fatigue; lassitude; tiredness
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Etiology
- mood disorder
- depression is most common cause (20-30%)
- see depression in the elderly
- stress, physical or social, anxiety
- infection, especially viral infection, HIV1 infection
- endocrine disorder
- adverse effect of medication
- cardiovascular disease: heart failure
- sleep apnea
- chronic liver disease
- chronic renal failure
- cancer
- anemia
- chronic lung disease, hypoxia
- obesity
- lifestyle
- sleep deprivation & poor sleep habits
- work schedule, night shift or swing shift
- diet
- exercise
- substance use
- work/life imbalance
- frailty
- systemic exertion intolerance syndrome
Clinical manifestations
- manifestations suggesting organic etiology
- duration of < 4 weeks
- progressive deterioration
- manifestations suggesting psychosocial etiology
- duration of symptoms > 4 months
- peak symptomatology in AM
- non-specific & multiple symptoms
Laboratory
- complete blood count (CBC)
- serum chemistries:
- as indicated
- avoid excessive tests
Diagnostic procedures
- Psychological screening tests:
- Beck Zung
- Center for Epidemiological Studies Depression Scale [CES-D]
- Minnesota Multiphasic Personality Inventory [MMPI]
- Screening tests for support & stress
- Duke social support & stress scale [DUSOCS]
- family APGAR & circle
- genogram
Complications
- not strongly associated with increased mortality
Differential diagnosis
Management
- treat underlying medical illness, if any
- brief counseling or referral for psychotherapy if indicated
- establish therapeutic relationship
- listen
- reassure
- empathy
- plan to reduce or manage stress
- discontinue suspect medications
- empirical trial of antidepressants
- healthy diet and aerobic exercise
- diary of symptoms
- patient education
- mind-body connection
- stress & personal management skills
- cognitive behavioral therapy[2]
- graded exercise therapy[2]
- follow-up
- physical examination
- evolution of symptoms
- palliatve care
- analeptics
- glucocorticoids
- promote sense of well-being
- effects may wane after 4-6 weeks
- dexamethasone
- prednisone
- erythropotein/analog for fatigue related to anemia
- epoeitin alpha
- darpoeitin alpha
More general terms
Additional terms
- chronic fatigue syndrome; myalgic encephalomyelitis; neurasthenia; systemic exertion intolerance disease (CFS)
- depression
- hypersomnia (hypersomnolence, excessive sleepiness)
- narcolepsy
References
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 1090-92
- ↑ 2.0 2.1 2.2 Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 18, 19. American College of Physicians, Philadelphia 1998, 2012, 2018, 2021.
- ↑ Abrahm JL A Physician's Guide to Pain and Symptom Management in Cancer Patients,2nd ed, Baltimore, MD, Johns Hopkins University Press, 2005
- ↑ Nijrolder I, van der Horst H, van der Windt D. Prognosis of fatigue. A systematic review. J Psychosom Res. 2008 Apr;64(4):335-49. PMID: https://www.ncbi.nlm.nih.gov/pubmed/18374732
- ↑ Alexander NB, Taffet GE, Horne FM Bedside-to-Bench conference: research agenda for idiopathic fatigue and aging. J Am Geriatr Soc. 2010 May;58(5):967-75. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20722821 Free PMC Article
- ↑ Murphy SL, Alexander NB, Levoska M, Smith DM. Relationship between fatigue and subsequent physical activity among older adults with symptomatic osteoarthritis. Arthritis Care Res (Hoboken). 2013 Oct;65(10):1617-24. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23592576 Free PMC Article
- ↑ Schnelle JF, Buchowski MS, Ikizler TA Evaluation of two fatigability severity measures in elderly adults. J Am Geriatr Soc. 2012 Aug;60(8):1527-33. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22860899 Free PMC Article