Bob
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I thought this had been posted before, but I can't find it anywhere...
Undiagnosed and comorbid disorders in patients with presumed chronic fatigue syndrome.
Mariman A, Delesie L, Tobback E, Hanoulle I, Sermijn E, Vermeir P, Pevernagie D, Vogelaers D.
J Psychosom Res. 2013 Nov;75(5):491-6.
doi: 10.1016/j.jpsychores.2013.07.010.
Epub 2013 Aug 20.
Full paper:
http://www.sciencedirect.com/science/article/pii/S0022399913002766
If the above link takes you to the jpsychores website instead of the ScienceDirect website, then (to access the full paper) click on "Access this article on ScienceDirect" (top-right of the jpsychores webpage.)
Abstract only:
http://www.ncbi.nlm.nih.gov/pubmed/24182640
http://www.jpsychores.com/article/S0022-3999(13)00276-6/abstract
Abstract
OBJECTIVE:
To assess undiagnosed and comorbid disorders in patients referred to a tertiary care center with a presumed diagnosis of chronic fatigue syndrome (CFS).
METHODS:
Patients referred for chronic unexplained fatigue entered an integrated diagnostic pathway, including internal medicine assessment, psychodiagnostic screening, physiotherapeutic assessment and polysomnography+multiple sleep latency testing. Final diagnosis resulted from a multidisciplinary team discussion. Fukuda criteria were used for the diagnosis of CFS, DSM-IV-TR criteria for psychiatric disorders, ICSD-2 criteria for sleep disorders.
RESULTS:
Out of 377 patients referred, 279 (74.0%) were included in the study [84.9% female; mean age 38.8years (SD 10.3)]. A diagnosis of unequivocal CFS was made in 23.3%. In 21.1%, CFS was associated with a sleep disorder and/or psychiatric disorder, not invalidating the diagnosis of CFS. A predominant sleep disorder was found in 9.7%, 19.0% had a psychiatric disorder and 20.8% a combination of both. Only 2.2% was diagnosed with a classical internal disease. In the total sample, a sleep disorder was found in 49.8%, especially obstructive sleep apnea syndrome, followed by psychophysiologic insomnia and periodic limb movement disorder. A psychiatric disorder was diagnosed in 45.2%; mostly mood and anxiety disorder.
CONCLUSIONS:
A multidisciplinary approach to presumed CFS yields unequivocal CFS in only a minority of patients, and reveals a broad spectrum of exclusionary or comorbid conditions within the domains of sleep medicine and psychiatry. These findings favor a systematic diagnostic approach to CFS, suitable to identify a wide range of diagnostic categories that may be subject to dedicated care.
Undiagnosed and comorbid disorders in patients with presumed chronic fatigue syndrome.
Mariman A, Delesie L, Tobback E, Hanoulle I, Sermijn E, Vermeir P, Pevernagie D, Vogelaers D.
J Psychosom Res. 2013 Nov;75(5):491-6.
doi: 10.1016/j.jpsychores.2013.07.010.
Epub 2013 Aug 20.
Full paper:
http://www.sciencedirect.com/science/article/pii/S0022399913002766
If the above link takes you to the jpsychores website instead of the ScienceDirect website, then (to access the full paper) click on "Access this article on ScienceDirect" (top-right of the jpsychores webpage.)
Abstract only:
http://www.ncbi.nlm.nih.gov/pubmed/24182640
http://www.jpsychores.com/article/S0022-3999(13)00276-6/abstract
Abstract
OBJECTIVE:
To assess undiagnosed and comorbid disorders in patients referred to a tertiary care center with a presumed diagnosis of chronic fatigue syndrome (CFS).
METHODS:
Patients referred for chronic unexplained fatigue entered an integrated diagnostic pathway, including internal medicine assessment, psychodiagnostic screening, physiotherapeutic assessment and polysomnography+multiple sleep latency testing. Final diagnosis resulted from a multidisciplinary team discussion. Fukuda criteria were used for the diagnosis of CFS, DSM-IV-TR criteria for psychiatric disorders, ICSD-2 criteria for sleep disorders.
RESULTS:
Out of 377 patients referred, 279 (74.0%) were included in the study [84.9% female; mean age 38.8years (SD 10.3)]. A diagnosis of unequivocal CFS was made in 23.3%. In 21.1%, CFS was associated with a sleep disorder and/or psychiatric disorder, not invalidating the diagnosis of CFS. A predominant sleep disorder was found in 9.7%, 19.0% had a psychiatric disorder and 20.8% a combination of both. Only 2.2% was diagnosed with a classical internal disease. In the total sample, a sleep disorder was found in 49.8%, especially obstructive sleep apnea syndrome, followed by psychophysiologic insomnia and periodic limb movement disorder. A psychiatric disorder was diagnosed in 45.2%; mostly mood and anxiety disorder.
CONCLUSIONS:
A multidisciplinary approach to presumed CFS yields unequivocal CFS in only a minority of patients, and reveals a broad spectrum of exclusionary or comorbid conditions within the domains of sleep medicine and psychiatry. These findings favor a systematic diagnostic approach to CFS, suitable to identify a wide range of diagnostic categories that may be subject to dedicated care.
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