Causes, symptoms and treatment of chronic fatigue syndrome. R53 Malaise and fatigue Factors provoking the development of the syndrome

Chronic fatigue syndrome is also called postviral weakness syndrome, myalgic encephalomyelitis, chronic fatigue syndrome, or immune dysfunction syndrome. It is a disease that results in severe permanent weakness over an extended period of time and is accompanied by a wide range of other symptoms.

Causes

The cause of the disease remains unknown, although it is believed that several different factors are involved in its development. In some cases, chronic fatigue syndrome appears after a viral infection or severe emotional trauma, such as divorce. In others, there were no previous illnesses or significant events noted.

Risk factors

Most often, the disease occurs in women in the age group from 25 to 45 years.

Symptoms

severe weakness, which can last up to 6 months;
impaired short-term memory and concentration;
sore throat;
painful lymph nodes;
pain in the joints and muscles without swelling and redness;
sleep that does not bring rest;
headache;
extreme fatigue and malaise after minimal exertion.

Because of the wide variability in symptoms, the disease is often not even recognized or misdiagnosed.

Complications

Most people with chronic fatigue syndrome develop, which manifests itself in a lack of interest in work, hobbies, or constant anxiety. With chronic fatigue syndrome, allergic diseases such as and are exacerbated.

Diagnostics

A doctor may diagnose chronic fatigue syndrome if weakness persists for more than 6 months without apparent cause and is accompanied by at least 4 of the above symptoms. These are the diagnostic criteria for this condition. However, constant weakness is a common symptom of many diseases, including and, and the doctor must first exclude these disorders. If no causes of weakness are found during the examination, then the diagnosis of chronic fatigue syndrome is made only if the diagnostic criteria are met. At the doctor's appointment, a general examination will be performed, questions will be asked about whether the patient has psychological problems, such as depression. Blood tests may also be done. Since there are no specific diagnostic tests, the diagnosis takes a significant amount of time.

Self-help measures

Although there is no specific treatment for chronic fatigue syndrome, there are a number of self-help measures that can help manage this condition. It is recommended to take the following actions:

try to separate periods of rest and work;
gradually build up physical and mental stress, force yourself to be active every week;
set yourself realistic goals;
make changes in diet, drink less alcohol and completely abandon caffeine;
try to reduce the level of stress in your life;
join a support group if the patient feels lonely.

Your doctor may prescribe medication to relieve some of your symptoms. For example, to relieve headache, joint and muscle pain, such as aspirin and are prescribed. They can also improve the patient's condition (even in the absence of symptoms of depression). The doctor will arrange for the patient to consult a psychologist in order to cope with the disease and receive support, cognitive and behavioral therapy will also be useful.

Chronic Fatigue Syndrome is a very long-term illness. Some patients experience worsening of symptoms in the first 1–2 years, and sometimes symptoms appear and disappear for many years. In about half of the cases, the disease resolves completely within a few years.

Fatigue is experienced by everyone without exception. For some, this feeling manifests itself in the form of slight fatigue, and for someone - in the form of a real breakdown. Under certain conditions, a person develops chronic fatigue.

From the point of view of medicine, fatigue is considered as a special condition, which is preceded by a period of intense physical or intellectual activity. Distinctive features of this condition are decreased efficiency, drowsiness, increased irritability, apathy.

If we talk about fatigue as a physical breakdown, then this term conveys the inability of the body to fully use the strength of the muscles of the body due to their weakness.

Mental fatigue can be characterized as the depletion of the ability to think constructively, make adequate decisions, and remember information.

It often happens that both of these conditions manifest themselves in a person at the same time. This makes it impossible to carry out productive activities.

A separate problem is a prolonged state of fatigue, which does not go away even after a long rest. This phenomenon is called "Chronic Fatigue Syndrome" (CFS).

Essence of CFS

A constant feeling of tiredness and exhaustion, which even a long rest is not able to overcome, is called chronic fatigue syndrome. According to the ICD-10 classification, CFS is a disease of the nervous system.

