DR Medhat MRCP

Chronic fatigue syndrome
- Diagnosed after at least 4 months of disabling fatigue affecting mental and physical
function more than 50% of the time in the absence of other disease which may
explain symptoms
• Epidemiology
More common in females
Past psychiatric history has not been shown to be a risk factor.
• Features : Fatigue + the following :
1) Sleep problems : such as insomnia, hypersomnia, un-refreshing sleep, a
disturbed sleep-wake cycle.
2) Muscle and/or joint pains.
3) Headaches.
4) Painful lymph nodes without enlargement.
5) Sore throat
6) Cognitive dysfunction e.g difficulty thinking, inability to concentrate,
impairment of short-term memory, and difficulties with word-finding
7) Physical or mental exertion makes symptoms worse.
8) General malaise or 'flu-like' symptoms.
9) Dizziness, nausea, palpitations
• Investigation :
NICE guidelines suggest carrying out a large number of screening blood tests to
exclude other pathology e.g. CBC,RFT & electrolytes , LFT, glucose, TFT, ESR, CRP,
calcium, CK, ferritin (Children and young people only), coeliac screening and also
urinalysis
• Confirm the diagnosis :
1) It must be new in onset, persistent or recurrent and unexplained by other conditions.
2) It should be characterised by post-exertional malaise.
3) It should result in a substantial reduction in activity level.
• Red flag symptoms that suggest another diagnosis :
1) Significant weight loss
2) Inflammatory arthropathy or connective tissue disease.
3) Localising or focal neurological signs
• Management
Graded exercise therapy - a formal supervised program, not advice to go to the gym
Cognitive behaviour therapy - very effective, number needed to treat = 2
'Pacing' - organising activities to avoid tiring
Low-dose amitriptyline may be useful for poor sleep
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