Get tested for Chronic Fatigue Syndrome. Chronic Fatigue Syndrome. KTM test for "karoshi". Who gets tired more often? Basic Treatments

In whom the aging process began to prevail over health. Now many young people are affected by overwork syndrome.

Chronic Fatigue Syndrome.

chronic fatigue syndrome - a syndrome of general overwork against the background of an unhealthy lifestyle, constant and illness.

3) Frequent urge to go to the toilet.

If at the age of 30 - 40 years the frequency of visiting the restroom has become higher, then the digestive and genitourinary systems have begun to age.

4) Decreased sexual function.

When a middle-aged person develops nagging pains in the lower back, legs ache, a decrease in sexual potency and libido appears, impotence appears in men, and menstruation stops early in a woman - these are the first signs of aging of the body.

5) Decreased memory.

You stop remembering phone numbers and names of people you know.

6) Account.

7) Pessimism.

Whatever you do, you often regret what you have done, easily get angry, look pessimistically into the future, and cannot cope with your mood.

8) Distracted look.

Attention is scattered, it becomes more and more difficult to collect thoughts.

9) Sleep disorders.

Sleep time is constantly reduced, and after waking up, fatigue is felt.

10) Sudden loss of concentration.

You are just about to do something, when suddenly, for no apparent reason, you lose your peace of mind, your thoughts get confused, it is difficult to concentrate.

11) Change of mood.

Whatever you look at, everything is not right, everything irritates, easily infuriates.

12) Avoidance of contact.

In a state of hypersensitivity, you begin to avoid people, places, or situations.

13) Running thoughts in a circle.

When the usual routine of life is violated, you begin to fussily think about everything, constantly returning mentally to what has already been done or said.

14) Pain of unknown origin.

Constantly, but doctors cannot find the cause. You worry and constantly think about it.

15) Anger and irritation.

You get very annoyed, and often do not know why exactly. Even when they are busy with something, the background is present, as if it does not let you go.

16) Loss of interest in life.

Boredom. You experience mental decline, e, nothing pleases you all day long, nothing arouses interest and spiritual uplift.

17) Overwork.

You easily get tired or for no apparent reason feel a decline in mental and physical strength.

18) The desire for solitude.

Afraid to communicate with other people, hate crowded places, get lost around other people, tense up or feel awkward.

19) Loss of contact with yourself.

In a bad mood, you lose your clarity of consciousness, do not control emotions and actions, to the point that you lose the power of speech, you see and experience nothing. There may even be muscle cramps.

20) Suspicion.

You think that everyone does not understand you, laugh at you or treat you with hostility. Some time later, you realize that you yourself have come up with too much for yourself, and you yourself have led yourself into a dead end of the problem.

According to these 20 signals, everyone can assess their condition.

You're tired? What degree of karoshi do you have?

2-3 signs out of 20. Green signal. You don't have to worry too much.

3-5 signs out of 20. Yellow signal. The first signs of karoshi (overwork) have formed.

6 or more signs out of 20. Red or orange signal. The danger is great, there is a complex karoshi syndrome (chronic fatigue syndrome). You are on the verge of an incurable disease and old age, even if you are 30 years old.

3 categories of people susceptible to karoshi:

Firstly, those who have money and power, especially those who spend a lot and do not care about health.

Secondly, having their own business or business, "workaholics".

Thirdly, predisposed to early old age due to heredity, as well as people who consider themselves absolutely healthy.

What degree of karoshi do you live in?

See how this karoshi test matches the test results

The modern world requires maximum output and constant tension from a person. All you have to do is relax a little and you're already out of the loop. Therefore, most people are always in a hurry somewhere, live in a frantic rhythm and do not give themselves a moment's rest.

This behavior has the flip side of the coin in the form of health problems. Moreover, they result in completely different diseases: someone is overcome by frequent acute respiratory infections, someone has hormonal disruptions, and someone even earns cancer in this way. The formulations of the main diseases are more or less clear to the average layman. But since the end of the last century, an official separate disease has appeared in medicine under the strange name “chronic fatigue syndrome”. Yes, chronic fatigue, today, is a disease, and not just a temporary condition. And like every disease, chronic fatigue syndrome has its own causes, symptoms and treatments. Since the state of prolonged fatigue accompanied almost every one of us at least once in a lifetime, let's try to figure out where is the line between the norm and pathology? What is considered ordinary fatigue, and what is already a disease? How to determine the presence of chronic fatigue syndrome in a person? You can find answers to these questions by reading this article.

Definition

The official definition of Chronic Fatigue Syndrome is something like this: Chronic Fatigue Syndrome (CFS) is a disease characterized by excessive physical and mental fatigue lasting at least 6 months, not relieved by rest or sleep, accompanied by numerous joint, muscle, infectious and neuropsychological symptoms. Thus, it becomes clear that fatigue can be considered a disease only if it exists for at least six months and in combination with other signs.

The first mention of chronic fatigue syndrome dates back to the 30s of the twentieth century, but until 1988 the wording was different. Synonyms of CFS are the following formulations: benign myalgic encephalomyelitis, chronic mononucleosis, myalgic encephalopathy, postviral fatigue syndrome. This is how the disease was called throughout the 20th century. Such different formulations of the same condition have been associated with the search for immediate causes of CFS. Since the only reason was never established, the scientists decided to associate the name with the main symptom. So, in 1988, the Americans proposed the term "chronic fatigue syndrome", and since 1994 the name has become international.

Causes of CFS

A reliable source of CFS development has not yet been established. There are only assumptions about the leading role of this or that process in each specific case. Among the conditions with which the connection of CFS is directly traced, it is worth noting the following:

• transferred viral infections (, Coxsackie virus group B, cytomegalovirus, herpes virus type 6, hepatitis C virus, enteroviruses);
• disturbances in the control of body functions by the nervous system. This is especially true of the sphere of higher nervous activity (memory, thinking, and so on);
• mental disorders. In most cases of CFS, precursors are detected in the form of mood changes, feelings of unmotivated anxiety;
• being in a state of chronic stress;
• unfavorable environmental conditions combined with an unhealthy lifestyle. Residents of large cities, working "for wear and tear", with an inadequate diet, without enough physical activity in conditions of constant lack of sleep, are the first contenders for CFS.

It cannot be said that any one of the above factors is decisive or more significant. Modern scientists believe that it is the coincidence of a number of conditions that leads to the development of CFS.

There are predisposing factors for CFS. It:

• female (according to statistics, 60-85% of all those suffering from this pathology are women);
• increased emotionality (cholerics are more likely to suffer from CFS);
• age 30-49 years;
• the presence of a responsible profession (doctors, firefighters, employees of the Ministry of Emergency Situations, pilots, etc.).

Symptoms

The main symptom of CFS is physical and mental fatigue that bothers a person for at least 6 months. Fatigue seems to the patient beyond. “I'm squeezed like a lemon”, “I'm exhausted to the point of exhaustion”, “it's like I was passed through a meat grinder”, - this is how patients with CFS formulate their feelings. The difference between simple overwork and chronic fatigue syndrome is that in CFS, no amount of rest helps to restore the body's strength. Neither sleep nor vacation with a change of scenery in any way affect the feeling of fatigue. At the same time, do not confuse the state of CFS with depression. With depression, a person does not want to do anything, does not strive for anything, and with CFS, the situation is reversed - desires do not coincide with opportunities.

Usually those who already feel that they have practically left the strength want to take the fatigue test. Perhaps there is no clear understanding of the cause of overwork, but you need to learn in detail about its root and what to do about it. It is important to understand why the body is so overworked, and in order to do this, it is useful to pass a special psychological test for fatigue.

It is possible that chronic fatigue syndrome (CFS) comes from another, more serious underlying condition. Maybe overwork came as a result of improper formation of thinking, or recently there have been many stressful situations in life. It may also turn out that the cause of moral fatigue lies in constant physical stress, or vice versa, its absence.

Why fatigue came: a test to determine the cause

The upcoming test will help to find out internal patterns and understand what is going wrong in life. One should read the indicated questions, and then honestly choose the most appropriate, and reflective of the current state of the answer.

When is fatigue most pronounced?

1. A. In the morning.
2. B. At noon.
3. C. Late afternoon.
4. D. In the evening.

The statement that most accurately describes patterns between wakefulness and sleep.

1. A. In the morning there is a feeling of fatigue, and by dinner I want to lie down.
2. B. Difficulty falling asleep but waking up early in the morning.
3. C. A lot of things to do, no time to get enough sleep.
4. D. Good sleep, cheerful morning, enough energy.

Which statement is most accurate regarding nutrition?

1. A. You have to eat irregularly throughout the day.
2. B. Breakfast is skipped, but lunch and dinner are included.
3. C. Full meals - three times a day, while lunch and dinner are solid.
4. D. Meals are regular, several times a day.

What food is the most preferred?

1. A. Favors fatty, salty and sweet foods.
2. B. Habitual in the diet of cereals and pasta.
3. C. More inclination towards hearty-type meals.
4. D. Nutrition is improved, there is more plant-based food, and portions are moderate.

What is stress exposure?

