The truth about chronic fatigue syndrome. Chronic fatigue syndrome Chronic fatigue syndrome mkb 10

CFS/ ME - Chronic fatigue syndrome/Myalgic encephalomyelitis in English.

Chronic Fatigue Syndrome - these three words, although they do not describe, but contain the transformation of my life into my daily suffering, my disability, pain and weakness of the body ...

For a while, CFS was again referred to by the name ME, which sounds like myalgic encephalomyelitis.

Some information about ME/CFS, translated by me from the Cfs-Aktuell.de pages, which always offer the latest news on the topic of ME/CFS and have many translations of English articles.

This information may differ significantly from what you already know or find in Russian.

DATA:

The disease Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a little-known disease in Germany.

In the US, it is also known as Chronic Fatigue Immune Dysfunction Syndrome - CFIDS

And in the UK it's called myalgic encephalomyelitis - ME.

The World Health Organization classifies it as a neurological disorder (ICD-10: G 93.3 below).

Doctors and patients alike are perplexed when faced with the massive, extremely debilitating symptoms of CFS.

Often, patients are so ill that they no longer work for many months and years, and sometimes they cannot cope even with the simplest daily activities, while the usual methods of physical examinations are positive.

This contradiction and lack of knowledge about the disease is unbearable, both for the patients themselves, and for their environment and their doctors.

It is this contradiction and lack of knowledge about the disease that further exacerbate the already precarious situation of patients.

Often, they are misdiagnosed as mentally ill. And doctors, as well as family and friends, see them as malingerers, hypochondriacs, or just lazy people.

Scientists and patients are in favor of separating CFS as a concomitant syndrome from CFS/ME as a separate, distinct independent serious disease.

Recently, scientists have begun to separate Chronic Fatigue Syndrome and Myalgic Encephalomyelitis. For example, they studied pain and exhaustion in patients with depression, fibromyalgia, and myalgic encephalomyelitis.

The use of "fatigue" as the name of an illness gives it an exclusive emphasis and is the most confusing and misused criterion.
No other disease that has fatigue is attached to the name "chronic fatigue".

For example, Cancer/Chronic Fatigue, Multiple Sclerosis/Chronic Fatigue -- excluding ME/CFS (ME/CFS).
Fatigue in other cases is usually proportional to exertion or duration with rapid recovery and will recur to the same extent, with the same exertion and duration, as on the same or next day.
The pathologically low ME fatigue threshold described in the following criteria often occurs with minimal physical or mental exertion and with reduced ability to undertake the same activity for the same or several days.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3427890/

What is chronic fatigue?

Chronic fatigue is a serious condition that often leads to severe disability. According to the latest international studies, this is a violation in a characteristic way of neuroendocrine and immunological control schemes and, consequently, their functions.

CFS is characterized by flu-like symptoms and extreme physical and mental fatigue following minimal activity.

It is called chronic fatigue syndrome only when the condition persists for more than 6 months and no other cause has been found.

In the International Classification of Diseases (ICD 10) of the World Health Organization (WHO), CFS is coded as a neurological disorder under code G 93.3.

The US health authorities first identified CFS in 1988 and gave it that name.
Studies have used a revised version of this definition since 1994.

What are the main symptoms of CFS?

In addition to the symptom of continued and overwhelming emaciation, there are others, such as:
- headache,
- sore throat,
- sensitive lymph nodes,
- muscle and joint pain,
- impaired concentration and memory,
- non-recoverable sleep and
- continued deterioration after exercise.

There are also:
- allergy,
- dizziness and
- coordination disorders, visual impairment,
- violation of temperature control,
- depression,
- sleep disturbance,
- tingling and nervous twitching
- recurrent infections
- gastrointestinal disorders and
- chemical sensitivity.

It should be noted that not all patients experience the same symptoms. Some of them have only minor pain symptoms, while others have pain in the foreground.

New symptoms should always be investigated medically, as they may be signs of other illnesses.

What are the causes of chronic fatigue syndrome (CFS)? What causes this disease?

Despite intensive international research in recent years, the causes and mechanisms of the disease are not yet clear.

There are typical predisposing and precipitating factors, however, about 75 percent of those who get sick have CFS onset abruptly, usually after a "trivial" infection.

In addition, accidents, surgeries, vaccinations, or exposure to toxic chemicals are cited as a trigger.

The remaining 25 percent report an insidious start.

After a recent study, a genetic predisposition is most likely confirmed.

Recent studies such as Martin Pall suggest that the central, self-reinforcing mechanism of disease is described as the NO/ONOO cycle. He claims that these mechanisms explain many multisystem diseases such as fibromyalgia, Gulf War syndrome, and multiple chemical sensitivity.

Also, according to the theory of some experts and, in particular, Judy Mikovits, ME appeared as a result of vaccination against polio, when the first vaccines were cultured from mice in the very early days.
And already this, as a result, contributed to the emergence of a retrovirus in people who already had transmitted from vaccinated to unvaccinated.

How long does CFS last?

The duration of CFS varies greatly, depending on the severity of the disease.

Some patients recover after a few months, others are severely limited for many years. However, most of those who get sick get better over time, but make them more or less limited again, allowing them to still participate in life and lead a fulfilling life.

It is very important not to set unrealistic goals!

You can make many small changes every day that will eventually lead to improvement.

Don't lose hope, but imagine also that the disease can take a long time.

There are quite different treatment approaches that alleviate symptoms and may improve the chances of recovery. It is important that through lifestyle changes to avoid overwork, and therefore possible relapses (worsening).

Will I be healthy again?

Complete recovery is very rare. Reputable studies report 2-12 percent complete recovery.

It is not known how many people managed to restore the ability to work that they had before the onset of the disease.

The severity of CFS varies greatly.

Some patients have a relatively mild form that lasts less than a year, others stay home for years or are even bedridden.

It is believed that the chances of a full recovery are less, the longer the disease lasts.

However, most of those who get sick over time recover only to a certain extent, and few get worse and worse.

Fluctuations in symptoms and relapses are normal phenomena belonging to CFS, which must be learned to cope.

Recovery is not a straight line, but includes these fluctuations.

It is often difficult not to get frustrated by temporary relapses (worsening).

Is there a cure for CFS?

Treatment that acts on the causes of CFS still does not exist.

However, there are many ways to relieve symptoms.

Crucial is the management of the Pacing disease.

This load limit can be very variable and is determined by the patient using cardiac monitoring.

If there is an aggravation of symptoms, which often occurs only with a delay of 24 to 48 hours, then the limit has been exceeded and the load must be reduced.

Only then does the body have the ability to heal itself. Proper stimulation means finding the right balance between activity and rest, and this can be an important key to recovery.

After the first stage of the disease or during periods of relapse, it makes sense to limit activity, but it is also important not to lower the load limit for a long time. A certain load is applied, which can then be expanded over time.

Symptoms such as sleep disorders, allergies, pain and depression can be treated with medication. It should be noted, however, that many patients are extremely sensitive to drugs. Thus, one should start with small doses of each.

In some cases, dietary supplements such as vitamins and minerals may be appropriate. However, any drug treatment should be discussed with your doctor.

Can you die from CFS?

CFS is not a progressive or fatal disease. However, in severe cases, it leads to complications, such as in other life-threatening chronic diseases.

