Medical conditions that may present with fatigue that may be apparently unexplained are generally, anemia, autoimmune disease, cancer, or chronic infection. Many endocrine diseases, such as, diabetes, hypothyroidism, and hypoadrenalism present initially with fatigue and fatigability. Obstructive sleep apnea and other sleep disorders are apparent frequently with fatigue mainly due to sleep debt. It is needless to mention that primary neuromuscular disorders, such as, myositis and multiple sclerosis present with fatigue simply due to the fact that muscles do not even have reserve for baseline functions.
Gastrointestinal disease, especially liver disease may present with symptoms of fatigue. Cardiac disease specifically myocardial disease or congestive cardiac failure characteristically present with fatigue as the prominent symptom. Chronic lung disease exemplified by chronic obstructive pulmonary disease presents with fatigue certainly due to oxygen deprivation of the tissues. In terms of specific diagnoses, a number of studies have found a significant association between chronic fatigue and anxiety disorders.
The psychiatric diagnoses commonly associated with fatigue would be depression, anxiety and panic, eating disorders, substance misuse disorders, and somatization disorders. Despite these, for a substantial proportion of patients with fatigue, the symptoms remain unexplained or idiopathic. In general, the more severe the extent of the fatigue and the larger the number of the somatic complaints; greater the disability, greater the likelihood of diagnosis of depression. In short, to be medically significant, these disorders would make patients unable to do anything.
To strictly adhere to definition, the assessment criteria must fulfill another precondition, the impairment must result from anatomical, physiological, or psychological abnormalities that can be shown by medically acceptable evidence consisting of signs, symptoms, and laboratory findings, not only by a statement of the symptoms. Most of the studies reviewed have their tools developed to measure the criteria defined by them. Apart from data obtained from the patient demographics, almost all studied attempted to quantify the impairment by means of impairment scale data (Ronnback, L.
, 2006). The model case can easily be conceived. Madam X was 52 years old when her wellbeing plummeted. She began to feel inexplicably tired day after day. Within 3 months, she “crashed and burned. ” She developed debilitating exhaustion, severe insomnia, muscle aches, and what she calls “brain fog. ” Whenever she overexerted herself, aches and pains would spread throughout her body sending her to bed for several days at a stretch. She tried ducking out her work only to steal a few naps.
It advanced to half time, sick leave, until it was never possible for her to return to work. This is a typical case of chronic fatigue syndrome where the patient may suffer from all the above symptoms and also may have low-grade fever, post-exertional malaise, sore throat, joint pain, memory impairment, and headache. Diagnosing such a disorder depends on first ruling out other potential causes of fatigue, such as, acute viral illness or depression. The diagnostic criteria that may be applied on these patients are those of exclusion and inclusion.
Inclusion criteria are a new-onset, clinically evaluated, medically unexplained fatigue of at least 6 months’ duration that is not a result of ongoing exertion and that is not substantially alleviated by rest. These patients often report substantial reduction in previous activity level. The antecedents would be at least four or more of these symptoms, subjective memory impairment, sore throat, tender lymph nodes, muscle pain, joint pain, headache, unrefreshing sleep, and post exertional malaise lasting for more than 24 hours.
These patients should not have active, unresolved, or suspected medical disease or psychotic, melancholic, or bipolar depression, psychotic disorders, dementia, anorexia, bulimia nervosa, severe obesity, or alcohol or other substance abuse as antecedents. Biologically, these patients are predisposed to have vulnerability to precipitate fatigue and most common antecedent is some acute disease. The perpetuating cause would be pathophysiology, excessive inactivity, or sleep disorder. Psychologically, the mechanism of chronic fatigue happens to people who have a vulnerable personality, and stress of any kind may precipitate fatigue.
Depression, unhelpful beliefs about cause and fearful avoidance of activity can perpetuate fatigue. Socially, these patients usually lack support, and either a life event or stress, and reinforcement of unhelpful beliefs usually precipitate the disease (Kato, K. , Sullivan, P. F. , Evengard, B. , and Pedersen, N. , 2006). Conclusion: Fatigue is a syndrome that is disabling and has probably multiple causes. These belong to both physiological and psychological categories. Graded exercise and cognitive behavior therapies are effective in treating chronic fatigue syndrome. References
“fatigue n. ” Concise Medical Dictionary. Oxford University Press, 2007. Oxford Reference Online. Oxford University Press. British Council Delhi. 10 October 2007 <http://www. oxfordreference. com/views/ENTRY. html? subview=Main&entry=t60. e3560> “fatigue” Food and Fitness: A Dictionary of Diet and Exercise. Michael Kent. Oxford University Press, 1997. Oxford Reference Online. Oxford University Press. British Council Delhi. 10 October 2007 <http://www. oxfordreference. com/views/ENTRY. html? subview=Main&entry=t38. e656> fatigue. (2007). In Encyclop? dia Britannica.
Retrieved October 11, 2007, from Encyclop? dia Britannica Online: http://search. eb. com/eb/article-9033818 Kato, K. , Sullivan, P. F. , Evengard, B. , and Pedersen, N. , (2006). Premorbid Predictors of Chronic Fatigue. Archive of General Psychiatry; 63: pp. 1267 – 1272. Ronnback, L. , (2006). Fatigue as a Window to the Brain. JAMA; 295: pp. 444 – 445. Ross, D. S. et al. , (2004). Disability and Chronic Fatigue Syndrome: A Focus on Function. Archive of Internal Medicine; 164: pp. 1098 – 1107. Sharpe, M. and Wilks, D. , (2002). ABC of psychological medicine: Fatigue. BMJ; 325: pp. 480 – 483.