Chief complaint fatigue: a longitudinal study from the patient's perspective. Chief complaint of fatigue: a prospective study. Evaluating the complaint of fatigue in primary care: diagnoses and outcomes. The mental health of patients with a chief complaint of chronic fatigue. A prospective evaluation and follow-up. Distinguishing patients with chronic fatigue from those with chronic fatigue syndrome: a diagnostic study in UK primary care. Diagnoses during follow-up of patients presenting with fatigue in primary care A comparison of the characteristics of chronic fatigue syndrome in primary and tertiary care. Chronic fatigue, abuse-related traumatization, and psychiatric disorders in a community-based sample. Fatigue in patients with chronic obstructive pulmonary disease. Psychological symptoms, somatic symptoms, and psychiatric disorder in chronic fatigue and chronic fatigue syndrome: a prospective study in the primary care setting. Patients with fatigue in general practice: a prospective study. Chronic Fatigue Self-Management in Primary Care: A Randomized Trial Prospective Study of the Prognosis of Unexplained Chronic Fatigue in a Clinic-Based Cohort Therapist effects in routine psychotherapy practice: An account from chronic fatigue syndrome Chronic fatigue in general practice: is counselling as good as cognitive behaviour therapy? A UK randomised trial. Patient, caregiver, and oncologist perceptions of cancer-related fatigue: results of a tripart assessment survey. The Fatigue Coalition. A qualitative study to explore the concept of fatigue/tiredness in cancer patients and in healthy individuals.
Fatigue is one of the 10 most common reasons for visiting a physician . Yet little is known about its course or impact , from the patient 's perspective , on quality of life or utilization of medical care . The Dartmouth COOP Project , a primary care research network , conducted a one-year prospect i ve study comparing chief complaint fatigue ( CCF ) patients with two age/sex matched comparison groups ( N = 243 ) . Results show that almost 67 % of the CCF patients improved over one year ; however , they had much higher utilization rates and substantial limitations in physical and emotional function . Fatigue was associated with physical symptoms and interference with many aspects of daily life . We conclude that fatigue has a powerful , adverse effect on quality of life . We hope the findings may help physicians to better underst and and treat patients who seek care for fatigue The Dartmouth COOP Project , a primary care research network , conducted a prospect i ve study of patients presenting to 28 primary care practice s with a chief complaint of fatigue . Data were gathered on fatigue status , associated systems , health status , and origin of fatigue .  Fatigue patients were demographically similar to nonfatigue patients but had significantly worse physical and mental health at study intake . Sixty-three percent of physicians and 52 % of patients rated fatigue origin as primarily physical ( gamma = 0.48 , P less than .05 ) , but in 41 % of cases , physicians indicated there was substantial interaction between physical and psychological factors . Only two factors -- depression and anxiety -- separated fatigue of physical origin from fatigue of psychological origin . Clinicians must thoughtfully evaluate fatigue 's often multiple causes and communicate their underst and ing of those causes to the patient to gain support for a reasonable treatment regimen PURPOSE This case series describes associated diagnoses and prognoses of persistent fatigue in a community-based , primary care population . PATIENTS AND METHODS All patients presenting to a private practice internist with a chief complaint of fatigue of more than 1 month 's duration were prospect ively evaluated with clinical ly directed examination and diagnostic testing .  Patients were excluded if they had a previously diagnosed illness associated with fatigue . Fatigue was attributed to newly established diagnoses or medication use based on explicit criteria . Change in the state of each patient 's fatigue was measured 6 months after entry . RESULTS Fifty-two consecutive patients entered the study . The diagnoses associated with fatigue were a medical disorder in 25 patients , depression in 10 patients , and no definitive diagnosis in 18 patients . The mean cost of diagnostic testing was $ 131 . At 6 months , 37 of 52 patients ( 72 % ) reported improvement in or resolution of their fatigue . CONCLUSION In a primary care setting , many patients presenting with persistent fatigue have an associated , treatable disease that can be determined using a cost-effective , clinical ly directed approach . Most will experience an improvement in their fatigue To determine the psychiatric morbidity of patients complaining of chronic fatigue , we undertook a prospect i ve evaluation of 100 adults ( 65 women and 35 men ; mean age , 41 years ; and mean duration of chronic fatigue , 13 years ) . The study was conducted in an internal medicine outpatient clinic . In addition to a comprehensive medical evaluation , the patients were administered