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Clinical Practice: Chronic fatigue syndrome

Abstract

The diagnosis chronic fatigue syndrome (CFS) was conceptualized in the mid-1980s. It is a clinically defined condition characterized by severe and disabling new onset fatigue with at least four additional symptoms: impaired memory or concentration, sore throat, tender cervical or axillary lymph nodes, muscle pain, multi-joint pain, new headaches, unrefreshing sleep or post-exertion malaise. Chronic fatigue syndrome in adolescents is a rare condition compared to symptomatic fatigue. The estimated prevalence of adolescent CFS ranges between 0.11 and 1.29 % in Dutch, British, and US populations. Diagnosis of the chronic fatigue syndrome is established through exclusion of other medical and psychiatric causes of chronic fatiguing illness. Taking a full clinical history and a full physical examination are therefore vital. In adolescence, CFS is associated with considerable school absence with long-term detrimental effects on academic and social development. One of the most successful potential treatments for adolescents with CFS is cognitive behavioural therapy, which has been shown to be effective after 6 months in two thirds of the adolescents with CFS. This treatment effect sustains at 2–3-year follow-up. In conclusion, the diagnosis CFS should be considered in any adolescent patient with severe disabling long-lasting fatigue. Cognitive behavioural therapy is effective in 60–70 % of the patients. Prompt diagnosis favours the prognosis.

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Abbreviations

CBT:

Cognitive behavioural therapy

CDC:

Centre for Disease Control and Prevention

CFS:

Chronic fatigue syndrome

UMC Utrecht:

University Medical Centre Utrecht

References

  1. 1.

    Afari N, Buchwald D (2003) Chronic fatigue syndrome: a review. Am J Psychiatry 160(2):221–236

    PubMed  Article  Google Scholar 

  2. 2.

    Ament W, Verkerke GJ (2009) Exercise and fatigue. Sports Med 39(5):389–422

    PubMed  Article  Google Scholar 

  3. 3.

    Anon (1956) A new clinical entity? Lancet i:789–790

    Google Scholar 

  4. 4.

    Bakker RJ, van de Putte EM (2012) De vermoeide puber. Praktische Pediatrie 4:195–200

    Google Scholar 

  5. 5.

    Bakker RJ, van de Putte EM, Kuis W, Sinnema G (2009) Risk factors for persistent fatigue with significant school absence in children and adolescents. Pediatrics 124(1):e89–e95

    PubMed  Article  Google Scholar 

  6. 6.

    Bakker RJ, van de Putte EM, Kuis W, Sinnema G (2011) Effects of an educational video film in fatigued children and adolescents: a randomised controlled trial. Arch Dis Child 96(5):457–460

    PubMed  Article  Google Scholar 

  7. 7.

    Bell DS, Jordan K, Robinson M (2001) Thirteen-year follow-up of children and adolescents with chronic fatigue syndrome. Pediatrics 107(5):994–998

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    Burns D (2012) Chronic fatigue syndrome or myalgic encephalomyelitis. Nurs Stand 26(25):48–56

    PubMed  Article  Google Scholar 

  9. 9.

    Chalder T, Goodman R, Wessely S, Hotopf M, Meltzer H (2003) Epidemiology of chronic fatigue syndrome and self reported myalgic encephalomyelitis in 5-15 year olds: cross sectional study. BMJ 327(7416):654–655

    PubMed  Article  CAS  Google Scholar 

  10. 10.

    Chalder T, Deary V, Husain K, Walwyn R (2010) Family-focused cognitive behaviour therapy versus psycho-education for chronic fatigue syndrome in 11- to 18-year-olds: a randomized controlled treatment trial. Psychol Med 40:1269–1279

    PubMed  Article  CAS  Google Scholar 

  11. 11.

    Cleare AJ, Heap E, Malhi GS, Wessely S, O'Keane V, Miell J (1999) Low-dose hydrocortisone in chronic fatigue syndrome: a randomised crossover trial [see comments]. Lancet 353(9151):455–458

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    Crawley E, Sterne JA (2009) Association between school absence and physical function in paediatric chronic fatigue syndrome/myalgic encephalopathy. Arch Dis Child 94(10):752–756

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    DeLuca J (2005) Fatigue as a window to the brain. MIT Press, Cambridge, pp 137–156

    Google Scholar 

  14. 14.

    Engel GL (1977) The need for a new medical model: a challenge for biomedicine. Science 196(4286):129–136

    PubMed  Article  CAS  Google Scholar 

  15. 15.

    Farmer A, Fowler T, Scourfield J, Thapar A (2004) Prevalence of chronic disabling fatigue in children and adolescents. Br J Psychiatry 184:477–481

    PubMed  Article  Google Scholar 

  16. 16.

