fatigue syndrome department of medicine慢性疲劳综合征医学系课件

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1、ApatientwithChronicFatigueSyndromeKristinSteffen,MD2/22/06Ihavenofinancialdisclosures.ObjectivesIdentifycasedefinitionforChronicFatigueSyndrome(CFS)RecognizesimilaritiesbetweenCFSandfibromyalgiaDescribeclinicalpresentation,prognosisofCFSReviewrecommendationsfordiagnosi

2、sIdentify2treatmentsIdentifyusefulreferencesInformationalpresentationonly(Iamnotsolicitingreferrals!!)CaseofAFAFisa35yoFdiagnosedwithCFSin1992withabruptonsetofsymptomsfollowingURIExtensivenegativeworkupforalternativecause(>14physicians,everyrecommendedtestplusmorethant

3、wiceasmanymore)Extensivetrialsofexperimentaltreatments(32+)OnSSItotaldisability,appealingemployerdecisiontorevokeemployer-baseddisabilitybenefitStable:neitherimprovingnorworsening,currentlytakingnospecificpharmacologictherapy1994CDCCaseDefinitionforCFSI.Clinicallyevalu

4、ated,unexplained,persistent,orrelapsingfatiguethatisofnewordefiniteonset;itisnottheresultofongoingexertion;isnotalleviatedbyrest;andresultsinsubstantialreductioninpreviouslevelsofoccupational,educational,social,orpersonalactivitiesAND1994CasedefinitionofCFS,contII.Four

5、ormoreofthefollowingsymptomsthatpersistorrecurduringsixormoremonthsofillnessthatdonotpredatefatigue:Self-reportedimpairmentinshorttermmemoryorconcentrationSorethroatTendercervicaloraxillarynodesMusclepain1994CasedefinitionofCFS,contII.Fourormoreofthefollowingsymptomsth

6、atpersistorrecurduringsixormoremonthsofillnessthatdonotpredatefatigue:MultijointpainwithoutrednessorswellingMusclepainHeadachesofanewpatternorseverityUnrefreshingsleepPost-exertionalmalaiselasting>24hoursConditionsthatexcludeCFSDxAnyactivemedicalconditionthatmayexplain

7、thepresenceofchronicfatigue…Anypreviouslydiagnosedmedicalconditionwhoseresolutionhasnotbeendocumentedbeyondreasonabledoubt…Anypastorcurrentdiagnosisofspecifiedpsychiatricdisorders…AlcoholorothersubstanceabuseSevereobesity(BMI>45)ConditionsthatdonotexcludeCFSDxAnycondit

8、iondefinedprimarilybysymptomsthatcannotbeconfirmedbydiagnosticlaboratorytests…Anyconditionunderspecifictreatmenttoall