1. A. Constant tension, worries and anxiety.
2. B. There are worries about obligations and ordinary life problems.
3. C. Calm always, except for unpleasant situations that cause experience.
4. D. There is self-control, but it happens that the stressful situation periodically absorbs completely.

How well do you manage your emotions on your own?

1. A. I usually manage my emotions.
2. B. Sometimes they are great to control, but sometimes they take over.
3. C. Feeling overwhelmed often.
4. D. Every day, regardless of the emotional background, time is allocated for relaxation.

How often do you have physical activity in your life?

1. A. Extremely rare.
2. B. Sedentary lifestyle, but walking every day.
3. D. Regular moderate physical activity, which only gives more energy and strength.

What do you usually do in your free time?

1. A. It is practically non-existent.
2. B. Leisure time is spent relaxing and calming down.
3. C. It is almost impossible to relax, everything is in my head, even free time, extra thoughts.
4. D. Free hours are spent on hobbies, family and friends.

The most preferred drink that is most often consumed?

1. A. This is usually coffee, in extreme cases, strong tea.
2. B. Carbonated drinks.
3. C. There is no particular difference in what to drink, but in general, it is preferable to drink with friends.
4. D. Pure water or juices.

How would you like to continue to live, or in what direction to change it?

1. A. Live without frequent stress.
2. B. Stop worrying about lack of strength.
3. C. Want to be in better control of your life.
4. D. Become the leader and soul of the company.

Answers to the test

1. More Answers A. A state of really strong overexertion, urgent unloading and rest is required.
2. Answers B or C predominate. Most people with such answers. By lunchtime, the energy is running out. In the evening, it is desirable to have a good rest, otherwise the effect of fatigue accumulation will go on.
3. More Answers D. Fatigue level is normal. Feeling a little tired at the end of the day is normal, but you need to dedicate the weekend to rest.

Experts do not yet have a complete unity of views on the nature of chronic fatigue syndrome (CFS). It seems that this is some kind of general specific "imbalance" of the body, which occurs as a result of prolonged nervous overload, leading to a decrease in immunity and disruption of the functioning of the central and peripheral nervous system.

The test results are indicative only. Only a doctor can make a correct diagnosis.

Fatigue test

Usually those who already feel that they have practically left the strength want to take the fatigue test. Perhaps there is no clear understanding of the cause of overwork, but you need to learn in detail about its root and what to do about it. It is important to understand why the body is so overworked, and in order to do this, it is useful to pass a special psychological test for fatigue.

It is possible that chronic fatigue syndrome (CFS) comes from another, more serious underlying condition. Maybe overwork came as a result of improper formation of thinking, or recently there have been many stressful situations in life. It may also turn out that the cause of moral fatigue lies in constant physical stress, or vice versa, its absence.

Why fatigue came: a test to determine the cause

The upcoming test will help to find out internal patterns and understand what is going wrong in life. One should read the indicated questions, and then honestly choose the most appropriate, and reflective of the current state of the answer.

When is fatigue most pronounced?

The statement that most accurately describes patterns between wakefulness and sleep.

1. A. In the morning there is a feeling of fatigue, and by dinner I want to lie down.
2. B. Difficulty falling asleep but waking up early in the morning.
3. C. A lot of things to do, no time to get enough sleep.
4. D. Good sleep, cheerful morning, enough energy.

Which statement is most accurate regarding nutrition?

1. A. You have to eat irregularly throughout the day.
2. B. Breakfast is skipped, but lunch and dinner are included.
3. C. Full meals - three times a day, while lunch and dinner are solid.
4. D. Meals are regular, several times a day.

What food is the most preferred?

1. A. Favors fatty, salty and sweet foods.
2. B. Habitual in the diet of cereals and pasta.
3. C. More inclination towards hearty-type meals.
4. D. Nutrition is improved, there is more plant-based food, and portions are moderate.

What is stress exposure?

1. A. Constant tension, worries and anxiety.
2. B. There are worries about obligations and ordinary life problems.
3. C. Calm always, except for unpleasant situations that cause experience.
4. D. There is self-control, but it happens that the stressful situation periodically absorbs completely.

How well do you manage your emotions on your own?

1. A. I usually manage my emotions.
2. B. Sometimes they are great to control, but sometimes they take over.
3. C. Feeling overwhelmed often.
4. D. Every day, regardless of the emotional background, time is allocated for relaxation.

How often do you have physical activity in your life?

1. A. Extremely rare.
2. B. Sedentary lifestyle, but walking every day.
3. D. Regular moderate physical activity, which only gives more energy and strength.

What do you usually do in your free time?

1. A. It is practically non-existent.
2. B. Leisure time is spent relaxing and calming down.
3. C. It is almost impossible to relax, everything is in my head, even free time, extra thoughts.
4. D. Free hours are spent on hobbies, family and friends.

The most preferred drink that is most often consumed?

1. A. This is usually coffee, in extreme cases, strong tea.
2. B. Carbonated drinks.
3. C. There is no particular difference in what to drink, but in general, it is preferable to drink with friends.
4. D. Pure water or juices.

How would you like to continue to live, or in what direction to change it?

1. A. Live without frequent stress.
2. B. Stop worrying about lack of strength.
3. C. Want to be in better control of your life.
4. D. Become the leader and soul of the company.

Answers to the test

1. More Answers A. A state of really strong overexertion, urgent unloading and rest is required.
2. Answers B or C predominate. Most people with such answers. By lunchtime, the energy is running out. In the evening, it is desirable to have a good rest, otherwise the effect of fatigue accumulation will go on.
3. More Answers D. Fatigue level is normal. Feeling a little tired at the end of the day is normal, but you need to dedicate the weekend to rest.

Feelings of nausea, general weakness, often occurring.

Feeling of weakness in the morning when it is difficult to get up from.

Dry and acute, wet and chronic, mild and.

Complaints of the patient that he became "hard.

Why weakness does not go away after a cold, how.

The information on the site is provided for informational purposes only, does not claim to be reference and medical accuracy, and is not a guide to action. Do not self-medicate. Consult with your physician.

chronic fatigue syndrome

Not everyone knows that chronic fatigue can develop not only and not so much with overwork, but also be the result of a long-term stressful effect on a person. There is another reason - infectious, but here we will not talk about such fatigue?

So what is chronic fatigue? It differs from ordinary fatigue very significantly. Since this is not only physical, but also emotional, nervous and intellectual depletion of the body's reserves.

Usually a person continues to live and work in the same, familiar rhythm, still performing daily duties, and at the same time begins to feel that he is already on the verge. You can determine if you are already in the grip of this ailment, if you have been feeling frequent or constant malaise for six months and at the same time seem to be not sick with anything (at least, during examinations, you do not have any or pathology). Well, you can find out even more precisely with the help of this test.

Try to answer honestly, sincerely, "YES" or "NO" to all questions.

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Chronic fatigue syndrome: take the test

Do you feel overwhelmed and do not get enough sleep even after 10 hours of sleep? You may have chronic fatigue syndrome. Take our quiz and find out if you should see a doctor.

1. Have you been constantly tired during the past four weeks?

2. Do you feel tired even after a week of rest and good sleep?

3. Do you feel especially overwhelmed in the morning?

4. Have you been refusing to meet friends lately because of fatigue?

5. After a working day, do you feel even worse than in the morning?

6. Do you often get sick with viral diseases?

7. Do you often have headaches and "twist" joints?

If you answered yes to 3 or more questions, you should immediately seek help from your therapist. He will help you adjust the daily regimen and, possibly, prescribe vitamins to make up for the lack of useful substances necessary for the body.

There are no comments, but you can be the first to comment 🙂

Copyright © Perehid Wimes Publishing

Test: Chronic Fatigue Syndrome

Try as honestly, sincerely, to answer “yes” or “no” to all questions of this small test. So:

1. When you wake up in the morning, do you need to “swing” longer than usual, making an effort on yourself in order to get involved in your usual (including work) life?

2. In the midst of work, do you begin to feel a drop in its productivity, the need to strain, to make additional efforts for its quality performance?

3. Do you need some kind of “dope” (coffee, strong tea…) to feel in good shape at least during working hours?

4. Have you begun to react badly to weather changes that cause you pain in your back, joints, headaches, weakness?

5. Do you have an increase or decrease in appetite?

6. Have you started to experience unpleasant, sometimes painful sensations in the area of ​​the heart?

7. Do you have chilliness of hands, feet?

8. Are you worried about any dysfunctions, any disturbances in the activity of the gastrointestinal tract?

9. Do you have increased irritability, irascibility, do you have episodes of unreasonable mood swings?

10. Have you experienced or increased allergic reactions?

11. Do you have a decreased sex drive?

12. Has your sleep become interrupted, restless, shallow, or have you been unable to fall asleep?

If most of your answers to the questions posed in the test turned out to be positive, then it's time for you to think about your health! And, of course, start taking the necessary measures in order not to be defeated by chronic fatigue.

Find the opportunity to fully relax and unwind

First of all, chronic fatigue should not be allowed to develop. But not everyone succeeds in avoiding stress, establishing a rational, healthy lifestyle.

