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Summary -What is the outcome of fatigue states? - What factors may delay recovery? - Does the doctor-patient relationship affect the outcome of CFS? - Box 3.1 - Box 3.2
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What is the outcome of fatigue states? |
Spontaneous recovery in cases of prolonged fatigue is high (Box 3.1;
Joyce et al. 1997). Similarly, prolonged fatigue after infectious
mononucleosis has a high rate of spontaneous resolution (White et al.
1995a). In the cohort studied by White et al., 41% of patients
reported prominent fatigue during the acute illness, of whom 71% had
prolonged fatigue one month later, 43% at two months, and 9% at six
months.
The long term outcome of CFS has been evaluated mostly in people treated within tertiary referral settings (Box 3.2). Such patient samples are biased towards chronic illness and limited patterns of recovery (Katon and Walker 1993; Wessely et al. 1995a; Joyce et al. 1997). Patient reports drawn from self-help group populations show similar biases (Sharpe et al. 1992). In an Australian study conducted within a specialist setting (Wilson et al. 1994b), 65 out of 103 patients (63%) who had been symptomatic for about five years reported improvement in symptoms and functional capacity over the next three years, but complete recovery was uncommon (6%). During follow-up, patients were very unlikely to develop other medical disorders (2%) but a significant number did develop other psychological disorders (19%), notably major depression and anxiety. Similar outcomes were confirmed in several other retrospective studies from tertiary referral centres. Up to 20% of cases of CFS may occur in children aged 10-19 years (Lloyd et al. 1990a). Children with prolonged fatigue or CFS do significantly better than adults, with 77%-94% reporting improvement or recovery in the two published studies specifically evaluating children (Feder et al. 1994; Carter et al. 1995). One death by suicide and two unrelated deaths occurred in 2075 people followed up in 19 published studies of the outcome of prolonged fatigue and CFS (Joyce et al. 1997). These studies included mean follow-up periods ranging from six months to four years, thus suggesting that suicide rates and overall mortality are not increased in people with CFS. | |
What factors may delay recovery? | The factors associated with a poorer outcome include older age, concurrent psychiatric disorder, and the person's belief that the illness is purely physical in origin (see Box 3.2; reviewed in Joyce et al. 1997). Outcome has not been found to be associated with gender, marital status or life stress events (Sharpe et al. 1992; Bruce-Jones et al. 1994), or with laboratory parameters, such as viral antibody titres and immunological measures (including T cell subset measurements) (Wilson et al. 1994a). In a study of the relationship of non-specific viral illness and the development of prolonged fatigue in general practice, the person's view of the illness and the doctor's behaviour, rather than the viral infection, were predictive of the development of prolonged fatigue (Cope et al. 1994). | |
Does the doctor-patient relationship affect the outcome of CFS? |
Doctors who display the essential therapeutic characteristics of
empathy, acceptance of their patient's suffering, non-judgemental
style and a commitment to continued care are more likely to make an
accurate diagnosis (Goldberg et al. 1993) and minimise the adverse
effects of the illness experience (Frank 1983; Mechanic 1993).
Conversely, doctors who reject the patient's illness experience are likely to promote feelings of alienation and perpetuate ill health (Twemlow et al. 1997). Simplistic notions offered by doctors, with unjustified medical labels such as "chronic viral infection" or pseudomedical diagnoses such as "hypoglycaemia", are inappropriate and unhelpful (Ernst 1996). If these labels lead to inappropriate pharmacological interventions, not only are they likely to be unsuccessful, but they will often result in increased hostility towards the medical profession and conventional medical treatments.
| Next... | Part 4: How should people with CFS be managed? |
| Chronic fatigue syndrome: | Title page | Contents | Send feedback | |