Category: Overview

Chronic fatigue syndrome: a review for clinicians

Abstract:

Syndromes characterized by persistent fatigue, musculoskeletal pain, sleep disturbance, and subjective cognitive impairment have been common problems in clinical practice for decades. The chronic fatigue syndrome case definition was created to standardize the patient population in research studies and to foster a systematic and comprehensive approach to the attempt to define the etiology and pathophysiology of these syndromes. The pathogenesis of chronic fatigue syndrome remains unknown, though it does appear to be associated with subtle neuroendocrine and immunologic abnormalities. Treatment of chronic fatigue syndrome is empirical. Significant palliation is often possible, though treatment success requires skillful practice of the art of medicine.

 

Source: Goshorn RK. Chronic fatigue syndrome: a review for clinicians. Semin Neurol. 1998;18(2):237-42. http://www.ncbi.nlm.nih.gov/pubmed/9608620

 

Chronic fatigue syndrome: a literature review from a physiatric perspective

Abstract:

To examine the literature on chronic fatigue syndrome (CFS), especially as it relates to cognitive deficits and exercise, more than 200 articles related to CFS were selected from computer-based research as well as pertinent articles noted in the references of individual articles. All were relevant articles on CFS, although articles in a foreign language were excluded. CFS is a controversial diagnosis of exclusion, but certain subgroups do appear to exist. It may represent multiple diseases or multiple stages of the same disease. Although cognitive deficits are commonly reported, the measured impairments are relatively subtle and are in the area of complex information processing speed, or efficiency.

Magnetic resonance imaging, single-photon emission computer tomography, and neuroendocrine studies present preliminary evidence suggestive of the cerebral involvement primarily in the white matter. The weakness and fatigue may be the result of alterations in the central nervous system, not in the peripheral muscles. However, it is hard to separate the documented weakness and endurance deficits from deconditioning.

Autonomic symptoms such as orthostatic intolerance and a predisposition to neurally mediated syncope may be explained by cardiovascular deconditioning, a postviral idiopathic autonomic neuropathy, or both. The review points out the need for more carefully designed studies of CFS that focus on the relationship between neuropathology, psychopathology and neuropsychologic functioning. The role of exercise as a stimulus for exacerbation or in treatment needs to be further studied using clear diagnostic criteria as well as control groups that carefully match the activity level.

 

Source: Jain SS, DeLisa JA. Chronic fatigue syndrome: a literature review from a physiatric perspective. Am J Phys Med Rehabil. 1998 Mar-Apr;77(2):160-7. http://www.ncbi.nlm.nih.gov/pubmed/9558019

 

Chronic fatigue syndrome: an update

Abstract:

Among the many patients who seek medical care for the complaint of fatigue, a small number suffer from chronic fatigue syndrome (CFS). CFS is a poorly understood condition characterized by debilitating fatigue and associated symptoms lasting at least six months. Studies indicate that the illness is not simply a manifestation of an underlying psychiatric disorder, but rather is an illness characterized by activation of the immune system, various abnormalities of several hypothalamic-pituitary axes, and reactivation of certain infectious agents.

 

Source: Komaroff AL, Buchwald DS. Chronic fatigue syndrome: an update. Annu Rev Med. 1998;49:1-13. http://www.ncbi.nlm.nih.gov/pubmed/9509246

 

Chronic fatigue syndrome

Abstract:

Chronic fatigue syndrome is a controversial disease entity. Opinions range from non-disease via psychiatric disorder to a somatic disturbance. Somatic pathogenetic hypotheses include persisting infections, intoxications, metabolic or immunologic disturbances, nervous system diseases and endocrine pathology. None of these hypotheses has been substantiated as yet. Psychological factors are important in the course of the disorder and can be used in the therapeutic approach of patients with chronic fatigue syndrome.

 

Source: van der Meer JW. Chronic fatigue syndrome. Ned Tijdschr Geneeskd. 1997 Aug 2;141(31):1507-9. [Article in Dutch] http://www.ncbi.nlm.nih.gov/pubmed/9543735

 

Chronic fatigue syndrome and occupational health

Abstract:

Chronic fatigue syndrome (CFS) is a controversial condition that many occupational physicians find difficult to advise on. In this article we review the nature and definition of CFS, the principal aetiologic hypotheses and the evidence concerning prognosis. We also outline a practical approach to patient assessment, diagnosis and management. The conclusions of this review are then applied to the disability discrimination field. The implications of the new UK occupational health legislation are also examined. Despite continuing controversy about the status, aetiology and optimum management of CFS, we argue that much can be done to improve the outcome for patients with this condition. The most urgent needs are for improved education and rehabilitation, especially in regard to employment. Occupational physicians are well placed to play an important and unique role in meeting these needs.

