tired all the time Flashcards
define fatigue
sensation of exhaustion during or after usual activities – feeling of inadequate energy to begin these activities
how may fatigue present?
- Lack of energy, feeling weak, being too tired to participate in family, work, leisure activities
- Unpleasant physical, cognitive and emotional symptom described as tiredness not relived by common strategies that restores energy – varies in duration, intensity and reduces ability to perform usual daily activities
- Extreme tiredness, weakness or exhaustion of mental/ physical origin that is not relieved by rest
how do classify TATT
origin
attribution
duration
what can attribute to TATT?
physical illness (infection, malignancy etc), psychological, social, physiological, occupational
how do you classify duration of TATT?
recent (<1 month), prolonged (>1 mth), chronic (>6mths)
who is more common to have TATT has POC?
women
in primary care what causes 2/3 of cases of TATT?
physical / psychological
in primary care what fraction of TATT is idiopathic?
1/3
what can be organic causes of TATT?
asthma, DM, hypothyroidism, anaemia
what can be physiological causes of TATT?
pregnancy, menopause, menstruation
what can be psychological causes of TATT?
depression
what is chronic fatigue syndrome AKA?
myalgia encephalomyelitis
what is chronic fatigue syndrome?
systemic exertion intolerance disease
how would you suspect chronic fatigue syndrome?
- Needs to have fatigue with new/sudden onset, persistent/ recurrent >4mths, unexplained from other conditions, reduction in activity, post-exertional malaise from activities – can be delayed or slow recovery
- Also seen with one of the following – difficulty sleeping, muscle/ joint pain with no inflammation, headaches, painful lymph nodes and no pathology, sore throat, cognitive dysfunction, physical/ mental exertion exacerbates symptoms, general malaise/ flu like symptoms, dizzy/ nausea, palpitations with no cardiac pathology
what is the aetiology of chronic fatigue syndrome?
idiopathic but seen in within other conditions – inflame, immune, viral, endocrine dysfunction
is children and chronic fatigue worrying?
RED FLAG – need urgent referral
when would you refer an adult with suspected chronic fatigue syndrome?
- Mild symptoms - <6mths
- Moderate – 3 to 4 mths
- Severe: immediately
what is the prognosis of chronic fatigue syndrome?
most people will recover and be able to resume normal activities but some may relapse and remain housebound. The prognosis in children and young people is more optimistic
how do you manage chronic fatigue syndrome?
- Ideally want to manage symptoms and improve functional capabilities
- Initial: counselling and supportive care
- Focus on severe symptoms and address individually one at a time
- Cognitive strategies such as coping skills can improve tolerance
what supportive care can be used within chronic fatigue care?
- Exercise programmes
- Body awareness therapy
- Mindfulness
- Sleep hygiene
occupational therapy
treat comorbidities - depression etc
what is sleep hygiene?
normalisation of sleep/ wake rhythm begins by stopping daytime napping, proceeds to improve quality of sleep through relaxation therapy – reducing screen time before bed
what is needed with fatigue as POC history?
- Characterise fatigue – struggle to fall asleep? Cant stay asleep?
- Assess presence of complaints suggesting organic illness associated with fatigue – systems review
- Evaluate medicines used or substance missuse – drug and social history
- Perform psychiatric screening
- Ask questions based on sleep quantity/ quality
- Perform physical exam
- Undertake investigations
how do you characterise fatigue?
- Duration
- Sudden/ progressive onset
- Recovery period
- Impact of rest
- Impact of physical activity
- Presence of weakness
- Seasonality – SAD
what are red flags alongside fatigue?
- Significant weight loss
- Lymphadenopathy suggestive of malignancy
- Other malignancy symptoms – haemoptysis, dysphagia, rectal bleeding, breast lump, postmenopausal bleeding
- Localising focal/ neurological signs may suggest neurodegenerative condition
- Carbon monoxide poisoning