In different countries of the world, this disease occurs under the following names:

post-viral syndrome;
chronic fatigue syndrome;
chronic fatigue syndrome and immune dysfunction.

CFS is considered a common problem associated with the peculiarities of life. Due to excessive emotional and mental stress, there is a decrease in the physical and mental activity of a person.

In the presence of such a disorder, the patient often feels drowsiness. With CFS, one or the other often develops.

The patient cannot concentrate on doing any work, concentrate attention. He becomes irritable, the emotional state is unstable.

Constant chronic fatigue can provoke the appearance of various kinds of phobias.

How is chronic fatigue different from normal fatigue?

The main difference between CFS and the usual fatigue inherent in every person is that the breakdown does not go away even with prolonged rest and a full sleep regimen.

Ordinary fatigue is also not accompanied by deep moral depression, which is typical for chronic fatigue.

In addition, symptoms of CFS include muscle pain, unreasonable weight loss, decreased libido, and fever.

CFS: Real Facts and Common Misconceptions

Below are the real facts about CFS:

There are also quite common misconceptions regarding this deviation:

fatigue syndrome cause only mental and physical stress. In fact, such a state can also arise from completely opposite reasons - lack of purpose and motivation, useless pastime.
CFS - self-hypnosis, not a real disease. In fact, chronic fatigue syndrome is deservedly categorized as a disease of the nervous system. Experts have proven that pathology inhibits all processes occurring in the body.

Factors provoking the development of the syndrome

The diagnosis of "chronic fatigue syndrome" appeared relatively recently: back in the 1980s, nothing was known about such a pathology.

To date, experts identify such main reasons why CFS can get an impetus for development, and in a person’s life there are only drowsiness, fatigue, weakness and apathy:

stress factor. Depression, emotional and mental stress provoke structural changes in the nervous system.
immune factor. Pathology can occur due to damage to the immune system.
genetic factor. The presence of deviations in individual genes is also a provocateur of CFS.
Viral factor. Herpes virus, cytomegaloviruses, enteroviruses, Epstein-Barr virus create a high risk of developing this pathology.

Individuals at particular risk are those who:

recently had serious illnesses, were injured, underwent radiation or chemotherapy;
suffer from allergic, infectious, endocrine diseases of a chronic progressive nature;
occupy positions of responsibility;
live in an area characterized by unfavorable environmental conditions;
malnutrition, little sleep and rest;
lead a sedentary lifestyle;
drink alcohol, smoke.

Clinical picture and symptoms

Chronic fatigue syndrome is defined by a number of specific symptoms.

The first sign of CFS is rapid fatigue, which appears even after minor exertion. The feeling of weakness and fatigue that accompanies CFS does not disappear during the day and even after sufficient sleep.

In addition to the above, chronic fatigue syndrome has the following symptoms:

emotional instability;
apathy;
a complete decrease in physical activity;
feeling of ache in the limbs and body;
unreasonable and sharp increase in temperature;
muscle pain;
swollen lymph nodes, sore throat, mild cough (with Epstein-Barr virus infection);
the development of skin diseases against the background of a nervous breakdown;
inflammatory processes;
anemia;
constipation or diarrhea.

Symptoms of CFS are characterized by a progressive course. Apathy with such a disorder indicates.

Diagnosis of CFS as a disorder of the nervous system

The diagnosis is made based on the analysis of the deviations observed in the patient. A certain number of criteria that a neurologist calculates indicate a disorder or refute it.

Since CFS may indicate the development of endocrine, oncological, somatic, infectious or psychiatric diseases, the patient is also examined by an infectious disease specialist, endocrinologist, internist and rheumatologist.

In addition, they conduct blood tests for the presence of infections, including HIV.

How to deal with constant fatigue on your own?

If a person suffers from CFS, then it is impossible to cure this condition on your own, since an integrated approach is required. But without actions that the patient is quite capable of performing on his own, chronic fatigue is unlikely to recede.