Therefore, it is important to isolate new or more developing symptoms, not immediately classify them as a diagnosis of CFS, but to conduct examinations.

In general, people don't die from CFS. It happens, however, that those who, due to the consequences of this disease, find themselves in difficult psychosocial conditions, reach despair and suicide.

Thus, psychological treatment is urgently needed if suicidal thoughts occur.

How to find a doctor who is familiar with CFS?

The first and main point of contact should always be with the family doctor.

Choose where there is a doctor who is ready to deal with this difficult disease and take care of you.

In Germany, unlike other countries, unfortunately, there is no such list of available "specialists".

Until now, only a few doctors are intensively involved in CFS. There are no specialized clinics.

Often patients are referred to psychosomatic clinics, but experience has shown that there are still no treatments that are suitable for CFS patients.

Many patients with ME/CFS who have left behind the psychosomatic clinic feel much worse after treatment than before, because they cannot cope with the stresses of everyday life in the clinic.

The treatments offered there do not help according to the experience of CFS/ME and rather cause worsening of symptoms or severe relapses.

Attention, also to "miracle healers" of any kind, who lure with promises of salvation and charge rather high fees.

The same is true for alternative forms of treatment, although they may well provide symptomatic relief.

How is CFS diagnosed?

There are no laboratory tests that can determine CFS positive, although some special laboratory values ​​are often abnormal.

Since routine laboratory tests often fail, patients are easily pushed into the "psychosomatic corner" and referred to a psychiatrist.

However, specific tests directed at characteristic immunological and endocrine disorders lead to significant and characteristic findings. These tests are correspondingly costly and also not well known in Germany.

In any case, a careful history and careful physical examination is necessary to rule out other diseases that may have similar symptoms.

Only when a certain group of symptoms develops, which corresponds to the international definition of 1994 (Fukuda), can one speak of CFS (CFS).

In addition to the major severe wasting criterion, four of the so-called minor criteria must be met.

They include:
- non-restorative sleep,
- sensitive lymph nodes, sore throat,
- muscle and joint pain, new type of headaches,
- severe disorders of concentration and memory,
- general malaise after exercise that lasts longer than 24 hours.

When someone is exhausted for a long time, there can be many other reasons for this.

Only a small percentage of these people actually suffer from chronic fatigue syndrome.

Even after cancer treatment, for example, people often suffer from "fatigue." But this is another reason, therefore, as a rule, it is well treated.

Is CFS an appropriate name for this disease? Why are there different names for it?

Many sufferers dismiss the name CFS on the grounds that it doesn't describe the severity of the symptoms somehow more accurately than if you called tuberculosis like chronic cough syndrome or Parkinson's disease - chronic shaking.

The term "fatigue" is a harmless-sounding name for extreme weakness and performance limitation that is incomparable to the normal everyday fatigue of a healthy person.

In the first official description of the disease by the US health authorities, the CDC since 1988, however, the name CFS was chosen to emphasize the leading main symptom, emaciation.

This definition was taken mainly for pragmatic reasons, in order to have a working basis for further research in this disease, in which differences from other wasting conditions are possible.

In other countries, some other names exist, for example:
- in the UK - ME myalgic encephalopathy,
- in the USA - CFIDS - Chronic Fatigue and Immune Dysfunction Syndrome,
- in Australia - PVS - post viral syndrome.

At the request of the United States Department of Health, an international working group CFS researchers, physicians and patient advocates in order to establish a new name that would directly indicate the causes and mechanisms of the disease and its main symptoms.

However, no agreement acceptable to all can yet be reached.

The name is discussed - Neuroendocrine immune disorder (NEID), reflecting the repeatedly proven disorders of the neuroendocrine and immunological control circuits.

Is CFS contagious or hereditary?

CFS is not known to be passed from person to person, but it is becoming more common in some families. This may be due to environmental or genetic factors, which indicate research on US twins and genome analysis at the University of Glasgow is currently under way.

Since CFS sometimes flares up, even as an epidemic, it is believed that although a virus caused CFS in these cases, it is not contagious.

Whether or not a patient develops CFS upon contact with a viral infection is a matter of individual predisposition.

Recent epidemiological studies from the US, Australia and Taiwan (Keyword: Dubbo studies and dengue fever) show that every certain percentage of people who have an acute infection develop CFS.

In Germany, the head of the Robert Koch Institute banned blood and organ donations from CFS patients until the causes of CFS were clarified.

Belgian researcher Kenny De Meer Leir reports cases that have occurred as a result of blood transfusions or organ transplants.

Who gets CFS?

CFS affects people of all ages, social classes and ethnic groups.

Children 12 years of age and young adults develop CFS. The most common manifestation is between 30 and 45 years of age.

About two-thirds of the affected people are women. The cause is unknown, but many immunological diseases are female-dominated.

How many sick people are there in Germany?

There are no frequency studies in Germany. However, in the UK and the US, so-called prevalence studies have been carried out, leading to an increase in the disease from 0.24 percent to 0.42 percent of the population.

In Germany, between 300,000 and 400,000 cases are expected. Since CFS is little known in Germany to both doctors, health authorities and the public it can still be assumed that more than 90 percent of affected people have received a correct diagnosis or not.

In addition, in Germany, in the usual classification of diseases, CFS, for some unknown reason, is considered as “somatoform disorders”. A simple equation from "not detected" leads to "psychosomatic/somatoform" and means that patients with ME/CFS are often misdiagnosed with psychiatry, which leads to extreme difficulties.

In addition to stigmatization and the refusal of doctors to treat symptomatic patients, they are often denied pensions and so on.

Secondary, emerging psychiatric disorders such as (often) reactive depression account for the cause of the disease, with fatal consequences for those who become ill.

CFS - a new disease?

No.
CFS has been described in the medical literature for centuries. An epidemic like an outbreak in a London hospital in 1955 has received quite a bit of attention in the literature. Dr. Melvin Ramsay, who described the outbreak, then gave it the common name in the UK, myalgic encephalomyelitis (ME).

However, some researchers believe that CFS has increased significantly since the 1980s and is merely an expression of a range of multisystem environmental diseases.

In the 1980s, there were outbreaks of a group type everywhere in the United States that knocked down hundreds and thousands of people.

Their initiative and pressure from physicians that took place in practice in such groups (such as Daniel Peterson, David Bell, Charles Lapp, Paul Cheney, Nancy Klimas and others) eventually led to the term "CFS" adopted by the health authorities. USA.

How do I explain CFS to my friends, my family, and my employer?

Undoubtedly, it is difficult to explain a disease that is associated with very strong functional impairment, but which is not “seen” and cannot be detected using standard laboratory tests.

Fluctuations in symptoms in patients are very difficult to understand by people from the outside. Patients are often confronted with doubt, distrust, and statements like, "I'm tired too" or "Pick it up once and then it'll work out," or "It's all just mental, of course."

Explain to those around you that your fatigue is by no means comparable to that of a healthy person. Not only is it a much more massive, in terms of severe illness, flu-like feeling, but it is not ameliorated by sleep or rest.

Explain that if you overexert yourself, you will feel worse afterwards and that it is not a matter of will.

Set clear boundaries.

Provide links to international research results that repeatedly show that CFS is a serious organic disease and psychological problems are usually only a consequence, not a cause of your condition.

