Chronic fatigue syndrome (N) Flashcards
What is chronic fatigue syndrome also known as?
Myalgic encephalomyelitis (ME/CFS)
Define chronic fatigue syndrome.
Characterised by sudden/gradual onset of persistent disabling fatigue, post-exertional malaise (PEM), unrefreshing sleep, cognitive and autonomic dysfunction, and pain, with symptoms lasting at least 6 months
6+ months of disabling fatigue affecting mental and physical function more than 50% of the time
Which demographics is chronic fatigue syndrome most common in? (3)
- F>M (3:1)
- adolescence
- 30-50y
What are the clinical features of chronic fatigue syndrome? (13)
- persistent disabling fatigue (6+ months)
- post-exertional malaise (PEM)/fatigue
- short-term memory or concentration impairment
- sore throat
- generalised arthralgia (joint stiffness)
- headache/migraine
- unrefreshing sleep
- flu-like Sx (may precede fatigue) - malaise, myalgia, fever
- painful lymph nodes
- orthostatic intolerance
- dizziness/light-headedness
- anxiety, affective disorder
- sensations of altered temperature or feverishness
What is post-exertional malaise (PEM)/fatigue in chronic fatigue syndrome?
Significant exhaustion and impairment following minimal physical or cognitive effort
What are some risk factors for chronic fatigue syndrome? (5)
- female sex
- EBV infection in adolescence
- family Hx
- infectious diseases (enteroviral gastritis, Lyme disease)
- autoimmunity
What is the first-line investigation for chronic fatigue syndrome?
DePaul symptom questionnaire
What is the DePaul symptom questionnaire (chronic fatigue syndrome)?
- first-line Ix - validated screening tool for ME/CFS
- both frequency and severity of ME/CFS Sx are combined to form an overall indicator for each Sx
- checklist of 54 items provides a thorough evaluation and grading of patient complaints
What bloods do we do for chronic fatigue syndrome and why?
- FBC, U&Es, LFTs, glucose, TFTs, ESR, CRP, calcium, CK, ferritin, coeliac screening, urinalysis
- exclude other diagnoses
What is post-exertional neuroimmune exhaustion (PENE) in chronic fatigue syndrome? (5)
Compulsory feature of ME/CFS
- marked, rapid physical and/or cognitive fatiguability in response to exertion
- post-exertional symptom exacerbation
- post-exertional exhaustion
- prolonged recovery period
- low threshold of physical and mental fatiguability resulting in substantial reduction in pre-illness activity levels
What symptom categories do you need at least one present to be diagnosed with chronic fatigue syndrome? (3)
- neurological impairments
- immune, GI and genitourinary impairments
- energy production/transportation symptoms
What are some differential diagnoses for chronic fatigue syndrome? (10)
- migraine
- anxiety
- MDD
- reactions to life crises
- sleep apnoea
- fibromyalgia - widespread pain, lower abdomen; fatigue, sleep, cognitive and somatic complaints (hard to distinguish from ME/CFS)
- Ehlers-Danlos syndrome
- dehydration
- infectious mononucleosis
- IBS
What makes chronic fatigue syndrome a difficult diagnosis?
There are no objective diagnostic tests, verified biomarkers, curative medications, or treatments for ME/CFS
What is first-line management for chronic fatigue syndrome? (1+5)
Individualised therapy –> manage Sx and improve functional capacity:
- CBT - very effective
- graded exercise therapy
- low-dose amitriptyline
- referral to pain management clinic if pain is a predominant feature
- mindfulness, sleep hygiene, occupational therapy
How do we manage sleep difficulties in chronic fatigue syndrome? (4)
- hygiene
- CBT
- trazodone
- low dose TCA