You can get rid of chronic fatigue and drowsiness on your own if:

Occupational Therapy

Treatment of chronic fatigue syndrome is impossible without professional help, the need to consult a specialist is due to the fact that the causes of CFS can have a different basis.

Thus, in the presence of mental disorders as a determining factor in CFS, attention is paid to auto-training and group therapy sessions.

In the presence of diseases of the internal organs and systems of the body as a risk factor, an effective method of treatment is physiotherapy.

To relieve chronic fatigue, the following methods are suitable:

The schedule for each procedure is prescribed by the doctor, depending on the individual characteristics of the patient and his current condition.

Medications for the treatment of CFS

Depending on the cause of chronic fatigue syndrome and its dominant symptoms, the following types of drugs can be prescribed:

Vitamin therapy is of great importance in the treatment of this pathology. The action of vitamins, of course, is not aimed at suppressing, but these beneficial elements will help support the immune system.

You should take preparations containing selenium, zinc, iron and magnesium. From chronic fatigue and weakness, you need to take vitamins A, B, E.

Dangers - hidden and obvious

As a rule, the prognosis for fatigue syndrome is favorable, the disease is treatable - of course, if it is adequate and timely. But, if for a long time you do not attach importance to such a condition and do not fight it, then it is fraught with the development of secondary diseases later. This:

infectious and viral diseases;
pathology of the male and female reproductive system;
in old age;
schizophrenia and (especially for children).

Preventive measures

It is quite possible to prevent the development of CFS. For this purpose it is necessary:

try to lead an active, healthy lifestyle;
spend more time outdoors, if most of the time you have to spend indoors, you need to at least ventilate it more often and maintain an optimal level of humidity;
avoid if possible;
change the environment from time to time to get new sensations;
to refuse from bad habits;
learn to correctly plan the regime of work and rest and follow it.

CFS is not fatal. But, since the pathology affects the nervous system, it must be dealt with without postponing it for later, otherwise you may later face even more serious consequences.

Chronic fatigue syndrome is a mysterious disease and ambiguous. The disease first received its name only in 1984, after a real epidemic of fatigue that broke out in Nevada.

However, none of these theories have yet been proven. This disease, despite its frivolous name, is quite serious.

In the International Classification of Diseases (ICD-10), chronic fatigue syndrome (CFS) appears under the name "myalgic encephalomyelitis". The syndrome got its name in 1984, after an epidemic in Nevada. Dr. Paul Cheney, who practiced in a small town Incline Village, located on the shores of Lake Tahoe, registered more than 200 cases of this disease. Patients felt depression, mood deterioration, muscle weakness. They found the Epstein-Barr virus or antibodies to it and to other viruses - "relatives" of the herpes virus. Whether the cause of the disease was a viral infection or something else, such as poor environmental conditions, remained unclear. Outbreaks of the disease have been observed before: in Los Angeles in 1934, in Iceland in 1948, in London in 1955, in Florida in 1956.

Many doctors do not consider CFS (Chronic Fatigue Syndrome) a disease, but believe that it is a sign of some other problem with the body. In unbearable fatigue, which does not go away even after a long rest, doctors blame the Epstein-Barr virus, herpes infections and malfunctions of the immune system. There are those who consider CFS to be a purely mental pathology - a kind of atypical depression.

Syndrome not limited any geographic or socio-demographic groups. In the US, CFS affects about 10 patients per 100,000 people. In Australia in 1990, the incidence was higher: 37 people per 100,000 population. Experts say that people 40-50 years old who live in large cities are more susceptible to CFS. Moreover, it is noticed that women develop CFS more often than men.

The main symptom of chronic fatigue syndrome is an incomprehensible weakness that does not disappear after rest and persists for a long time. Such a picture, of course, does not always mean that a person suffers from CFS. You can talk about the syndrome if the patient has undergone a volumetric examination: complete blood count, blood test on sensitivity gluten, thyroid and liver function tests, urinalysis, etc., which showed that he was absolutely healthy. This, by the way, is rare: usually doctors still find some kind of pathology or condition (pregnancy, for example), which is the cause of a sharp decline in strength.

