level of both patient and general practitioner dissatisfaction.

This pilot study sought through repeated action research cycles to start to identify culturally and contextually sensitive forms of language and models for service delivery suitable for people with CFS in a general practice setting. It worked through a number of action research cycles, to initiate the identification of conceptual models acceptable to both doctors and to patients suffering from CFS, self-management options which encouraged the body’s ability to heal itself and services and delivery mechanisms which met patient needs within health provider options.

 

Source: Denz-Penhey H, Murdoch JC. Service delivery for people with chronic fatigue syndrome: a pilot action research study. Fam Pract. 1993 Mar;10(1):14-8. http://www.ncbi.nlm.nih.gov/pubmed/8477887

 

Chronic fatigue syndrome. A fresh look at an old problem

Abstract:

Chronic fatigue syndrome (CFS), an organic disease of unexplained origin, affects about three people in 100,000. Symptoms last approximately 2 1/2 years, and most CFS patients return to normal health. Diagnosis of CFS is by exclusion. No single remedy has yet proven consistently beneficial. Family physicians can help by providing medical validation of disability to persons who might otherwise be seen as malingerers.

You can read the full article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2379748/pdf/canfamphys00108-0118.pdf

 

Comment in: Disagreeing on how to treat CFS patients. [Can Fam Physician. 1993]

 

Source: McSherry J. Chronic fatigue syndrome. A fresh look at an old problem. Can Fam Physician. 1993 Feb;39:336-40. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2379748/

 

Chronic fatigue syndrome. Recent advances in diagnosis and treatment

Abstract:

Chronic fatigue syndrome is a chronic debilitating illness that is marked in the majority of cases by sudden onset of fatigue and flulike symptoms. Symptoms subsequently relapse and remit and may persist for years. Physical examination typically reveals relatively minor, nonspecific abnormalities in an apparently well patient. Although immunologic abnormalities are associated with chronic fatigue syndrome, tests for these features are expensive, nonspecific, and generally reserved for research purposes. The diagnosis is made on the basis of new onset of severe fatigue, a characteristic pattern of symptoms, and exclusion of other illnesses. Treatment is aimed at alleviating symptoms and helping patients adjust to the debilitating and chronic nature of the illness.

 

Source: Bell DS. Chronic fatigue syndrome. Recent advances in diagnosis and treatment. Postgrad Med. 1992 May 1;91(6):245-52. http://www.ncbi.nlm.nih.gov/pubmed/1579531

 

Chronic fatigue syndrome: a joint paediatric-psychiatric approach

Comment in: Chronic fatigue syndrome: a joint paediatric-psychiatric approach. [Arch Dis Child. 1992]

 

Prolonged fatigue after an apparent viral infection, occurring sporadically or as an epidemic, has been described over the past 50 years. It has been given various names including Royal Free disease (1) and myalgic encephalomyelitis, but the preferred terms in the medical literature have been postviral fatigue syndrome (2) or chronic fatigue syndrome (CFS). (3)

However, the validity of this syndrome as a nosological entity has created a good deal of controversy and remains in doubt. (4) A constellation of symptoms make up the syndrome. There is fatigue of defined onset that is generally reported to follow a viral illness, often an influenza-like illness or an infection of the upper respiratory tract. The patient experiences profound fatigue with the initial illness and then fails to make the expected recovery, with fatigue that can persist over months or years. Fatigue is defined as a subjective sensation, which the patient often describes as tiredness or weariness and that occurs at rest. These patients also report a clear relationship of fatigue to activity. The term fatiguability has been used to describe the greater than normal fatigue that occurs after physical and sometimes after mental exertion in these patients. A great variety of associated symptoms have been described that include increased sleepiness, dizziness, vertigo, headache, difficulty in concentrating, sore throat, muscle weakness, and myalgia. The majority of patients have some emotional symptoms. There can be irritability and anxiety, tearfulness and depression. The fatigue and associated symptoms are of such severity as to impair significantly normal daily activities. There is a remarkable absence of physical signs and physical investigations fail to detect any organic pathology or current infection to account for the symptoms.

You can read the rest of this article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1793327/pdf/archdisch00639-0088.pdf

 

Source: Vereker MI. Chronic fatigue syndrome: a joint paediatric-psychiatric approach. Arch Dis Child. 1992 Apr;67(4):550-5. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1793327/