Chronic fatigue syndrome

Abstract

Chronic fatigue syndrome (CFS) is an illness characterized by disabling fatigue of at least 6 months. The aetiology of the condition has been hotly debated. In this chapter the evidence for CFS as a post viral condition and/or a neurological condition is reviewed. Although there is evidence that CFS is triggered by certain viruses in some patients and that neurobiological changes such as hypocortisolism are associated with the syndrome, neither mechanism is sufficient to explain the extent of the symptoms or disability experienced by patients. It is unlikely that CFS can be understood through one aetiological mechanisms. Rather it is a complex illness which is best explained in terms of a multifactorial cognitive behavioural model. This model proposes that CFS is precipitated by life events and/or viral illness in vulnerable individuals, such as those who are genetically predisposed, prone to distress, high achievement, and over or under activity. A self perpetuating cycle where physiological changes, illness beliefs, reduced and inconsistent activity, sleep disturbance, medical uncertainty and lack of guidance interact to maintain symptoms. Treatments based on this model including cognitive behavioural therapy and graded exercise therapy are effective at significantly reducing fatigue and disability in CFS. This chapter provides a description of these approaches and details of the trials conducted in the area.

Are there sleep-specific phenotypes in patients with chronic fatigue syndrome? A cross-sectional polysomnography analysis

“…In sum, research suggests that in CFS multiple processes in distinct domains, such as physiology, illness beliefs, inconsistent activity, sleep disturbance, medical uncertainty and lack of guidance, can interact to maintain or exacerbate symptoms. 19 As aforementioned, unrefreshing sleep is one key diagnostic characteristic of CFS. 1 It is also one of the most common symptom complaints, 20 21 with 87-95% of patients reporting sleep difficulties (Gotts ZM, unpublished PhD thesis) that do not improve over the course of the illness.…”

Outcomes and predictors of response from an optimised, multidisciplinary intervention for chronic fatigue states

“…The second arm comprised three compulsory modules provided in a typical CBT framework as developed for CFS and PCF and delivered by a clinical psychologist: psycho‐education about the illness and the rationale for intervention; sleep–wake cycle disturbance management, which sought to optimise sleep hygiene, notably to minimise daytime napping and to ensure an unbroken, regimented night‐time sleep routine and neurocognitive disturbance management, essentially a cognitive remediation approach analogous to GET. In addition, three optional modules of problem‐focused CBT were applied to patients with significant clinician‐designated depression, anxiety or poor coping …”

The experience of sleep in chronic fatigue syndrome: A qualitative interview study with patients

“…This is a voice that is often obscured in the ideological battles that occur in CFS. It is an illness which is often poorly understood, where a crude dualism pits biological against psychological models and the complex experience of living with it is often lost (Deary, Chalder, & Sharpe, ; Moss‐Morris & Deary, ). By utilizing qualitative methods, the patients' experience of living with the condition, and their own understanding of it, becomes the focus of research (Braun & Clarke, ).…”