Download Chronic Fatigue Syndrome: Time For Clarity

Chronic Fatigue Syndrome:
Time For Clarity
Department of General Practice
Justin Beilby
Professor of General Practice
University of Adelaide
Talk Outline
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Background
How to Diagnose
Management
Prognosis
Role of patient/family
Background
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• Females: Males – 2: 1
• Peaks 15-20 yrs and 33-45 years
• 0.5% of patients attending general practice
• SA – 3000-7000 sufferers
• All groups across society
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Symptoms usually worsened with
minimal physical and mental exertion.
Diagnosis
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Persistent fatigue, relapsing fatigue > 6 months
• Is of new or definite onset
• Is not the result of ongoing exertion
• Is not substantially relieved by rest
• Results in previous reduction in occupational,
educational, social and personal activities
• AND
Diagnosis
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Muscle aches and pains
Unrefreshing sleep
Poor concentration and memory
Stomach symptoms
Low blood pressure
Unusual headaches
Cause not well understood
Positive diagnosis first key step
Examination and tests normal
Watch depression
and anxiety overlap
Flexibility re
management
Management – Whole person
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• Activity Management
• Sleep
• Mood
• Prognosis
• Family/Carer
Activity Management
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• Graded exercise programs
– Recent Australian Medical Journal of Australia
• Graded exercise program for 68 volunteers for 12 weeks
– Walking, cycling, swimming every second day
– Unless relapse then reduced
– Flexible – “pacing”
• Results
– Improved blood pressure
– Work capacity improved
– Less depression and less mental fatigue
Sleep
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• Avoid daytime sleep
• Attempt to develop good sleep hygiene
• Appropriate medications for short periods
• Non – prescriptions medication – St John’s Wort,
Valerian
Mood
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• Counselling
• Patient centre realistic goals
• Medications at times
• Cognitive behavioural therapy (CBT)
– how we think impacts on our illness
– aim to alter these negative perceptions
Prognosis
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Variable
Most patients will improve over 3-5 years
Fluctuations and relapses
Need early interventions
Some patients will remain quite debilitated
Children and Adolescents
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• Dynamic individuals with multiple goals
• Early intervention – debate re 3-6 months’ duration
• Supportive plan involving all players including
schools
• Peer support/academic activity/open access
schooling
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Family and Carer
Support and Counselling
What does this mean to you/us
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• Make the diagnosis
• Find someone who feels comfortable to manage this
• Build a partnership with a health care provider
• Educate all health care providers
• Overall Community Education
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Resources
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• www.co-cure.org
• www.ahmf.org
• www.afme.org.uk
GP Guidelines
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• Chaired a group of experts
• Clear and brief guidelines
• Now can be used by GPs
• Consumers can move this process forward
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Consumer and Community Driven
Change
• Women with breast cancer screening
• Men with prostate cancer
• The use of natural therapies in depression and
anxiety
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CFS is a sufficient indignity by itself; do not
compound this. It takes considerable time and
infinite patience to take an accurate history from a
frail patient with impaired memory and
concentration, especially if that history is long and
complex. Resist the temptation of a hurried,
superficial evaluation. English JAMA 1991.
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