Chronic Fatigue Syndrome: Time For Clarity

Department of General Practice

Chronic Fatigue Syndrome: Chronic Fatigue Syndrome: Time For Clarity Time For Clarity

Justin Beilby Justin Beilby Professor of General Practice Professor of General Practice University of Adelaide University of Adelaide


Talk OutlineTalk Outline

• Background Background • How to Diagnose How to Diagnose • Management Management • Prognosis Prognosis • Role of patient/family Role of patient/family


Background Background

• Females: Males – 2: 1Females: Males – 2: 1

• Peaks 15-20 yrs and 33-45 years Peaks 15-20 yrs and 33-45 years

• 0.5% of patients attending general practice 0.5% of patients attending general practice

• SA – 3000-7000 sufferers SA – 3000-7000 sufferers

• All groups across society All groups across society


Symptoms usually worsened with Symptoms usually worsened with minimal physical and mental exertionminimal physical and mental exertion. .


Diagnosis Diagnosis

Persistent fatigue, relapsing fatigue > 6 months Persistent fatigue, relapsing fatigue > 6 months • Is of new or definite onset Is of new or definite onset • Is not the result of ongoing exertion Is not the result of ongoing exertion • Is not substantially relieved by rest Is not substantially relieved by rest • Results in previous reduction in occupational, Results in previous reduction in occupational,

educational, social and personal activities educational, social and personal activities

• AND AND


Diagnosis Diagnosis

• Muscle aches and painsMuscle aches and pains• Unrefreshing sleep Unrefreshing sleep • Poor concentration and memory Poor concentration and memory • Stomach symptoms Stomach symptoms • Low blood pressureLow blood pressure• Unusual headaches Unusual headaches

Cause not well understood Cause not well understood

Positive diagnosis first key step Positive diagnosis first key step

Examination and tests normalExamination and tests normal

Watch depression Watch depression and anxiety overlap and anxiety overlap

Flexibility re Flexibility re management management


Management – Whole person Management – Whole person

• Activity Management Activity Management

• Sleep Sleep

• Mood Mood

• Prognosis Prognosis

• Family/Carer Family/Carer


Activity Management Activity Management

• Graded exercise programs Graded exercise programs – Recent Australian Medical Journal of Australia Recent Australian Medical Journal of Australia

• Graded exercise program for 68 volunteers for 12 weeks Graded exercise program for 68 volunteers for 12 weeks – Walking, cycling, swimming every second day Walking, cycling, swimming every second day – Unless relapse then reduced Unless relapse then reduced – Flexible – “pacing” Flexible – “pacing”

• Results Results – Improved blood pressure Improved blood pressure – Work capacity improved Work capacity improved – Less depression and less mental fatigue Less depression and less mental fatigue


Sleep Sleep

• Avoid daytime sleepAvoid daytime sleep

• Attempt to develop good sleep hygiene Attempt to develop good sleep hygiene

• Appropriate medications for short periodsAppropriate medications for short periods • Non – prescriptions medication – St John’s Wort, Non – prescriptions medication – St John’s Wort,

Valerian Valerian


Mood Mood

• Counselling Counselling

• Patient centre realistic goalsPatient centre realistic goals

• Medications at times Medications at times

• Cognitive behavioural therapy (CBT) Cognitive behavioural therapy (CBT) – how we think impacts on our illness how we think impacts on our illness – aim to alter these negative perceptions aim to alter these negative perceptions


Prognosis Prognosis

• VariableVariable• Most patients will improve over 3-5 years Most patients will improve over 3-5 years • Fluctuations and relapsesFluctuations and relapses• Need early interventions Need early interventions • Some patients will remain quite debilitated Some patients will remain quite debilitated


Children and Adolescents Children and Adolescents

• Dynamic individuals with multiple goalsDynamic individuals with multiple goals

• Early intervention – debate re 3-6 months’ durationEarly intervention – debate re 3-6 months’ duration

• Supportive plan involving all players including schoolsSupportive plan involving all players including schools

• Peer support/academic activity/open access Peer support/academic activity/open access schoolingschooling


Family and Carer Family and Carer

Support and Counselling Support and Counselling


What does this mean to you/us What does this mean to you/us

• Make the diagnosis Make the diagnosis

• Find someone who feels comfortable to manage this Find someone who feels comfortable to manage this

• Build a partnership with a health care provider Build a partnership with a health care provider

• Educate all health care providers Educate all health care providers

• Overall Community Education Overall Community Education


Resources Resources

• www.co-cure.orgwww.co-cure.org

• www.ahmf.orgwww.ahmf.org

• www.afme.org.ukwww.afme.org.uk


GP Guidelines GP Guidelines

• Chaired a group of expertsChaired a group of experts

• Clear and brief guidelinesClear and brief guidelines

• Now can be used by GPsNow can be used by GPs

• Consumers can move this process forwardConsumers can move this process forward


Consumer and Community Driven Consumer and Community Driven Change Change

• Women with breast cancer screeningWomen with breast cancer screening

• Men with prostate cancerMen with prostate cancer

• The use of natural therapies in depression and The use of natural therapies in depression and anxietyanxiety


CFS is a sufficient indignity by itself; do not CFS is a sufficient indignity by itself; do not compound this. It takes considerable time and compound this. It takes considerable time and

infinite patience to take an accurate history from a infinite patience to take an accurate history from a frail patient with impaired memory and frail patient with impaired memory and

concentration, especially if that history is long and concentration, especially if that history is long and complex. Resist the temptation of a hurried, complex. Resist the temptation of a hurried,

superficial evaluation.superficial evaluation. English JAMA 1991. English JAMA 1991.

Chronic Fatigue Syndrome: Time For Clarity

Documents

Transcript of Chronic Fatigue Syndrome: Time For Clarity