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Idiopathic chronic fatigue

From Wikipedia, the free encyclopedia
This article is about chronic fatigue that does not result from chronic fatigue syndrome or another illness. Not to be confused with medically explained Chronic Fatigue, Chronic fatigue syndrome, or Neurasthenia.
Idiopathic Chronic Fatigue
Other namesChronic Idiopathic Fatigue (CIF), insufficient/idiopathic fatigue (ISF), unexplained chronic fatigue
SpecialtyFamily medicine, Internal medicine, Musculoskeletal
SymptomsChronic fatigue
Usual onsetAcquired (not lifelong)[1]
DurationAt least six consecutive months
CausesUnknown
Diagnostic methodBased on symptoms. Diagnosis of exclusion requiring laboratory evaluation, physical and biopsychosocial assessment.[1]
Differential diagnosisOccupational burnout; chronic fatigue due to a known medical condition such as chronic fatigue syndrome, overtraining
TreatmentSymptomatic
Frequency6.2 to 64.2 per 1000[2]

Idiopathic chronic fatigue (ICF) or chronic idiopathic fatigue or insufficient/idiopathic fatigue[3] is a term used for cases of unexplained fatigue that have lasted at least six consecutive months[1] and which do not meet the criteria for myalgic encephalomyelitis/chronic fatigue syndrome.[4] Such fatigue is widely understood to have a profound effect on the lives of patients who experience it.[1][5]

Definition

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A 1994 definition of ICF was a physical medical condition of unknown origin, persisting or relapsing for a minimum of six consecutive months, where CFS symptoms are not met.[6]

Classification

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ICF does not have a dedicated diagnostic code in the World Health Organization's ICD-11 classification.[7]

ICF is sometimes diagnosed under physical symptom classifications such as MG22 (Fatigue) in the ICD-11, and R53.8 (Other malaise and fatigue) in the ICD-10. This allows ICF to be coded as fatigue or unspecified chronic fatigue, and help distinguish it from other forms of fatigue including cancer-related fatigue, chronic fatigue syndrome, fatigue due to depression, fatigue due to old age, weakness/asthenia, and in the ICD-10, also from fatigue lasting under 6 months.[8] [9] The ICD-11 MG22 Fatigue code is also shared with lethargy, and exhaustion, which may not be as long lasting.[7]

The WHO does not recognize any kind of fatigue-based psychiatric illness (unless it is accompanied by related psychiatric symptoms).[10][11]

Diagnosis

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There are no agreed upon international criteria for idiopathic chronic fatigue, however the CDC's 1994 Idiopathic Chronic Fatigue criteria, known as the Fukuda ICF criteria, are commonly used.[1][5]

Signs and symptoms

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  • Clinically evaluated fatigue
  • New or definite onset (not lifelong)
  • Fatigue persists or is relapsing for six consecutive months or longer
  • Fails to meet the criteria for chronic fatigue syndrome
  • The cause is unknown (not resulting from another medical condition)[1][6][5]

Exclusions

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Other medical causes of fatigue must also be ruled out before a diagnosis of ICF can be made. These include

  • Infectious diseases including viruses and TB
  • chronic fatigue syndrome
  • Vascular diseases (affecting heart and circulation)
  • Toxins and drug effects including poisons and substance use (addiction)
  • Diseases affecting the lungs, including chronic obstructive pulmonary disease (COPD)
  • Endocrine and metabolic problems, e.g., thyroid diseases and diabetes
  • Diseases involving benign or cancerous tumours, including cancer fatigue
  • Anaemia, Lupus and certain autoimmune or neurological diseases
  • dementia (any form)
  • severe obesity (a body mass index greater than 45)[1]

2023 guidance for fatigue stated that when unexplained, clinically evaluated chronic fatigue could be separated into ME/CFS and ICF.[12]

Differential diagnosis

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Differences from chronic fatigue

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ICF differs from other forms of chronic fatigue since it is unexplained rather than linked to a medical or psychological illness (for example, diabetes or depression).[6] This means that ICF patients have reduced treatment options: there is no underlying disease or known cause that could be treated in order to reduce the degree of fatigue, which results in a poorer prognosis for ICF.[13]

In ICF, the fatigue lasts for a minimum of six months, but chronic fatigue is usually (but not always) considered to last for a minimum of six months to be considered chronic, and if lasting between one and six months it is considered prolonged fatigue.