In this case, find advice and support in a self-help organization.

Published in March 2008, Daphne Wurzbacher's book Living with CFS/ME gives a very good impression of the devastating effects of this disease and can make it clear to a doubting relative, friend and professional helper that the affected person is not just "always tired" but seriously ill.

Does stress play a role?

Often, patients report that they were exposed to long-term stress prior to the onset of CFS. Stress is the cause of many possible factors, but is not the cause of disease.

Martin Poll lists various stressors that are suitable triggers for multisystem disease.

In addition to infections, psychological stress is also included. Stress can be a disease-related factor and should be reduced as much as possible.

After the outbreak of the disease in general, all patients have very weak stress resistance.
Normal stresses for many people, such as light and noise, can very quickly lead to temperature fluctuations, sensorimotor and emotional problems, to the limits of the CFS patient and lead to worsening of his symptoms.

Can I work with CFS?

This is highly dependent on individual symptoms and the specific requirements of your job.
Some people who have a relatively mild form of CFS can keep their jobs, albeit with difficulty, if they give up any further activities.

You can try to work part-time. But there are patients who are no longer able to work.

According to a study in the US about 53 percent of those who work in some form.

The decision to change careers or retire should always be carefully considered.

If necessary, consult with an employee of your company or other consultant about your disability.

Why has CFS been ignored by doctors for so long and misunderstood?

ME/CFS is not a fatal and/or contagious disease such as HIV.

Consequently, for health authorities, the need for action seems to be less relevant and is not a major topic for physician training. But in vain.

Conventional laboratory tests for CFS often show no abnormalities that would have "clinical significance" from the point of view of physicians.

Especially in Germany and German-speaking countries, it is customary to include diseases that are "not associated with any known disease" and should be classified as "somatoform disorders".

This means - for medical professionals, patients no longer meet their specialization, but are referred to a psychologist or psychiatrist.

Due to a lack of understanding of the problem, there are no funds to conduct biomedical research into the causes of ME/CFS in Germany.

In other countries, such as the US, UK and Belgium, there will be significant funding from governments as well.

In the UK, there should be public funding to ensure that people who get sick are supported through the National Health Service.

In Germany, however, there is not yet even a consultation center or special medical service centers.

Is ME/CFS a depression or mental disorder?

Primary psychiatric disorders such as depression or Majore eating disorders are exclusion criteria for CFS.

Numerous international studies show important biochemical and symptomatic differences between patients with depression and those with CFS.

However, depression occurs in many CFS patients, as in many other chronic diseases, as a secondary symptom and as such also needs to be treated.

In the history of medicine and until recently, illnesses whose causes are not yet understood have often been called hysteria, depression, somatoform disorders or "psychological factors".

Examples include multiple sclerosis, tuberculosis, and gastrointestinal diseases caused by Helicobacter pylori.

What can I do to feel better?

Pay attention to your body signals!

When exceeding - too long and too strong maximum load (determined subjectively!), Serious relapses can occur.

Patients' organizations in the UK and the USA recommend the "Pacing" concept, that is, their own assessment of the possibilities corresponding to the load, at which its limit should not be exceeded.

This lifestyle change promotes the healing process and allows for expansion of exercise limits over time.

Excessive overload is just as harmful as constant underload!

At the same time, some patients feel so bad that they can hardly get out of bed for a long time.

Manage your financial affairs and professional prospects so as to keep the stress as low as possible as a result.

Creating an environment where you can relax and find long-term support. Never give up, look for these conditions, even if they are hard to come by.

Since there is still no cure for CFS, it is important to learn how to live with the disease.

And this means living in such a way that the symptoms do not become stronger, but weaken.

The experiences of thousands of patients have been included in short messages which are compiled by the UK Patients' Organization in one of their DOE brochures Living with CFS:

1. “Learn to manage your energy and equally your physical, mental and emotional activity.

Become an expert in disease control and you will be in control of your life.

2. Treat the symptoms that hurt you the most so they don't define your life. These include pain, sleep disturbance and depression.

Symptoms that you can't control can be your path to recovery.
Your doctor can help you manage your side effects by prescribing appropriate medications.
There are other strategies that can help you.
Share your activity, take breaks, and reduce your activity level.
In addition, you may benefit from relaxation techniques or complementary therapies.

3. Build a good collaborative relationship with your family doctor.
This may take some time, and in some cases, can be difficult, but the overall approach of partnering with your doctor can be the deciding factor in order to stabilize your health and allow recovery.

4. Always remember that you can recover from ME/CFS!
Learn to accept your condition, only in this way the likelihood that you will recover increases.

5. You are not alone in your condition!
In the UK, an estimated 240,000 people are affected, in Germany (300,000 - 400,000).

This definition of chronic fatigue syndrome (CFS) has several variations, and the heterogeneity of patients who meet the criteria for this definition is considerable. Precise determination of prevalence is impossible; it varies from 7 to 38/100,000 people. Prevalence may vary due to differences in diagnostic evaluation, physician-patient relationship, social acceptability, risk of exposure to an infectious or toxic substance, or case finding and definition. Chronic fatigue syndrome is more common in women. Office-based studies have shown that the incidence is higher among white people. However, community surveys indicate higher prevalence among blacks, Hispanic Hispanics, and American Indians.

Approximately one in five patients (10-25%) applying for medical care complains of prolonged fatigue. Usually, a feeling of fatigue is a transient symptom that disappears spontaneously or when the underlying disease is treated. Nevertheless, in some patients, this complaint begins to persist and has a negative impact on general state health. When fatigue cannot be explained by any disease, it is assumed that it is associated with chronic fatigue syndrome, the diagnosis of which can only be made after the exclusion of other physical and mental disorders.

The prevalence of chronic fatigue syndrome in the adult population, according to some data, can reach 3%. Approximately 80% of all cases of chronic fatigue syndrome remain undiagnosed. Children and adolescents develop chronic fatigue syndrome much less frequently than adults. The peak incidence of chronic fatigue syndrome falls on the active age (40-59 years). Women in all age categories are more susceptible to chronic fatigue syndrome (60-85% of all cases).

Causes of Chronic Fatigue Syndrome

Initially, they leaned towards the infectious theory of the development of chronic fatigue syndrome ( viral infection), but further studies have revealed a wide variety of changes in many areas, including the structure and function of the brain, neuroendocrine response, sleep structure, immune system, psychological profile. Currently, the most common stress-dependent model of the pathogenesis of chronic fatigue syndrome, although it cannot explain everything. pathological changes characteristic of this syndrome. Based on this, most researchers postulate that chronic fatigue syndrome is a heterogeneous syndrome, which is based on various pathophysiological abnormalities. Some of them may predispose to the development of chronic fatigue syndrome, others directly cause the development of the disease, and still others cause its progression. Risk factors for chronic fatigue syndrome include female gender, genetic predisposition, certain personality traits or behaviors, and others.

