Tag: management

Chronic fatigue in primary care attenders

Abstract:

From 686 patients attending primary care physicians, 77 were identified by a screening procedure as having chronic fatigue. Of these, 65 were given a comprehensive psychological, social and physical evaluation.

Seventeen cases (26%) met criteria for the chronic fatigue syndrome. Forty-seven (72%) received an ICD-9 diagnosis of whom 23 had neurotic depression, with a further 5 meeting criteria for neurasthenia.

Forty-nine were ‘cases’ as defined by the revised Clinical Interview Schedule (CIS-R), and 42 if the fatigue item was excluded. Psychiatric morbidity was more related to levels of social stresses than was severity of fatigue.

The main difference between these subjects and those examined in hospital settings is that the former are less liable to attribute their symptoms to wholly physical causes, including viruses, as opposed to social or psychological factors. Identification and management of persistent fatigue in primary care may prevent the secondary disabilities seen in patients with chronic fatigue syndromes.

 

Source: McDonald E, David AS, Pelosi AJ, Mann AH. Chronic fatigue in primary care attenders. Psychol Med. 1993 Nov;23(4):987-98. http://www.ncbi.nlm.nih.gov/pubmed/8134522

 

Evaluation and management of patients with chronic fatigue

Abstract:

Chronic fatigue is a common and disabling problem in primary care practice. The differential diagnosis of chronic fatigue is extensive and includes medical disorders, altered physiologic states (eg, pregnancy, exertion), psychiatric disorders, lifestyle derangements, drugs, and controversial entities (eg, chronic candidiasis, food allergies, environmental illness, and chronic fatigue syndrome). The most common diagnoses are psychiatric disorders, including mood, anxiety, and somatoform disorders.

A comprehensive approach to diagnosis and management is necessary, including structured psychiatric interviewing, functional assessment, and elicitation of the patient’s diagnostic beliefs. Patients often believe they are suffering from an organic medical disorder (eg, viral or immunologic) and resist psychiatric labelling of their symptoms and referral to mental health practitioners. Establishing and maintaining rapport, having a flexible approach, and demonstrating a personal concern for the patient is essential. Drug therapy for specific psychiatric and medical illnesses and cognitive-behavioral approaches for enhancing coping mechanisms are effective.

 

Source: Matthews DA, Manu P, Lane TJ. Evaluation and management of patients with chronic fatigue. Am J Med Sci. 1991 Nov;302(5):269-77. http://www.ncbi.nlm.nih.gov/pubmed/1750445

 

Psychiatric management of PVFS

Abstract:

Psychiatric management of PVFS (considered as a subtype of CFS) is a pragmatic approach to a disorder for which strictly biomedical treatments have so far had little to offer. Psychiatric assessment embraces a comprehensive (biopsychosocial) approach, and distinguishes factors that perpetuate the condition from those that may have precipitated it. Treatments are targeted at perpetuating factors.

Few controlled treatment trials have been reported in patients selected specifically as meeting criteria for CFS. There is evidence available, however, that suggests useful management strategies. An uncontrolled study of treatment of CFS with combined antidepressant drug and psychological treatment has produced promising results. In addition there is useful evidence arising from the study and treatment of the individual symptoms of CFS, occurring both in isolation as part of other syndromes.

The results of controlled trials of antidepressant drugs, and of psychological and rehabilitative treatment are awaited. It is already possible to offer provisional guidelines for treatment.

 

Source: Sharpe M. Psychiatric management of PVFS. Br Med Bull. 1991 Oct;47(4):989-1005. http://www.ncbi.nlm.nih.gov/pubmed/1794095

 

The chronic fatigue syndrome. A multifactorial approach and the treatment possibilities

Abstract:

The chronic fatigue syndrome is a poorly defined symptoms complex characterized primarily by chronic or recurrent debilitating fatigue and various combinations of other symptoms, including psychological symptoms, sore throat, lymph node pain, headache, myalgia, arthralgias. Psychological disturbances, ranging from mild depression or anxiety to severe behavioral abnormalities, are always present. Chronic fatigue syndrome is the name that more accurately describes this symptom complex of unknown cause.

A viral aetiology has long been hypothesized: many viruses are potential candidates, including any of the 23 Coxsackie A or 6 Coxsackie B viruses, herpes viruses, particularly Epstein-Barr virus and varicella. These studies, though interesting, remain unconvincing because of methodological flaws such as a poor case definition and inadequate control groups.

This syndrome may represent an infection by a yet unidentified virus. It is more likely due to an abnormal immune response toward different intracellular pathogens. There is no treatment to ameliorate the chronic fatigue syndrome. Epidemiological studies are essential with explicit operational case definition before progress can be made in the management of this distressing disorder.

 

Source: Pinardi G, Scarlato G. The chronic fatigue syndrome. A multifactorial approach and the treatment possibilities. Recenti Prog Med. 1990 Dec;81(12):773-7. [Article in Italian] http://www.ncbi.nlm.nih.gov/pubmed/2075278

 

Chronic fatigue syndrome and the psychiatrist

Abstract:

The number of patients who are identified as having chronic fatigue syndrome (CFS) has increased, and as a result, chronic fatigue syndrome has received widespread attention. Research has demonstrated that cognitive, affective and behavioural symptoms are prominent in CFS. Psychiatrists are therefore being asked to participate in the assessment and management of patients with this syndrome. This paper will provide an overview of the clinical characteristics of CFS and the current empirical findings related to its pathology, and will conclude with a discussion of the management of these patients.

 

Source:  Abbey SE, Garfinkel PE. Chronic fatigue syndrome and the psychiatrist. Can J Psychiatry. 1990 Oct;35(7):625-33. http://www.ncbi.nlm.nih.gov/pubmed/2268845

 

Patient management of post-viral fatigue syndrome

Abstract:

A case definition for post-viral fatigue syndrome is proposed within which various subgroups of patients exist. Any one treatment may not apply to all the subgroups. In particular, patients’ experiences do not show that avoidance of exercise is maladaptive. It is proposed that the recently ill often try to exercise to fitness whereas the chronically ill have learnt to avoid exercise. Recovery is more likely to be achieved if patients learn about their illness and do not exhaust their available energy.

 

Source: Ho-Yen DO. Patient management of post-viral fatigue syndrome. Br J Gen Pract. 1990 Jan;40(330):37-9. http://www.ncbi.nlm.nih.gov/pubmed/2107839

Note: You may read the full article here:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1371214/