psychological problem , depression , anxiety

2. CFS : DEFINITION
• Persistent fatigue accompanied by
other specific symptoms for a
minimum of six months.
• not due to ongoing exertion.
• not substantially relieved by rest.
• not caused by other medical
conditions.

3. CFS : DEFINITION
• Chronic fatigue syndrome is disorder
without a known cause.
• May be related to a previous infection.
• CFS for six months .
• Accompanied by cognitive difficulties :
---problems with short-term memory. ---
- Concentration.

4. WHY THIS GUIDELINE MATTERS
- Prevalence of CFS : 0.2–0.4%
-Age: Occur at any age, but it most
commonly affects people in their 40s and
50s.
- sex: Women more than men
- Live style : overweight and inactive .
- Stress appears to be a factor.

5. FIVE SYMPTOM CATEGORIES
1- Post-exertional malaise with loss of physical or mental stamina,
rapid muscle or cognitive fatigability.
2. Unrefreshing sleep; disturbance of quantity and/or rhythm
3. Myofascial pain, joint pain, abdominal and/or head pain
4. Two or more neurocognitive manifestations
5. At least one symptom from two of three subcategories:
Autonomic manifestations
Neuroendocrine manifestations
Immune manifestations

6. ADOLESCENT CFS
1. Unexplained, persistent or relapsing chronic
fatigue.
- Over the past 3 months that was not the result of
ongoing exertion and was not substantially alleviated
by rest.
2. Substantial reduction in previous levels of
social, educational, and personal activities.
3. Specific symptoms within the five classic
symptom categories, which have persisted or recurred
during the past 3 months of illness, but may predate
the reported onset of fatigue

7. ONSET OF CFS
• Start suddenly, by a "flu-like illness“
• After infection by viral and non-viral
pathogens.

8. SYMPTOMS
1.A new onset of unexplained, persistent fatigue unrelated to exertion and not
substantially relieved by rest, that causes a significant reduction in previous
activity levels.
2.Four or more of the following symptoms that last six months or longer:
Impaired memory or concentration
Post-exertional malaise, where physical or mental exertions bring on "extreme,
prolonged exhaustion and sickness"
Unrefreshing sleep
Muscle pain (myalgia)
Pain in multiple joints (arthralgia)
Headaches of a new kind or greater severity
Sore throat, frequent or recurring
Tender lymph nodes (cervical or axillary)

9. OTHER COMMON SYMPTOMS
1. Irritable bowel, abdominal pain, nausea, diarrhea or bloating
2. Chills and night sweats
3. Brain fog
4. Chest pain
5. Shortness of breath
6. Chronic cough
7. Visual disturbances (blurring, sensitivity to light, eye pain or dry eyes)
8. Allergies or sensitivities to foods, alcohol, odors, chemicals, medications
or noise
9. Difficulty maintaining upright position (orthostatic instability, irregular
heartbeat, dizziness, balance problems or fainting)
10. Psychological problems (depression, irritability, mood swings, anxiety,
panic attacks)

10. COGNITIVE FUNCTIONING
• Decreased attention, memory, and reaction time.
• Attention deficit was in the range of 0.5 to 1.0 SD
below expected and were judged likely to affect day-
to-day activities.
• Simple and complex information processing speed
and working memory were moderately to
extensively impaired.
• Perceptual abilities, motor speed, language,
reasoning, and intelligence did not appear to be
significantly altered

11. PATHOPHYSIOLOGY
1. Unknown including oxidative stress,
2. Genetic predisposition,
3. Infection by viruses as Epstein-Barr,
human herpesvirus 6 and mouse
leukemia viruses.
4. Hypothalamic-pituitary-adrenal axis
5. Immune dysfunction as well as
psychological and psychosocial
factors.

12. DIAGNOSIS AND MANAGEMENT: ADULTS
-Initial assessment
- Take a full history
- Examine the person
- Assess for psychological state

13. DIAGNOSIS OF CFS: ADULTS
– Difficulty with sleeping, such as insomnia, hypersomnia, unrefreshing sleep, a
disturbed sleep–wake cycle
– muscle and/or joint pain without evidence of inflammation
– headaches
– painful lymph nodes without pathological enlargement
– sore throat
– cognitive dysfunction, such as difficulty thinking, inability to concentrate,
impairment of short-term memory, and difficulties with word-finding,
planning/organising thoughts and information processing
– physical or mental exertion makes symptoms worse
– general malaise or ‘flu-like’ symptoms
– dizziness and/or nausea
– palpitations in the absence of identified cardiac pathology.

14. COMORBIDITY
• In particular, investigate these ‘red flag’ features:
• localizing/focal neurological signs
• signs and symptoms of inflammatory arthritis or connective tissue
disease
• signs and symptoms of cardiorespiratory disease
• significant weight loss
• sleep apnea
• clinically significant lymphadenopathy.

15. GRADING OF CFS: MILD CFS
• Mobile, can care for themselves and do
light domestic tasks with difficulty
• May still be in work or education but has
probably stopped all leisure and social
pursuits
• Often takes days off or uses the
weekend to cope with the rest of the
week

16. GRADING OF CFS: MODERATE CFS
• Reduced mobility and is restricted
in all activities of daily living
• Has probably stopped work, school
or college and needs rest periods
• Sleep is generally poor quality and
disturbed

17. GRADING OF CFS: SEVERE CFS
• Unable to do any activity, or minimal
daily tasks only
• Severe cognitive difficulties.
• Depends on a wheelchair for mobility.
• Barely able to leave the house.
• May spend most of their time in bed.
• Often extremely sensitive to light and
noise.

18. INITIAL MANAGEMENT
Manage symptoms early – do not wait for
diagnosis
Advise about:
-Fitness for work and education
- Adjustments or adaptations
-Liaise with:
- employers
-education providers
- support services

19. SPECIALIST CFS CARE
Refer to specialist CFS care depend on:
- Person’s needs
- Symptoms (type, duration, complexity,
severity)
- Comorbidities
- Referral within 6 months if CFS is mild,
3-4 months if moderate and immediately
if severe

20. SPECIALIST CFS CARE
Management options including :
- Cognitive behavioural therapy
- Graded exercise therapy
-Activity management
- Sleep management
- Rest and relaxation
- Diet

21. TREATMENT OF CFS
Antidepressants : low dose
antidepressants
improve sleep and relieve pain.
Sleeping pills

22. THERAPY OF CFS
Combination of psychological counseling with a gentle exercise
program.
Graded exercise : Inactive people often begin with range-of-motion
and stretching exercises for just a few minutes a day.
Psychological counseling: To figure out options to work around
some of the limitations.
Feeling more in control of life can improve CFS dramatically.

23. ALTERNATIVE MEDICINE
Pain associated with chronic fatigue
syndrome may be helped by:
Acupuncture
Massage
Yoga or tai chi

24. Thank You

26. DIAGNOSTIC CRITERIA
To meet the diagnostic criteria of chronic fatigue syndrome, you must have
unexplained, persistent fatigue for six months or more, along with at least
four of the following signs and symptoms:
Loss of memory or concentration
Sore throat
Enlarged lymph nodes in your neck or armpits
Unexplained muscle pain
Pain that moves from one joint to another without swelling or redness
Headache of a new type, pattern or severity
Unrefreshing sleep
Extreme exhaustion lasting more than 24 hours after physical or mental exercise