But some sufferers find out that they are not sick at all, but still feel bad. Doctors have so-called "large" and "small" criteria for diagnosing CFS. “Major” includes the absence of a serious underlying disease or condition that can cause a breakdown, plus constant fatigue for no apparent reason for at least 6 months. There is also a whole complex of "small criteria": a decline in physical and mental strength, rapid fatigue during the work of muscles and the brain, lasting more than 24 hours; sleep that does not bring a feeling of cheerfulness, a noticeable deterioration in short-term memory and concentration, muscle pain, joint pain (without redness and swelling), a new type of headache for a person, painful lymph nodes, frequent sore throats.

A patient is diagnosed with chronic fatigue syndrome if both major criteria and at least 4 minor criteria are met. It also happens that the diagnosis of "chronic fatigue syndrome" is confused with fibromyalgia - chronic musculoskeletal pain. In the course of research, scientists have figured out how to distinguish pathological fatigue from fibromyalgia. However, it turned out that symptoms such as soreness of the lymph nodes and fever are not characteristic of fibromyalgia, but may indicate chronic fatigue syndrome.

The saddest fact is that there is no proven and effective way to treat CFS yet: which is natural, because the causes of the disease have not been established. Therefore, while doctors profess an integrated approach, which is individual for each patient and consists mainly in relieving the most severe symptoms. Painkillers are prescribed for muscle pain, antidepressants for apathy, and so on. Helps and functional rehabilitation: acupuncture, exercise therapy, etc. In order for the treatment to be more effective, doctors also recommend sleeping at least 8 hours a day, refuse from non-standardized work schedule, eat right and take vitamins.

Doctors advise patients to refuse from energy drinks, cola, coffee and strong tea, preparations with ginseng and the like. Of course, the temptation is great: after all, it is these substances that seem to increase the tone. The problem is that they do not generate energy, but borrow from the body. So after 5-12 hours the patient feels even more exhausted than before.

... in the International Classification of Diseases - ICD-10 - there is no such diagnosis in principle. There is a syndrome, there is no diagnosis. Paradox!

... this term is often used in general medical practice, despite the fact that the criteria for its allocation by 97% coincide with the characteristics of neurasthenia in ICD-10 (A.Farmer et al., 1995).

Introduction(relevance of the topic). It is believed that chronic fatigue syndrome can manifest itself at any age, including children. According to Australian scientists, chronic fatigue syndrome occurs with a frequency of 37 cases per 100,000 people (Vollmer-Conna V., Lloid A., Hickie I., Wakefield D., 1998). With chronic fatigue syndrome, there are no changes in the composition of blood and urine, no radiological changes, no organic or functional abnormalities of ultrasound are detected. Indicators of clinical biochemical studies are normal, no changes in the endocrine and immune status are detected. Such patients are usually diagnosed with "neuro-vegetative dystonia" and neuroses. At the same time, the courses of treatment prescribed for such cases usually do not give any effect at all. The disease typically progresses with deterioration, and in advanced cases, severe memory and mental disorders are detected, confirmed by changes in the EEG.

chronic fatigue syndrome- this is a disease of unknown etiology, the main manifestation of which is unmotivated severe general weakness, for a long time depriving the patient of active participation in everyday life.

(! ) Due to the fact that the development of chronic fatigue syndrome is closely associated with significant disorders in the functioning of the immune system, this disease has received a new name - "chronic fatigue syndrome and immune dysfunction", although the old term is still widely used when characterizing it as a nosological form. - chronic fatigue syndrome.

