CLINICAL CONDITIONS

PHYSICAL ACTIVITY AND CHRONIC FATIGUE SYNDROME

DIAGNOSIS OF CFS

Chronic fatigue syndrome (CFS) is characterised by severe, disabling fatigue as the principal symptom (1).

The fatigue: ● should be of definite onset that is not life long ● must have been present for a minimum of six months and for more than 50% of the time ● must affect physical and men- tal functioning Other symptoms, such as myalgia, mood and sleep disturbance (but not a clinical sleep disorder) may be present.

Patients excluded from the defin- ition are those with: ● established medical conditions known to cause fatigue ● a diagnosis of schizophrenia,

proven organic brain disease, sub- stance abuse, manic depressive illness or eating disorders

Patients with other psychiatric disorders such as anxiety or depressive illness need not nec- essarily be excluded (1).

The post-infectious fatigue syn- drome (PIFS) is characterised by the same symptoms as CFS but in addition there must be definite evidence of an infection at onset or presentation, and the syn- drome must be present for a min- imum of 6 months after the onset of infection (2).

By Dr Kathy Fulcher

Patients who complain of chronic disabling fatigue of uncertain cause have received much attention in recent years. The con- troversial fatigue condition does not lend itself well to normal medical concepts, with the complex clinical presentation of muscular, neurological, psychological and autonomic symptoms, in addition to fatigue, which can last up to several years. Specific diagnostic tests are lacking and several potential causes have been pro- posed for CFS. To clarify the diagnosis, a set of diagnostic criteria for two broad syn- dromes, Chronic Fatigue Syndrome and Post-Infectious Fatigue Syndrome were developed by the British consensus meet- ing in Oxford in 1990 (1) (opposite box).

Causes Patients presenting with CFS may or may not be able to pinpoint a definite onset or cause, particularly since symptoms may have been present for a number of years.

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