And therefore, first of all, one should not gather strength, not mobilize the remnants of energy (as, alas, very often not very experienced specialists recommend doing this), but, on the contrary, give yourself the opportunity to rest and relax.

To do this, you should sleep at least 8 or even 9 hours. And if possible, add sleep also in the daytime.

To relieve muscle tension can help the so-called. relaxation exercises based on the release of clamps from the muscles, on their maximum relaxation.

Positive emotions also help to relax. And various kinds of hobbies contribute to their emergence (including the sauna that is fashionable these days, but you shouldn’t be in it to the point of weakness and dizziness), and music, and just rational rest. The hormones of pleasure produced at the same time - endorphins - relieve irritability, and unmotivated excitability, and pain, and, of course, improve mood.

Do the exercises

During work, it is best to do a light workout every two hours. Then you can sit, relaxed and slightly moving your fingers and toes, in your work chair.

If your job (and your boss) allows it, you can warm up with the following simple exercises:

1) Jump (legs together - arms apart) for 1 minute. Do 20 sit-ups, 25 push-ups, or run in one place for a couple of minutes. This is often enough to speed up blood circulation and increase oxygen supply.

2) You can use self-massage in order to "recharge your internal battery."

Change clothes after work

Returning home after a hard day at work, it is imperative to immediately change clothes (especially underwear!). The fact is that after a difficult, stressful day, biologically active substances produced by the body in response to stressful effects remain on it. Being absorbed into the skin, they can increase your uncomfortable, if not painful, condition.

Do self-massage

Don't forget about the healing effects of water! By washing your hands under running water for at least a short time, you will thus be cleansed, freed from the painful, “evil” energy that accumulates during the day. At the same time, one should not forget that in the summer, hot season, the water should be cold, but in winter, on the contrary, warm.

In addition, rubbing your hands under running water, you will act on certain biologically active points, conducting a kind of tonic self-massage.

Well, since after a hard day of work, especially filled with stress, most people have a feeling of facial tension, you can knead it, barely touching your cheeks and forehead with your fingertips.

Drink vitamin drinks and moderate the impact of bad habits

And it’s also good to drink vitamin drinks - a decoction of rose hips, an infusion of nettle (3-4 tablespoons of it should be infused for 1-2 hours in 1 liter of boiling water and drink 2/3 cup 3-5 times a day after meals) or infusion dry fruits of mountain ash (brew with a glass of boiling water, let it brew for 1 hour) - take 0.5 cup 2-3 times a day.

Try to limit your computer time, spend less time watching TV. Avoid hard liquor. Try to quit smoking. And do not forget about the need for a balanced diet. It is advisable to drink fresh carrot juice with cream for breakfast, focus your diet on plant foods (especially nuts, herbs, vegetables, fruits) with a decrease in the amount of meat and animal fats.

Further information: Causes of chronic fatigue

Not everyone knows that chronic fatigue can develop not only and not so much with overwork, but also be the result of prolonged stress on a person. There is another reason, but here we will not talk about the so-called. chronic fatigue syndrome, which has not yet been fully studied by modern medicine, the cause of which is a certain infectious factor.

So, what is this chronic fatigue manifested in? And it differs from ordinary fatigue very dramatically. Since this is not only physical, but also emotional, nervous, intellectual depletion of the body's reserves.

Usually a person continues to live and work in the same, familiar rhythm, still performing his usual duties, and at the same time begins to feel that he is already on the verge. Remember that it is possible to determine whether you have already fallen into the tightening grip of this ailment if you have been feeling frequent or constant malaise for six months, and at the same time, it seems that you are not sick with anything yet (at least during examinations you no pathology is detected). Well, even more accurately you can do with this test.

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5 minute chronic fatigue test

The test for chronic fatigue, or rather, the degree of fatigue, is just one picture-illusion. All that is required of you is to carefully examine the picture for a few minutes.

People often do not notice fatigue and overwork to the detriment of their health. It happens and vice versa - sometimes you feel very tired just because the work is rather boring or monotonous. But in fact - the body is objectively quite capable of working further.

This is a simple and quick test to quickly determine the level of fatigue. If you are busy with a very important urgent matter, and you need to decide what is better - to get enough sleep and finish the urgent work in the morning or, without harm to your health, sit for another hour and go to bed with a sense of accomplishment. To understand how tired you are, it is enough to take this five-minute psychological test for the level of fatigue ... Look ... Tell me what you see?

Chronic fatigue test -

Illusions are actually motionless - you are calm, balanced, you do not urgently need to quit work and go to rest.

If illusions are actively moving, you need rest.

If the illusions are moving very quickly, you need to urgently rest, otherwise there may be negative consequences for your health.

Article Author: Keeper

leave a comment

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Online Chronic Fatigue Test (Asthenia)

Test for asthenic condition online

TEST FOR ASTHENIA

One of the scourges of our depressive time is asthenic syndrome, the essence of which is the growing mental and physical weakness, depression, nervous exhaustion, which our crazy lifestyle contributes to so much.

The asthenic condition scale was created on the basis of the well-known American MMPI questionnaire and data from clinical and psychological observations of a number of researchers (L.D. Malkova, T.G. Chertova).

When answering the test questions, carefully read each sentence and evaluate it in relation to your condition. Then choose one of the 4 answer options on the right. After clicking on the "Answer" button, the program will calculate the number of points you have scored and assess the severity of your asthenia.

Experts do not yet have a complete unity of views on the nature of chronic fatigue syndrome (CFS). It seems that this is some kind of general specific "imbalance" of the body, which occurs as a result of prolonged nervous overload, leading to a decrease in immunity and disruption of the functioning of the central and peripheral nervous system.

The test results are indicative only. Only a doctor can make a correct diagnosis.

chronic fatigue syndrome

Chronic fatigue syndrome is a psycho-emotional disease. It most often occurs due to prolonged physical and mental overstrain. The disease is more prone to middle-aged people living in the city.

The main symptom of the disease is a stable feeling of powerlessness: it is difficult for a person to cope with daily tasks at home and at work. It seems that such a state is addictive, like a swamp. However, it can and should be treated.

Causes of fatigue

Chronic fatigue syndrome is not yet a fully understood phenomenon in medicine. Opinions about the reasons were divided into two groups:

1. The disease is the result of hidden chronic processes in the body or is provoked by experienced nervous disorders.

2. Constant exhaustion occurs due to improper lifestyle and excessive stress. That is, developing "visible" symptoms, such as reduced immunity or mental instability, are considered as the result of regular overwork.

If we summarize all the possible reasons, they can be represented as follows:

Symptoms and Diagnosis

To identify the disease and isolate it from other, similar diseases, medical scientists have developed a classification of symptoms of chronic fatigue syndrome:

1. Main features. There are two of them: permanent fatigue, not eliminated even by prolonged sleep, which has been observed for more than six months, and the exclusion of obvious ailments in the body.

2. Minor. These are physical symptoms:

• feeling of chills;
• migraine;
• dryness in the throat and mucous membranes of the eyes;
• muscle and spinal pain;
• shortness of breath;
• subfebrile temperature;
• enlargement of the lymph nodes.

3. Neuropsychological signs. These include various phobias (especially the fear of bright light), irritability, poor concentration, feelings of depression and hopelessness.

If more than eight signs are present (both major, about six from the list of minor plus at least one of the third group), the diagnosis is chronic fatigue syndrome.

What to do for treatment

For starters, you can visit a doctor to understand the possible underlying causes of the syndrome. What specialist is needed for this? It all depends on the goal:

• they go to the therapist and immunologist to identify the presence of chronic diseases, infections and viruses in the body;
• to a psychologist - to test yourself for the presence of traumatic factors and get a referral for individual or group therapy;
• other specialists (endocrinologist, cardiologist, etc.) are treated for the treatment of symptomatic manifestations of the disease (enlarged lymph nodes, tachycardia, etc.).

If necessary, doctors will prescribe treatment with medications or physiotherapy:

• soothing relaxing massages;
• medical gymnastics;
• water procedures;
• acupuncture (a method of influencing the body with acupressure).

Unfortunately, chronic fatigue syndrome, in its early stages, is very difficult to identify. You'll have to help yourself. If you notice signs from all three groups listed in the "symptoms and diagnosis" section, you need to start self-organization measures:

1. Establish a normal diet:

• do not forget about the hot lunch;
• reduce the consumption of fatty foods;
• drink plenty of clean water;
• enrich your diet with vitamins.

2. Arrange the daily routine:

• try to do all the important things before lunch;
• avoid doing several things at the same time;
• make time for walking;
• do five minutes at work to warm up and just relax.

3. Get good sleep:

• go to bed early;
• ventilate the room;
• sleep in comfortable clothes.

The last point is the most important. A good rest is the first thing you need to organize yourself if you have symptoms of an illness. On weekends, turn off your phone and get as much sleep as your body needs.

Medical treatment

Homeopathic remedies are often prescribed to alleviate the condition. The most popular of them are shown in the table:

Attacks of "lack" of air;

Violent palpitations after little physical exertion;

Small trembling of hands.

