FATIGUE Objectives gue cal approach of Fatigue Syndrome

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FATIGUE

FATIGUE

Objectives: gue cal approach of Fatigue Syndrome 7 Treatment.

Objectives: gue cal approach of Fatigue Syndrome 7 Treatment.

Fatigue is the subjective complaint of tiredness or diminished energy level to the point

Fatigue is the subjective complaint of tiredness or diminished energy level to the point that interferes with normal and usual activity. v. Among the most common presenting complaints to family physicians. v Bimodal distribution by age : first peak in late teens/ early 20 s; second peak after 60. Women present with fatigue > than men.

Classification Acute fatigue: Fatigue of recent onset Because of common illnesses or Because of

Classification Acute fatigue: Fatigue of recent onset Because of common illnesses or Because of medication side effects

Prolonged fatigue: Fatigue lasting at least 1 month. Chroni c fatigue: Unexplained fatigue lasting

Prolonged fatigue: Fatigue lasting at least 1 month. Chroni c fatigue: Unexplained fatigue lasting at least 6 months. In most cases, physician is unable to cause. Chronic fatigue syndrome – severe disabling fatigue at least 6 months duration and a combination of symptoms, include self-reported problems with concentration and short-term memory, sleep disturbances , musculoskeletal pain.

Causes of Fatigue Unexplained fatigue and Chronic fatigue yndrome

Causes of Fatigue Unexplained fatigue and Chronic fatigue yndrome

Psychological causes atigue. Usually more than 6 months, and fluctuates in severity, it also

Psychological causes atigue. Usually more than 6 months, and fluctuates in severity, it also can be essors , non –supportive family structure, or sorder may be found.

Psychological causes - Patients usually have a sleep disturbance i. e. insomnia or early

Psychological causes - Patients usually have a sleep disturbance i. e. insomnia or early morning awakening. -Worse in the morning and may be decreased by activity. -Adjustment reaction to life changes ( death of family members, marital status change) and substance abuse ( caffeine, alcohol, illicit drugs).

Lifestyle causes from conditions that ost of people to n. Common among mothers of

Lifestyle causes from conditions that ost of people to n. Common among mothers of newborn, shift workers, over-exercising, and medical students

Physical causes ent more abruptly, - The most common disorders- DM, Acute infections, CVD,

Physical causes ent more abruptly, - The most common disorders- DM, Acute infections, CVD, and Lung - Medication side effects ( analgesics, psychotropics, antihypertensives, antihistamines.

Physical causes tigue is less in the morning and -More specific complaints, physical exam.

Physical causes tigue is less in the morning and -More specific complaints, physical exam. , may show evidence of - Sleep disturbance is secondary to the disease, secondary depression may develop.

Practical approach on) 3) Associated symptoms (constitutional 4) Impact of fatigue on relationships, work,

Practical approach on) 3) Associated symptoms (constitutional 4) Impact of fatigue on relationships, work, and leisure activities

5) Environmental stress: personal, family, 7)Personal habits and behaviors: sleep, diet, exercise, alcohol or

5) Environmental stress: personal, family, 7)Personal habits and behaviors: sleep, diet, exercise, alcohol or recreational drug use

Physical examination Complete physical exam should be General inspection: body habits, skin ra, nails.

Physical examination Complete physical exam should be General inspection: body habits, skin ra, nails. Cardiovascular

Endocrine If diagnosis uncertain

Endocrine If diagnosis uncertain

Level one- Laboratory evaluation ount Testing suggests etiology - further evaluation/ management Age/ gender-

Level one- Laboratory evaluation ount Testing suggests etiology - further evaluation/ management Age/ gender- appropriate cancer screening ( Pap smear, mammography) Testing normal Consider level two laboratory tests.

Level two-Laboratory tests -Chest X-ray ( adenopathy , tumors schemia) -Serologies for rheumatic diseases

Level two-Laboratory tests -Chest X-ray ( adenopathy , tumors schemia) -Serologies for rheumatic diseases ( RF, - Drug screen for unreported substances. Testing normal - HIV, HCB ab, PPD, VDRL Consider Chronic fatigue syndrome ; Or chronic idiopathic fatigue

Chronic Fatigue syndrome Al so called CFS/ME( Myalgic CFS includes both an encephalitic component

Chronic Fatigue syndrome Al so called CFS/ME( Myalgic CFS includes both an encephalitic component ( cognitive difficulties) and a The cause is unknown

Diagnosis Unexplained fatigue > 6 months accompanied by cognitive dysfunction

Diagnosis Unexplained fatigue > 6 months accompanied by cognitive dysfunction

Major criteria: 1. New onset persistent or relapsing ue not previously present, sufficient to

Major criteria: 1. New onset persistent or relapsing ue not previously present, sufficient to reduce daily activity by 2. Exclusion of other conditions.

Physical criteria 3. Palpable or tender anterior or posterior cervical or axillary nodes (2

Physical criteria 3. Palpable or tender anterior or posterior cervical or axillary nodes (2 cm in diameter)

Minor criteria: 3. Painful cervical or axillary lymph nodes nexplained generalized muscle weakness 5.

Minor criteria: 3. Painful cervical or axillary lymph nodes nexplained generalized muscle weakness 5. Myalgia 6. Prolonged >24 h generalized fatigue after d exercise daches 8. Migratory arthralgia without joint swelling or 9. Neuropsychiatric complaints. . inability to on, depression, confusion. 10. Sleep disturbances

Symptoms of CFS Symptoms Low-grade fever Difficulty concentrating Headaches Pharyngitis Painful Lymph nodes Percentage%

Symptoms of CFS Symptoms Low-grade fever Difficulty concentrating Headaches Pharyngitis Painful Lymph nodes Percentage% 60 -95 % 90 % 35 -85 % 50 -75 % 30 -40 %

Muscle pain 20 -95 % Arthralgias 40 -50% Difficulty sleep 15 -90% Impaired cognition

Muscle pain 20 -95 % Arthralgias 40 -50% Difficulty sleep 15 -90% Impaired cognition 50 -85% Depression 70 -85% Anxiety 50 -70% Postexertional malaise 50 -60%

Treatment -Counseling ( Supportive psychoterapy, Cognitive-behavioral therapy) and patient complementary therapy acupuncture, massage)

Treatment -Counseling ( Supportive psychoterapy, Cognitive-behavioral therapy) and patient complementary therapy acupuncture, massage)

THANK’S

THANK’S