Chronic fatigue syndrome (CFS) is a disorder characterized by persistent and unexplained fatigue which results in impairment of daily activities. They also have vague aches and pains, poor cognitive functions like attention, memory, learning, problem solving and decision making. They develop headache, sore throat, muscle or joint aches, allergy, feverishness and abdominal cramps. Persistence of this condition may result in the development of psychiatric problems associated with difficulty in sleeping. Causes of chronic fatigue syndrome Majority of the individuals are females with age of onset in the early fourth decade of life. It is more commonly seen in lower socio-economic and education status persons. CFS may be familial in some cases. The exact cause of this condition is not known. The predisposing factors are childhood trauma like sexual abuse, emotional and physical neglect or abuse, physical inactivity or excessive activity during childhood. These events increase the risk of CFS in adults. The disorder is usually precipitated by an illness, pregnancy, surgery or stress of life. Diagnosis A complete history and systematic physical examination is essential to exclude other chronic diseases causing fatigue. Laboratory tests are done to exclude other diseases. The patient should be asked to describe the symptoms of fatigue and any associated symptoms. Their duration as well as the reduction in daily activities is recorded. Chronic fatigue by definition lasts longer than six months. The patient is asked to describe a typical day, from morning till night so as to assess symptom severity and the extent of daily-life impairment. This is then compared with earlier period when the person was asymptomatic. The potential fatigue-precipitating factors are identified. There is no test which is diagnostic of CFS though a scoring system is devised to assess the level of fatigue. A score of more than 18 indicates severe fatigue. The psychiatric disorders like bipolar disorder, schizophrenia and substance abuse should also be excluded. Hence CFS remains a diagnosis of exclusion. Majority of the CFS individuals are females in their forties. Management of CFS The treatment of these cases is mainly supportive. The impact of CFS on patient’s daily work and life is assessed by the physician. A denial by the patient may result in exacerbation of symptoms. The final assessment is discussed with the patient. Non-steroidal anti-inflammatory agents are helpful for aches and pains. Relief of these symptoms definitely improves the quality of life. Behavior therapy is helpful in the initial management. It includes educating the patient about the syndrome, setting of goals, restoration of time to sleep and wake up. Any anxiety or depression is treated. The patient should be encouraged to maintain regular sleep habits, to remain dynamic and to gradually return to previous exercise and activity levels. Patients must be encouraged to continue their daily activities and to resist their fatigue as much as possible. A minimal workload is better than complete absence from work. Psychiatric treatment of any associated depression is done to improve the outcome. Antidepressants with nonsedating properties like bupropion may be helpful. Nefazodone was found to decrease pain and improve in these patients. Graded exercise therapy has been found to be beneficial. A change in the fatigue related activities is sought. The activities are spread evenly throughout the day. Physical activity is gradually increased with a plan to return to work. The intervention involves of 12–14 sessions over a period of 6 months and usually involves a home exercise program. Walking or cycling is systematically increased, with set target heart rates. Complete recovery from untreated CFS is rare though an improvement always occurs. Patients with associated psychiatric disorder have poorer outcomes. Those who continue working and maintain social life have a better prognosis. A chronic fatigue without any other disease definitely requires an assessment by a psychiatrist. Source
