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
- unrefreshing sleep
- short-term memory or concentration impairment
- painful lymph nodes
- sore throat
- generalised arthralgia (joint stiffness)
- headache/migraine
- flu-like Sx (may precede fatigue) - malaise, myalgia, fever
- 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
How do we manage depression in chronic fatigue syndrome?
SNRI or SSRI
How do we manage anxiety in chronic fatigue syndrome?
Benzodiazepine
How do we manage fibromyalgia in chronic fatigue syndrome?
SSRI - citalopram, fluoxetine, paroxetine
How do we manage neuropathic pain in chronic fatigue syndrome?
Anticonvulsant medications - pregabalin, gabapentin
What is a complication of chronic fatigue syndrome?
Major depressive disorder
Describe the prognosis of chronic fatigue syndrome.
Longitudinal studies indicate that 17-64% of patients improve with Rx; however <10% meet criteria for full recovery, and up to 20% may worsen over time