Decreased concentration;

Loss of visual acuity;

Discomfort in muscles and joints;

In addition to taking homeopathic and anti-inflammatory drugs, doctors recommend the treatment of chronic fatigue syndrome and other groups of medications:

• complexes of vitamins and minerals;
• drugs that modulate immunity;
• antiviral drugs;
• antidepressants.

Psychotropic drugs help treat disorders of the autonomic nervous system (strictly on prescription).

A simple self-diagnosis test

Many of us lack the fortitude or time to go to the doctor. To find out if you really have chronic fatigue syndrome and how serious the problem is, you can try with a small test.

Answer the suggested questions of each block by answering “Yes” or “No”:

1. The appearance of frequent pain:

2. Regular gastrointestinal problems:

3. Increasingly frequent seizures:

• rapid heartbeat;
• arrhythmias;
• breath holding;
• dizziness;
• pre-fainting state;
• blanching of the skin of the face;
• blackouts in the eyes.

4. I really want:

• sleep;
• lie down on the bed;
• fall asleep right on the desktop;
• wake up without feeling "broken";
• stop having nightmares.

5. There is tangible discomfort when changing:

6. Progression of difficulties:

• when memorizing new information;
• concentration of attention;
• decision making;
• manifestations of a timely reaction to someone else's act or question.

7. Loss of interest:

8. The appearance of obsessive states:

9. Frequent disease state:

• persistent colds;
• chronic tonsillitis;
• exacerbation of a chronic disease;
• muscle cramps;
• the appearance of allergies;
• permanent runny nose;
• pain in the eyes;
• feeling of unrelenting thirst.
• subfebrile temperature for no apparent reason.

10. Emotional instability, manifested as follows:

• in flashes of unreasonable anger;
• in irritability over trifles;
• in reactive change of moods;
• in frequent apathy;
• in acute anguish.

11. We began to “calm down” ourselves with new methods:

• learned to smoke or increase the number of cigarettes;
• there was a craving for alcohol in the evenings.

12. Terribly annoying:

13. No energy for simple household chores.

In total, 60 questions were asked in 13 blocks. If you answered "Yes" to only 20 or fewer questions, you are simply tired. A good rest will restore strength in full.

If there were positive answers in the range of 20-40, chronic fatigue syndrome is already present, but you can try to fight it yourself.

But in the case of a result of more than 40 "Yes", you should consult a doctor.

How to help yourself

Many psychologists believe that man's greatest battles are with himself and his weaknesses. Many sages are sure that the most significant victory is the one where you managed to give up the fight, realizing the vanity of the goal (the idea that life is good not with achievements, but with something more, is perfectly revealed in the film "Peaceful Warrior").

Write a rough list of things that you think are not very important, but take a lot of time. Having managed to refuse any of them, put yourself a fat checkmark and say “Well done!”. You really deserve self-respect.

Before starting the fight against the disease, called "chronic fatigue syndrome", give yourself a proper rest and gain strength. In any case, you have to sacrifice something. For example, cleaning the kitchen to a perfect shine or participating in a corporate "beer meeting" on the occasion of the end of Friday.

Review the possible reasons that led to your deplorable physical condition, and write another list of not the best habits that you are quite capable of breaking.

The main thing is not to rush to reshape your lifestyle too zealously:

• if you are used to fatty foods, do not exclude them from the menu all at once, gradually replace them with energy products (cereals, nuts, dried fruits);
• if you have never drunk 2 liters of pure water daily, an excessively sharp increase in fluid can provoke swelling;
• if you're looking to tone up, don't plan on doing 40 push-ups today.

Chronic fatigue syndrome was formed for months. Do not think that you can remove its effects in a week. Do not forget that the main task is to give the body a rest, and not to freeze it even more. Be patient. Move towards your goal in small steps. And be sure, just be sure to praise yourself.

Chronic fatigue syndrome: what is it, symptoms, signs and treatment

In the 19th century, it was condescendingly called "hypochondria". In the 20th century, it began to be called "chronic fatigue", and in the 21st century - "the disease of the century." The symptoms are the same, but the age and scale of distribution have changed significantly. The disease is like an epidemic, more and more young people, residents of megacities, and the population of economically prosperous countries fall into its sphere of influence.

Scientists break spears, arguing about the causes of the various disorders of the nervous system characteristic of this syndrome, and cannot come to a common denominator. However, they are unanimous in one thing: CFS is a diagnosis officially recognized by medicine.

What is Chronic Fatigue Syndrome?

Chronic fatigue syndrome is a disease in which a feeling of weakness and fatigue accompanies a person for a long time (more than six months). Moreover, this condition does not disappear even after prolonged sleep and rest.

Facts and figures: Chronic fatigue syndrome has been considered a disease in its own right since 1988, with recognition of the need for treatment.

Symptoms of CFS are found in 20% of the inhabitants of the planet Earth. And this number is growing.

2% of adolescents suffer from CFS.

80% of patients are women.

Causes: 3 different opinions

There are many versions about the mechanism and causes of the disease, but there are three main ones that deserve attention.

1. The intense rhythm of modern life. This version is supported by the fact that the age most prone to chronic fatigue syndrome - 25–45 years - is the most efficient age when a person imposes exorbitant loads on himself in an effort to succeed. The body can not stand it and fails. There are persistent symptoms of overwork. The unfavorable ecological situation of gassed megacities also contributes, provoking oxygen starvation - hypoxia of the brain. Decrease in oxygenation entails failures in the metabolic processes of the body, leads to its slagging
2. It's all the fault of the virus. A fairly common theory is that CFS is provoked by a group of viruses - herpes, retrovirus, enterovirus, cytomegalovirus. Recently, scientists at Stanford University received new confirmation of the viral nature of the syndrome. They identified its specific biomarkers - an increased content in the body of some people of hormone-like proteins, peptides, cytokines. It has been shown that the higher a patient's levels of certain anti-inflammatory cytokines, the more severe their symptoms of CFS.
3. Chronic diseases are to blame. At risk are patients suffering from heart disease, autoimmune disorders - those who often "catch" viral infections. And also those who, trying not to miss anything at work, do not take sick leave and endure tonsillitis and SARS on their feet. Often this turns into a payback in the form of chronic fatigue. The mechanism of this relationship is simple: an undertreated organism, weakened by a disease, malfunctions. The immune system is undermined, the nervous system is overloaded, the physical system is exhausted. As a result, there is a persistent feeling of fatigue, decline, physical and moral. In this case, the quality of life really deteriorates - gloomy thoughts attack the subconscious, anxiety and fear do not leave.

Scientists from the Netherlands have found a connection between the syndrome and a lack of iodine in the body or chronic problems with the thyroid gland. The composition of the blood of patients suffering from a lack of hormones TSH and T4, as well as people with CFS, is similar. If this conclusion is correct, then the iodine diet is able to return the patient with the syndrome to normal life.

Risk factors

• Representatives of professions subjected to constant stress, which require increased responsibility and concentration of attention - air traffic controllers, military, firefighters, surgeons.
• Hard-working mental workers who ignore vacations and weekends.
• Teenagers preparing to enter the university, students during the session.
• Not receiving adequate nutrition.
• Sleep-deprived.
• Leading an inactive lifestyle.
• Living in an unfavorable ecological environment.
• Not getting enough sunlight and fresh air.
• Surviving life's troubles and troubles.
• Possessors of suspicious, conflict psychotype.

Thus, the main factor leading to the occurrence of CFS is of a nervous nature - emotional burnout, nervous stress, insomnia, mental overwork. All this provokes endocrine and metabolic failures of the body, a decrease in the protective forces of immunity.

What to Look for When Diagnosing CFS

How to recognize chronic fatigue syndrome: signs and symptoms

Jamming the nervous system in a permanent state of emergency is fraught with serious health problems and far-reaching consequences, so it is important to recognize the "enemy" in the early stages in order to know how to deal with it.

Symptoms of CFS are divided into mental and somatic.

• Decrease in working capacity - absent-mindedness, problems with concentration of attention, memorization, systematization of information, inability to creative activity.
• Psychological disorders - depression, anxiety, anxiety, irritability, gloomy thoughts.
• Intolerance to bright light.

• Decreased physical activity - weakness, feeling tired and overwhelmed even after doing simple work.
• Migraines are frequent, accompanied by "pulsation of the temples", dizziness.
• Insomnia - despite fatigue, sleep does not come or is weak, intermittent.
• Tachycardia.
• Enlargement and soreness of the lymph nodes.
• Violation of motor functions - muscle and joint pain, hand tremor, muscle weakness.
• Reduced immunity - pharyngitis, sore throat, frequent colds, exacerbation of chronic diseases.

Symptomatic diagnosis of chronic fatigue syndrome

The presence of these symptoms is a reason to consult a doctor so that he can prescribe the necessary studies and tests. And already on the basis of the results obtained, he made an expert opinion and prescribed treatment. It is useless to wait for it to “pass by itself”, as well as to hope that this is ordinary overwork and it is enough to go to the sea and sleep off on the weekend. With CFS, neither a change of activity nor a change of environment will help. Qualified treatment is required.

On a note: a full-fledged examination is also important because such dangerous diseases as oncology in the early stages, tuberculosis are cleverly disguised as chronic fatigue syndrome.