the 260-item Diagnostic Interview Schedule  , a highly structured instrument that enabled the physician-interviewer to make accurate psychiatric diagnoses . A thorough follow-up examination was given an average of 8.4 months later . Sixty-six patients had one or more psychiatric disorders that were considered a major cause of their chronic fatigue ( mood disorder , 47 patients ; somatization disorder , 15 patients ; and anxiety disorder , nine patients ) . Five patients had medical conditions that were considered a major cause of their fatigue . The complaint of chronic fatigue remained unexplained in 31 patients . In this prospect i ve study , two thirds of cases of chronic fatigue appeared to be caused by psychiatric disorders . A thorough evaluation of the mental health of patients complaining of chronic fatigue could therefore provide pharmacologic and psychotherapeutic approaches and avoid unnecessary and costly medical investigations and therapies BACKGROUND Chronic fatigue syndrome ( CFS ) has been defined , but many more patients consult in primary care with chronic fatigue that does not meet the criteria for CFS . General practitioners ( GPs ) do not generally use the CFS diagnosis , and have some doubt about the validity of CFS as an illness . AIM To describe the proportion of patients consulting their GP for fatigue that met the criteria for CFS , and to describe the social , psychological , and physical differences between patients with CFS and those with non-CFS chronic fatigue in primary care . DESIGN OF STUDY Baseline data from a trial of complex interventions for fatigue in primary care . SETTING Twenty-two general practice s located in London and the South Thames region of the United Kingdom recruited patients to the study between 1999 and 2001 . METHOD One hundred and forty-one patients who presented to their GP with unexplained fatigue lasting six months or more as a main symptom were recruited , and the Centers for Disease Control ( CDC ) case definition was applied to classify CFS . RESULTS Approximately two-thirds ( 69 % ) of patients had chronic fatigue  and not CFS . The duration of fatigue ( 32 months ) and perceived control over fatigue were similar between groups ; however , fatigue , functioning , associated symptoms , and psychological distress were more severe in the patients in the CFS group , who also consulted their GP significantly more frequently , were twice as likely to be depressed , and more than twice as likely to be unemployed . About half ( CFS = 50 % ; chronic fatigue = 55 % ) in each group attributed their fatigue to mainly psychological causes . CONCLUSIONS In primary care , CFS is a more severe illness than chronic fatigue , but non-CFS chronic fatigue is associated with significant fatigue and is reported at least twice as often . That half of patients , irrespective of CFS status , attribute their fatigue to psychological causes , more than is observed in secondary care , indicates an openness to the psychological therapies provided in that setting . More evidence on the natural history of chronic fatigue and CFS in primary care is required , as are trials of complex interventions . The results may help determine the usefulness of differentiating between chronic fatigue and CFS Background : Little is known about the distribution of diagnoses that account for fatigue in patients in primary care . We evaluated the diagnoses established within 1 year after presentation with fatigue in primary care that were possibly associated with the fatigue . Methods : We conducted a prospect i ve observational cohort study with 1-year follow-up . We included adult patients who presented with a new episode of fatigue between June 2004 and January 2006 . We extracted data on diagnoses during the follow-up period from the patients ’ medical records as well as data on pre-existing chronic diseases . Results : Of the 571 patients for whom diagnostic data were available , 268 ( 46.9 % ) had received one or more diagnoses that could be associated with fatigue . The diagnoses were diverse and mostly included symptom diagnoses , with main categories being musculoskeletal ( 19.4 % ) and psychological problems ( 16.5 % ) . Clear somatic pathology was diagnosed in 47 ( 8.2 % ) of the patients . Most diagnoses were not made during the consultation when fatigue was presented . Interpretation : Only a minority of patients were diagnosed with serious pathology . Half of the patients did not receive any diagnosis that could explain their fatigue . Nevertheless , because of the wide range of conditions and symptoms that may explain or co-occur with the fatigue , fatigue is a complex problem that deserves attention not only as a symptom of underlying specific disease BACKGROUND To evaluated the characteristics of Chronic Fatigue Syndrome ( CFS ) in primary and tertiary care . METHOD A comparison of subjects fulfilling criteria for CFS , identified as part of a prospect i ve cohort study in primary care , compared to 79 adults fulfilling the same criteria referred for treatment to a specialist CFS clinic .  