Chronic fatigue is the term used when medical tests and a mental and physical assessment has not yet been carried out. ICF can only be diagnosed after these are done and the results show no underlying untreated cause.[6]

Differential diagnosis from chronic fatigue syndrome

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Chronic fatigue syndrome (CFS) requires the additional symptoms of:

  1. post-exertional malaise (significantly worsening symptoms with activity which results in a significant reduction in daily activities, which may be delayed by up to 3 days)
  2. sleep dysfunction
  3. either:

A range of other symptoms commonly result from CFS including headaches, muscle and joint pain and low-grade fever.[14]

ICF requires:

  1. only one symptom: chronic fatigue
  2. does not need a significant reduction in activities: some people are able to push through the fatigue to continue activities
  3. is only diagnosed if CFS symptoms are not met.[6]

Prevalence of ICF is between 3–15%, which is two to ten times higher than CFS.[13] Older age at onset is more common in ICF, particularly from age 50,[13] while in CFS age at onset is typically 16–35 years old.[14]

The recovery rate within a year is significantly higher for ICF patients at 30–50% compared to under 10% in CFS.[13][14]

ICF is categorized within general signs and symptoms by the World Health Organization,[7] while CFS is categorized as a neurological disease.[15]

Ability to tolerate exertion including exercise has been shown to be greater in ICF patients compared to CFS patients, particularly on consecutive days, and this applies to both men and women.[16][17][18]

Severity of illness in ICF is typically less than in CFS, with some relatively small studies finding no severe ICF patients, the same studies found fibromyalgia was significantly less common in ICF.[17][18]

Differences from neurasthenia

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Neurasthenia was a diagnosis in the World Health Organization's ICD-10, but deprecated, and thus no more diagnosable, in ICD-11.[19][20] It also is no longer included as a diagnosis in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders.[21]

  • ICF has no known cause, and psychological factors such as stress have been ruled out, but neurasthenia was believed to be caused by the stresses of the modern age and psychological or psychosocial factors were seen as important.[23][19]
  • Neurasthenia has been very rarely reported since the 21st century, and was deprecated in the World Health Organization's most recent International Classification of Diseases, known as the ICD-11.[7] Neurasthenia had previously been categorized as a psychological illness,[23] and originally as neurological. ICF is not psychological- the WHO does not have a classification for any fatigue-only psychiatric illness.[9][7]

Management

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Idiopathic chronic fatigue is typically managed in general medicine rather than by referral to a specialist. There is no cure, no approved drug, and treatment options are limited.[24] Management may involve a form of counseling, or antidepressant medication, although some patients may prefer herbal or alternative remedies.[1]

Counseling

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A form of counseling known as cognitive behavioral therapy may help some people manage or cope with idiopathic chronic fatigue.[1]

Medication

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There are no approved drugs for ICF.[24]

Antidepressants

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Antidepressants drugs such as tricyclic antidepressants (TCAs) or selective serotonin reuptake inhibitors (SSRIs) may be appropriate if symptoms are exacerbated by suspected or diagnosed serotonin related health issues, such as depression.[1]

Alternative and complementary treatments

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Only limited trials had been conducted for alternative and complementary treatments; there is no clear evidence of these treatments being effective for ICF due to a lack of randomized controlled trials.[24]

Prognosis

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Between 30% and just under 50% of patients recover within one year.[1][25]

