Volume 177 - Issue 9
Chronic fatigue syndrome clinical practice guidelines: psychological factors
Author: James D Hundertmark
Med J Aust 2002; 177 (9): 525-527. || doi: 10.5694/j.1326-5377.2002.tb04935.x
Published online: 4 November 2002
Published online: 4 November 2002
To the Editor: The working group responsible for the recent chronic fatigue syndrome (CFS) guidelines needs to be congratulated for producing a sensible and well balanced document in a most controversial area.1 Larkins and Molesworth have contributed a somewhat predictable response.2 Some sufferers of CFS can be characterised by their capacity to react strongly to the suggestion that psychological factors may be involved in the pathogenesis of their condition.3
From the perspective of the consultation-liaison psychiatrist, their response can be written with the comments on physical and psychological issues substituted for one another. Hence it can read (1) there is no current evidence that the syndrome has a specific physical origin, and (2) there is evidence that a range of psychological issues occur in people with CFS, although it remains unclear whether these changes are primary or secondary.
The mental health movement has worked hard in recent times to reduce the stigma associated with psychiatric conditions. The sufferers of chronic physical illness now accept the importance of looking after their emotional health as well as their physical well-being. Enlightened CFS sufferers and support groups accept the links between physical and psychological morbidity and do not mindlessly exclude the latter. There is ample evidence that cognitive–behavioural strategies and graded exercise programs assist those with CFS, and psychiatrists are skilled in providing these treatments.4
References
- Chronic fatigue syndrome clinical practice guidelines – 2002. Med J Aust 2002; 176 Suppl: S17-S55.
- Larkins RG, Molesworth SR. Chronic fatigue syndrome clinical practice guidelines [letter]. Med J Aust 2002; 177: 51-52. i1149918
- White PD. Discomfort of patient power: power sharing is not a takeover bid. BMJ 2002; 324; 1214. i1149920
- Whiting P, Bagnall A, Sowden AJ et al. Interventions for the treatment and management of chronic fatigue syndrome: a systematic review. JAMA 2001; 286: 1360-1368. i1149922
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