Understanding Chronic Fatigue Syndrome

People with this condition have profound fatigue after exercise, muscle pain, sleep disturbances, faulty temperature control, memory disturbance and poor concentration, dizziness and frequent headaches. They may also have irritable bowel syndrome...

The mean length of the illness is 4 ½ years and it can affect both sexes and all ages. The cause is unknown but it is often thought to be associated with a viral infection or considerable stress in the person's life. The person's immune system seems to be faulty, as a consequence of the constant stress of modern society and this produces severe fatigue and burnout, so that the victim finds it more and more difficult to cope with work or routine activities, even on a limited basis. The personality of sufferers can frequently be that of an extremely hard working, driven perfectionist, who always likes to do an excellent job and pushes himself constantly beyond normal limits.

Diagnosis

There are no specific tests to confirm the diagnosis but the illness needs to have continued for at least six months and all other physical and psychological causes need to be eliminated. Frequently an MRI scan of the brain and various blood tests, including thyroid function tests will be carried out, with negative results. It is also important to exclude depressive illness, as both conditions can coexist, or in some cases mimic each other.

Treatment

The best approach is a holistic approach to the illness and it has been shown from various research papers four forms of treatment are particularly useful. The concept of "pacing" is very effective in that the person on a good day is able to do more and on a bad day has to rest. Cognitive behavioural therapy is also effective for this illness and is designed to change the person's attitude and to develop a more positive approach to the illness in general, as well as boosting self esteem and confidence. Graded exercise and activity programmes have been proven to be very effective for this syndrome. Antidepressants may also be useful for certain people and assuming there is no evidence of depressive illness, they have been shown to help boost the immune system.
Treatments may involve improving the sleep pattern, improving symptoms of anxiety and depression, bowel symptoms and allergies. In some cases physiotherapy will be used to improve mobilisation after the person is fully assessed in terms of their physical ability.

Out-patient treatment

Experienced psychiatrists, nurses and trained therapists who have experience in CFS can provide out-patient treatment with training in lifestyle management and cognitive behaviour therapy. Lifestyle management provides information on how to manage day to day living and improve functional ability. Many people benefit from telephone consultations or home visits as well, if they cannot attend for treatment at the consulting room or out patient clinic.

In-patient treatment

There may be situations when in-patient care is required. There are many benefits - you are able to fully concentrate on your recovery and you will receive 24-hour support and care. In-patients will have direct medical care from the Consultant Psychiatrist and Staff Psychiatrists, in addition to trained nurses, counsellors, physiotherapists and dieticians. The average length of stay is between two and eight weeks.

Treatment outcomes

By using these treatment approaches, sixty to seventy per cent of people can see an improvement in symptoms after completing the course of treatment. However the illness can be relapsing in nature and it is extremely important that the individual learns not to drive themselves so hard and develop a more philosophical attitude to life, otherwise relapse can occur.

Dr. Adrian J Winbow MB BS FRCPsych DPM Consultant Psychiatrist Medical Director for Private Psychiatry LLP www.privatepsychiatry.co.uk