Stress-dependent hypothesis

• In the premorbid history of patients with chronic fatigue syndrome, as a rule, there are indications of a large number of stressful life events, infectious diseases and surgical interventions. The manifestation or exacerbation of chronic fatigue syndrome and its comorbid conditions in adults are often associated with stress or conflict situations.
• Mental trauma in childhood (child abuse, abuse, neglect, etc.) is considered an important factor risk of developing chronic fatigue syndrome. High reactivity to adverse psychosocial factors is characteristic of the entire spectrum of disorders associated with childhood trauma. Stress in early life, during a critical period of increased brain plasticity, constantly affects brain regions involved in cognitive-emotional processes and regulating the endocrine, autonomic, and immune systems. There is experimental and clinical evidence that traumatic events experienced at a young age lead to a long-term disruption of the hypothalamic-pituitary-adrenal system and a more pronounced reaction to stress. However, childhood psychotrauma is present in the anamnesis of far from all patients with chronic fatigue syndrome. Probably, this mechanism can play a leading role in the pathogenesis of only a certain group of patients with chronic fatigue syndrome.
• Comprehensive studies of the neuroendocrine status in chronic fatigue syndrome revealed significant changes in the activity of the hypothalamic-pituitary-adrenal system, which confirms the violation of the physiological response to stress. In a third of patients with chronic fatigue syndrome, hypocorticism is detected, which is probably of central origin. The discovery in the families of patients with chronic fatigue syndrome of a mutation that disrupts the production of a protein necessary for the transport of cortisol in the blood also deserves attention. Women (but not men) with chronic fatigue syndrome have lower morning cortisol peaks than healthy women. These sex differences in the circadian rhythm of cortisol production may explain more high risk development of chronic fatigue syndrome in women. A low level of cortisol leads to disinhibition of immune mediators and determines the response to stress of the suprasegmental divisions of the autonomic nervous system, which in turn causes fatigue, pain phenomena, cognitive impairment and affective symptoms. Taking serotonin agonists in patients with chronic fatigue syndrome leads to a greater increase in plasma prolactin levels compared to healthy individuals. In patients suffering from major depression, the pattern of neuroendocrine disorders is reversed (hypercorticism, serotonin-mediated prolactin suppression). In contrast, depletion of morning cortisol levels has been noted in individuals suffering from chronic pain and various emotional disturbances. Currently, dysfunction of the hypothalamic-pituitary-adrenal system, hormonal response to stress, and features of the neurotransmitter effects of serotonin are the most reproducible changes found in patients with chronic fatigue syndrome.
• Patients with chronic fatigue syndrome are characterized by a distorted perception of natural bodily sensations as painful symptoms. They are also characterized by increased sensitivity to physical activity (low threshold for changes in heart rate, blood pressure etc.) A similar pattern of perceptual disturbance can be observed in relation to stress-induced bodily sensations. It is believed that perceptual disturbances, regardless of the etiology of chronic fatigue syndrome, are the basis for the appearance and persistence of symptoms and their painful interpretation.

CNS disorders. Some symptoms of chronic fatigue syndrome (fatigue, impaired concentration and memory, headache) suggest the pathogenetic possibility of CNS dysfunction. In some cases, MRI reveals nonspecific changes in the subcortical white matter of the brain, which, however, are not associated with cognitive impairment. Regional disturbances of brain perfusion (usually hypoperfusion) are typical according to SPECT-scan. In general, all the changes identified so far have no clinical significance.

Autonomic dysfunction. D.H. Streeten, G.H. Anderson (1992) suggested that one of the causes of chronic fatigue may be a violation of the maintenance of blood pressure in vertical position. It is possible that a separate subgroup of patients with chronic fatigue syndrome has orthostatic intolerance [the latter is understood as symptoms of cerebral hypoperfusion, such as weakness, lipothymia, blurred vision that occur in an upright position and are associated with sympathetic activation (tachycardia, nausea, trembling) and an objective increase in heart rate over than 30 per minute]. Postural tachycardia associated with orthostatic intolerance is often observed in individuals with chronic fatigue syndrome. Symptoms characteristic of postural tachycardia (dizziness, palpitations, pulsations, intolerance to physical and mental stress, lipothymia, chest pain, gastrointestinal symptoms, anxiety disorders, etc.) are also noted in many patients with chronic fatigue syndrome. The pathogenesis of postural tachycardia syndrome remains unclear, suggesting the role of baroreceptor dysfunction, increased sensitivity of alpha- and beta-adrenergic receptors, pathological changes in the venous system, norepinephrine metabolism disorders, etc. In general, in some patients, chronic fatigue syndrome pathogenetically, indeed, may be due to autonomic dysfunction manifesting orthostatic intolerance.

infections. Epstein-Barr virus, type 6 herpes virus, group B Coxsackie virus, type II T-cell lymphotropic virus, hepatitis C virus, enteroviruses, retroviruses, etc. were previously considered as possible etiological agents of chronic fatigue syndrome. evidence infectious nature chronic fatigue syndrome were not obtained. In addition, therapy aimed at suppressing the viral infection does not improve the course of the disease. Nevertheless, a heterogeneous group of infectious agents continues to be considered as a factor contributing to the manifestation or chronic course of chronic fatigue syndrome.

Violations by immune system . Despite numerous studies, only minor deviations in the immune status have been identified in patients with chronic fatigue syndrome. First of all, they concern an increase in the expression of active markers on the surface of T-lymphocytes, as well as an increase in the concentration of various autoimmune antibodies. Summarizing these results, it can be stated that mild activation of the immune system is typical for patients with chronic fatigue syndrome, however, it remains unknown whether these changes have any pathogenetic significance.

Mental disorders. Since there is no conclusive evidence of a somatic cause of chronic fatigue syndrome yet, many researchers postulate that this is a primary mental illness. Others believe that chronic fatigue syndrome is one of the manifestations of other mental illnesses, in particular, somatization disorder, hypochondria, major or atypical depression. Indeed, in patients with chronic fatigue syndrome, the frequency of affective disorders is higher than in the general population or among individuals with chronic somatic diseases. In most cases, mood disorders or anxiety precede the onset of chronic fatigue syndrome. On the other hand, the high prevalence of affective disorders in chronic fatigue syndrome may be the result of an emotional response to disabling fatigue, immune changes, and CNS disorders. There are other objections to the identification of chronic fatigue syndrome with mental illness. Firstly, although some manifestations of chronic fatigue syndrome are close to non-specific mental symptoms, many others, such as pharyngitis, lymphadenopathy, and arthalgia, are not at all typical for mental disorders. Secondly, anxiety-depressive disorders are associated with central activation of the hypothalamic-pituitary-adrenal system (moderate hypercortisolism), on the contrary, in chronic fatigue syndrome, central inhibition of this system is more often observed.

Symptoms of Chronic Fatigue Syndrome

Subjectively, patients can formulate the main complaint in different ways (“I feel completely exhausted”, “I constantly lack energy”, “I am completely exhausted”, “I am exhausted”, “normal loads bring me to exhaustion”, etc. .). With active questioning, it is important to differentiate the actual increased fatigue from muscle weakness or a feeling of despondency.

Most patients rate their premorbid physical condition as excellent or good. Feeling extremely tired comes on suddenly and is usually associated with flu-like symptoms. The disease may be preceded by respiratory infections, such as bronchitis or vaccination. Less often, the disease has a gradual onset, and sometimes begins gradually over many months. After the onset of the disease, patients notice that physical or mental efforts lead to an aggravation of the feeling of fatigue. Many patients find that even minimal physical effort leads to significant fatigue and an increase in other symptoms. Prolonged rest or lack of physical activity can reduce the severity of many symptoms of the disease.

