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This talk by Professor Justin Beilby provides an overview of Chronic Fatigue Syndrome (CFS) including background information, how to diagnose and manage the condition, prognosis, and the role of patients and their families. It emphasizes the importance of accurate diagnosis and appropriate management strategies. The talk also includes information on CFS in children and adolescents, as well as support and counseling for families and caregivers. Resources for community education and GP guidelines are provided.
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Chronic Fatigue Syndrome: Time For Clarity Justin Beilby Professor of General Practice University of Adelaide
Talk Outline • Background • How to Diagnose • Management • Prognosis • Role of patient/family
Background • 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
Symptoms usually worsened with minimal physical and mental exertion.
Diagnosis 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 • 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 • Activity Management • Sleep • Mood • Prognosis • Family/Carer
Activity Management • 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 • Avoid daytime sleep • Attempt to develop good sleep hygiene • Appropriate medications for short periods • Non – prescriptions medication – St John’s Wort, Valerian
Mood • 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 • Variable • Most patients will improve over 3-5 years • Fluctuations and relapses • Need early interventions • Some patients will remain quite debilitated
Children and Adolescents • 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
Family and Carer Support and Counselling
What does this mean to you/us • 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
Resources • www.co-cure.org • www.ahmf.org • www.afme.org.uk
GP Guidelines • Chaired a group of experts • Clear and brief guidelines • Now can be used by GPs • Consumers can move this process forward
Consumer and Community Driven Change • Women with breast cancer screening • Men with prostate cancer • The use of natural therapies in depression and anxiety
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.