Physicians to whom it makes sense to consult

• Psychologist / psychotherapist - with symptoms in the form of insomnia, anxiety, increased psycho-emotional stress.
• Neurologist - for migraines, dizziness, decreased performance, depressive states that have arisen against the background of constant stress and nervous tension.
• Endocrinologist - for tremors, muscle pain, a constant state of weakness and fatigue.
• Immunologist - with frequent colds and exacerbations of chronic diseases.
• Therapist - in case of difficulty with symptoms. The therapist will either prescribe the treatment himself, or give a referral to the right specialist.

Basic Treatments

The disease requires complex therapy, which includes 4 important components:

1. Good rest - a deep night's sleep for at least 8 hours, daily half-hour walks in the fresh air.
2. Balanced nutrition - high-quality products that supply the body with the necessary amount of proteins, fats and carbohydrates, vitamins and minerals. Minimize or eliminate sweets that cause blood sugar spikes that a weakened body does not need.
3. Psychotherapy is the help of a psychologist or psychotherapist, aimed at improving mood, self-confidence, and getting out of a stressful situation.
4. A competent daily routine - the exclusion of overload, emotional and physical, the alternation of work and rest, 3 breaks for food, more time in the fresh air.

Note: it is important to treat diseases that can provoke constant hypoxia - sinusitis, rhinitis or chronic inflammation - carious teeth, tonsillitis.

Medical treatment

In addition to psychotherapeutic treatment, medications are often prescribed for CFS. There are 5 groups of drugs that are used for therapy.

• Non-steroidal anti-inflammatory drugs. They are prescribed for pain syndromes - headache, muscle, joint pain.
• Vitamin complexes. Their goal is to restore the correct metabolism, the energy supply of the body, strengthen the immune system - B vitamins, magnesium.
• Immunomodulators. They are prescribed to increase the body's immune forces and its resistance to infections, viruses.
• Antiviral drugs. They fight viruses in the body, prevent their reproduction.
• Psychotropic drugs. Antidepressants, daytime tranquilizers normalize the functioning of the nervous system. Remove the feeling of anxiety, anxiety.

The fact that taking tonics, such as eleutherococcus and lemongrass, is useful for raising vitality is a myth. In fact, they are not able to eliminate any of the causes of a decrease in vitality. Their intake by people with chronic fatigue syndrome will only lead to an increased consumption of internal reserves, which are already scarce. As a result - aggravation of health problems.

Taking tonic drugs is indicated only for healthy people who are facing serious physical or nervous stress.

Treatment at home

At home, simple folk remedies and preventive measures are available, in which there is also nothing complicated.

You can resort to the methods of traditional medicine and prepare "invigorating oil".

For this you will need:

• olive oil - 1 bottle;
• fresh rosemary - 1 teaspoon.

Mix and use when cooking.

Licorice root is an excellent anti-inflammatory agent that reduces the level of cortisol in the blood. Its regular use (2 g each) can restore vitality in 2 weeks.

Aromatherapy with lavender oil, rosemary or sandalwood. A few drops - on a handkerchief and inhale. Helps to relax, promote healthy sleep.

• Breaks every 2 hours.
• Physical activity - walking, swimming, morning exercises.
• Refusal of bad habits and fast food.
• Increase in the diet of fresh vegetables and fruits with the addition of nuts, honey, berries.
• Full 8 hour sleep.
• Change of scenery - trips to nature, out of town, visits to resorts.

Acupuncture is often used to combat chronic fatigue.

Useful physiotherapy for chronic fatigue syndrome

• Acupuncture / acupuncture - impact on certain points of the body helps relieve pain, calms the nervous system, restores energy balance. It has a positive effect on the immune system, helps relieve tension, both muscular and nervous.
• Massage - therapeutic, acupressure, lymphatic drainage. It improves blood circulation and lymph flow, metabolic processes, helps cleanse the body of toxins and toxins, and improves immunity.
• Therapeutic exercise - activation of different muscle groups, improvement of blood circulation and restoration of energy.
• Laser therapy - activates metabolism, stimulates the activity of the nervous system.
• Magnetotherapy - has a good effect on the endocrine and immune systems. Has analgesic and relaxing effect.
• Hydrotherapy - water treatments relieve stress, soothe and relax.

Can idleness be cured?

The answer to this question is not as simple as it seems. On the one hand, there is a common misconception that laziness is an excuse for those who shirk work. In fact, laziness can be a manifestation of a natural instinct - the desire to save vitality.

Important: if the desire to lie down, relax occurs often and becomes regular, then this is an alarm signal that the body is on the verge, and its supply of vitality has dried up. Laziness can be evidence of both CFS and another serious illness.

On the other hand, there is another persistent myth: "Chronic fatigue will go away if you get some rest."

It won't pass! If a person is healthy, then even with great physical exertion, his strength will be restored after a night's sleep. With CFS, you can not bother with anything, sleep all night and in the morning feel completely overwhelmed and devastated.

The causes of fatigue are inside, not outside. For example, it may be a violation of the thyroid gland, slowing down the metabolism, depriving the brain of good nutrition.

Fact: 14% of patients who are referred to a psychiatrist for signs of depression and weakness are actually suffering from a decrease in thyroid function.

The question arises: what leads to a malfunction of the thyroid gland? Psychologists believe that the imbalance between stimuli is to blame for this - those that are sent to us by the external environment and those that we issue in response.

Most often this occurs in housewives and people of monotonous work. They don't get enough stimulation of their nervous system. In other words, they lack impressions, a certain dose of stress, so that the body has the opportunity to shake itself up, mobilize and respond properly.

When there are few such incentives, the settings begin to go astray. A similar situation occurs when there is too much stress.

Everything is good in moderation. Achieving the golden mean, finding harmony with yourself and the world around you will become the very antidote that will save humanity from the disease of the 21st century - chronic fatigue syndrome.

Fatigue test

Usually those who already feel that they have practically left the strength want to take the fatigue test. Perhaps there is no clear understanding of the cause of overwork, but you need to learn in detail about its root and what to do about it. It is important to understand why the body is so overworked, and in order to do this, it is useful to pass a special psychological test for fatigue.

It is possible that chronic fatigue syndrome (CFS) comes from another, more serious underlying condition. Maybe overwork came as a result of improper formation of thinking, or recently there have been many stressful situations in life. It may also turn out that the cause of moral fatigue lies in constant physical stress, or vice versa, its absence.

Why fatigue came: a test to determine the cause

The upcoming test will help to find out internal patterns and understand what is going wrong in life. One should read the indicated questions, and then honestly choose the most appropriate, and reflective of the current state of the answer.

When is fatigue most pronounced?

The statement that most accurately describes patterns between wakefulness and sleep.

1. A. In the morning there is a feeling of fatigue, and by dinner I want to lie down.
2. B. Difficulty falling asleep but waking up early in the morning.
3. C. A lot of things to do, no time to get enough sleep.
4. D. Good sleep, cheerful morning, enough energy.

Which statement is most accurate regarding nutrition?

1. A. You have to eat irregularly throughout the day.
2. B. Breakfast is skipped, but lunch and dinner are included.
3. C. Full meals - three times a day, while lunch and dinner are solid.
4. D. Meals are regular, several times a day.

What food is the most preferred?

1. A. Favors fatty, salty and sweet foods.
2. B. Habitual in the diet of cereals and pasta.
3. C. More inclination towards hearty-type meals.
4. D. Nutrition is improved, there is more plant-based food, and portions are moderate.

What is stress exposure?

1. A. Constant tension, worries and anxiety.
2. B. There are worries about obligations and ordinary life problems.
3. C. Calm always, except for unpleasant situations that cause experience.
4. D. There is self-control, but it happens that the stressful situation periodically absorbs completely.

How well do you manage your emotions on your own?

1. A. I usually manage my emotions.
2. B. Sometimes they are great to control, but sometimes they take over.
3. C. Feeling overwhelmed often.
4. D. Every day, regardless of the emotional background, time is allocated for relaxation.

How often do you have physical activity in your life?

1. A. Extremely rare.
2. B. Sedentary lifestyle, but walking every day.
3. D. Regular moderate physical activity, which only gives more energy and strength.

What do you usually do in your free time?

1. A. It is practically non-existent.
2. B. Leisure time is spent relaxing and calming down.
3. C. It is almost impossible to relax, everything is in my head, even free time, extra thoughts.
4. D. Free hours are spent on hobbies, family and friends.

The most preferred drink that is most often consumed?

1. A. This is usually coffee, in extreme cases, strong tea.
2. B. Carbonated drinks.
3. C. There is no particular difference in what to drink, but in general, it is preferable to drink with friends.
4. D. Pure water or juices.

How would you like to continue to live, or in what direction to change it?

1. A. Live without frequent stress.
2. B. Stop worrying about lack of strength.
3. C. Want to be in better control of your life.
4. D. Become the leader and soul of the company.

Test: Chronic Fatigue Syndrome

Try as honestly, sincerely, to answer “yes” or “no” to all questions of this small test. So:

1. When you wake up in the morning, do you need to “swing” longer than usual, making an effort on yourself in order to get involved in your usual (including work) life?