The frequently observed pain syndrome is characterized by diffuseness, uncertainty, and a tendency to migrate. pain. In addition to muscle and joint pain, patients complain of headache, sore throat, soreness lymph nodes, abdominal pain (often associated with a comorbid condition - irritable bowel syndrome). Pain in chest is also typical for this category of patients, some of them complain of "painful" tachycardia. Some patients complain of pain in unusual places [eyes, bones, skin (pain at the slightest touch to the skin), perineum and genitals].

Immune system changes include tenderness of the lymph nodes, repeated episodes of sore throat, recurrent flu-like symptoms, general malaise, and hypersensitivity to previously well tolerated foods and/or drugs.

In addition to the 8 main symptoms that have the status of diagnostic criteria, patients may have many other disorders, the frequency of which varies widely. Most often, patients with chronic fatigue syndrome note a decrease in appetite up to anorexia or its increase, fluctuations in body weight, nausea, sweating, dizziness, poor tolerance to alcohol and drugs that affect the central nervous system. The prevalence of autonomic dysfunction in patients with chronic fatigue syndrome has not been studied; nevertheless, autonomic disorders have been described both in individual clinical observations and in epidemiological studies. More often than others, orthostatic hypotension and tachycardia, episodes of sweating, pallor, sluggish pupillary reactions, constipation, frequent urination, respiratory disorders (feeling of lack of air, obstruction in respiratory tract or pain when breathing).

Approximately 85% of patients complain of impaired concentration, memory impairment, however, routine neuropsychological examination usually does not reveal impaired mnestic function. However, an in-depth study often reveals minor, but undoubted violations of memory and digestibility of information. In general, patients with chronic fatigue syndrome have normal cognitive and intellectual capabilities.

Diagnostic criteria

Chronic fatigue syndrome has been repeatedly described under various names; search for a term that most fully reflects the essence of the disease. are continuing at the present time. In the literature, the following terms were most often used: "benign myalgic encephalomyelitis" (1956), "myalgic encephalopathy", "chronic mononucleosis" (chronic Epstein-Barr virus infection) (1985), "chronic fatigue syndrome" (1988), "postviral syndrome fatigue." In ICD-9 (1975), chronic fatigue syndrome was not mentioned, but there was a term "benign myalgic encephalomyelitis" (323.9). ICD-10 (1992) introduced a new category - postviral fatigue syndrome (G93).

For the first time, the term and definition of chronic fatigue syndrome were presented by US scientists in 1988, who suggested a viral etiology of the syndrome. Epstein-Barr virus was considered as the main causative agent. In 1994, a revision of the definition of chronic fatigue syndrome was carried out and, in an updated version, it acquired international status. According to the 1994 definition, a diagnosis requires persistence (or remittance) of unexplained fatigue that is not relieved by rest and significantly limits daily activities for at least 6 months. In addition, 4 or more of the 8 following symptoms must be present.

• Impaired memory or concentration.
• Pharyngitis.
• Soreness on palpation of the cervical or axillary lymph nodes.
• Muscle soreness or stiffness.
• Joint tenderness (no redness or swelling).
• A new headache or a change in its characteristics (type, severity).
• Sleep that does not bring a sense of recovery (freshness, vivacity).
• Exacerbation of fatigue to the point of exhaustion after physical or mental effort lasting more than 24 hours.

In 2003, the International Chronic Fatigue Syndrome Study Group recommended that standardized scales be used to assess the main symptoms of chronic fatigue syndrome (impaired daily activity, fatigue, and the accompanying symptom complex).

Conditions that exclude the diagnosis of chronic fatigue syndrome are as follows:

• Presence of any current medical conditions that may explain the persistence of chronic fatigue, such as severe anemia, hypothyroidism, sleep apnea, narcolepsy, cancer, chronic hepatitis B or C, uncontrolled diabetes, heart failure and other severe cardiovascular diseases, chronic kidney failure, inflammatory and disimmune diseases, diseases of the nervous system, severe obesity, etc., as well as taking medications, the side effects of which include a feeling of general weakness.
• Mental illness (including history).
  • Major depression with psychotic or melancholic symptoms.
  • Bipolar affective disorder.
  • Psychotic states (schizophrenia).
  • Dementia.
  • Anorexia nervosa or bulimia.
• Abuse of drugs or alcohol for 2 years before the onset of fatigue and for some time after.
• Severely obese (body mass index of 45 or more).

The new definition also indicates diseases and conditions that do not exclude the diagnosis of chronic fatigue syndrome:

• Painful conditions that are diagnosed based on clinical criteria only and that cannot be confirmed by laboratory tests.
  • Fibromyalgia.
  • anxiety disorders.
  • somatoform disorders.
  • Non-melancholic depression.
  • Neurasthenia.
• Diseases associated with chronic fatigue, but the successful treatment of which has led to an improvement in all symptoms (the adequacy of therapy must be verified). For example, the success of replacement therapy for hypothyroidism should be verified by a normal level of thyroid hormones, the adequacy of treatment bronchial asthma- evaluation respiratory function etc.
• Diseases associated with chronic fatigue and caused by a specific pathogen, such as Lyme disease, syphilis, if they were adequately treated before the onset of symptoms of chronic fatigue.
• Isolated and unexplained paraclinical abnormalities (changes in laboratory parameters, neuroimaging findings), which are not enough to rigorously confirm or rule out any disease. For example, these findings may include an increase in antinuclear antibody titers in the absence of additional laboratory or clinical evidence to reliably diagnose the disease. connective tissue.

Unexplained chronic fatigue that does not fully meet the diagnostic criteria may be regarded as idiopathic chronic fatigue.

In 2007, the UK National Institutes of Health (NICE) published less stringent criteria for chronic fatigue syndrome, recommended for use by various professionals.

• The presence of new, persistent or recurrent fatigue (greater than 4 months in adults and 3 months in children) that:
  • cannot be explained by any other disease;
  • significantly limits the level of activity;
  • characterized by malaise or worsening fatigue after any effort (physical or mental) followed by an extremely slow recovery (over at least 24 hours, but usually within a few days).
• The presence of one or more symptoms from the following list: sleep disturbance, muscle or joint pain of polysegmental localization without signs of inflammation, headache, soreness of the lymph nodes without their pathological increase, pharyngitis, cognitive dysfunction, worsening of symptoms with physical or mental stress, general malaise, dizziness and / or nausea, palpitations in the absence of organic heart disease.

The NICE criteria for chronic fatigue syndrome have been subject to considerable criticism from experts, so most researchers and clinicians continue to use the 1994 international criteria.

Along with chronic fatigue syndrome, secondary forms of this syndrome are also isolated in a number of neurological diseases. Chronic fatigue is observed in multiple sclerosis, Parkinson's disease, motor neuron diseases, chronic cerebral ischemia, strokes, post-poliomyelitis syndrome, etc. as a reaction to a neurological disease.

Diagnosis of chronic fatigue syndrome

There are no specific paraclinical tests to confirm the clinical diagnosis of chronic fatigue syndrome. At the same time, a mandatory examination is carried out to exclude diseases, one of the manifestations of which may be chronic fatigue. Clinical evaluation of patients with a leading complaint of chronic fatigue includes the following activities.

