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
Medical Knowledge Self Assessment Program (MKSAP) 20 American College of Physicians, Philadelphia 2025 - ↑ 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://pubmed.ncbi.nlm.nih.gov/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://pubmed.ncbi.nlm.nih.gov/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://pubmed.ncbi.nlm.nih.gov/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://pubmed.ncbi.nlm.nih.gov/22860899 Free PMC Article
- ↑ Dukes JC, Chakan M, Mills A, et al. Approach to fatigue: best practice. Med Clin North Am. 2021;105:137-148. PMID: https://pubmed.ncbi.nlm.nih.gov/33246515