Epidemiology

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Fatigue is common in the general population and often caused by overwork, too much activity or a specific illness or disease. Around 20% of patients who visit their clinician report fatigue.[1] Prolonged fatigue is fatigue that persists for more than a month, and chronic fatigue is fatigue that lasts at least six consecutive months, which may be caused by a physical or psychological illness, or may be idiopathic (no known cause).[1] Chronic fatigue with a known cause is twice as common as idiopathic chronic fatigue.[6]

Idiopathic chronic fatigue affects between 2.4% and 6.42% of patients,[26] with females more likely to be affected than men.[1] Age at onset is typically over 50 years of age.[13] A significant number of patients present with idiopathic chronic fatigue as part of a mix of medically unexplained symptoms, while others present with a primary problem of fatigue alone.[1]

See also

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References

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  1. ^ a b c d e f g h i j k l m n o p Saultz, J (2002-09-23). "Care of the Patient with Fatigue". In Taylor, Robert (ed.). Family Medicine: Principles and Practice. Springer Science & Business Media. pp. 465–469. ISBN 978-0-387-95400-4.
  2. ^ Kim, Tae-Hun; Kim, Do-Hoon; Kang, Jung Won (2020-04-01). "Medicinal herbs for managing fatigue symptoms in patients with idiopathic chronic fatigue: A PRISMA compliant updated systematic review and meta-analysis of randomized controlled trials based on the GRADE approach". European Journal of Integrative Medicine. 35: 101069. doi:10.1016/j.eujim.2020.101069. ISSN 1876-3820. S2CID 214256657.
  3. ^ Vincent, Ann; Brimmer, Dana J.; Whipple, Mary O.; Jones, James F.; Boneva, Roumiana; Lahr, Brian D.; Maloney, Elizabeth; St. Sauver, Jennifer L.; Reeves, William C. (December 2012). "Prevalence, Incidence, and Classification of Chronic Fatigue Syndrome in Olmsted County, Minnesota, as Estimated Using the Rochester Epidemiology Project". Mayo Clinic Proceedings. 87 (12): 1145–1152. doi:10.1016/j.mayocp.2012.08.015. ISSN 0025-6196. PMC 3518652. PMID 23140977.
  4. ^ van Campen, C. (Linda) M. C.; Visser, Frans C. (June 19, 2021). "Comparing Idiopathic Chronic Fatigue and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) in Males: Response to Two-Day Cardiopulmonary Exercise Testing Protocol". Healthcare. 9 (6): 683. doi:10.3390/healthcare9060683. PMC 8230194. PMID 34198946.
  5. ^ a b c d Son, Chang-Gue (2019-06-01). "Differential diagnosis between "chronic fatigue" and "chronic fatigue syndrome"". Integrative Medicine Research. 8 (2): 89–91. doi:10.1016/j.imr.2019.04.005. ISSN 2213-4220. PMC 6522773. PMID 31193269.
  6. ^ a b c d e f g h i Fukuda, K.; Straus, S. E.; Hickie, I.; Sharpe, M. C.; Dobbins, J. G.; Komaroff, A. (1994-12-15). "The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group". Annals of Internal Medicine. 121 (12). American College of Physicians: 954–957. doi:10.7326/0003-4819-121-12-199412150-00009. ISSN 0003-4819. PMID 7978722. S2CID 510735.
  7. ^ a b c d e "ICD-11 - Mortality and Morbidity Statistics | MG22 Fatigue". World Health Organization. 2019. Retrieved 2023-04-25. MG22 Fatigue
    A feeling of exhaustion, lethargy, or decreased energy, usually experienced as a weakening or depletion of one's physical or mental resource and characterised by a decreased capacity for work and reduced efficiency in responding to stimuli. Fatigue is normal following a period of exertion, mental or physical, but sometimes may occur in the absence of such exertion as a symptom of health conditions.
