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Chronic unexplained fatigue

Published online by Cambridge University Press:  18 September 2015

Summary

Fatigue is a common symptom in the community and the commonest associations are with stress or mood disturbance. One in a hundred people complain of unexplained and prolonged fatigue, with half that number meeting the strictest criteria for the chronic fatigue syndrome (CFS). Discrete fatigue syndromes have been described, particularly after Epstein Barr virus infection. The majority of patients with CFS have a syndrome similar to the ICD-10 definition of neurasthenia. Mood and somatoform disorders are common comorbid or differential diagnoses.

The prognosis is poor, particularly in patients attending hospitals and those with comorbid psychiatric disorders. The aetiology of both CFS and chronic unexplained fatigue are essentially unknown, perhaps reflecting the heterogenenous natures of both the symptom and syndrome. There is reasonable evidence to suggest that particular infections may trigger both prolonged fatigue and CFS. Maintaining factors are different from triggering factors and include mood and sleep disorders, illness beliefs and behaviours, and possibly inactivity. Treatments aimed at reversing these maintaining factors show promise.

Type
Research Article
Copyright
Copyright © Cambridge University Press 1999

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References

Literature

1.Bates, DW, Buchwald, D, Lee, J, et al.A comparison of case definitions of chronic fatigue syndrome. Clin Infect Dis 1994; 18 Suppl 1: SI1–5.CrossRefGoogle ScholarPubMed
2.Buchwald, D, Pearlman, T, Umali, J, et al.Functional status in patients with chronic fatigue syndrome, other fatiguing illnesses, and healthy individuals. Am J Med 1996; 101: 364–70.CrossRefGoogle ScholarPubMed
3.Wessely, SC, Hotopf, M, Sharpe, M. Chronic fatigue and its syndromes. Oxford, Oxford University Press, 1998.CrossRefGoogle Scholar
4.Lloyd, AR. Chronic fatigue and chronic fatigue syndrome: shifting boundaries and attributions. Am J Med 1998: 105: S7–10.CrossRefGoogle ScholarPubMed
5.Royal, Colleges. Chronic Fatigue Syndrome: Report of a joint working group of the Royal Colleges of Physicians, Psychiatrists and General Practitioners. 1996; CR54: 158.Google Scholar
6.Sharpe, MC, Archard, LE, Banatvala, J, et al.A report – chronic fatigue syndrome. J R Soc Med 1991; 84: 118–21.CrossRefGoogle ScholarPubMed
7.Fukuda, K, Straus, SE, Hickie, I, et al.The chronic fatigue syndrome: a comprehensive approach to its definition and study. Ann Intern Med 1994; 121: 953–9.CrossRefGoogle ScholarPubMed
8.Pawlikowska, T, Chalder, T, Hirsch, SR, et al.Population based study of fatigue and psychological distress. Br Med J 1994; 308: 763–6.CrossRefGoogle ScholarPubMed
9.Hadler, NM. Fibromyalgia, chronic fatigue, and other iatrogenic diagnostic algorithms. Postgrad Med 1997: 102: 161–7.CrossRefGoogle ScholarPubMed
10.Quintner, JL, Cohen, ML. Fibromyalgia falls foul of a fallacy. Lancet 1999; 353: 1092–4.CrossRefGoogle ScholarPubMed
11.White, PD, Grover, SA, Kangro, HO, et al.The validity and reliability of the fatigue syndrome that follows glandular fever. Psychol Med 1995; 25: 917–24.CrossRefGoogle ScholarPubMed
12.Hickie, I, Lloyd, A, Hadzi-Pavlovic, D, et al.Can the chronic fatigue syndrome be defined by distinct clinical features? Psychol Med 1995; 25: 925–35.CrossRefGoogle ScholarPubMed
