Abstract
Chronic fatigue syndrome (CFS) is a poorly understood condition primarily characterized by debilitateing, persistent or recurrent fatigue, increased physical and mental fatigability, cognitive impairment and widespread musculoskeletal pain. During the past two decades, there have been heated debates about CFS among researchers, practitioners and patients. The existence of the disorder has been questioned, its underlying pathophysiology debated and an effective treatment opposed (such as antidepressants, stimulants or antibiotics). A lot of multidisciplinary literature is found about CFS, but to date, many psychiatrists seem to unknown the existence of this illness or think that it is a purely psychological disorder. However, CFS is sitting on the border between medicine and psychiatry. The aim of this review is to make psychiatrists aware of the existence of CFS and that they will, one day, be confronted with the management of this illness. Thus, this update allows understanding what is CFS, the diversity of physiopathology underlined and its management.
Highlights
Fatigue is a physiological phenomenon, induced by physical or intellectual activity
Different immune abnormalities have been shown in Chronic Fatigue Syndrome (CFS) patients such as reduced level of the cytokine TGFB1 which contributes to myalgia [22], increased level of IL-6, reduced natural killer (NK) cell activity [14], increased expression of activation markers on the cell surface of T lymphocytes, especially increased number of CD8+ cytotoxic cells that bear certain antigenic markers [13], decrease in certain subclasses of immunoglobulins, presence of various antibodies and circulating immune complexes, increased levels of TNFa, TNFb, IL1a, TNFa and TNFb [4]
In adults, a recent review of 28 studies describing the prognosis of chronic fatigue and CFS reported a median of 40% for improvement for the 14 studies of subjects meeting operational criteria for CFS
Summary
Fatigue is a physiological phenomenon, induced by physical or intellectual activity. “Fatigue” has been a core symptom in medicine ever since Hippocrates described “the disease of the Scythians”, who spent the day on horseback and had a state of persistent fatigue. Yuppie Flu syndrome (“yuppie” standing for young upwardly mobile professional, as a consequence of it being viewed as affecting only dynamic urban people), a milder Anglo-Saxon version of the ME [3], that appeared on the East Coast of United States [3,4]. On this basis, ME was renamed first “post-viral fatigue syndrome”, following the occurrence of an abnormally persistent fatigue in patients with a serological profile suggestive of Epstein Barr virus infection and renamed “Chronic fatigue syndrome” in 1988. The existence of CFS is controversial and numerous papers have been recently published on this topic
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