RESULTS Hospital cases were more likely to belong to upper socio-economic groups , and to have physical illness attributions . They had higher levels of fatigue and more somatic symptoms , and were more impaired functionally , but had less overt psychological morbidity .  Women were over-represented in both primary care and hospital groups . Nearly half of those referred to a specialist clinic did not fulfil operational criteria for CFS . CONCLUSION The high rates of psychiatric morbidity and female excess that characterise CFS in specialist setting s are not due to selection bias . On the other h and higher social class and physical illness attributions may be the result of selection bias and not intrinsic to CFS The relationship between sexual and physical abuse history and negative health effects has been well-documented in medical facility sample s. Few studies have examined the role of abuse history and its relationship with chronic fatigue and psychiatric disorders in a diverse , r and omly selected community-based sample . The present study compared rates of different types of abuse events in individuals with chronic fatigue and non-symptomatic controls . Relationships between specific types of abuse and psychiatric disorders commonly associated with chronic fatigue were also explored . A stratified r and om sample of 18,675 adults residing in ethnically and socioeconomically diverse neighborhoods in Chicago first completed a telephone screening question naire . A control group and a group of individuals with chronic fatigue symptomatology were identified and administered a semi-structured psychiatric interview assessing DSM-IV Axis I psychiatric disorders and a sexual and physical abuse history question naire . Controlling for sociodemographic differences , fatigue outcome was significantly predicted by childhood sexual abuse and the total number of different childhood abuse events . Within the chronic fatigue group , diagnosis of posttraumatic stress disorder ( PTSD ) was significantly predicted by childhood sexual abuse , childhood death threat , the total number of childhood abuse events , and lifetime abuse events . Sexual abuse during adolescence or adulthood significantly predicted other anxiety disorders among individuals with chronic fatigue . These findings suggest that a history of abuse , particularly during childhood , may play a role in the development and perpetuation of a wide range of disorders involving chronic fatigue . Among individuals with chronic fatigue , PTSD and other anxiety disorders appear to demonstrate the strongest association with abuse history . The implication s of these findings are discussed BACKGROUND Fatigue is a frequently occurring symptom in patients with chronic obstructive pulmonary disease ( COPD ) . Despite this , relatively few studies have objective ly assessed patients ' perceptions of fatigue and the impact of perceived fatigue on their everyday lives . OBJECTIVE The purpose of this study was to describe the prevalence , duration and severity of fatigue among patients with COPD and the impact of perceived fatigue on cognitive , physical and psychosocial functioning in comparison with controls . METHOD The  Fatigue Impact Scale , including physical , psychosocial and cognitive dimension and structured questions about the frequency , duration , and severity of fatigue  was mailed to 44 out patients with COPD and 88 r and omly selected age- and sex-matched controls . In total 36 patients and 37 controls completed the question naire . RESULTS Almost half of the patients ( 47.2 % ) , reported fatigue every day during the preceding month compared with 13.5 % of the control group ( P < 0.001 ) . The duration of fatigue was more than 6 hours in 52.7 % of the patients and 44.4 % reported that fatigue was either the worst or one of the worst symptoms they had , compared with 18.9 % ( P < 0.001 ) and 10.8 % ( P < 0.01 ) in the control group . The patients reported a significantly greater impact of fatigue on cognitive , physical and psychosocial functioning compared with the control group ( P < 0.001 ) . CONCLUSION These findings indicate that fatigue is a highly prevalent symptom , which impacts on patients ' functional condition and needs to be professionally assessed and managed OBJECTIVE This study assessed relationships among psychological symptoms , past and current psychiatric disorder , functional impairment , somatic symptoms , chronic fatigue , and chronic fatigue syndrome . METHOD A prospect i ve cohort study was followed by a nested case-control study . The subjects , aged 18 - 45 years , had been in primary care for either clinical viral infections or a range of other problems .  