    Fukuda K, Straus SE, Hickie I, Sharpe MC, Dobbins JG, Komaroff A (1994) The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group. Ann Intern Med 121(12):953–959

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    Garralda ME, Rangel L (2002) Annotation: chronic fatigue syndrome in children and adolescents. J Child Psychol Psychiatry 43(2):169–176

    PubMed  Article  Google Scholar 

  18. 18.

    Garralda E, Rangel L, Levin M, Roberts H, Ukoumunne O (1999) Psychiatric adjustment in adolescents with a history of chronic fatigue syndrome. J Am Acad Child Adolesc Psychiatry 38(12):1515–1521

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Harris F, Taitz LS (1989) Damaging diagnosis of myalgic encephalitis in children. BMJ 299(6702):790

    PubMed  Article  CAS  Google Scholar 

  20. 20.

    Horton SM, Poland F, Kale S, Drachler ML, de Carvalho Leite JC, McArthur MA, Campion PD, Pheby D, Nacul L (2010) Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) in adults: a qualitative study of perspectives from professional practice. BMC Fam Pract 11:89

    PubMed  Article  Google Scholar 

  21. 21.

    Jones JF, Nisenbaum R, Solomon L, Reyes M, Reeves WC (2004) Chronic fatigue syndrome and other fatiguing illnesses in adolescents: a population-based study. J Adolesc Health 35(1):34–40

    PubMed  Google Scholar 

  22. 22.

    Knoop H, Stulemeijer M, de Jong LW, Fiselier TJ, Bleijenberg G (2008) Efficacy of cognitive behavioral therapy for adolescents with chronic fatigue syndrome: long-term follow-up of a randomized, controlled trial. Pediatrics 121(3):e619–e625

    PubMed  Article  Google Scholar 

  23. 23.

    Knoop H, Prins JB, Moss-Morris R, Bleijenberg G (2010) The central role of cognitive processes in the perpetuation of chronic fatigue syndrome. J Psychosom Res 68(5):489–494

    PubMed  Article  Google Scholar 

  24. 24.

    Lim A, Lubitz L (2002) Chronic fatigue syndrome: successful outcome of an intensive inpatient programme. J Paediatr Child Health 38(3):295–299

    PubMed  Article  CAS  Google Scholar 

  25. 25.

    Marshall GS (1999) Report of a workshop on the epidemiology, natural history, and pathogenesis of chronic fatigue syndrome in adolescents. J Pediatr 134(4):395–405

    PubMed  Article  CAS  Google Scholar 

  26. 26.

    McKenzie R, O'Fallon A, Dale J, Demitrack M, Sharma G, Deloria M, Garcia-Borreguero D, Blackwelder W, Straus SE (1998) Low-dose hydrocortisone for treatment of chronic fatigue syndrome: a randomized controlled trial. JAMA 280(12):1061–1066

    PubMed  Article  CAS  Google Scholar 

  27. 27.

    NICE (2007) Chronic fatigue syndrome/myalgic encephalomyelitis (or encephalopathy). Clinical guidelines. National Institute for Health and Clinical Excellence

  28. 28.

    Nijhof SL, Bleijenberg G, Uiterwaal CSPM, Kimpen JLL, van de Putte EM (2011) Fatigue in teenagers on the internet—the FITNET trial. A randomized controlled trial of web-based cognitive behavioural therapy for adolescents with chronic fatigue syndrome: study protocol. [ISRCTN59878666]. BMC Neurol 11:23

    PubMed  Article  Google Scholar 

  29. 29.

    Nijhof SL, Maijer K, Bleijenberg G, Uiterwaal CS, Kimpen JL, van de Putte EM (2011) Adolescent chronic fatigue syndrome: prevalence, incidence, and morbidity. Pediatrics 127(5):e1169–e1175

    PubMed  Article  Google Scholar 

  30. 30.

    Nijhof SL, Bleijenberg G, Uiterwaal CS, Kimpen JL, van de Putte EM (2012) Effectiveness of internet-based cognitive behavioural treatment for adolescents with chronic fatigue syndrome (FITNET): a randomised controlled trial. Lancet 379(9824):1412–1418

    PubMed  Article  Google Scholar 

  31. 31.

    Nijhof SL, Priesterbach LP, Uiterwaal CS, Bleijenberg G, Kimpen JL, van de Putte EM (2013) Internet-based therapy for adolescents with chronic fatigue syndrome: long-term follow-up. Pediatrics 131:e1788–e1795

    PubMed  Article  Google Scholar 

  32. 32.

    Rimes KA, Goodman R, Hotopf M, Wessely S, Meltzer H, Chalder T (2007) Incidence, prognosis, and risk factors for fatigue and chronic fatigue syndrome in adolescents: a prospective community study. Pediatrics 119(3):e603–e609

    PubMed  Article  Google Scholar 

  33. 33.

    Rowe KS (1997) Double-blind randomized controlled trial to assess the efficacy of intravenous gammaglobulin for the management of chronic fatigue syndrome in adolescents. J Psychiatr Res 31(1):133–147

    PubMed  Article  CAS  Google Scholar 

  34. 34.

