Chronic fatigue syndrom and its treatment - psychiatric view

Chronic fatigue syndrome (CFS) is a specific clinical condition that characterises unexplained disabling fatigue and a combination of non-specific accompanying symptoms for at least 6 months, in the absence of a medical diagnosis that would otherwise explain the clinical presentation. Consequences of CFS found include social isolation and stigmatization, physical inactivity, psychological disturb ances and a reduced quality of life. Plausible mechanism for the development of CFS is based on loss of immunological tolerance to the vasoactive neuropeptides following infection, significant physical exercise or de novo. Considerable evidence points towards a prominent role for central nervous system (CNS) mechanisms in the pathogenesis of CFS. Patients with CFS are described as perfectionist, conscientious, hardworking, somewhat neurotic and introverted individuals with high personal standards, a great desire to be socially accepted and with a history of continuously pushing themselves past their limits. Fewer than 20% of persons with CFS have been diagnosed and treated. Graded exercise therapy and cognitive behaviour therapy appeared to reduce symptoms and improve function based on evidence from RCTs.