Question naire measures of fatigue and psychological symptoms were completed by 1,985 subjects 6 months later ; 214 subjects with chronic fatigue were then compared with 214 matched subjects without fatigue . Assessment s were made with question naires , interviews , and medical records of fatigue , somatic symptoms , psychiatric disorder , and functional impairment . RESULTS Subjects with chronic fatigue were at greater risk than those without chronic fatigue for current psychiatric disorder assessed by st and ardized interview ( 60 % versus 19 % ) or by question naire ( 71 % versus 31 % ) . Chronic fatigue subjects were more likely to have received psychotropic medication or experienced psychiatric disorder in the past . There was a trend for previous psychiatric disorder to be associated with comorbid rather than noncomorbid chronic fatigue . Most subjects with chronic fatigue syndrome also had current psychiatric disorder when assessed by interview ( 75 % ) or question naire ( 78 % ) . Both the prevalence and incidence of chronic fatigue syndrome were associated with measures of previous psychiatric disorder . The number of symptoms suggested as characteristics of chronic fatigue syndrome was closely related to the total number of somatic symptoms and to measures of psychiatric disorder . Only postexertion malaise , muscle weakness , and myalgia were significantly more likely to be observed in chronic fatigue syndrome than in chronic fatigue . CONCLUSIONS Most subjects with chronic fatigue or chronic fatigue syndrome in primary care also meet criteria for a current psychiatric disorder . Both chronic fatigue and chronic fatigue syndrome are associated with previous psychiatric disorder , partly explained by high rates of current psychiatric disorder . The symptoms thought to represent a specific process in chronic fatigue syndrome may be related to the joint experience of somatic and psychological distress OBJECTIVE --To describe the characteristics of patients attending their general practitioners and complaining of fatigue or being " tired all the time . " DESIGN -- Prospect i ve study of cohort aged 16 years and older with follow up at two weeks and by question naires at two and six months . SUBJECTS--220 patients ( 164 women ) with mean age 43 years and an age-sex matched comparison group . SETTING S -- Doctors and patients in four practice s in Lancashire , Mid Glamorgan , Suffolk , and Surrey . MAIN OUTCOME MEASURES --General clinical data , results from st and ard group of laboratory tests , fatigue question naire , and 12 item general health question naire . RESULTS --Over twice as many patients with fatigue had high scores on the health question naire compared with the comparison group ( 156 ( 75 % ) v 69 ( 34 % ) ) . Results of laboratory tests were abnormal and contributed to the diagnosis in 19 patients . 59 out of 102 patients who responded had high fatigue scores six months later . Patients with persistent fatigue were more likely to have a history of anxiety or depression and to have had fatigue for more than three months on entry to the study . CONCLUSIONS --Women are particularly at risk of fatigue . The outcome is better if patients have had symptoms for three months or less or there is no history of emotional illness Objective To assess the efficacy of brief fatigue self-management ( FSM ) for medically unexplained chronic fatigue ( UCF ) and chronic fatigue syndrome ( CFS ) in primary care . Methods A r and omized controlled design was used wherein 111 patients with UCF or CFS were r and omly assigned to two sessions of FSM , two sessions of symptom monitoring support ( attention control ; AC ) , or a usual care control condition ( UC ) . Participants were assessed at baseline and at 3 and 12 months after treatment . The primary outcome , the Fatigue Severity Scale , measured fatigue impact on functioning . Analysis was by intention to treat ( multiple imputation ) and also by per protocol . Results A group × time interaction across the 15-month trial showed significantly greater reductions in fatigue impact in the FSM group in comparison with the AC group ( p < .023 ) and the UC group ( p < .013 ) . Medium effect sizes for reduced fatigue impact in the FSM group were found in comparison with the AC group ( d = 0.46 ) and the UC group ( d = 0.40 ) . The per- protocol analysis revealed large effect sizes for the same comparisons . Clinical ly significant decreases in fatigue impact were found for 53 % of participants in the FSM condition , 14 % in the AC condition , and 17 % in the UC condition . Dropout rates at the 12-month follow-up were high ( 42%–53 % ) , perhaps attributable to the burden of monthly telephone calls to assess health care use . Conclusion A brief self-management intervention for patients with UCF or CFS seemed to be clinical ly effective for reducing the impact of fatigue on functioning . Trial Registration clinical trials.gov Identifier : NCT00997451 Objectives To determine prospect i ve changes in clinical status related to chronic fatigue over an 18-month period , and to test demographic and clinical predictors of outcome . Methods A cohort of 100 patients with unexplained chronic fatigue ( UCF ) , which encompasses both chronic fatigue syndrome ( CFS ) and idiopathic chronic fatigue ( ICF ) , completed question naire measures and medical and psychiatric evaluations on four occasions , each six months apart . Results Approximately 21 % of the sample did not meet criteria for either CFS or ICF at their last research appointment 1.5 years after their index visit . Vitality increased over time , and physical functioning tended to