Etiology and pathogenesis. Despite an active discussion, there is still no single point of view on the etiology and pathogenesis of chronic fatigue syndrome. Some authors attach importance to various viruses (Epstein-Barr, cytomegaloviruses, herpesvirus types I and II, enteroviruses, herpesvirus type 6, etc.), nonspecific activation of immune responses and mental factors. At the same time, the majority points to the connection of the disease with environmentally unfavorable conditions and to the fact that it is a “disease of the middle class”, thus giving an important role to social factors (however, without detailing the latter). Recent studies indicate increased brain serotonin activity in patients with chronic fatigue syndrome, which may play a role in the development of this pathological condition. However, there are also studies in which such a pattern could not be identified. The reason for this was probably the heterogeneity of the groups of subjects and the use of various stimulants of serotonin metabolism. Thus, increased serotonin metabolism may underlie the development of chronic fatigue syndrome. The increase in prolactin secretion stimulated by serotonin in chronic fatigue syndrome may be secondary to various behavioral features (eg, such as prolonged inactivity and disturbances in falling asleep and waking up).

Currently, in the pathogenesis of chronic fatigue syndrome, a large role is given to disorders in the cytokine system. The latter, being mediators of the immune system, not only have an immunotropic effect, but also affect many functions of the body, participating in the processes of hematopoiesis, repair, hemostasis, the activity of the endocrine and central nervous systems. It should be emphasized that the infectious or viral theory remains the most convincing (the debut of chronic fatigue syndrome is often associated with an acute flu-like illness).

Clinical manifestations. One of the leading symptoms in chronic fatigue syndrome is exhaustion, which is especially clearly detected in the study by special methods for studying performance (Schulte tables, correction test, etc.), which manifests itself as hyposthenic or hypersthenic syndromes. With the phenomena of exhaustion in chronic fatigue syndrome, the lack of active attention is directly related, which manifests itself as an increase in the number of errors.

Chronic fatigue syndrome differs from a transient state of weakness in healthy people and in patients with various diseases in the initial stage and in the convalescence stage in terms of the duration and severity of psychosomatic disorders. Clinical manifestations of chronic fatigue syndrome are commensurate with the classical ideas about the disease as an independent nosological unit.

Typical clinical manifestations for developing chronic fatigue syndrome in the early stages are: (1) weakness, fatigue, increasing attention disorders, (2) increased irritability and instability of the emotional and mental state; (3) recurring and increasing headaches not associated with any pathology; (4) disorders of sleep and wakefulness in the form of drowsiness during the day and insomnia at night; progressing against this background, a decrease in efficiency, which forces patients to use various psychostimulants on the one hand and sleeping pills on the other; (5) typical: frequent and intense smoking for the purpose of mental stimulation during the day, daily evening alcohol intake to relieve neuropsychic excitation in the evening, which leads to widespread domestic drunkenness; (6) weight loss (insignificant, but clearly noted by patients) or, for groups of financially secure individuals leading a physically inactive lifestyle, stage I-II obesity; (7) pain in the joints, usually large and in the spine; (8) apathy, gloomy mood, emotional depression. (!) It is very important that this symptomatology flows progressively and cannot be explained by any somatic diseases. Moreover, a thorough clinical examination fails to reveal any objective changes in the state of the body - laboratory studies show no deviations from the norm.

Clinical diagnostics. The criteria published in 1988, 1991, 1992 and 1994 are used to diagnose Chronic Fatigue Syndrome. Center for Disease Control (USA), which include a complex of large (1 - prolonged fatigue for an unknown reason, not passing after rest and a decrease of more than 50% of the motor regime observed for at least 6 months; 2 - absence of diseases or other causes, that can cause such a condition.), and small objective criteria. The minor symptomatic criteria of the disease include the following: the disease begins suddenly, as with influenza, with (1) an increase in temperature to 38 ° C; (2) sore throat, perspiration; (3) slight enlargement (up to 0.3-0.5 cm) and tenderness of cervical, occipital and axillary lymph nodes; (4) unexplained generalized muscle weakness; (5) soreness of individual muscle groups (myalgia); (6) migratory joint pain (arthralgia); (7) recurrent headaches; (8) rapid physical fatigue followed by prolonged (more than 24 hours) fatigue; (9) sleep disorders (hypo- or hypersomnia); (10) neuropsychological disorders (photophobia, memory loss, increased irritability, confusion, decreased intelligence, inability to concentrate, depression); (11) rapid development (within hours or days) of the entire symptom complex.

