Chronic fatigue syndrome in the psychiatric practice

Background: Chronic fatigue syndrome (CFS) is a complex syndrome with a psychiatric comorbidity of 70-80%. A psychiatric interview is necessary in order to exclude psychiatric illness and to identify psychiatric comorbidity. Studies have demonstrated that in general medical practice and in the non-psychiatric specialist practice, physicians tend to underdiagnose psychopathology in patients with CFS. There are many questions unanswered about the treatment of CFS. Aim: Typical issues for the psychiatric practice are reviewed: psychiatric comorbidity, dysregulation of the PHA-axis and the treatment of CFS. Conclusions: Depression, somatization, sleeping disorders and anxiety disorders are the most important psychopathological symptoms found in CFS patients. CFS should not be regarded as a masked (somatoform) depression. Although the results from neuroendocrinological studies assessing the hypothalamic-pituitary-adrenal axis (HPA-axis) are inconsistent, they suggest that there is a subgroup of CFS patients suffering from a discrete dysregulation of the HPA-axis resulting in basal hypocortisolaemia. These findings, however, do not reveal a causal relationship. Antidepressants do not seem to have a positive influence on the symptom of fatigue, but appear to be beneficial in alleviating the symptoms of depression and social functioning. Cognitive behaviour therapy and graded exercise show a significant improvement on fatigue and other symptoms and are the only treatments available for CFS patients

Identifying subgroups in the chronic fatigue syndrome

The chronic fatigue syndrome affecting a large patient population with different symptoms such as sleeplessness, tiredness and pain is examined in our center. Patients can be selected using different criteria, Fukuda's criteria being the most recommended nowadays and Holmes's criteria the earlier more restricted criteria. We evaluated in 40 patients(32 women, 8 men; mean age 43.0 +/- 7.8 years, mean +/- SD fulfilling Fukuda's criteria for tender points' pain pressure sensitivity and infrared thermography emission. By considering Holmes' (H) criteria for the chronic fatigue syndrome and fibromyalgia (F) criteria, we subdivided the population into 4 subgroups: (F+ H+, F+ H-, F- H+, F- H-). Fibromyalgia patients not fulfilling Holmes' criteria (F+ H-) were statistically different for pain pressure threshold (p = 0.03) from the other patients. Moreover, this first group showed a normal infrared thermographic emission considering pain, where the other patients showed a rather abnormal vasomotor reaction