Chronic fatigue syndrome is defined by at least six months of severe, disabling fatigue and affects around 0.004-2.6% of the population. It is more prevalent in middle-aged women and results in significant reduction in functioning. While the pathophysiology is unclear, potential causes include viral, neuroendocrine, and psychosocial factors. Treatment involves non-pharmacological approaches and antidepressants, and around 5% of patients fully recover within an average of 21 months follow up.

1. CHRONIC FATIQUE SYNDROME
ADE WIJAYA, MD – SEPTEMBER 2018

2. OUTLINE:
• Introduction
• Diagnosis
• Epidemiology
• Pathophysiology
• Treatment
• Prognosis
• Summary

3. INTRODUCTION
• CFS is defined by at least six months of severe, persistent, disabling fatigue.
• 20 % of primary care patients
• Middle-aged women
• Chronic unexplained fatigue
• Reduction in functioning
Rea T, Buchwald D. Chronic fatigue syndrome. In: Goldman MB, Hatch M, editors. Women and health. Elsevier; 1999.
Prins JB, Van der Meer JWM, Bleijenberg G. Chronic fatigue syndrome. Lancet 2006;367:34655.
Johnson SK. Chronic fatigue syndrome in medically unexplained illness: gender and biopsychosocial implications. Washington, DC: American Psychological Association; 2008.
Fukuda K, Straus SE, Hickie I, Sharpe MC, Dobbins JGH, Komaroff A, The International Chronic Fatigue Syndrome Study Group, et al. The chronic fatigue syndrome: a comprehensive approach to its definition and study. Ann Intern Med
1994;121:9539.

5. EPIDEMIOLOGY
• Prevalence: 0.004-2,6 %
• Women > men
• The prevalence of chronic fatigue was significantly higher in whites than non-
whites, in the 40 to 69 year age groups, and in individuals with lower incomes and
education
Johnson SK. Chronic fatigue syndrome. InWomen and Health (Second Edition) 2013 (pp. 1321-1330).

6. PATHOPHYSIOLOGY
• Viral Immune Explanations
• Neuroendocrine Explanations
• Psychiatric and Psychosocial Factors
Johnson SK. Chronic fatigue syndrome. InWomen and Health (Second Edition) 2013 (pp. 1321-1330).

7. TREATMENT
• Non-pharmacological treatments
• Antidepressants
Johnson SK. Chronic fatigue syndrome. InWomen and Health (Second Edition) 2013 (pp. 1321-1330).

8. PROGNOSIS
• The median full recovery rate was 5%, while 39.5% had some improvement during
follow-up periods which averaged 21 months
• The strongest predictors of improved outcome were less severe fatigue at
baseline, lack of patient attribution of the symptoms to somatic causes (hereafter
called somatic attribution), and less psychiatric disorder
Cairns R, Hotopf M. A systematic review describing the prognosis of chronic fatigue syndrome. Occup Med 2005;55:2031.

9. SUMMARY
• High prevalence
• Significant functional reduction
• Exclude anaemia and hypothyroidism
• Middle-aged women
• Non-pharmacological treatments + antidepressants