Chronic Fatigue Syndrome: Time For Clarity

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Chronic Fatigue Syndrome Time For Clarity
Justin Beilby Professor of General Practice
University of Adelaide
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Talk Outline

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

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Background

• Females Males 2 1
• Peaks 15-20 yrs and 33-45 years
• 0.5 of patients attending general practice
• SA 3000-7000 sufferers
• All groups across society

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Symptoms usually worsened with minimal physical
and mental exertion.
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Diagnosis

• Persistent fatigue, relapsing fatigue gt 6 months
  
• Is of new or definite onset
• Is not the result of ongoing exertion
• Is not substantially relieved by rest
• Results in previous reduction in occupational,
  educational, social and personal activities
• AND

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Diagnosis

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

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Cause not well understood
Positive diagnosis first key step
Examination and tests normal
Watch depression and anxiety overlap
Flexibility re management
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Management Whole person

• Activity Management
• Sleep
• Mood
• Prognosis
• Family/Carer

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Activity Management

• Graded exercise programs
• Recent Australian Medical Journal of Australia
• Graded exercise program for 68 volunteers for 12
  weeks
• Walking, cycling, swimming every second day
• Unless relapse then reduced
• Flexible pacing
• Results
• Improved blood pressure
• Work capacity improved
• Less depression and less mental fatigue

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Sleep

• Avoid daytime sleep
• Attempt to develop good sleep hygiene
• Appropriate medications for short periods
• Non prescriptions medication St Johns Wort,
  Valerian

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Mood

• Counselling
• Patient centre realistic goals
• Medications at times
• Cognitive behavioural therapy (CBT)
• how we think impacts on our illness
• aim to alter these negative perceptions

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Prognosis

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

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Children and Adolescents

• Dynamic individuals with multiple goals
• Early intervention debate re 3-6 months
  duration
• Supportive plan involving all players including
  schools
• Peer support/academic activity/open access
  schooling

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Family and Carer

• Support and Counselling

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What does this mean to you/us

• Make the diagnosis
• Find someone who feels comfortable to manage this
  
• Build a partnership with a health care provider
• Educate all health care providers
• Overall Community Education

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Resources

• www.co-cure.org
• www.ahmf.org
• www.afme.org.uk

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GP Guidelines

• Chaired a group of experts
• Clear and brief guidelines
• Now can be used by GPs
• Consumers can move this process forward

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Consumer and Community Driven Change

• Women with breast cancer screening
• Men with prostate cancer
• The use of natural therapies in depression and
  anxiety

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CFS is a sufficient indignity by itself do not
compound this. It takes considerable time and
infinite patience to take an accurate history
from a frail patient with impaired memory and
concentration, especially if that history is long
and complex. Resist the temptation of a hurried,
superficial evaluation. English JAMA 1991.

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