    Inclusions General physical deterioration Lethargy
    Exclusions Combat fatigue (QE84) Exhaustion due to exposure (NF07.2) heat exhaustion (NF01) Bodily distress disorder (6C20) Depressive disorders (6A70-6A7Z) Sleep-wake disorders (7A00-7B2Z) Bipolar or related disorders (6A60-6A6Z) senile fatigue (MG2A) Chronic fatigue syndrome (8E49) Myalgic encephalomyelitis (8E49) Postviral fatigue syndrome (8E49) pregnancy-related exhaustion and fatigue (JA65).
  8. ^ National Center for Health Statistics (April 1, 2023). "ICD-10-CM Official Guidelines for Coding and Reporting | FY 2023. Updated April 1, 2023" (PDF). p. 73. Retrieved 2023-04-25. Chapter 18: Symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)
    Chapter 18 includes symptoms, signs, abnormal results of clinical or other investigative procedures, and ill-defined conditions regarding which no diagnosis classifiable elsewhere is recorded. Signs and symptoms that point to a specific diagnosis have been assigned to a category in other chapters of the classification.
  9. ^ a b "ICD-10 Version:2019 | R53". World Health Organization. Retrieved 2023-04-25. R53 Malaise and fatigue.
    R53.0 Neoplastic (malignant) related fatigue. R53.1 Weakness. Asthenia NOS.
    Excludes: age-related weakness (R54) muscle weakness (generalized) (M62.81) sarcopenia (M6 2.84) senile asthenia (R54)
    R53.2 Functional quadriplegia. Excludes: frailty NOS (R54), hysterical paralysis (F44.4), immobility syndrome (M62.3) neurologic quadriplegia (G82.5-) quadriplegia (G82.50).
    R53.8 Other malaise and fatigue
    Excludes: combat exhaustion and fatigue (F43.0) congenital debility (P96.9) exhaustion and fatigue due to excessive exertion (T73.3) exhaustion and fatigue due to exposure (T73.2) exhaustion and fatigue due to heat P'67.-) exhaustion and fatigue due to pregnancy (026.8-), exhaustion and fatigue due to recurrent depressive episode (F33) exhaustion and fatigue due to senile debility (R54)
    R53.81 Other malaise. Chronic debility Debility NOS. General physical deterioration. Malaise NOS. Nervous debility. Excludes: age-related physical debility (R54).
    R53.82 Chronic fatigue, unspecified. Excludes: chronic fatigue syndrome (G93.32) myalgic encephalomyelitis (G93.32) post infection and related fatigue syndromes (G93.39) postviral fatigue syndrome (G93.31)
    R53.83 Other fatigue
    Fatigue NOS. Lack of energy. Lethargy. Tiredness Excludes: exhaustion and fatigue due to depressive episode (F32.-)
    R54 Age-related physical debility.Frailty. Old age. Senescence. Senile asthenia. Senile debility. Excludes: age-related cognitive decline (R41.81) sarcopenia (M62.84) senile psychosis (F03) senilityNOS(R41.81).
    R55 Syncope and collapse...
  10. ^ Desai, Geetha; Sagar, Rajesh; Chaturvedi, Santosh K. (November 2018). "Nosological Journey of Somatoform Disorders: From Briquet's Syndrome to Bodily Distress Disorder". Indian Journal of Social Psychiatry. 34 (Suppl 1): S29. doi:10.4103/ijsp.ijsp_37_18. ISSN 0971-9962. S2CID 149462235.
  11. ^ Basavarajappa, Chethan; Dahale, Ajit Bhalchandra; Desai, Geetha (September 2020). "Evolution of bodily distress disorders". Current Opinion in Psychiatry. 33 (5): 447–450. doi:10.1097/YCO.0000000000000630. ISSN 0951-7367. PMID 32701520. S2CID 220731306.
  12. ^ "Evaluation of fatigue - Differential diagnosis of symptoms". BMJ Best Practice. Archived from the original on 2023-12-03. Retrieved 2024-03-25.
