Chronic fatigue syndrome

Introduction
Fatigue refers to the universally familiar state of weariness or exhaustion resulting from physical or mental exertion. More than half of all patients entering a general hospital register a complaint of fatigability or admit to it when questioned. During World War II, fatigue was such a prominent symptom in combat personnel as to be given a separate term in medical terminology, namely combat fatigue, a term that came to be applied to practically all acute psychiatric disorders occurring in the battle field. In civilian life (our day to day life), fatigue is the main cardinal feature of chronic fatigue syndrome.

Diagnosis of chronic fatigue syndrome:
The diagnostic criteria for the chronic fatigue syndrome are the presence of persistent and disabling fatigue for at least 6 months without underlying medical disorder or psychiatric illness, along with six to eight of the following somatic or neuropsychological symptoms:

• Low grade fever
• Cervical or axillary lymph node enlargement
• Myalgias(muscle pain)
• Migrating arthralgias(joint pain)
• Sore throat, forgetfulness
• Headaches
• Difficulty in concentration and thinking,
• Irritability
• Sleep disturbances

Probable causative factors for chronic fatigue syndrome:
In one series, 85% of the patients admitted for the complaints of chronic fatigue syndrome were diagnosed finally to have anxiety neurosis or anxious depression. A patient with a bout of viral illness or infectious mononucleosis may complaint of fatigue even years after the disease. But there is no correlation between the two. Some of the patients, complaint of fatigue after minor trauma or silicone breast implantation. Colitis, hypoglycemia, brucellosis, spinal irritation infectious mononucleosis has been proposed as the cause of chronic fatigue syndrome.

Fatigue has many effects on a normal person which are as follows:

• A series of biochemical and physiologic changes in muscles and reduced capacity to generate-manifest as weakness or asthenia
• An overt disorder in behavior, taking the form of reduced output of work(work decrement) or lack of endurance
• Subjective feeling of tiredness and discomfort.

Aside from feeling weary and tired, the fatigued person is unable to deal effectively with complex problems and may behave awkwardly to a given situation. The ability to make judgment is impaired. He is unable to do his duty as a head in the household. There will not be any tendency to even make an effort for doing a work in a fatigued person.

Symptoms of chronic fatigue syndrome:
The great majority of the patients who seek medical help for unexplained chronic fatigue have some type of psychiatric illness. The usual symptoms in the patient with chronic fatigue syndrome are:

• Nervousness, irritability
• Depression
• Insomnia
• Headaches
• Dizziness
• Difficulty in concentrating
• Reduced sexual impulse
• Loss of appetite.
• Paresthesias in the feet or hands


• Pain in the muscles, shoulder, neck and joints

Medical conditions associated with fatigue:
The following conditions may be associated with fatigue:

• Muscular dystrophy.
• Congenital Myopathy.
• Amyotropic lateral sclerosis
• Patients recovering from Guillain-Barre syndrome
• Multiple sclerosis
• Parkinson's disease
• Drugs like Beta blockers, anticonvulsants
• Following chemotherapy and radiotherapy
• Myasthenia gravis
• Acute or chronic infection(like tuberculosis)
• Addison disease
• Hypothyroidism
• Pancreatic carcinoma
• Myocardial infarction
• Nutritional deficiency

Treatment of chronic fatigue syndrome:
In one study of more than 1000 patient following an infective illness, the chronic fatigue syndrome was no more frequent than in the general population. Most of the patients with chronic fatigue syndrome are suffering from depression. They are best treated with anti depressants like fluoxetine. Medical conditions like hypothyroidism should be corrected. Myalgias and arthralgias are treated with simple analgesics like acetaminophen (Tylenol). Exercise is very helpful. Meditation and yoga are also helpful in overcoming the chronic fatigue syndrome.

Did you know?
During World War II, fatigue was such a prominent symptom in combat personnel as to be given a separate term in medical terminology, namely combat fatigue, a term that came to be applied to practically all acute psychiatric disorders occurring in the battle field. In civilian life (our day to day life), fatigue is the main cardinal feature of chronic fatigue syndrome.