Fatigue

From Anvita Health Wiki

Contents 1 Etiology 2 Clinical-manifestations 3 Laboratory 4 Diagnostic-procedures 5 Differential-diagnosis 6 Management 7 More General Terms 8 Additional Terms 9 References

Etiology

• mood disorder - depression is most common cause (20-30%)
• stress, physical or social
• infection, especially viral infection
• endocrine disorder

• thyroid disease
• diabetes
• adrenal dysfunction

• Cushing's disease
• Addison's disease

• adverse effect of medication
• cardiovascular disease
• lifestyle

• sleep habits
• work schedule
• diet
• exercise
• substance use

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:

• glucose, electrolytes, renal function tests, liver function tests, calcium, albumin, phosphate, thyroid function tests

• HIV testing
• urinalysis
• erythrocyte sedimentation rate (ESR)
• cancer screening as appropriate

• Pap smear
• fecal occult blood

• 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

Differential-diagnosis

• hypersomnolence
• narcolepsy

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

• follow-up

• physical examination
• evolution of symptoms

• palliatve care

• analeptics

• methylphenidate
• dextroamphetamine
• modafinil

• 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

• sign/symptom

Additional Terms

• chronic fatigue syndrome (CFS, myalgic encephalomyelitis; neurasthenia)
• depression
• hypersomnia (hypersomnolence, excessive sleepiness)
• narcolepsy

References

1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 1090-92
2. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
3. Abrahm JL A Physician's Guide to Pain and Symptom Management in Cancer Patients,2nd ed, Baltimore, MD, Johns Hopkins University Press, 2005

fatigue; lassitude; tiredness