Small criteria can be combined into several groups. (1) The first group includes symptoms reflecting the presence of a chronic infectious process (subfebrile temperature, chronic pharyngitis, swollen lymph nodes, muscle and joint pain). (2) The second group includes mental and psychological problems (sleep disorders, memory impairment, depression, etc.). (3) The third group of minor criteria combines the symptoms of autonomic-endocrine dysfunction (rapid change in body weight, dysfunction of the gastrointestinal tract, loss of appetite, arrhythmias, dysuria, etc.). (4) The fourth group of minor criteria includes symptoms of allergy and hypersensitivity to drugs, sun exposure, alcohol, and some other factors. Objective (physical) criteria are: (1) subfebrile fever; (2) non-exudative pharyngitis; (3) palpable cervical or axillary lymph nodes (less than 2 cm in diameter).

To make a diagnosis of chronic fatigue syndrome, the presence of 1 and 2 major criteria, as well as minor symptomatic criteria: (1) 6 or more of 11 symptomatic criteria and 2 or more of 3 physical criteria; or (2) 8 or more of the 11 symptomatic criteria.

According to the chronic fatigue syndrome diagnostic scheme adopted by the International Chronic Fatigue Syndrome Study Group in 1994, all cases of unexplained fatigue can be clinically divided into (1) chronic fatigue syndrome and (2) idiopathic chronic fatigue.

The criteria for chronic fatigue syndrome are: (1) the presence of chronic fatigue, which is defined as clinically established, unexplained, persistent or intermittent chronic fatigue of a new type (not previously encountered in life), not associated with physical or mental exertion, not relieved by rest and leading to a significant fall earlier achieved levels of professional, educational or personal activity; (2) the simultaneous presence of four or more of the following symptoms (all symptoms can be observed constantly or recur for 6 months or more): 1 - headaches that differ in nature from previously observed, 2 - muscle pain, 3 - pain in several joints in the absence of itching and redness, 4 - unrefreshing sleep, 5 - discomfort after physical or neuropsychic stress lasting more than 24 hours, 6 - impaired short-term memory or concentration of attention, significantly reducing the level of professional, educational or other social and personal activity. 7 - signs of inflammation of the mucous membrane of the throat. 8 - soreness of the cervical or axillary lymph nodes.

Cases of idiopathic chronic fatigue are defined as clinically established chronic fatigue that does not meet the criteria for chronic fatigue syndrome. The reasons for this discrepancy need to be investigated. Chronic fatigue is defined as subjectively recorded persistent or increasing fatigue that lasts 6 months or more. Prolonged fatigue is fatigue that lasts more than 1 month. The presence of a history of long-term or chronic fatigue requires a clinical examination to identify the underlying and concomitant diseases and subsequent treatment.

Further diagnosis and verification of a clinical case of chronic fatigue cannot be carried out without an additional medical examination, including: (1) an assessment of the state of the psyche to identify deviations in mood, intelligence and memory characteristics; special attention should be paid to current symptoms of depression and anxiety, the presence of suicidal thoughts, as well as the data of an objective psychophysiological examination; (2) examination of somatic systems; (3) laboratory screening tests, including: a complete complete blood count, ESR, blood transaminase levels, blood levels of total protein, albumin, globulins, alkaline phosphatase, calcium, phosphorus, glucose, urea, electrolytes, and creatinine; determination of the level of thyroid-stimulating hormone and clinical analysis of urine. Additional laboratory tests are not needed for all patients. A more in-depth laboratory test is ordered on an individual basis to confirm or rule out other diseases, such as multiple sclerosis. In these cases, it is necessary to use the advanced panel of laboratory methods of analysis. When making a diagnosis, in order to prevent diagnostic errors, attention should be paid to a number of symptoms that are not characteristic of chronic fatigue syndrome, but are significant in other diseases.

