Endocrine Abstracts

Case Definition
Psychiatrists, probably because of their experience with poorly understood and symptom-defined conditions have had a major role in generating workable definitions for clinically significant idiopathic fatigue. This is currently termed chronic fatigue syndrome (CFS). Although the working definitions of chronic fatigue syndrome have been valuable in achieving comparability of resarch studies, their validity must not be over stated. There is overlap between CFS and other symptom syndromes including pain, depression, and anxiety.
Aetiology
Psychiatric research into the aetiology of chronic fatigue syndrome has found previous depression to be a risk factor and illness beliefs to be predictive in established cases. It has not identified a specific cause.
Patient Assessment
Depression and anxiety are differential diagnoses for CFS because of the implication for treatment. Reduced activity and fear of the effect of activity appear to be key factors in the perpetuation of CFS.
Treatment
Psychiatric treatments in the form of rehabilitative therapies including cognitive behaviour therapy (CBT) address the identified aetiological factors and currently have the strongest evidence base and are supported at the level of the systematic review.
Practical management
On a practical and political level, there has been much hostility to the above contribution of psychiatrists to the understanding and management of CFS. This is related at least in part to widely held dualist beliefs and associated values about the nature of illness.
Implications
If we are to develop effective approaches to managing CFS and associated syndromes that are acceptable to patients we must change the emphasis from disease based single speciality management to a multi-speciality chronic illness management and rehabilitation programme.
References
Wessley, Hotopf and Sharpe (1998) Chronic Fatigue and its Syndromes, OUP
Campling and Sharpe (2000) Chronic Fatigue Syndrome: the facts, OUP