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Chronic fatigue syndrome in the psychiatric practice

Published online by Cambridge University Press:  24 June 2014

A. Van Duyse ,
A. Mariman ,
C. Poppe ,
W. Michielsen  and
R. Rubens
A. Van Duyse*
Affiliation:
Psychosomatic Centre, Ghent, Belgium Department of Psychiatry, University Hospital, Ghent, Belgium
A. Mariman
Affiliation:
Department of Psychiatry, University Hospital, Ghent, Belgium
C. Poppe
Affiliation:
Psychosomatic Centre, Ghent, Belgium
W. Michielsen
Affiliation:
Internal Medicine University Hospital, Ghent, Belgium
R. Rubens
Affiliation:
Endocrinology, University Hospital, Ghent, Belgium
*
University Hospital, Psychosomatic Center, Poli 2, De Pintelaan 185–9000 Ghent, Belgium.Tel: + 32 9240 23 50; Fax: + 32 9240 3895.e-mail: anne.vanduyse@rug.ac.be
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Abstract

Background:

Chronic fatigue syndrome (CFS) is a complex syndrome with a psychiatric comorbidity of 70–80%. A psychiatric interview is necessary in order to exclude psychiatric illness and to identify psychiatric comorbidity. Studies have demonstrated that in general medical practice and in the non-psychiatric specialist practice, physicians tend to underdiagnose psychopathology in patients with CFS. There are many questions unanswered about the treatment of CFS

Aim:

Typical issues for the psychiatric practice are reviewed: psychiatric comorbidity, dysregulation of the PHA-axis and the treatment of CFS.

Conclusions:

Depression, somatization, sleeping disorders and anxiety disorders are the most important psychopathological symptoms found in CFS patients. CFS should not be regarded as a masked (somatoform) depression. Although the results from neuroendocrinological studies assessing the hypothalamic–pituitary–adrenal axis (HPA-axis) are inconsistent, they suggest that there is a subgroup of CFS patients suffering from a discrete dysregulation of the HPA-axis resulting in basal hypocortisolaemia. These findings, however, do not reveal a causal relationship. Antidepressants do not seem to have a positive influence on the symptom of fatigue, but appear to be beneficial in alleviating the symptoms of depression and social functioning. Cognitive behaviour therapy and graded exercise show a significant improvement on fatigue and other symptoms and are the only treatments available for CFS patients.

Keywords

antidepressantsanxiety disorderschronic fatigue syndromecognitive behaviour therapycomorbiditydepressionneuroendocrinologypsychiatry
Type
Review Article
Information
Acta Neuropsychiatrica , Volume 14 , Issue 3 , June 2002 , pp. 127 - 133
Copyright
Copyright © Acta Neuropsychiatrica 2002

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