 

Source: Mounstephen A, Sharpe M. Chronic fatigue syndrome and occupational health. Occup Med (Lond). 1997 May;47(4):217-27. http://occmed.oxfordjournals.org/content/47/4/217.long (Full article)

 

Chronic fatigue syndrome

Abstract:

Fatigue is one of the most common medical complaints. Sometimes, fatigue is chronic, unexplained and induces significant distress or impairment in social, occupational or other important areas of functioning. This condition was described as neurasthenia by Beard at the end of the 19th Century; more recently the United States Centers for Disease Control and Prevention (CDC) suggested to call it “Chronic Fatigue Syndrome” (SFC). Both are considered as physical diseases and share certain therapeutic measures. Pathophysiology is still unknown and may involve viral agents, immunological processes or psychiatric disorders. Similarly most of the treatments which have been properly evaluated seem to be more or less inefficacious.

 

Source: Rouillon F, Delhommeau L, Vinceneux P. Chronic fatigue syndrome. Presse Med. 1996 Dec 21;25(40):2031-6. [Article in French] http://www.ncbi.nlm.nih.gov/pubmed/9082378

 

Is there a postinfection fatigue syndrome?

Abstract:

Prolonged fatigue syndromes are common in general practice. Most of these syndromes are secondary to other common medical or psychological disorders. It appears, however, that some specific infectious illnesses are associated with prolonged recovery. Theories as to the mechanisms for such post infection fatigue syndromes include a range of immunological, psychological and neurobiological processes. Current evidence suggests disruption of fundamental central nervous system mechanisms, such as the sleep-wake cycle and the hypothalamic-pituitary-adrenal axis, may underpin the clinical features of this disorder. Treatment should focus on the provision of continuous medical care, physical rehabilitation and adjunctive psychological therapies.

 

Source: Hickie I, Lloyd A, Wakefield D, Ricci C. Is there a postinfection fatigue syndrome? Aust Fam Physician. 1996 Dec;25(12):1847-52. http://www.ncbi.nlm.nih.gov/pubmed/9009004

 

Chronic fatigue syndrome. Summary of a report of a joint committee of the Royal Colleges of Physicians, Psychiatrists and General Practitioners

Abstract:

Chronic Fatigue Syndrome (CFS) is not a single diagnostic entity. It is a symptom complex which can be reached by many different routes. The conceptual model of CFS needs to be changed from one determined by a single cause/agent to one in which dysfunction is the end stage of a multifactorial process. Although it is important to recognise the role of factors that precipitate the condition, greater understanding is required of factors that predispose individuals to develop the illness, and those that perpetuate disability.

 

Source: Wessely S. Chronic fatigue syndrome. Summary of a report of a joint committee of the Royal Colleges of Physicians, Psychiatrists and General Practitioners. J R Coll Physicians Lond. 1996 Nov-Dec;30(6):497-504. http://www.ncbi.nlm.nih.gov/pubmed/8961200

 

Myths dispelled about chronic fatigue syndrome

Chronic fatigue syndrome, despite being commonly known as “yuppie flu,” is not restricted to any social class or occupational group, according to a report by the Royal Colleges of Physicians, Psychiatrists, and General Practitioners.

The report, written at the request of the chief medical officer, Kenneth Calman, aims to dispel some of the popular myths surrounding this controversial condition. It says that there is no convincing evidence that common viral infections cause the chronic fatigue syndrome, although 10% of those with Epstein-Barr virus develop the syndrome.

You can read the rest of this article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2359076/pdf/bmj00562-0011.pdf

 

Source: Mulube M. Myths dispelled about chronic fatigue syndrome. BMJ. 1996 Oct 5;313(7061):839. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2359076/

 

Neurobiology of chronic fatigue syndrome

Abstract:

1. Chronic fatigue syndrome (CFS) is characterized by a new onset of significant fatigue for a period of six months or longer usually following an infection, injury or period of high stress.

2. The exact etiology of CFS is not known and a diagnostic test is not available. Hence, the diagnosis is made by exclusion of other explanations for the patient’s symptoms and by meeting the CDC research case definitions. Early studies supported an infectious or immune dysregulation hypothesis for the pathophysiology of CFS.

3. Subsequent studies documented that neurological, affective and cognitive symptoms also occur at high rates in CFS patients. Neuropsychological, neuroendocrine studies and brain imaging have now confirmed the occurrence of neurobiological abnormalities in most patients with CFS.

4. In this article, the authors review these findings in relation to the clinical neurobiology of CFS and their potential relevance to biological psychiatry.

 

Source: Gonzalez MB, Cousins JC, Doraiswamy PM. Neurobiology of chronic fatigue syndrome. Prog Neuropsychopharmacol Biol Psychiatry. 1996 Jul;20(5):749-59. http://www.ncbi.nlm.nih.gov/pubmed/8870062