13.World Health Organisation I.C.D.-10 Chapter V, Mental and Behavioural Disorders: Diagnostic Criteria for Research. Geneva, World Health Organisation, 1990; 1137.Google Scholar
14.Hickie, I, Koschera, A, Hadzi-Pavlovic, D, et al.The temporal stability and co-morbidity of prolonged fatigue; a longitudinal study in primary care. Psychol Med 1999; 29: 855–61.CrossRefGoogle ScholarPubMed
15.Van der Linden, G, Chalder, T, Hickie, I, et al.Fatigue and psychiatric disorder: different or the same? Psychol Med 1999: 29: 863–8.CrossRefGoogle ScholarPubMed
16.Meringakas, K, Angst, J. Neurasthenia in a longitudinal cohort study of young adults. Psychol Med 1994: 24: 1013–24.CrossRefGoogle Scholar
17.Manu, P, Lane, TJ, Matthews, DA. Chronic fatigue and chronic fatigue syndrome: clinical epidemiology and aetiological classification. Ciba Found Symp 1993; 173: 2331.Google ScholarPubMed
18.Magnusson, A, Nias, DKB, White, PD. Is perfectionism associated with fatigue? J Psychosom Res 1996; 41: 377–83.CrossRefGoogle ScholarPubMed
19.Blakely, AA, Howard, RC, Sosich, RM, et al.Psychiatric symptoms, personality and ways of coping in chronic fatigue syndrome. Psychol Med 1991; 21: 347–62.CrossRefGoogle ScholarPubMed
20.Straus, SE, Dale, JK, Wright, R, Metcalfe, DD. Allergy and the chronic fatigue syndrome. J Allergy Clin Immunol 1988; 81: 791–5.CrossRefGoogle ScholarPubMed
21.Benjamin, JE, Hoyt, RC. Disability following postvaccinal (yellow fever) hepatitis: a study of 200 patients manifesting delayed convalescence. JAMA 1945; 128: 319–24.CrossRefGoogle Scholar
22.Lambore, S, McSherry, J, Kraus, AS. Acute and chronic symptoms of mononucleosis. J Fam Pract 1991; 33: 33–7.Google ScholarPubMed
23.Muller, R, Nylander, I, Larsson, LE, et al.Sequelae of primary aseptic meningo-encephalitis. A clinical, sociomedical, electro-encephalographic and psychological study. Acta Psychiatr Neurol Scand 1958; 33 (Suppl. 126): 1115.Google Scholar
24.Lepow, ML, Coyne, N, Thompson, LB, et al.A clinical, epidemiological and laboratory investigation of aseptic meningitis during the four-year period, 1955–1958. II. The clinical disease and its sequelae. N Engl J Med 1962; 266: 1188–93.CrossRefGoogle ScholarPubMed
25.Wessely, S, Chalder, T, Hirsch, S, et al.Postinfectious fatigue: prospective cohort study in primary care. Lancet 1995; 345: 1333–8.CrossRefGoogle ScholarPubMed
26.Hotopf, M, Noah, N, Wessely, S. Chronic fatigue and psychiatric morbidity following viral meningitis; a controlled study. J Neurol Neurosurg Psychiatry 1996; 60: 495503.CrossRefGoogle ScholarPubMed
27.Berelowitz, GJ, Burgess, AP, Thanabalasingham, T, et al.Posthepatitis syndrome revisited. J Viral Hepat 1995; 2: 133–8.CrossRefGoogle ScholarPubMed
28.White, PD, Thomas, JM, Amess, J, et al.Incidence, risk and prognosis of acute and chronic fatigue syndromes and psychiatric disorders after glandular fever. Br J Psychiatry 1998; 173:475–81.CrossRefGoogle ScholarPubMed
29.Marmion, BP, Shannon, M, Maddocks, I, et al.Protracted debility and fatigue after acute Q fever. Lancet 1996; 347: 977–8.CrossRefGoogle ScholarPubMed
30.Ayres, JG, Flint, N, Smith, EG, et al.Postinfection fatigue syndrome following acute Q fever: follow up study of patients involved in the 1989 outbreak in the West Midlands. Q J Med 1998; 91: 105–23.CrossRefGoogle Scholar