• Detailed medical history, including those used by the patient medicines which can cause fatigue.
• Exhaustive examination of the somatic and neurological status of the patient. Superficial palpation of the somatic muscles in 70% of patients with chronic fatigue syndrome with gentle pressure reveals painful points localized in various muscles, often their location corresponds to that of fibromyalgia.
• Screening study of cognitive and mental status.
• Carrying out a set of screening laboratory tests:
  • general blood test (including leukocyte formula and determination of ESR);
  • biochemical analysis blood (calcium and other electrolytes, glucose, protein, albumin, globulin, creatinine, ALT and ACT, alkaline phosphatase);
  • function evaluation thyroid gland(thyroid hormones);
  • urine analysis (protein, glucose, cellular composition).

Additional studies usually include the determination of C-reactive protein (a marker of inflammation), rheumatoid factor, CK activity (muscle enzyme). Determination of ferritin is advisable in children and adolescents, as well as in adults if other tests confirm iron deficiency. Specific tests confirming infectious diseases (Lyme disease, viral hepatitis, HIV, mononucleosis, toxoplasmosis, cytomegalovirus infection), as well as a serological panel of tests for Epstein-Barr viruses, enteroviruses, retroviruses, herpes viruses type 6 and candida albicans carried out only if there is a history of indications of an infectious disease. On the contrary, MRI of the brain, the study of the cardiovascular system are classified as routine methods for suspected chronic fatigue syndrome. Polysomnography should be performed to rule out sleep apnea.

In addition, it is advisable to use special questionnaires that help assess the severity of the disease and monitor its course. The most commonly used are the following.

• The Multidimensional Fatigue Inventory (MFI) assesses general fatigue, physical fatigue, mental fatigue, reduction in motivation and activity. Fatigue is defined as severe if the overall fatigue score is 13 points or more (or the activity reduction scale is 10 points or more).
• SF-36 (Medical outcomes survey short form-36) questionnaire for assessing functional impairment in 8 categories (limitation of physical activity, limitation of usual role activity due to health problems, limitation of usual role activity due to emotional problems, bodily pain assessment, general health assessment, vitality assessment, social functioning and general mental health). The ideal score is 100 points. Patients with chronic fatigue syndrome are characterized by a decrease in functional activity (70 points or less), social functioning (75 points or less), and a decrease in the emotional scale (65 points or less).
• The list of CDC symptoms (CDC Symptom Inventory) for identifying and assessing the duration and severity of the accompanying fatigue symptom complex (in a minimized form is a total assessment of the severity of 8 symptoms-criteria of chronic fatigue syndrome).
• If necessary, the McGill Pain Score and the Sleep Answer Questionnaire are also used.

Chronic Fatigue Syndrome is a diagnosis of exclusion, that is, it requires careful differential diagnosis to exclude many severe and even life-threatening diseases (chronic heart disease, anemia, thyroid pathology, tumors, chronic infections, endocrine diseases, connective tissue diseases, inflammatory bowel diseases, mental disorders, etc.).

In addition, it should be remembered that feeling tired can be a side effect of certain medications (muscle relaxants, analgesics, beta-blockers, benzodiazepines, antihistamines and anti-inflammatory drugs, beta interferons).

Treatment of chronic fatigue syndrome

Since the causes and pathogenesis of chronic fatigue syndrome are still unknown, reasonable therapeutic recommendations do not exist. Controlled studies have been conducted on the effectiveness of certain drugs, nutritional supplements, behavioral therapy, physical training, etc. In most cases, the results were negative or inconclusive. The most encouraging results were obtained in relation to complex non-drug treatment.

Drug treatment of chronic fatigue syndrome

There are a few studies showing some positive effect of intravenous immunoglobulin (compared to placebo), but the effectiveness of this method of therapy cannot yet be considered proven. Most other drugs (glucocorticoids, interferons, antivirals, etc.) were ineffective in relation to both the actual feeling of fatigue and other symptoms of chronic fatigue syndrome.

In clinical practice, antidepressants are widely used to successfully relieve some symptoms of chronic fatigue syndrome (improve sleep and reduce pain, positively affect comorbid conditions, in particular fibromyalgia). Some open studies have established a positive effect of reversible MAO inhibitors, especially in patients with clinically significant autonomic symptoms. However, it should be borne in mind that most patients with chronic fatigue syndrome do not tolerate medications acting on the central nervous system, so therapy should be started with low doses. Preference should be given to antidepressants with a favorable tolerability spectrum. In addition, official herbal preparations with a significantly lower amount side effects may be considered as an alternative therapy in individuals who have had negative experiences with antidepressants. The basis of most official complex herbal remedies is valerian. Controlled randomized trials demonstrate that the effects of valerian on sleep include improved sleep quality, longer sleep time, and reduced time to fall asleep. The hypnotic effect of valerian on sleep is more evident in insomniacs than in healthy individuals. These properties allow the use of valerian in individuals with chronic fatigue syndrome, core clinical picture which are dyssomnic manifestations. More often, not a simple valerian extract is used, but complex herbal preparations (novopassitis), in which a harmonious combination of extracts of medicinal plants provides a complex psychotropic (sedative, tranquilizing, mild antidepressant) and "organotropic" (antispasmodic, analgesic, antiallergic, vegetostabilizing) effect.

There is evidence that in some patients a positive effect was obtained when prescribing amphetamine and its analogues, as well as modafinil.

In addition, paracetamol or other NSAIDs are used, which are especially indicated for patients with musculoskeletal disorders (muscle soreness or stiffness).

In case of sleep disorders, sleeping pills may sometimes be required. Generally, you should start with antihistamines(doxylamine) and only in the absence of effect, prescribe prescription sleeping pills in minimal doses.

Some patients use alternative treatment- vitamins in large doses, herbal medicine, special diets, etc. The effectiveness of these measures has not been proven.

Non-pharmacological treatment of chronic fatigue syndrome

Cognitive behavioral therapy is widely used to address pathological perceptions and perverted interpretations of bodily sensations (i.e., factors that play a significant role in maintaining symptoms of chronic fatigue syndrome). Cognitive behavioral therapy may also be useful in teaching the patient more effective coping strategies, which in turn may lead to increased adaptive capacity. In controlled studies, it has been found that 70% of patients note a positive effect. A combination of a stepped program can be useful. exercise with cognitive behavioral therapy.

Deep breathing techniques, muscle relaxation techniques, massage, kinesiotherapy, yoga are considered as additional influences (mainly to eliminate comorbid anxiety).

Forecast

With long-term monitoring of patients with chronic fatigue syndrome, it was found that improvement occurs in approximately 17-64% of cases, deterioration - in 10-20%. The probability of a complete cure does not exceed 10%. 8-30% of patients return to their previous professional activities in full. Elderly age, long duration of the disease, severe fatigue, comorbid mental illness- risk factors for poor prognosis. In contrast, children and adolescents are more likely to experience a complete recovery.

It's important to know!