improve , but UCF symptoms did not decrease significantly . Less education , being unemployed , worse mental health , more use of sedating and antidepressant medications , and more somatic attributions for their symptoms were associated with worsening symptom severity over time . Older age , current depression , and more somatic attributions predicted worsening physical functioning . Better mental health , less use of sedating medications , and fewer somatic attributions for illness were significant predictors of increases in vitality . Conclusions Demographic and clinical variables predict outcomes over time among a cohort of patients with unexplained chronic fatigue Abstract The effect of therapists in psychotherapy is a much debated topic , with a number of studies showing therapist variance being large while other studies show little or no variability in outcomes due to therapists . The aim of this study was to investigate therapist effects in a well-defined sample of patients and therapists from an outpatient service which specializes in providing cognitive behaviour therapy ( CBT ) for patients with chronic fatigue syndrome ( CFS ) . Therapy was provided in a highly specialized clinical setting for CFS and was delivered by qualified CBT therapists with at least 2 years experience with this client group . Three hundred and seventy-four patients with CFS and 12 cognitive behavioural psychotherapists took part .  Therapist effects on the primary outcomes of fatigue and disability were investigated with multilevel r and om effects models and variance component analysis . Different models were computed and compared . Results showed a reduction in fatigue and disability scores after therapy . Variance explained by therapists , when demographic covariates were accounted for , was 0 % for fatigue and under 2 % for disability . A number of important factors may have played a significant role in minimizing therapist effects in our study . These are : specialist setting , single centre , patients with the same primary diagnosis , therapists of the same orientation and training , shared environment and supervision . Future studies may stress the importance of these factors in the investigation of the therapist effect in psychotherapy BACKGROUND Fatigue is a common symptom for which patients consult their doctors in primary care . With usual medical management the majority of patients report that their symptoms persist and become chronic . There is little evidence for the effectiveness of any fatigue management in primary care . AIM To compare the effectiveness of cognitive behaviour therapy ( CBT ) with counselling for patients with chronic fatigue and to describe satisfaction with care . DESIGN OF STUDY R and omised trial with parallel group design . SETTING Ten general practice s located in London and the South Thames region of the United Kingdom recruited patients to the trial between 1996 and 1998 . Patients came from a wide range of socioeconomic background s and lived in urban , suburban , and rural areas . METHOD Data were collected before r and omisation , after treatment , and six months later . Patients were offered six sessions of up to one hour each of either CBT or counselling . Outcomes include : self-report of fatigue symptoms six months later , anxiety and depression , symptom attributions , social adjustment and patients ' satisfaction with care . RESULTS One hundred and sixty patients with chronic fatigue entered the trial , 45 ( 28 % ) met research criteria for chronic fatigue syndrome ; 129 completed follow-up . All patients met Chalder et al 's st and ard criteria for fatigue . Mean fatigue scores were 23 on entry ( at baseline ) and 15 at six months ' follow-up . Sixty-one ( 47 % ) patients no longer met st and ard criteria for fatigue after six months . There was no significant difference in effect between the two therapies on fatigue ( 1.04 [ 95 % CI = -1.7 to 3.7 ] ) , anxiety and depression or social adjustment outcomes for all patients and for the subgroup with chronic fatigue syndrome . Use of antidepressants and consultations with the doctor decreased after therapy but there were no differences between groups . CONCLUSION Counselling and CBT were equivalent in effect for patients with chronic fatigue in primary care . The choice between therapies can therefore depend on other considerations , such as cost and accessibility Although fatigue is the most common symptom reported by cancer patients and has serious adverse effects on quality of life , it remains poorly understood . A survey was design ed to characterize the epidemiology of cancer-related fatigue from the perspectives of the patient , primary caregiver , and oncologist . A telephone survey included 419 cancer patients recruited from 100,000 r and omly selected households nationwide . Patients provided access to 200 primary caregivers ( usually family members ) who were also interviewed by telephone . In a separate mail survey , 197 of 600 r and omly sample d oncologists ( unrelated to the patients ) responded to a question naire that assessed perceptions and attitudes concerning fatigue in cancer