2. In the midst of work, do you begin to feel a drop in its productivity, the need to strain, to make additional efforts for its quality performance?

3. Do you need some kind of “dope” (coffee, strong tea…) to feel in good shape at least during working hours?

4. Have you begun to react badly to weather changes that cause you pain in your back, joints, headaches, weakness?

5. Do you have an increase or decrease in appetite?

6. Have you started to experience unpleasant, sometimes painful sensations in the area of ​​the heart?

7. Do you have chilliness of hands, feet?

8. Are you worried about any dysfunctions, any disturbances in the activity of the gastrointestinal tract?

9. Do you have increased irritability, irascibility, do you have episodes of unreasonable mood swings?

10. Have you experienced or increased allergic reactions?

11. Do you have a decreased sex drive?

12. Has your sleep become interrupted, restless, shallow, or have you been unable to fall asleep?

If most of your answers to the questions posed in the test turned out to be positive, then it's time for you to think about your health! And, of course, start taking the necessary measures in order not to be defeated by chronic fatigue.

Find the opportunity to fully relax and unwind

First of all, chronic fatigue should not be allowed to develop. But not everyone succeeds in avoiding stress, establishing a rational, healthy lifestyle.

And therefore, first of all, one should not gather strength, not mobilize the remnants of energy (as, alas, very often not very experienced specialists recommend doing this), but, on the contrary, give yourself the opportunity to rest and relax.

To do this, you should sleep at least 8 or even 9 hours. And if possible, add sleep also in the daytime.

To relieve muscle tension can help the so-called. relaxation exercises based on the release of clamps from the muscles, on their maximum relaxation.

Positive emotions also help to relax. And various kinds of hobbies contribute to their emergence (including the sauna that is fashionable these days, but you shouldn’t be in it to the point of weakness and dizziness), and music, and just rational rest. The hormones of pleasure produced at the same time - endorphins - relieve irritability, and unmotivated excitability, and pain, and, of course, improve mood.

Do the exercises

During work, it is best to do a light workout every two hours. Then you can sit, relaxed and slightly moving your fingers and toes, in your work chair.

If your job (and your boss) allows it, you can warm up with the following simple exercises:

1) Jump (legs together - arms apart) for 1 minute. Do 20 sit-ups, 25 push-ups, or run in one place for a couple of minutes. This is often enough to speed up blood circulation and increase oxygen supply.

2) You can use self-massage in order to "recharge your internal battery."

Change clothes after work

Returning home after a hard day at work, it is imperative to immediately change clothes (especially underwear!). The fact is that after a difficult, stressful day, biologically active substances produced by the body in response to stressful effects remain on it. Being absorbed into the skin, they can increase your uncomfortable, if not painful, condition.

Do self-massage

Don't forget about the healing effects of water! By washing your hands under running water for at least a short time, you will thus be cleansed, freed from the painful, “evil” energy that accumulates during the day. At the same time, one should not forget that in the summer, hot season, the water should be cold, but in winter, on the contrary, warm.

In addition, rubbing your hands under running water, you will act on certain biologically active points, conducting a kind of tonic self-massage.

Well, since after a hard day of work, especially filled with stress, most people have a feeling of facial tension, you can knead it, barely touching your cheeks and forehead with your fingertips.

Drink vitamin drinks and moderate the impact of bad habits

And it’s also good to drink vitamin drinks - a decoction of rose hips, an infusion of nettle (3-4 tablespoons of it should be infused for 1-2 hours in 1 liter of boiling water and drink 2/3 cup 3-5 times a day after meals) or infusion dry fruits of mountain ash (brew with a glass of boiling water, let it brew for 1 hour) - take 0.5 cup 2-3 times a day.

Try to limit your computer time, spend less time watching TV. Avoid hard liquor. Try to quit smoking. And do not forget about the need for a balanced diet. It is advisable to drink fresh carrot juice with cream for breakfast, focus your diet on plant foods (especially nuts, herbs, vegetables, fruits) with a decrease in the amount of meat and animal fats.

Further information: Causes of chronic fatigue

Not everyone knows that chronic fatigue can develop not only and not so much with overwork, but also be the result of prolonged stress on a person. There is another reason, but here we will not talk about the so-called. chronic fatigue syndrome, which has not yet been fully studied by modern medicine, the cause of which is a certain infectious factor.

So, what is this chronic fatigue manifested in? And it differs from ordinary fatigue very dramatically. Since this is not only physical, but also emotional, nervous, intellectual depletion of the body's reserves.

Usually a person continues to live and work in the same, familiar rhythm, still performing his usual duties, and at the same time begins to feel that he is already on the verge. Remember that it is possible to determine whether you have already fallen into the tightening grip of this ailment if you have been feeling frequent or constant malaise for six months, and at the same time, it seems that you are not sick with anything yet (at least during examinations you no pathology is detected). Well, even more accurately you can do with this test.

Chronic Fatigue Syndrome: Symptoms and Diagnosis

The modern world requires maximum output and constant tension from a person. All you have to do is relax a little and you're already out of the loop. Therefore, most people are always in a hurry somewhere, live in a frantic rhythm and do not give themselves a moment's rest.

This behavior has the flip side of the coin in the form of health problems. Moreover, they result in completely different diseases: someone is overcome by frequent acute respiratory infections, someone has hormonal disruptions, and someone even earns cancer in this way. The formulations of the main diseases are more or less clear to the average layman. But since the end of the last century, an official separate disease has appeared in medicine under the strange name “chronic fatigue syndrome”. Yes, chronic fatigue, today, is a disease, and not just a temporary condition. And like every disease, chronic fatigue syndrome has its own causes, symptoms and treatments. Since the state of prolonged fatigue accompanied almost every one of us at least once in a lifetime, let's try to figure out where is the line between the norm and pathology? What is considered ordinary fatigue, and what is already a disease? How to determine the presence of chronic fatigue syndrome in a person? You can find answers to these questions by reading this article.

Definition

The official definition of Chronic Fatigue Syndrome is something like this: Chronic Fatigue Syndrome (CFS) is a disease characterized by excessive physical and mental fatigue lasting at least 6 months, not relieved by rest or sleep, accompanied by numerous joint, muscle, infectious and neuropsychological symptoms. Thus, it becomes clear that fatigue can be considered a disease only if it exists for at least six months and in combination with other signs.

The first mention of chronic fatigue syndrome dates back to the 30s of the twentieth century, but until 1988 the wording was different. Synonyms of CFS are the following formulations: benign myalgic encephalomyelitis, chronic mononucleosis, myalgic encephalopathy, postviral fatigue syndrome. This is how the disease was called throughout the 20th century. Such different formulations of the same condition have been associated with the search for immediate causes of CFS. Since the only reason was never established, the scientists decided to associate the name with the main symptom. So, in 1988, the Americans proposed the term "chronic fatigue syndrome", and since 1994 the name has become international.

Causes of CFS

A reliable source of CFS development has not yet been established. There are only assumptions about the leading role of this or that process in each specific case. Among the conditions with which the connection of CFS is directly traced, it is worth noting the following:

• past viral infections (Epstein-Barr virus, group B Coxsackie virus, cytomegalovirus, type 6 herpes virus, hepatitis C virus, enteroviruses);
• disturbances in the control of body functions by the nervous system. This is especially true of the autonomic nervous system, the sphere of higher nervous activity (memory, thinking, and so on);
• mental disorders. In most cases of CFS, precursors are detected in the form of mood changes, feelings of unmotivated anxiety;
• being in a state of chronic stress;
• unfavorable environmental conditions combined with an unhealthy lifestyle. Residents of large cities, working "for wear and tear", with an inadequate diet, without enough physical activity in conditions of constant lack of sleep, are the first contenders for CFS.

It cannot be said that any one of the above factors is decisive or more significant. Modern scientists believe that it is the coincidence of a number of conditions that leads to the development of CFS.

There are predisposing factors for CFS. It:

• female (according to statistics, 60-85% of all those suffering from this pathology are women);
• increased emotionality (cholerics are more likely to suffer from CFS);
• grow up;
• the presence of a responsible profession (doctors, firefighters, employees of the Ministry of Emergency Situations, pilots, etc.).

Symptoms

The main symptom of CFS is physical and mental fatigue that bothers a person for at least 6 months. Fatigue seems to the patient beyond. “I'm squeezed like a lemon”, “I'm exhausted to the point of exhaustion”, “it's like I was passed through a meat grinder”, - this is how patients with CFS formulate their feelings. The difference between simple overwork and chronic fatigue syndrome is that in CFS, no amount of rest helps to restore the body's strength. Neither sleep nor vacation with a change of scenery in any way affect the feeling of fatigue. At the same time, do not confuse the state of CFS with depression. With depression, a person does not want to do anything, does not strive for anything, and with CFS, the situation is reversed - desires do not coincide with opportunities.