Diseases with explainable chronic fatigue: (1) the most common causes of complaints of chronic fatigue are hypothyroidism, narcolepsy and iatrogenic diseases, including side effects of pharmacotherapy; (2) chronic fatigue may be accompanied by cancer; (3) mental illness with symptom complexes of a psychotic and melancholic nature (bipolar affective disorders, schizophrenia of any type, manic-depressive psychosis, bulimia nervosa, dementia of any origin) simultaneously cause a decrease in working capacity and rapid fatigue; (4) abuse of alcohol and drugs for more than two years with the formation of dependence, preceding the appearance of complaints of chronic fatigue, is actually its immediate cause; (5) being overweight, as measured by body mass index (weight (kg)/height (m2)), when the index value is equal to or greater than 45, may be the cause of complaints of increased fatigue. Chronic fatigue may be accompanied by an undiagnosed viral infection.

Diseases that may be associated with chronic fatigue syndrome. A special clinical situation is the combination of chronic fatigue syndrome with other diseases. In this case, the following options are possible: (1) diseases with symptoms that are not determined by diagnostic laboratory tests (fibromyalgia, anxiety, somatic disorders, non-psychotic or non-melancholic depression, neurasthenia, hypersensitivity to chemicals); (2) diseases resistant to treatment; this is primarily hypothyroidism, in the treatment of which the adequacy of replacement therapy was verified only by the achievement of a normal level of thyroid-stimulating hormone in the blood plasma, and other options for adjusting the prescribed dose were not used; constant fatigue is possible with bronchial asthma, infectious diseases, such as Lyme disease or syphilis; (3) isolated unexplained symptoms on physical examination or questionnaire testing, as well as persistent abnormalities in laboratory values that are clinically significant but not sufficient to make a diagnosis of a particular disease, such as clinical cases in which the titer of antinuclear antibodies in the serum of patients increases, but the diagnosis of autoimmune lesions of the connective tissue has no other laboratory or clinical confirmation.

Risk Factors for Chronic Fatigue Syndrome: (1) unfavorable environmental and hygienic living conditions, especially with increased radiation exposure to the body; (2) effects that weaken the general, immunological and neuropsychic resistance of the body (narcosis, surgical interventions, chronic diseases, chemotherapy, radiation therapy, and possibly other types of non-ionizing radiation (computers), etc.; (3) frequent and prolonged stresses as typical conditions of work and life in a modern technically highly developed society; (4) one-sided hard work; (5) constant insufficient physical activity and lack of physical culture and sports activities with sufficient well-being and excessive structural non-physiological nutrition; (6) lack of life prospects and wide interest in life.

Concomitant pathology and typical bad habits that become pathogenetically significant in the development of chronic fatigue syndrome: (1) irrational and high-calorie excess nutrition, leading to stage I-II obesity; (2) alcoholism, often in the form of domestic drinking, usually associated with an attempt to relieve nervous excitement in the evening; (3) heavy smoking, which is an attempt to stimulate declining performance during the day; (4) chronic diseases of the genital area, including currently chlamydia; (5) hypertension stage I-II, vegetative-vascular dystonia and others.

Laboratory diagnostics. Among the objective indicators of chronic fatigue syndrome, changes in the immune status are primarily described: (1) a decrease in IgG due primarily to G1 and G3 classes, (2) a decrease in the number of lymphocytes with the CD3 and CD4 phenotype, (3) a decrease in natural killers, (4) an increase in levels of circulating complexes, (5) increased levels of various types of antiviral antibodies, (6) increased beta-endorphin, (7) increased interleukin-1 (beta), interferon, and tumor necrosis factor. All this, together with a 5-8-fold increase in the frequency of allergic diseases in such patients, indicates non-specific activation, as well as an imbalance in the immune system, the causes of which are not clear. Special studies of the biochemistry of muscle tissue and energy exchange did not show any changes. KLA (the number of leukocytes, platelets and Hb content) - normal; (!) typical low ESR (0–3 mm/h). OAM without pathology. ALT, AST are normal. The level of thyroid hormones, steroid hormones is normal. Bacteriological cultures from the nasopharyngeal mucosa are not informative

(! ) Currently, there are no laboratory tests that would unambiguously indicate the presence or absence of chronic fatigue syndrome in a patient. Moreover, the data cited by various researchers indicate the possibility of changing many indicators, both upward and downward.