Muscle fatigue can be caused not only by damage to the neuromuscular junction (immune-dependent myasthenia gravis and myasthenic syndromes), but also by general internal diseases without direct damage to the neuromuscular apparatus, such as chronic infections, tuberculosis, sepsis, Addison's disease or malignant diseases.

chronic fatigue syndrome- This article or section needs to be revised. Please improve the article in accordance with the rules for writing articles ... Wikipedia

chronic fatigue syndrome- - a state of persistent neuropsychic exhaustion of a complex and completely unexplored etiology, includes somatogenic, procedural and psychogenically conditioned asthenic conditions. See Neurasthenia. * * * Constant fatigue with a decrease ... ... Encyclopedic Dictionary of Psychology and Pedagogy

Chronic Fatigue Syndrome- see Myalgic encephalomyelitis. Source: Medical Dictionary... medical terms

chronic fatigue syndrome- Chronic fatigue syndrome / Fatigue syndrome after a viral illness / Benign myalgic encephalomyelitis ICD 10 G93.3 ICD 9 780.71 DiseasesDB ... Wikipedia

irritable bowel syndrome- ICD 10 K58.58. ICD 9 564.1564.1 DiseasesDB ... Wikipedia

Honey. Myofascial syndrome is local pain and tension in certain areas of the skeletal muscles. The predominant age is over 20 years. The predominant gender is female. Risk factors exercise stress Long-term static voltage, ... ... Disease Handbook

Chinese Syndrome- This term has other meanings, see Chinese Syndrome (meanings). China syndrome (eng. China Syndrome) is an ironic expression that originally denoted a hypothetical severe accident at a nuclear power plant with a meltdown ... ... Wikipedia

CFS- chronic fatigue syndrome... Dictionary of abbreviations of the Russian language

Honey. Fibromyalgia is a rheumatic disease characterized by generalized muscle weakness (feeling tired) and tenderness on palpation of characteristic areas of the body, referred to as tender points. Frequency 3% of the adult population ... Disease Handbook

fibromyalgia- Rice. 1. Location of sensitive points in fibromyalgia ICD 10 M79.779.7 ... Wikipedia

Books

• Pathophysiological mechanisms of chronic fatigue syndrome, A. A. Podkolzin. Chronic fatigue syndrome (CFS) is a new pathology of the modern age, a disease of civilized countries associated with the characteristics and type of life of the population of large cities, the general ecological…

Chronic fatigue syndrome is a mysterious disease and ambiguous. The disease first received its name only in 1984, after a real epidemic of fatigue that broke out in Nevada.

However, none of these theories have yet been proven. This disease, despite its frivolous name, is quite serious.

In the International Classification of Diseases (ICD-10), chronic fatigue syndrome (CFS) appears under the name "myalgic encephalomyelitis". The syndrome got its name in 1984, after an epidemic in Nevada. Dr. Paul Cheney, who practiced in a small town Incline Village, located on the shores of Lake Tahoe, registered more than 200 cases of this disease. Patients felt depression, mood deterioration, muscle weakness. They found the Epstein-Barr virus or antibodies to it and to other viruses - "relatives" of the herpes virus. Whether the cause of the disease was a viral infection or something else, such as poor environmental conditions, remained unclear. Outbreaks of the disease have been observed before: in Los Angeles in 1934, in Iceland in 1948, in London in 1955, in Florida in 1956.

Many doctors do not consider CFS (Chronic Fatigue Syndrome) a disease, but believe that it is a sign of some other problem with the body. In unbearable fatigue, which does not go away even after a long rest, doctors blame the Epstein-Barr virus, herpes infections and malfunctions of the immune system. There are those who consider CFS to be a purely mental pathology - a kind of atypical depression.

Syndrome not limited any geographic or socio-demographic groups. In the US, CFS affects about 10 patients per 100,000 people. In Australia in 1990, the incidence was higher: 37 people per 100,000 population. Experts say that people 40-50 years old who live in large cities are more susceptible to CFS. Moreover, it is noticed that women develop CFS more often than men.

The main symptom of chronic fatigue syndrome is an incomprehensible weakness that does not disappear after rest and persists for a long time. Such a picture, of course, does not always mean that a person suffers from CFS. You can talk about the syndrome if the patient has undergone a volumetric examination: complete blood count, blood test on sensitivity gluten, thyroid and liver function tests, urinalysis, etc., which showed that he was absolutely healthy. This, by the way, is rare: usually doctors still find some kind of pathology or condition (pregnancy, for example), which is the cause of a sharp decline in strength.

But some sufferers find out that they are not sick at all, but still feel bad. Doctors have so-called "large" and "small" criteria for diagnosing CFS. "Major" refers to the absence of a serious underlying disease or condition that can cause a breakdown, plus constant fatigue for no apparent reason for at least 6 months. There is also a whole complex of "small criteria": a decline in physical and mental strength, rapid fatigue during the work of muscles and the brain, lasting more than 24 hours; sleep that does not bring a feeling of cheerfulness, a noticeable deterioration in short-term memory and concentration, muscle pain, joint pain (without redness and swelling), a new type of headache for a person, painful lymph nodes, frequent sore throats.

A patient is diagnosed with chronic fatigue syndrome if both major criteria and at least 4 minor criteria are met. It also happens that the diagnosis of "chronic fatigue syndrome" is confused with fibromyalgia - chronic musculoskeletal pain. In the course of research, scientists have figured out how to distinguish pathological fatigue from fibromyalgia. However, it turned out that symptoms such as soreness of the lymph nodes and fever are not characteristic of fibromyalgia, but may indicate chronic fatigue syndrome.

The saddest fact is that there is no proven and effective way to treat CFS yet: which is natural, because the causes of the disease have not been established. Therefore, while doctors profess an integrated approach, which is individual for each patient and consists mainly in relieving the most severe symptoms. Painkillers are prescribed for muscle pain, antidepressants for apathy, and so on. Helps and functional rehabilitation: acupuncture, physiotherapy And so on. In order for the treatment to be more effective, doctors also recommend sleeping at least 8 hours a day, refuse from non-standardized work schedule, eat right and take vitamins.

Doctors advise patients to refuse from energy drinks, cola, coffee and strong tea, preparations with ginseng and the like. Of course, the temptation is great: after all, it is these substances that seem to increase the tone. The problem is that they do not generate energy, but borrow from the body. So after 5-12 hours the patient feels even more exhausted than before.

Psychiatrist Gleb Pospelov about a semi-mythical popular diagnosis

The diagnosis of "chronic fatigue syndrome" has been constantly in the focus of attention of the medical community for the past couple of decades. Often I have to hear about it from colleagues or patients, despite the fact that, strictly speaking, such a diagnosis formally does not exist at all.

The situation is paradoxical. In the International Classification of Diseases - ICD-10 - this diagnosis is not. In the section "Diseases of the nervous system" there is code G93.3: Fatigue syndrome after a viral illness. Benign myalgic encephalomyelitis. Yes, yes, this is the official designation of our syndrome! And deal with them, in fact, should be neurologists. However, the phrase CFS has become firmly established in everyday life, so further we will use it.

Subject to CFS, according to various estimates, about 2% of the general population.

Chronic fatigue syndrome (CFS, benign myalgic encephalomyelitis, postviral asthenia syndrome, immune dysfunction) is a disease characterized by excessive, disabling fatigue lasting at least 6 months and accompanied by numerous articular, infectious and neuropsychic symptoms.

A bit of history

In 1984, in the resort town of Incline Village on Lake Tahoe in the state of Nevada (USA), more than two hundred patients applied for medical help in a short time. They complained of a constant feeling of fatigue. The disease state was accompanied by similar symptoms in all: drowsiness, depression, muscle pain and mild fever. Moreover, the epidemic did not affect the residents of the resort city, but vacationers, which excluded the pathogenic influence of local environmental factors.