31.Theorell, T, Blomkvist, V, Lindh, G, et al.Critical life events, infections, and symptoms during the year preceding chronic fatigue syndrome (CFS): an examination of CFS patients and subjects with a non-specific life crisis. Psychosom Med 1999; 61: 304–10.CrossRefGoogle Scholar
32.Bruce-Jones, WDA, White, PD, Thomas, JM, et al.The effect of social adversity on the fatigue syndrome, psychiatric disorders and physical recovery, following glandular fever. Psychol Med 1994; 24: 651–9.CrossRefGoogle ScholarPubMed
33.Ray, C, Jefferies, S, Weir, WRC. Life events and the course of chronic fatigue syndrome. Br J Med Psychol 1995; 68: 323–31.CrossRefGoogle ScholarPubMed
34.Fekety, R. Infection and chronic fatigue syndrome. In: Straus, SE (ed). Chronic Fatigue Syndrome. New York, Marcel Dekker Ine, 1994, pp 101–79.Google Scholar
35.Strober, W. Immunological function in chronic fatigue syndrome. In: Straus, SE (ed). Chronic Fatigue Syndrome. New York, Marcel Dekker Ine, 1994, pp 207–37.Google Scholar
36.Peakman, M, Deale, A, Field, R, et al.Clinical improvement in chronic fatigue syndrome is not associated with lymphocyte subsets of function or activation. Clin Immunol Immunopath 1997; 82: 8391.CrossRefGoogle ScholarPubMed
37.Stokes, MJ, Cooper, RG, Edwards, RH. Normal muscle strength and fatiguability in patients with effort syndrome. Br Med J 1988; 297: 1014–7.CrossRefGoogle Scholar
38.Rutherford, OM, White, PD. Human quadriceps strength and fatiguability in patients with post viral fatigue. J Neurol Neurosurg Psychiatry 1991; 54: 961–4.CrossRefGoogle ScholarPubMed
39.Fulcher, KY, White, PD. Disability, strength and physiological response to exercise in patients with the chronic fatigue syndrome. Submitted.Google Scholar
40.Fulcher, KY, White, PD. Randomised controlled trial of graded exercise in patients with the chronic fatigue syndrome. Br Med J 1997;314:1647–52.CrossRefGoogle ScholarPubMed
41.Riley, MS, O'Brien, CJ, McCluskey, DR, et al.Aerobic work capacity in patients with chronic fatigue syndrome. Br Med J 1990; 301:953–6.CrossRefGoogle ScholarPubMed
42.Demitrack, MA, Dale, JK, Straus, SE, et al.Evidence for impaired activation of the hypothalamic-pituitary-adrenal axis in patients with chronic fatigue syndrome. J Clin Endocrinol Metabol 1991; 73: 1224–34.CrossRefGoogle ScholarPubMed
43.Young, AH, Sharpe, M, Clements, A, et al.Basal activity of the hypothalamic-pituitary-adrenal axis in patients with the chronic fatigue syndrome (neurasthenia). Biol Psychiatry 1998; 43: 236–7.CrossRefGoogle ScholarPubMed
44.Leese, G, Chattington, P, Fraser, W, et al.Short-term night-shift working mimics the pituitary-adrenocortical dysfunction of chronic fatigue syndrome. J Clin Endocrinol Metab 1996; 81: 1867–70.Google ScholarPubMed
45.Morriss, R, Sharpe, M, Sharpley, AL, et al.Abnormalities of sleep in patients with the chronic fatigue syndrome. Br Med J 1993; 306: 1161–4.CrossRefGoogle ScholarPubMed
46.Manu, P, Lane, TJ, Matthews, DA, et al.Alpha-delta sleep in patients with a chief complaint of chronic fatigue. South Med J 1994; 87: 465–70.CrossRefGoogle ScholarPubMed
47.Sharpe, M, Hawton, K, Seagroatt, V, Pasvol, G. Follow up of patients presenting with fatigue to an infectious diseases clinic. Br Med J 1992; 305: 147–52.CrossRefGoogle Scholar
48.Moss-Morris, R, Petrie, KJ. Functioning in chronic fatigue syndrome: do illness perceptions play a regulatory role? Br J Health Psychol 1996; 1: 1525.CrossRefGoogle Scholar