Differential Diagnosis. Since chronic fatigue syndrome is still considered a disease with unknown etiology, the most correct diagnosis is to verify the diagnosis by excluding other causes of chronic fatigue. When making the final diagnosis of "Chronic Fatigue Syndrome" based on the results of the study of the anamnesis, when assessing the patient's complaints, the data of objective and laboratory and instrumental studies, it is necessary to exclude diseases (1) of the endocrine system - hypothyroidism, hyperthyroidism, hypocorticism, impaired carbohydrate metabolism; (2) autoimmune diseases - fibromyalgia, polymyalgia rheumatica, polymyositis, scleroderma, systemic lupus erythematosus, reactive arthritis, rheumatoid arthritis; (3) neuropsychiatric diseases - chronic depression, multiple sclerosis, Alzheimer's disease; (4) infectious diseases - Lyme disease, mononucleosis, AIDS, tuberculosis, toxoplasmosis, viral and fungal infections; (5) diseases of the blood system - anemia, malignant lymphomas, leukemias; (6) chronic toxic poisoning - drugs, heavy metals, pesticides, industrial chemicals harmful to health; (7) chronic sleep deprivation and unbalanced nutrition with metabolic disorders; (8) drug and other related addictions (drug, alcohol, nicotine, cocaine, heroin or opioid). The differential diagnosis of chronic fatigue syndrome is based on the exclusion of symptoms of these diseases.

Principles of treatment. It is currently believed that there is no effective monotherapy for chronic fatigue syndrome; (!) therapy should be complex and strictly individualized. One of the important conditions of treatment is also the observance of the protective regimen and the constant contact of the patient with the attending physician. Of the medicines, small doses of psychotropic drugs have proven themselves well: tricyclic antidepressants, selective serotonin reuptake inhibitors (fluoxetine, sertraline), etc. Vitamins and microelements are also prescribed. A noticeable clinical effect is described when using essential fatty acids, the possibility of using acetylcarnitine is discussed. The effectiveness of immunotropic therapy (introduction of immunoglobulins, immunity stimulants, etc.), antimicrobial and antiviral treatment is being studied. In patients with chronic fatigue syndrome, there is a pronounced immune dysfunction in the cellular and humoral immunity and in the interferon system, which requires appropriate correction and long-term immunorehabilitation. A number of authors also recommend correcting the state of the immune system: small doses of glucocorticoids, short courses of L-DOPA, etc.). Symptomatic therapy is used: non-steroidal anti-inflammatory drugs (NSAIDs), painkillers, H2 blockers, etc. Significant assistance is provided by methods of psychological as well as functional rehabilitation, including methods: physiotherapy, acupuncture, physiotherapy, etc. Certain hopes are pinned on the use of polypeptide nootropic drugs, as they effectively restore disturbed metabolism and integrative functions of the brain. One of the most popular drugs in this group is Cortexin.

chronic fatigue syndrome- This article or section needs to be revised. Please improve the article in accordance with the rules for writing articles ... Wikipedia

chronic fatigue syndrome- - a state of persistent neuropsychic exhaustion of a complex and completely unexplored etiology, includes somatogenic, procedural and psychogenically conditioned asthenic conditions. See Neurasthenia. * * * Constant fatigue with a decrease ... ... Encyclopedic Dictionary of Psychology and Pedagogy

Chronic Fatigue Syndrome- see Myalgic encephalomyelitis. Source: Medical Dictionary... medical terms

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Books

Pathophysiological mechanisms of chronic fatigue syndrome, A. A. Podkolzin. Chronic fatigue syndrome (CFS) is a new pathology of the modern age, a disease of civilized countries associated with the characteristics and type of life of the population of large cities, the general ecological…