There have been several hypotheses about the origin of the disease. The first hypothesis - an epidemic - was the result of mass hysteria, but it was considered untenable. The second - the cause of the epidemic lies in a viral infection. Epstein-Barr virus or antibodies to it and other viruses (herpes, Coxsackie) were found in the blood of all patients. However, even then it was known that the same viruses are present in the blood of healthy people.

The local general practitioner Paul Cheney managed to systematize the complaints of patients and identify common factors in the anamnesis. Most of the victims were city dwellers, middle-aged office workers (25-45), prone to careerism and working more than 12 hours a day.

Their work was most often routine, devoid of a creative component. These people made excessive demands on themselves and their duties, painfully perceived losses and failures, and were in a state of permanent stress.

As a result of his research, Cheney came to the conclusion that a completely original, previously unknown disease had been discovered. In subsequent years, new theories of its origin arose and, accordingly, new definitions: “chronic Epstein-Barr virus”, “chronic mononucleosis”, “epidemic neuromyasthenia”, “myalgic encephalomyelitis”.

Formation of nosology

As an independent disease, "chronic fatigue syndrome" was first identified in 1988 by the Centers for Disease Control (CDC, Atlanta, USA). A report published by the CDC in the Annals of Internal Medicine in March 1988 formulated diagnostic criteria (major and minor) for CFS. The criteria were revised in 1991, 1992 and 1994. at workshops of study groups.

Currently, most researchers are of the opinion that CFS is a heterogeneous syndrome, which is based on various pathophysiological anomalies. Some of them may predispose to the development of CFS, others directly cause the disease or support its progression. The provoking factor is an unbalanced emotional and intellectual load to the detriment of physical activity.

According to a 1994 definition by the Centers for Disease Control, a diagnosis of CFS requires at least 6 months of persistent, unexplained fatigue that is not relieved by rest and significantly reduces daily activity levels. Four or more of the eight symptoms must also be present in the 6-month period:

• impaired memory or concentration;
• pharyngitis;
• painful on palpation cervical or axillary lymph nodes;
• muscle soreness or stiffness;
• sore joints (no redness or swelling)
• new headache or change in its characteristics (type, severity);
• sleep that does not bring a sense of recovery (freshness, cheerfulness);
• aggravation of fatigue up to exhaustion after physical or mental effort, lasting more than 24 hours.

How does this happen in real life?

Here is a very typical example from my own practice. A 44-year-old woman came to the reception. For convenience and in order to preserve the secret - let's call her M. M.'s heredity was not burdened, she lived in a complete, prosperous family (husband and child). She had a higher humanitarian education, worked for many years in a public institution, successfully moving up the career ladder; at the time of the application - held the post of head of a large division.

The patient was very satisfied with her work, spoke about it actively and with pleasure, noted that her work was associated with intense psycho-emotional stress, strict accountability, including financial. The usual was an irregular working day, work on weekends, rare holidays, from which she could also be recalled. The patient regarded these difficulties as a "necessary evil", which "at least - pays off ...". She denied other psychotraumatic events in her life.

Over the past two years, the patient was disturbed by a feeling of constant fatigue, "exhaustion, impotence"; drowsiness during the daytime and shallow, disturbing sleep at night, not giving a feeling of cheerfulness. Attention to detail and efficiency decreased noticeably, doubts began to appear in their own business competence. Suddenly, the feeling of anxiety increased, when it became difficult to sit still, there was a need to be distracted, to find an interlocutor: “I’m afraid that something bad will happen to me ...”.

Periodically there was "ache and twitching" in the muscles of the legs and back, a feeling of stiffness, tension, sometimes - numbness. There were frequent headaches, causeless sweating, "goosebumps", at times - palpitations. M. reported that about a year and a half ago she suffered a severe “cold”, when, against the background of typical manifestations of an acute respiratory infection, long-term preservation subfebrile temperature bodies manifested the symptoms described above, which persist to this day. The patient said that she had “light periods” lasting up to two weeks, but then the situation worsened again, the severity of symptoms increased over time.

The woman was examined for a long time by therapists, an endocrinologist and a neurologist (no significant deviations were found) - and only after a long time, on the advice of the doctors who observed her, she decided to consult a psychiatrist.

In accordance with the logic of the specialists of the Center for Disease Control, I had enough reason to diagnose the patient with chronic fatigue syndrome. Which, in fact, was done by two of the doctors who examined the patient before me. However, looking ahead, I must say that my diagnosis sounded completely different. Despite the fact that the patient's therapy was consistent with modern recommendations for the treatment of CFS.

The patient was prescribed small amounts of timoneuroleptics (sulpiride, alimemazine), an antidepressant (citalopram) and tranquilizers (hydroxyzine, etifoxine, buspirone). For symptomatic analgesia, a myotropic antispasmodic (benciclane) was used. Nootropics (hopantenic acid, ipidacrine) were used to compensate for asthenia and restore cognitive activity. A progressive improvement in well-being was noted by the patient from the third week of treatment - and continued to increase. From the second month of treatment, M. began attending sessions of cognitive-behavioral therapy.

Three months later, M. was clinically healthy, therapy with psychopharmacological agents was discontinued. In the future, the woman is recommended a preventive course of nootropics and tranquilizers, the choice of a gentle work regime and a full-fledged active rest.

Maybe it's not CFS, but...

From the point of view of a practicing psychiatrist, an interesting thing catches the eye. If you open the section "Mental disorders ..." of the same ICD - 10, we will find a code there F48.0, which denotes a long and well-known disorder - neurasthenia. And if you read a detailed description of neurasthenia, available in any psychiatric manual, it is easy to find a large number of matches in all respects: etiology, pathogenesis, clinic, treatment! Only now it was described almost a hundred years earlier ... It was this diagnosis that I made to patient M.

The main signs of neurasthenia according to the ICD:

1. Persistent and disturbing complaints of feeling tired after little mental exertion (eg, after doing or attempting daily tasks that do not require unusual mental effort)
2. Persistent and distressing complaints of feeling tired and weak after light exertion.

In both cases, the patient cannot get rid of these symptoms through rest, relaxation, or entertainment.

At least one of the following additional symptoms is present:

• feeling dull or sharp muscle pain;
• dizziness;
• tension headache;
• inability to relax;
• irritability.

The duration of the disorder is at least 3 months.

And these coincidences are by no means my discovery. Many representatives of the medical community have long pointed out the glaring similarity of the two nosologies. At the same time, the diagnosis of "neurasthenia", in my experience, is not often made, but "CFS" has all the features of a promoted brand: dissertations are defended on it, research is constantly being conducted, for which generous grants are allocated.

It is impossible not to pay attention to the colossal amount of advertising of “all-healing” devices, “cleansing” methods, compositions and preparations (including long-known ones) aimed at combating the “great and terrible” CFS, which is already pathetically called the “disease of civilization”. While methods of treating neurasthenia have been developed for a long time and are very stable.

So what is chronic fatigue syndrome? A new, insidious and merciless disease, another scourge of our civilization with an unknown etiology? Or is CFS another business project, successfully promoted by businessmen from medicine and pharmacology, masking a long-known painful mental disorder?