    Royal College of Paediatrics and Child Health (2004) Evidence based guideline for the management of CFS/ME (chronic fatigue syndrome/myalgic encephalopathy) in children and young people. Royal College of Paediatrics and Child Health, UK

    Google Scholar 

  35. 35.

    Stulemeijer M, de Jong LW, Fiselier TJ, Hoogveld SW, Bleijenberg G (2005) Cognitive behaviour therapy for adolescents with chronic fatigue syndrome: randomised controlled trial. BMJ 330:14

    PubMed  Article  Google Scholar 

  36. 36.

    Sullivan PF, Pedersen NL, Jacks A, Evengard B (2005) Chronic fatigue in a population sample: definitions and heterogeneity. Psychol Med 35(9):1337–1348

    PubMed  Article  Google Scholar 

  37. 37.

    Taillefer SS, Kirmayer LJ, Robbins JM, Lasry JC (2003) Correlates of illness worry in chronic fatigue syndrome. J Psychosom Res 54(4):331–337

    PubMed  Article  Google Scholar 

  38. 38.

    Tak LM, Cleare AJ, Ormel J, Manoharan A, Kok IC, Wessely S, Rosmalen JG (2011) Meta-analysis and meta-regression of hypothalamic-pituitary-adrenal axis activity in functional somatic disorders. Biol Psychol 87(2):183–194

    PubMed  Article  Google Scholar 

  39. 39.

    ter Wolbeek M, van Doornen LJ, Kavelaars A, Heijnen CJ (2006) Severe fatigue in adolescents: a common phenomenon? Pediatrics 117(6):e1078–e1086

    PubMed  Article  Google Scholar 

  40. 40.

    Trendall J (2000) Concept analysis: chronic fatigue. J Adv Nurs 32(5):1126–1131

    PubMed  Article  CAS  Google Scholar 

  41. 41.

    van de Putte EM, van Doornen LJ, Engelbert RH, Kuis W, Kimpen JL, Uiterwaal CS (2006) Mirrored symptoms in mother and child with chronic fatigue syndrome. Pediatrics 117(6):2074–2079

    PubMed  Article  Google Scholar 

  42. 42.

    van de Putte EM, Engelbert RH, Kuis W, Kimpen JL, Uiterwaal CS (2007) Alexithymia in adolescents with chronic fatigue syndrome. J Psychosom Res 63(4):377–380

    PubMed  Article  Google Scholar 

  43. 43.

    van Geelen SM, Sinnema G, Hermans HJ, Kuis W (2007) Personality and chronic fatigue syndrome: methodological and conceptual issues. Clin Psychol Rev 27(8):885–903

    PubMed  Article  Google Scholar 

  44. 44.

    van Geelen SM, Bakker RJ, Kuis W, van de Putte EM (2010) Adolescent chronic fatigue syndrome: a follow-up study. Arch Pediatr Adolesc Med 164(9):810–814

    PubMed  Article  Google Scholar 

  45. 45.

    Vercoulen JH, Swanink CM, Galama JM, Fennis JF, Jongen PJ, Hommes OR, van der Meer JW, Bleijenberg G (1998) The persistence of fatigue in chronic fatigue syndrome and multiple sclerosis: development of a model. J Psychosom Res 45(6):507–517

    PubMed  Article  CAS  Google Scholar 

  46. 46.

    Viner R, Gregorowski A, Wine C, Bladen M, Fisher D, Miller M, El Neil S (2004) Outpatient rehabilitative treatment of chronic fatigue syndrome (CFS/ME). Arch Dis Child 89(7):615–619

    PubMed  Article  CAS  Google Scholar 

  47. 47.

    Wessely S, Hotopf M, Sharpe M (1999) Chronic fatigue and its syndromes. Oxford University Press, Oxford

    Google Scholar 

  48. 48.

    White PD, Goldsmith KA, Johnson AL, Potts L, Walwyn R, DeCesare JC, Baber HL, Burgess M, Clark LV, Cox DL, Bavinton J, Angus BJ, Murphy G, Murphy M, O'Dowd H, Wilks D, McCrone P, Chalder T, Sharpe M (2011) Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial. Lancet 377(9768):823–836

    PubMed  Article  CAS  Google Scholar 

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Acknowledgments

Charlotte L. Werker is a medical student participating in the Honours program of the Faculty of Medicine, UMC Utrecht.

Conflict of interest

The authors declare that they have no competing interests.

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Correspondence to Elise M. van de Putte.

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Werker, C.L., Nijhof, S.L. & van de Putte, E.M. Clinical Practice: Chronic fatigue syndrome. Eur J Pediatr 172, 1293–1298 (2013). https://doi.org/10.1007/s00431-013-2058-8

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Keywords

  • Chronic fatigue syndrome
  • Chronic fatigue
  • Adolescents
  • Cognitive behavioural therapy
  • Prevalence