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Chronic Fatigue Syndrome: Time For Clarity

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

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Chronic Fatigue Syndrome: Time For Clarity

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  1. Chronic Fatigue Syndrome: Time For Clarity Justin Beilby Professor of General Practice University of Adelaide

  2. Talk Outline • Background • How to Diagnose • Management • Prognosis • Role of patient/family

  3. 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

  4. Symptoms usually worsened with minimal physical and mental exertion.

  5. 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

  6. Diagnosis • Muscle aches and pains • Unrefreshing sleep • Poor concentration and memory • Stomach symptoms • Low blood pressure • Unusual headaches

  7. Cause not well understood Positive diagnosis first key step Examination and tests normal Watch depression and anxiety overlap Flexibility re management

  8. Management – Whole person • Activity Management • Sleep • Mood • Prognosis • Family/Carer

  9. 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

  10. Sleep • Avoid daytime sleep • Attempt to develop good sleep hygiene • Appropriate medications for short periods • Non – prescriptions medication – St John’s Wort, Valerian

  11. 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

  12. Prognosis • Variable • Most patients will improve over 3-5 years • Fluctuations and relapses • Need early interventions • Some patients will remain quite debilitated

  13. 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

  14. Family and Carer Support and Counselling

  15. 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

  16. Resources • www.co-cure.org • www.ahmf.org • www.afme.org.uk

  17. GP Guidelines • Chaired a group of experts • Clear and brief guidelines • Now can be used by GPs • Consumers can move this process forward

  18. Consumer and Community Driven Change • Women with breast cancer screening • Men with prostate cancer • The use of natural therapies in depression and anxiety

  19. 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.

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