  13. ^ a b c d e Valiani, Vincenzo; Corbett, Duane B.; Knaggs, Jeffrey D.; Manini, Todd M. (November 2016). "Metabolic Rate and Perceived Exertion of Walking in Older Adults With Idiopathic Chronic Fatigue". The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 71 (11): 1444–1450. doi:10.1093/gerona/glw108. ISSN 1758-535X. PMC 5975719. PMID 27271253.
  14. ^ a b c "What is ME/CFS? | Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)". Centers for Disease Control and Prevention. 12 July 2018. Archived from the original on 17 August 2020. Retrieved 21 May 2020.
  15. ^ 8EF9 - Postviral syndrome,Chronic fatigue syndrome, Myalgic Encephalomyelitis ICD-11. WHO. 2023-01.
  16. ^ Vermeulen, Ruud CW; van Vermeulen Eck, Ineke WG (2014-01-23). "Decreased oxygen extraction during cardiopulmonary exercise test in patients with chronic fatigue syndrome". Journal of Translational Medicine. 12 (1): 20. doi:10.1186/1479-5876-12-20. ISSN 1479-5876. PMC 3903040. PMID 24456560.
  17. ^ a b van Campen, C. (Linda) M. C.; Visser, Frans C. (June 2021). "Female Patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome or Idiopathic Chronic Fatigue: Comparison of Responses to a Two-Day Cardiopulmonary Exercise Testing Protocol". Healthcare. 9 (6): 682. doi:10.3390/healthcare9060682. ISSN 2227-9032. PMC 8229058. PMID 34198913.
  18. ^ a b van Campen, C. (Linda) M. C.; Visser, Frans C. (June 2021). "Comparing Idiopathic Chronic Fatigue and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) in Males: Response to Two-Day Cardiopulmonary Exercise Testing Protocol". Healthcare. 9 (6): 683. doi:10.3390/healthcare9060683. ISSN 2227-9032. PMC 8230194. PMID 34198946.
  19. ^ a b c Connor, Henry (2022-10-20). "Doctors and 'Educational Overpressure' in Nineteenth-Century Britain: A Fatigue State that Divided Medical Opinion". European Journal for the History of Medicine and Health. 80 (1): 3–38. doi:10.1163/26667711-bja10026. ISSN 2666-7703.
  20. ^ World Health Organization. "ICD-11 for Mortality and Morbidity Statistics". Retrieved 2023-04-24.
  21. ^ Dimsdale, Joel E.; Xin, Yu; Kleinman, Arthur; Patel, Vikram; Narrow, William E.; Sirovatka, Paul J.; Regier, Darrel A. (2 March 2009). Somatic Presentations of Mental Disorders: Refining the Research Agenda for DSM-V. American Psychiatric Pub. p. 58. ISBN 978-0-89042-656-2.
  22. ^ Beard, G (1869). "Neurasthenia, or nervous exhaustion". The Boston Medical and Surgical Journal. 80 (13): 217–221. doi:10.1056/NEJM186904290801301.
  23. ^ a b c WHO (2007). "Chapter V Mental and behavioural disorders (F00-F99)". Retrieved 2009-10-09.
  24. ^ a b c Adams, Denise; Wu, Taixiang; Yang, Xunzhe; Tai, Shusheng; Vohra, Sunita (2009). "Traditional Chinese medicinal herbs for the treatment of idiopathic chronic fatigue and chronic fatigue syndrome". Cochrane Database of Systematic Reviews (4): CD006348. doi:10.1002/14651858.CD006348.pub2. ISSN 1465-1858. PMID 19821361.
  25. ^ Joyce J, Hotopf M, Wessely S. The prognosis of chronic fatigue and chronic fatigue syndrome: a systematic review. Quarterly Journal of Medicine 1997;90:223‐233.
  26. ^ Wessely, S.; Chalder, T.; Hirsch, S.; Wallace, P.; Wright, D. (1997). "The prevalence and morbidity of chronic fatigue and chronic fatigue syndrome: A prospective primary care study". American Journal of Public Health. 87 (9): 1449–1455. doi:10.2105/ajph.87.9.1449. PMC 1380968. PMID 9314795.
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