patients who had received chemotherapy or radiotherapy and their caregivers . The median patient age was 65 years , and the principal cancer diagnoses were breast ( females ) and genitourinary ( males ) . Fifty-nine percent of the patients had received chemotherapy , 63 % radiation therapy  , and 24 % both ; 20 % of patients received their last treatment within 6 weeks , 31 % within 7 weeks to 1 year , and 49 % more than 1 year ago . More than three quarters of patients ( 78 % ) experienced fatigue ( defined as a general feeling of debilitating tiredness or loss of energy ) during the course of their disease and treatment . Thirty-two percent experienced fatigue daily , and 32 % reported fatigue significantly affected their daily routines . Caregivers reported observing fatigue in 86 % of the index patients , and oncologists perceived that 76 % of their patients experienced fatigue . Although oncologists believed that pain adversely affected their patients to a greater degree than fatigue ( 61 % v 37 % ) , patients felt that fatigue adversely affected their daily lives more than pain ( 61 % v 19 % ) . Most oncologists ( 80 % ) believed fatigue is overlooked or undertreated , and most patients ( 74 % ) considered fatigue a symptom to be endured . Fifty percent of patients did not discuss treatment options with their oncologists , and only 27 % reported that their oncologists recommended any treatment for fatigue . When used , treatments for fatigue were generally perceived by patients and caregivers to be successful . These data confirm the high prevalence and adverse impact of cancer-related fatigue , although it is seldom discussed and infrequently treated . For patients and oncologists , improving the quality of life of cancer patients requires a heightened awareness of fatigue , a better underst and ing of its impact , and improve communication and familiarity with interventions that can reduce its debilitating effects Interest in fatigue research has grown since the finding that fatigue/tiredness is the most frequently reported symptom of cancer and its treatment . But even though several authors have tried to conceptualise fatigue , its mechanisms are still poorly understood . The aim of this study was twofold : ( a ) to explore fatigue in cancer patients inductively , and ( b ) to compare experiences of fatigue/tiredness of healthy individuals with those of cancer patients to identify cancer-specific fatigue/tiredness and related concepts . A qualitative research strategy was adopted using a grounded-theory approach . The prospect i ve study took place in the oncology department of the Kantonsspital , St. Gallen , Switzerl and , with sample s of 20 cancer patients and 20 healthy individuals .  Unstructured , tape-recorded interviews were conducted to collect data . The transcripts of the interviews were analysed using content analysis and constant comparison . Different themes emerged between the two groups although both fitted a classification system that categorised fatigue into physical , affective and cognitive expressions of fatigue/tiredness . Physical signs were more frequent than affective and cognitive signs in both groups . In the cancer patients , fatigue involved decreased physical performance , extreme , unusual tiredness , weakness and an unusual need for rest , which was distinctly different for healthy persons . Affective and cognitive distress was also more prominent in cancer patients . Interestingly , the concept of malaise was not identified by either sample and not understood as an expression of fatigue by this German-speaking population . Linguistic differences in the description of fatigue/tiredness between healthy and ill individuals revealed different perceptions of the phenomenon . A step-like theory , explaining the production of fatigue/tiredness was tentatively put forward involving nociception , perception and expression of tiredness . The emerging concepts break tiredness/fatigue into an expression of physical , affective and cognitive tiredness/fatigue . The experience is different between healthy individuals and cancer patients . Care must be taken when drawing generalised conclusions but the results of the study identify and clarify ideas that might form an important basis for further , controlled studies
Pooling was not appropriate for CFS.In studies with control groups of patients without the symptom of tiredness , prevalence of somatic disease was identical to those complaining of tiredness .
Depression , however , was more frequent among those with tiredness .
Conclusions Serious somatic disease is rare in patients complaining of tiredness .
Since prevalence is similar in patients without tiredness , the association may not be causal .
Background Tiredness is one of the most frequent complaints in primary care .
Although often self-limiting and frequently associated with psychosocial stress , patients but also their physicians are often uncertain regarding a serious cause and appropriate diagnostic work-up .
We conducted a systematic review and meta- analysis of studies reporting on differential diagnosis of fatigue in primary care .