1 / 28

Chronic Fatigue Syndrome

Chronic Fatigue Syndrome. Camille Bowen. Why Chronic Fatigue? Why am I chronically fatigued?. Overview. History Characteristics Diagnosis What it is Tests Treatments Nutritional recommendations What to know/do Conclusion. History – Initial Finding.

chin
Télécharger la présentation

Chronic Fatigue Syndrome

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Chronic Fatigue Syndrome Camille Bowen

  2. Why Chronic Fatigue?Why am I chronically fatigued?

  3. Overview • History • Characteristics • Diagnosis • What it is • Tests • Treatments • Nutritional recommendations • What to know/do • Conclusion

  4. History – Initial Finding • Fatigue with hypothyroidism, chronic heart failure, multiple sclerosis, depression • 1980 -1st recognized as medical condition • Persistent or relapsing fatigue

  5. History- Unknown disease • Many names from speculated cause: • “Post-viral fatigue syndrome” • “Myalgic encephalomyelitis” • “Neuromyasthnia” • 1988 CDC defined it Chronic Fatigue Syndrome (CFS) • Prevalence 0.2-2.6 % • Cause: unknown no treatment • No geographic/ethnic difference • Twice as prevalent in women

  6. Characteristics • Severe and disabling fatigue • Headache (90%) • Difficulty concentrating (90%) • Sore throat (85%) • Tender lymph nodes (80%) • Muscle/joint aches (75%) • Fever (75%) • Difficulty sleeping (70%) • Psychiatric problems (65%) • Rapid pulse (10%)

  7. Current Diagnosis • 1994 CDC published diagnostic criteria for CFS • Sever fatigue for 6 months with • 4 or more physical symptoms • Memory impairment • Tender lymph nodes • Joint pain • Headache • Unrefreshing sleep • Postexertional malaise (>24 h)

  8. Exclusion criteria: • Active, unresolved, suspected disease causing fatigue • Depression (psychotic, melancholic, bipolar) • Psychotic disorders • Dementia • Anorexia/bulimia nervosa • Alcohol/substance misuse • Severe obesity

  9. What is CFS?—hypothesis • Hypothalamo-pituitary-adrenal (HPA) axis—major role in regulating stress response • Stress related disorders, CFS, fibromyalgia, chronic pelvic pain, post traumatic stress disorder alterations in HPA axis • Most studies show underactive HPA • Body’s adaption to chronic stress (Burnout) • Contradictory results

  10. CFS-what it is • No structural problem with endocrine organs= functional • Noted- patients selected for study, methods used for investigation, stage of syndrome when tested, interpretation of the results. • Pathogenesis: unknown; multiple causes studied

  11. CFS-what it is • Chronic stress may switch from hyper- to hyporesponsiveness • Defect at/above level of the hypothalamus, resulting in a deficiency in release of CRF and/or other secretagogues • Level of HPA axis dysfunction correlated to length of illness

  12. CFS- what it is • Corticotropin-releasing factor (CRF) • excitatory peptide and has analgesic properties. Reduced availability = lethargy and pain

  13. CFS-what it is • Main Findings: • Hypocortisolism • Blunted ACTH responses • Enhanced negative glucocorticoid feedback • Still don’t know the cause

  14. CFS • Large longitudinal studies needed to examine how HPA axis disturbances evolve over time and determine if they precede the development of stress-related disorders • difficult because only small percentage of stressed individuals develop CFS symptoms

  15. Tests • Determine HPA axis function through: • Insulin tolerance test (ITT) • Short ACTH (250ug) stimulation test • Low-dose ACTH (1ug) stimulation test • CRH stimulation test • Metyrapone test • Glucagon test • AVP stimulation test

  16. Tests • Example: peak cortisol after ITT <500/550 nmol/l = underactive HPA axis IQ : tests insert substance into body and measure levels (cortison, ATPH,) • Abnormal suggests HPA axis dysfunction • Each test has its limitations (no standardization, chemical availability limited, reproducibility problems)

  17. Treatments • No medical treatments • Some tendency for spontaneous improvement

  18. treatments • Study #1: 136 patients • Physical activity & antidepressant • Physical activity & placebo • Therapist & antidepressant • Therapist and placebo • Physical activity: less fatigued, more fit • Antidepressant: helped depression symptoms

  19. treatments • Study #2: • Aerobic activity OR flexibility & relaxation therapy • Aerobic training = fitness, muscle strength, less fatigue • Flexibility & relaxation= significantly less effect

  20. treatments • Study #3: • Medical care • Face to face- explained symptoms, designed exercise program • Telephone consultation • Face to face consultation • 69% had satisfactory physical functioning • Improved fatigue, mood, sleep, & disability (phys. activity or psychological support) • Other groups—therapy alone doesn’t help patient’s symptoms

  21. TreatmentAcupuncture/Moxibustion • More effective than cortisone • Response rates: 78-100% • Quality of the studies were poor: • Poor design • No standard evaluation • None mentioned blinding clinicians, subject, or raters

  22. Treatments Physical activity— low intensity to moderate; increase duration AND • Cognitive behavioral therapy • Phys. activity increases muscle strength, stamina, endurance = better daily life Chemicals released = better mood, less pain

  23. Treatments • Establish sleep routine—going to bed, wake-time • Schedule activity— be consistent • Switch from “feeling” to “ability” • Adolescents & children: family therapy approach

  24. Nutrition Claims • Probiotics • Antifungal agents • Vitamin/mineral supplementation • Dietary change

  25. Nutrition • One study- improved MRI scans with ultra-pure EPA and n-6 long-chain polyunsaturated fatty acids • Neurocognitive functions improved in pilot study using probiotics • Preliminary glutamine supplementation- improved mood & appetite, decreased muscle pain, increased physical activity.

  26. Nutrition • Low sugar low yeast (LSLY) diet • Study showed very difficult to follow • Healthy eating (HE) diet is more practical • Insures adequate nutrient • Multivitamin supplements • not supported by research • may help in overall improvement of diet

  27. Overall- yes to what? • Basic healthy eating • Probiotics • Possible supplements • Exercise routine • Sleep schedule • Cognitive behavior therapy • More research is needed!

  28. conclusion • History • Characteristics • Diagnosis • Hypothesis/what it is • Tests • Treatments • Nutritional recommendations • Summed up what to do

More Related