49.Vercoulen, JHMM, Swanink, CMA, Galama, JMD, et al.The persistence of fatigue in chronic fatigue syndrome and multiple sclerosis: development of a model. J Psychosom Res 1998; 45: 507–17.CrossRefGoogle ScholarPubMed
50.Joyce, J, Hotopf, M, Wessely, S. The prognosis of chronic fatigue and chronic fatigue syndrome: a systematic review. Q J Med 1997; 90: 223–33.CrossRefGoogle ScholarPubMed
51.Wilson, A, Hickie, I, Lloyd, A, et al.Longitudinal study of outcome of chronic fatigue syndrome. Br Med J 1994; 308: 756–9.CrossRefGoogle ScholarPubMed
52.Clark, MR, Katon, W, Russo, J, et al.Chronic fatigue: risk factors for symptom persistence in a 2.5 year follow-up study. Am J Med 1995; 98: 187–95.CrossRefGoogle Scholar
53.Vercoulen, JHMM, Swanink, CMA, Fennis, JFM, et al.Prognosis in chronic fatigue syndrome: a prospective study on the natural course. J Neurol Neurosurg Psychiatry 1996; 60: 489–94.CrossRefGoogle ScholarPubMed
54.Lloyd, A, Hickie, I, Boughton, R, et al.Immunologic and psychologic therapy for patients with chronic fatigue syndrome: A double-blind, placebo-controlled trial. Am J Med 1993; 94: 197203.CrossRefGoogle ScholarPubMed
55.Sharpe, M, Hawton, K, Simkin, S, et al.Cognitive behaviour therapy for the chronic fatigue syndrome: a randomised controlled trial. Br Med J 1996; 312: 22–6.CrossRefGoogle Scholar
56.Deale, A, Chalder, T, Marks, I, Wessely, S. Cognitive behavior therapy for chronic fatigue syndrome: a randomized controlled trial. Am J Psychiatry 1997; 154: 408–14.Google ScholarPubMed
57.Wearden, A, Morriss, R, Mullis, R, et al.A randomised, double-blind, placebo controlled treatment trial of fluoxetine and a graded exercise programme for chronic fatigue syndrome. Br J Psychiatry 1998; 172: 485–90.CrossRefGoogle Scholar
58.Deale, A, et al.Illness beliefs and treatment outcome in chronic fatigue syndrome. J Psychosom Res 1998; 45: 7783.CrossRefGoogle ScholarPubMed
59.Vercoulen, J, Swanink, C, Zitman, F, et al.Fluoxetine in chronic fatigue syndrome: a randomized, double-blind, placebo-controlled study. Lancet 1996; 347: 858–61.CrossRefGoogle Scholar
60.Goldenberg, DL, Felson, DT, Dinerman, H. A randomized, controlled trial of amitriptyline and naproxen in the treatment of patients with fibromyalgia. Arthr Rheum 1986; 29: 1371–7.CrossRefGoogle ScholarPubMed
61.McKenzie, R, O'Fallon, A, Dale, J, et al.Low-dose hydrocortisone for treatment of chronic fatigue syndrome: a randomized controlled trial. JAMA 1998; 280: 1061–6.CrossRefGoogle ScholarPubMed
62.Cleare, AJ, Heap, E, Malhi, GS, et al.Low-dose hydrocortisone in chronic fatigue syndrome: a randomised crossover trial. Lancet 1999; 353: 455–8.CrossRefGoogle ScholarPubMed
63.Rowe, KS. Double-blind randomized controlled trial to assess the efficacy of intra-venous gammaglobulin for the management of chronic fatigue syndrome in adolescents. J Psychiatr Res 1997; 133–47.CrossRefGoogle Scholar
64.Vollmer-Conna, U, Hickie, I, Hadzi-Pavolvic, D, et al.Intravenous immunoglobulin is ineffective in the treatment of patients with chronic fatigue syndrome. Am J Med 1997; 102: 3843.CrossRefGoogle Scholar
65.Marlin, RG, Anchel, H, Gibson, JC, et al.An evaluation of multidis-ciplinary intervention for chronic fatigue syndrome with long-term follow-up, and a comparison with untreated controls. Am J Med 1998; 105: SI10–4.CrossRefGoogle Scholar