Psychiatric Clinics of North America 1996 - CHRONIC FATIGUE SYNDROME , Michael Sharpe

[Sly Saint]

Although similar illnesses have been described for many years, the chronic fatigue syndrome (CFS) was first operationally defined in 1988.48 It has subsequently become a topical and controversial illness and is now the subject of more than 800 indexed publications. Despite this volume of research, our understanding of the condition is poor and positive approaches to treatment few. A major reason for this slow progress has been the conceptual difficulties that are encountered when trying to understand illnesses that are unexplained by readily identifiable organic disease. These difficulties have hindered research into the nature and treatment of CFS and may even have played a part in shaping the illness itself.
The first part of this article briefly examines the concept of medically unexplained illness and the implications for the definition of CFS. Research into the nature and cause of CFS is then reviewed. I conclude that whereas the current concept of CFS has major shortcomings, simply replacing a medical diagnosis with a psychiatric one does not solve the clinical problem. Instead, I advocate a systematic description of each case from biologic, psychological, and social perspectives. In the second part of the article a practical evidence-based guide to the management of CFS based on this approach is outlined.

Section snippets​

Fatigue as a Symptom​

Fatigue has been defined in a variety of ways.6 Here, however, we are concerned with fatigue as a subjective feeling of weariness, lack of energy, and exhaustion.11 The feeling of fatigue is a common human experience and subjective ratings of its severity are continuously distributed in the population, 78 with approximately 20% of persons reporting fatigue to be a problem.62 Although only a small minority of these people seek a medical opinion, fatigue is a common presenting symptom in primary

THE MANAGEMENT OF PATIENTS PRESENTING WITH CFS​

In this section I suggest a pragmatic approach to the management of patients presenting with chronic disabling medically unexplained fatigue. Several useful accounts have been previously published.23, 98, 117 The approach I suggest is applicable to any medically unexplained illness.8, 91 The overriding principle to be adhered to when managing patients with syndromes that do not fit comfortably into either medical or psychiatric services is to ensure that they obtain the maximum benefit from

CONCLUSIONS AND FUTURE DIRECTIONS​

CFS is best regarded as a descriptive term for a type of clinical presentation. The patient group it defines is almost certainly etiologically heterogeneous and needs to be subclassified. Although psychiatric diagnosis provides one approach to subclassification, current diagnostic systems have significant limitations and a multidimensional description of the patient's characteristics may be more clinically useful.
The illness defined by the term CFS is important because it represents potentially

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https://www.sciencedirect.com/science/article/abs/pii/S0193953X05703051