In addition to feeling tired, a person with CFS has other symptoms:

• pain. It can be joint and muscle pain, pain in the abdomen, throat, chest, eyes, bones, perineum, genitals, skin, headaches. Pain tends to migrate from place to place, has no stability. Pain in the same place is different in sensations (“yesterday it shot, today it aches or pricks”);
• deterioration of memory and attention. These changes are noticed by the patient and give him a lot of trouble;
• sleep disorders (difficulty falling asleep, intermittent sleep at night and, as a result, daytime sleepiness);
• decrease in working capacity;
• irritable bowel syndrome (bloating, nausea, diarrhea, abdominal pain);
• shivering and sweating at night;
• low or high body temperature (up to 36.0°C and 38.0°C, respectively);
• shortness of breath (“something prevents breathing”), chronic cough in the absence of objective reasons for it;
• increased sensitivity to noise, light;
• sudden intolerance to smells and tastes that you previously liked;
• problems associated with a change in body position. In this case, we mean dizziness, increased heart rate, fainting when changing the position of the body from horizontal to vertical;
• mood instability, anxiety, irritability, apathy, causeless fears;
• decrease or increase in body weight;
• frequent colds.

Of course, not all symptoms are observed in every patient. Fatigue usually accompanies several additional complaints.

When analyzing all the above symptoms, one important fact should be taken into account: all of them can be regarded as indirect signs of CFS only if there are no other health problems. That is, for example, if a person suffers from migraine, and he has an intolerance to bright lights and loud sounds, then this cannot be regarded as a symptom in the case of CFS. Modern medicine has identified a whole group of conditions, the presence of which obviously excludes the possibility of making such a diagnosis as chronic fatigue syndrome. These include:

• chronic somatic diseases (hepatitis B or C, hypothyroidism, diabetes mellitus, severe anemia, chronic renal failure, chronic heart failure, bronchial asthma, cancer, and so on);
• some mental disorders (anorexia or bulimia, dementia, depression, manic-depressive disorder, schizophrenia);
• addiction to alcohol or drugs for 2 years before the onset of symptoms of chronic fatigue syndrome;
• overweight (obesity of the 3rd degree);
• taking medications that in themselves can provoke a feeling of general weakness (for example, muscle relaxants, tranquilizers).

To date, official medicine has the following interesting information about the duration of CFS. The average duration of the disease is about 5-7 years, although cases of the presence of CFS for more than 20 years have already been described. Such a long existence of the disease is connected, perhaps, with an underestimation of symptoms, with a lack of perception of one's condition as a disease, and also, to be honest, with the illiteracy of medical personnel, who often brush aside people with CFS.

Often the disease has an undulating course with periods of slight improvement in well-being. Periods of partial or even complete remission are possible, but relapses almost always occur. Constant fatigue does not allow a person to work, so up to 2/3 of all patients with such problems do not work at all or have part-time employment.

Diagnostics

CFS does not have a single specific diagnostic test or examination. Domestic medicine generally rarely establishes such a diagnosis. And, nevertheless, since such a disease exists, let's try to understand the intricacies of its diagnosis.

In 1994, clinical criteria for chronic fatigue syndrome were developed. According to them, to establish the diagnosis of CFS, 4 or more of the following 8 symptoms must be present:

• deterioration of memory, ability to concentrate;
• pain when feeling the cervical or axillary lymph nodes;
• pain or a feeling of muscle tension;
• joint pain (without other signs of damage in the form of redness or swelling);
• a new onset headache or a change in the characteristics of a pre-existing headache;
• unproductive sleep (without a feeling of recuperation);
• increased fatigue up to complete exhaustion after any physical or mental stress, lasting more than a day.

The next important step in the diagnosis of chronic fatigue syndrome is the exclusion of other diseases, the manifestation of which may be symptoms of CFS. For this, an exhaustive examination of the patient is carried out (after all, the symptoms are so non-specific and can serve as a manifestation of a huge number of somatic problems). The main studies include:

• a general blood test (including the determination of the leukocyte formula, ESR, platelets);
• biochemical indicators (liver and kidney tests, protein, glucose, calcium, sodium, potassium, alkaline phosphatase and others);
• general urine analysis;
• acute phase reactions (determination of C-reactive protein and rheumatoid factor);
• specific tests for infectious diseases (they are carried out if the patient associates the appearance of symptoms with an infectious disease): examination for syphilis, viral hepatitis, herpes viruses, toxoplasmosis, chlamydia, candidiasis, and so on. An HIV test is mandatory for every patient with complaints of constant fatigue;
• study of the hormonal background of the patient;
• electrocardiography;
• MRI (magnetic resonance imaging) of the brain;
• polysomnography (computer study of the sleep period with simultaneous recording of multiple indicators).

This is by no means the whole range of possible examinations. Their list may be different, depending on the complaints of a particular patient (for example, in case of chronic cough, a chest x-ray is necessary). You may need to consult several specialists (otorhinolaryngologist, ophthalmologist, gastroenterologist, cardiologist, infectious disease specialist, oncologist, and others) to make sure there is no organic cause of CFS. It can be said that chronic fatigue syndrome is rather a diagnosis of exclusion than the establishment of specific disorders.

In addition to laboratory and instrumental research methods, patients undergo a screening study of cognitive and mental status. They are also asked to take special questionnaires designed for CFS (multivariate fatigue questionnaire, quality of life questionnaire, McGill pain questionnaire and sleep quality questionnaire). Such a versatile and multifaceted study of the human body allows us to clarify the nature of violations.

The result of the survey is as follows: in the absence of obvious signs of another disease and the presence of at least 4 out of 8 clinical criteria (from 1994), we can talk about the presence of CFS.

Chronic fatigue syndrome is a relatively new formulation of the health problems of a modern person, associated with urbanization, an accelerated pace of life. Mankind has existed for many centuries, but only the last 100 years have been associated with such a condition as chronic fatigue syndrome. And although CFS is not yet a very common diagnosis, it is possible that in the future much more attention will be paid to this problem due to the increase in cases of treatment of this pathology.

Channel "Medicine of Israel", a program on the topic "Chronic Fatigue Syndrome":

chronic fatigue syndrome

Chronic fatigue syndrome is a disease characterized by excessive, disabling fatigue that persists for at least 6 months and is accompanied by numerous articular, infectious, and neuropsychiatric symptoms.

Chronic fatigue syndrome is defined as prolonged, severe, disabling fatigue without obvious muscle weakness. There are no comorbid disorders that could explain the fatigue. As a rule, depression, anxiety and other psychological diagnoses are absent. Treatment is rest and psychological support; often with the use of antidepressants.

ICD-10 code

Epidemiology

This definition of chronic fatigue syndrome (CFS) has several variations, and the heterogeneity of patients who meet the criteria for this definition is significant. Precise determination of prevalence is impossible; it varies from 7 to 38/person. Prevalence may vary due to differences in diagnostic evaluation, physician-patient relationship, social acceptability, risk of exposure to an infectious or toxic substance, or case finding and definition. Chronic fatigue syndrome is more common in women. Office-based studies have shown that the incidence is higher among white people. However, community surveys indicate higher prevalence among blacks, Hispanic Hispanics, and American Indians.

Approximately one in five patients (10-25%) seeking medical care complains of prolonged fatigue. Usually, a feeling of fatigue is a transient symptom that disappears spontaneously or when the underlying disease is treated. Nevertheless, in some patients, this complaint begins to persist and has a negative impact on the general state of health. When fatigue cannot be explained by any disease, it is assumed that it is associated with chronic fatigue syndrome, the diagnosis of which can only be made after the exclusion of other physical and mental disorders.

The prevalence of chronic fatigue syndrome in the adult population, according to some data, can reach 3%. Approximately 80% of all cases of chronic fatigue syndrome remain undiagnosed. Children and adolescents develop chronic fatigue syndrome much less frequently than adults. The peak incidence of chronic fatigue syndrome falls on the active age (40-59 years). Women in all age categories are more susceptible to chronic fatigue syndrome (60-85% of all cases).

Causes of Chronic Fatigue Syndrome

Initially, they were inclined to the infectious theory of the development of chronic fatigue syndrome (viral infection), but further research revealed a wide variety of changes in many areas, including brain structure and function, neuroendocrine response, sleep structure, immune system, and psychological profile. Currently, the most common stress-dependent model of the pathogenesis of chronic fatigue syndrome, although it cannot explain all the pathological changes characteristic of this syndrome. Based on this, most researchers postulate that chronic fatigue syndrome is a heterogeneous syndrome, which is based on various pathophysiological abnormalities. Some of them may predispose to the development of chronic fatigue syndrome, others directly cause the development of the disease, and still others cause its progression. Risk factors for chronic fatigue syndrome include female gender, genetic predisposition, certain personality traits or behaviors, and others.

