CHRONIC
FATIGUE SYNDROME:
A Primer For Physicians and Allied Health Professional
© 1992 Massachusetts CFIDS Association
Table 1. 1988 CDC SURVEILLANCE CRITERIA
MAJOR CRITERIA
1. Exclusion of other systemic disease
with similar symptoms
2. Persistant or relapsing SEVERE fatigue
(New onset)
PHYSICAL FINDINGS
1. Low grade fever
2. Nonexudative inflamed pharynx
3. Palpable or tender cervical or axillary
lymph nodes
MINOR CRITERIA
1. Debilitating fatigue > 6 months
2. Chronic headaches
3. Sleep disturbance
4. Neuropsychiatric symptoms
5. Migratory joint pain
6. Unexplained muscle weakness
7. Myalgias
8. Sore throat
9. Fatigue prevents normal activity (50%
of time)
10. Painful lymph nodes
11. Acute or subacute onset
Patient meets CDC criteria when:
1. Both Major criteria are met and then either:
A. Patient meets 6 or more minor criteria and 2 physical criteria
OR
B. Patient meets 8 or more minor criteria
Adapted from Holmes et. al. [14]
.
CHARACTERISTICS
WHICH DIFFERENTIATE CFIDS FROM PSYCHIATRIC DISORDERS
Table 2.
|
CFIDS |
Mood disorders |
| . | Depressive episode (DSM III-R 296.2) |
| Frustrating Fatigue | Fatigue accompanied by lacks of interest or motivation |
| Frequent flu like onset | Onset not usually associated with physical illness |
| Somatic symptoms include sore throats, fevers, myalgias, visual symptoms, etc. | May involve somatic symptoms but rarely myalgias, sore throat, fever, or visual symptoms. |
| Sleep disorder in Non-REM phases | Sleep disorder in REM phases |
| Depressed mood: Grief, fear and despair are understandable, given the patient's symptoms and circumstances | Depressed mood: Dysphoria, anxiety, and hopelessness are inappropriate or excessive |
| Suicidality appears to be a response to desperation | suicidality may be desperate, but also may be experienced as thoughts of death or self-harm which are persistent, recurrent or intrusive |
| Self-doubt | Self-blame |
| Responsive to positive stimuli | Unable to respond with pleasure to praise, rewards, or good news |
| Fluctuating multi-system complaints, some vague, or bizarre | Presentation may include persistence and idiosyncratic, pervasiveness of symptoms; possible recognizable syndrome of melancholia (anhedonia, diurnal variation, early a.m. awakening, psychomotor retardation or agitation, and anorexia); may also have brooding or rumination, or psychotic symptoms (delusions or hallucinations) |
| Decreased concentration with specific cognitive inpairments | Globally decreased concentration may be sue to preoccupations, distractibility, slowed mentation |
| May benefit from low doses of antidepressants | Treatment requires full therapeutic dose of antidepressant medication |
| Cognitive difficulties, somatic symptoms, and energy level are not responsive to psychiatric treatment, even if mood improves | Entire syndrome is alleviated by treatment |
CFIDS
Anxiety Disorders
. Panic Disorder (DSM III-R 300.01) Panic attacks accompanied by fatigue, sleep disorder, and multi-system complaints Somatic symptoms limited to episodes of panic or fear of a recurrence of panic . Agoraphobia, School Phobia (DSM III-R 300.02, 309.21) Avoidance behaviors, such as staying at home, do not eliminate symptoms Avoidance behaviors constrict functioning but control symptoms . Generalized Anxiety (DSM III-R 300.02) Anxiety symptoms are variable Symptoms of anxiety (autonomic hyperactivity, motor tension, worries) are persistent and chronic Anxiety symptoms may appear sporadically or independent from worries, or in context of illness and its effects Worries and concerns are about two or more life circumstances or events
CFIDS
Somatoform Disorder
. Hypochondriasis (DSM III-R 300.7) CFIDS is clinically recognizable and real Enduring and unrealistic fear or belief of having serious disease; no detectable pathology or actual loss of body function . Conversion Disorder (DSM III-R 300.11) Multiple symptoms May be single symptom Possibly explained by infections or immune mechanism Symptom cannot be explained by any known pathophysiological mechanism or physical disorder . Somatization Disorder (Briquet's Syndrome) (DSM III-R 300.81) Recognizable multi-system profile Very different profile; symptom list of 35 particular symptoms (of which patients must have 13). Does not include fatigue, sleep disorder or decreased concentration
CFIDS
Other Psychiatric Disorders
.. Factitious Disorder (DSM III-R 301.51) Symptoms are real and genuine Intentional production or feigning of physical symptoms; presumed psychological need to assume the sick role; chronic form is "Munchausen Syndrome" .. Malingering (DSM III-R V 65.20) Symptoms are real and genuine Intentional production or feigning of symptoms for external incentives or personal gain