Adolescent health (incl. section on CFS), 2022, Walsh & Nicholson

[Dolphin]

I would be very interested in seeing the full text of this paper/book chapter written by 2 Irish paediatricians if anyone was able to access it.

These 2 paediatricians have been deemed sympathetic by some people to the condition so it would be interesting to know more about their views as there are few other options in Ireland.

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Adolescent health

Órla Walsh Alf John Nicholson

Órla Walsh MB BCh BAO LRCPI & LRCSI MSc Ed FRCPCH is a Consultant Paediatrician with a special interest in Adolescent Medicine at Children’s Health Ireland, Temple Street, Dublin, Ireland. Competing interests: none declared

Alf John Nicholson FRCPI FRCPCH is a Professor of Paediatrics and Head of the School of Medicine, RCSI, Bahrain. Competing interests: none declared


"Important contributors to morbidity among adolescents include substance use, sexually transmitted infections (STIs), mental illness (e.g. eating disorders), non-communicable diseases (e.g. obesity), and other chronic issues (e.g. chronic fatigue syndrome) which impact their quality of life."


"Keywords: adolescence/adolescents; chronic fatigue syndrome; development/neurodevelopment mental illness/eating disorders puberty/growth

Includes:
"We understand the impact that chronic fatigue syndrome can have on a young person's life and can describe assessment and management of this condition in detail. This is one of several conditions occurring in adolescence that will be …"


https://www.sciencedirect.com/science/article/abs/pii/S2666869622000355

 

[BrightCandle]

Given the rest of the abstract this is going to be about the environment impacting the adolescents psychological health and resulting in CFS. There is no chance that assessment and management ends up NICE 2021 compliant since its thrown in with mental illnesses. I am really interested to read how STIs are caused by mental health though that is going to be a classic.

 

[cassava7]

The authors recognize the main symptoms (PEM first and foremost) and degrees of severity of ME. They recommend a full biological workup, a neurological evaluation and also advise screening for POTS.

However they advise against oversleeping, prolonged bed rest and complete inactivity as they say it leads to deconditioning, and they recommend CBT which they say there is “strong evidence” for.

Here is the excerpt on CFS:

Chronic fatigue syndrome (CFS)

Chronic fatigue syndrome (CFS), as the name suggests, is a long-term illness with a wide range of symptoms including extreme fatigue and general malaise after minimal effort with the result that it becomes very challenging to perform tasks and activities.

In CFS, symptoms cannot be explained by another cause and are present for four months in an adult or three months in a child or young person. The pattern and severity of symptoms vary greatly and range from mild to severe.

Major symptoms include post-exertional malaise, cognitive dysfunction, sleep disturbance, muscle pain, joint pain, general malaise, headaches, sore throat, dizziness, painful lymph nodes, nausea, and palpitations. Younger children have a different set of symptoms with fewer cognitive or sleep problems. Tender lymphadenopathy and dizziness are more likely in preadolescents.

Those with ’mild’ symptoms are generally able to carry on everyday activities such as school—however, they may have to give up hobbies to allow extra time for rest. Those with ’moderate’ symptoms can usually no longer attend school and sleep a lot during the day. Finally, those with ’severe’ symptoms may be house or bedbound, and it takes them a long time to recover from an activity involving extra effort.

CFS is the leading cause of prolonged school absence in adolescence with 1 per cent of secondary school children missing a day a week with only 1 in 10 having received a diagnosis. About 1 in 1000 adolescents are so severely affected that they do not attend school at all.

All symptoms experienced (particularly profound fatigue) require assessment in terms of severity, onset, and course. A sleep diary should be taken. It is essential to look for a history of chronic illness or similar symptoms in either parent. Twin studies show a moderate genetic risk.

Look for evidence of postural orthostatic tachycardia syndrome during the examination by focusing on weight and height centiles and blood pressure and heart rate in both standing and laying positions. A detailed neurological examination and palpation for lymphadenopathy or hepatosplenomegaly should also be conducted.

Investigations should incorporate a FBC, CRP, ESR, blood chemistry, creatine kinase (CK), LFTs, TFTs, Epstein-Barr virus (EBV) IgM and IgG and urinalysis to exclude alternative causes of fatigue in adolescents.

Referral from primary care to a paediatric or adolescent service is warranted. A paediatrician should be able to make a diagnosis, exclude other causes, treat symptoms, provide advice about sleep and activity, and consider referral to a specialist service if required. For sleep, advise against oversleeping and to anchor wake up time to avail of the normal cortisol surge in the morning. Prolonged bed rest or complete inactivity should be avoided as physical deconditioning is likely to exacerbate the fatigue.

There is strong evidence for the effectiveness of cognitive behaviour therapy (CBT) especially in younger children and adolescents, in those with significant depression and anxiety, in athletes and others with high levels of pain. If pain is a dominant symptom and simple analgesics and CBT are ineffective, referral to a specialist pain management service is warranted. Antidepressant drugs may be helpful if there is a comorbid mood disorder; SSRIs should be considered as first choice. Be sure to allow adequate time for onset before assessing for a response.

In terms of long-term prognosis, most recover at 6 months with specialist treatment, whereas less than 10 per cent recover without specialist treatment (Box 4).

Box 4

Clinical bottom line on chronic fatigue syndrome

Chronic fatigue syndrome is the leading cause of prolonged school absence in adolescence. If suspected, advise that the child or adolescent avoid prolonged bed rest or complete physical inactivity. Analgesia for pain and cognitive behaviour therapy are effective, but early referral to a specialised service is advised and improves prognosis.

 

[Trish]

"Important contributors to morbidity among adolescents include substance use, sexually transmitted infections (STIs), mental illness (e.g. eating disorders), non-communicable diseases (e.g. obesity), and other chronic issues (e.g. chronic fatigue syndrome) which impact their quality of life."

Given the rest of the abstract this is going to be about the environment impacting the adolescents psychological health and resulting in CFS. There is no chance that assessment and management ends up NICE 2021 compliant since its thrown in with mental illnesses. I am really interested to read how STIs are caused by mental health though that is going to be a classic.

I don't read that short paragraph that way. They are simply listing health problems that cause ill health in adolescents. Some are physical diseases, some have a psychological component and some have a behavioural component. They are not saying they are all mental illnesses.