Stress-dependent hypothesis

• In the premorbid anamnesis of patients with chronic fatigue syndrome, as a rule, there are indications of a large number of stressful life events, infectious diseases and surgical interventions. The manifestation or exacerbation of chronic fatigue syndrome and its comorbid conditions in adults are often associated with stress or conflict situations.
• Childhood trauma (child abuse, abuse, neglect, etc.) is considered an important risk factor for chronic fatigue syndrome. High reactivity to adverse psychosocial factors is characteristic of the entire spectrum of disorders associated with childhood trauma. Stress in early life during a critical period of enhanced brain plasticity constantly affects brain regions involved in cognitive-emotional processes and regulating the endocrine, autonomic, and immune systems. There is experimental and clinical evidence that traumatic events experienced at a young age lead to a long-term disruption of the hypothalamic-pituitary-adrenal system and a more pronounced reaction to stress. However, childhood psychotrauma is present in the anamnesis of far from all patients with chronic fatigue syndrome. Probably, this mechanism can play a leading role in the pathogenesis of only a certain group of patients with chronic fatigue syndrome.
• Comprehensive studies of the neuroendocrine status in chronic fatigue syndrome revealed significant changes in the activity of the hypothalamic-pituitary-adrenal system, which confirms the violation of the physiological response to stress. In a third of patients with chronic fatigue syndrome, hypocorticism is detected, which is likely to be of central origin. Noteworthy is the discovery in families of patients with chronic fatigue syndrome of a mutation that disrupts the production of a protein necessary for the transport of cortisol in the blood. Women (but not men) with chronic fatigue syndrome have lower morning cortisol peaks than healthy women. These sex differences in the circadian rhythm of cortisol production may explain the higher risk of chronic fatigue syndrome in women. A low level of cortisol leads to disinhibition of immune mediators and determines the response to stress of the suprasegmental divisions of the autonomic nervous system, which in turn causes fatigue, pain phenomena, cognitive impairment and affective symptoms. Taking serotonin agonists in patients with chronic fatigue syndrome leads to a greater increase in plasma prolactin levels compared to healthy individuals. In patients suffering from major depression, the pattern of neuroendocrine disorders is reversed (hypercorticism, serotonin-mediated prolactin suppression). In contrast, depletion of morning cortisol levels has been noted in individuals suffering from chronic pain and various emotional disturbances. Currently, dysfunction of the hypothalamic-pituitary-adrenal system, hormonal response to stress, and features of the neurotransmitter effects of serotonin are the most reproducible changes found in patients with chronic fatigue syndrome.
• Patients with chronic fatigue syndrome are characterized by a distorted perception of natural bodily sensations as painful symptoms. They also tend to be hypersensitive to exercise (low threshold for heart rate, blood pressure, etc.). A similar pattern of perceptual disturbance can be seen with stress-induced bodily sensations. It is believed that perceptual disturbances, regardless of the etiology of chronic fatigue syndrome, are the basis for the appearance and persistence of symptoms and their painful interpretation.

CNS disorders. Some symptoms of chronic fatigue syndrome (fatigue, impaired concentration and memory, headache) suggest the pathogenetic possibility of CNS dysfunction. In some cases, MRI reveals nonspecific changes in the subcortical white matter of the brain, which, however, are not associated with cognitive impairment. Regional disturbances of brain perfusion (usually hypoperfusion) are typical according to SPECT-scan. In general, all the changes identified so far have no clinical significance.

Autonomic dysfunction. D.H. Streeten, G.H. Anderson (1992) suggested that one of the causes of chronic fatigue may be impaired maintenance of blood pressure in an upright position. It is possible that a separate subgroup of patients with chronic fatigue syndrome has orthostatic intolerance [the latter is understood as symptoms of cerebral hypoperfusion, such as weakness, lipothymia, blurred vision that occur in an upright position and are associated with sympathetic activation (tachycardia, nausea, trembling) and an objective increase in heart rate over than 30 per minute]. Postural tachycardia associated with orthostatic intolerance is often observed in individuals with chronic fatigue syndrome. Symptoms characteristic of postural tachycardia (dizziness, palpitations, pulsations, intolerance to physical and mental stress, lipothymia, chest pain, gastrointestinal symptoms, anxiety disorders, etc.) are also noted in many patients with chronic fatigue syndrome. The pathogenesis of postural tachycardia syndrome remains unclear, suggesting the role of baroreceptor dysfunction, increased sensitivity of alpha- and beta-adrenergic receptors, pathological changes in the venous system, norepinephrine metabolism disorders, etc. In general, in some patients, chronic fatigue syndrome pathogenetically, indeed, may be due to autonomic dysfunction manifesting orthostatic intolerance.

infections. Epstein-Barr virus, type 6 herpes virus, group B Coxsackie virus, type II T-cell lymphotropic virus, hepatitis C virus, enteroviruses, retroviruses, etc. were previously considered as possible etiological agents of chronic fatigue syndrome. evidence of the infectious nature of chronic fatigue syndrome has not been obtained. In addition, therapy aimed at suppressing the viral infection does not improve the course of the disease. Nevertheless, a heterogeneous group of infectious agents continues to be considered as a factor contributing to the manifestation or chronic course of chronic fatigue syndrome.

Immune System Disorders. Despite numerous studies, only minor deviations in the immune status have been identified in patients with chronic fatigue syndrome. First of all, they concern an increase in the expression of active markers on the surface of T-lymphocytes, as well as an increase in the concentration of various autoimmune antibodies. Summarizing these results, it can be stated that mild activation of the immune system is typical for patients with chronic fatigue syndrome, however, it remains unknown whether these changes have any pathogenetic significance.

Mental disorders. Since there is no conclusive evidence of a somatic cause of chronic fatigue syndrome yet, many researchers postulate that this is a primary mental illness. Others believe that chronic fatigue syndrome is one of the manifestations of other mental illnesses, in particular, somatization disorder, hypochondria, major or atypical depression. Indeed, in patients with chronic fatigue syndrome, the frequency of affective disorders is higher than in the general population or among individuals with chronic somatic diseases. In most cases, mood disorders or anxiety precede the onset of chronic fatigue syndrome. On the other hand, the high prevalence of affective disorders in chronic fatigue syndrome may be the result of an emotional response to disabling fatigue, immune changes, and CNS disorders. There are other objections to the identification of chronic fatigue syndrome with mental illness. First, although some manifestations of chronic fatigue syndrome are close to non-specific mental symptoms, many others, such as pharyngitis, lymphadenopathy, and arthalgia, are not at all typical for mental disorders. Secondly, anxiety-depressive disorders are associated with central activation of the hypothalamic-pituitary-adrenal system (moderate hypercortisolism), on the contrary, in chronic fatigue syndrome, central inhibition of this system is more often observed.

Symptoms of Chronic Fatigue Syndrome

Subjectively, patients can formulate the main complaint in different ways (“I feel completely exhausted”, “I constantly lack energy”, “I am completely exhausted”, “I am exhausted”, “normal loads bring me to exhaustion”, etc. .). With active questioning, it is important to differentiate the actual increased fatigue from muscle weakness or a feeling of despondency.

Most patients rate their premorbid physical condition as excellent or good. Feeling extremely tired comes on suddenly and is usually associated with flu-like symptoms. The disease may be preceded by respiratory infections, such as bronchitis or vaccination. Less often, the disease has a gradual onset, and sometimes begins gradually over many months. After the onset of the disease, patients notice that physical or mental efforts lead to an aggravation of the feeling of fatigue. Many patients find that even minimal physical effort leads to significant fatigue and an increase in other symptoms. Prolonged rest or lack of physical activity can reduce the severity of many symptoms of the disease.

Often observed pain syndrome is characterized by diffuseness, uncertainty, a tendency to migration of pain sensations. In addition to muscle and joint pain, patients complain of headache, sore throat, soreness of the lymph nodes, abdominal pain (often associated with a comorbid condition - irritable bowel syndrome). Chest pain is also typical for this category of patients, some of them complain of "painful" tachycardia. Some patients complain of pain in unusual places [eyes, bones, skin (pain at the slightest touch to the skin), perineum and genitals].

Immune system changes include tenderness of the lymph nodes, repeated episodes of sore throat, recurrent flu-like symptoms, general malaise, and hypersensitivity to previously well tolerated foods and/or drugs.

In addition to the 8 main symptoms that have the status of diagnostic criteria, patients may have many other disorders, the frequency of which varies widely. Most often, patients with chronic fatigue syndrome note a decrease in appetite up to anorexia or its increase, fluctuations in body weight, nausea, sweating, dizziness, poor tolerance to alcohol and drugs that affect the central nervous system. The prevalence of autonomic dysfunction in patients with chronic fatigue syndrome has not been studied, however, autonomic disorders are described both in individual clinical observations and in epidemiological studies. More often than others, orthostatic hypotension and tachycardia, episodes of sweating, pallor, sluggish pupillary reactions, constipation, frequent urination, respiratory disturbances (feeling of lack of air, obstruction in the airways or pain when breathing) are observed.

Approximately 85% of patients complain of impaired concentration, memory impairment, however, routine neuropsychological examination usually does not reveal impaired mnestic function. However, an in-depth study often reveals minor, but undoubted violations of memory and digestibility of information. In general, patients with chronic fatigue syndrome have normal cognitive and intellectual capabilities.

Sleep disorders are represented by difficulty falling asleep, interrupted night sleep, daytime sleepiness, while the results of polysomnography are highly variable. The most commonly described are “alpha intrusion” (imposition) during non-REM sleep and a decrease in the duration of stage IV sleep. However, these findings are unstable and have no diagnostic value, in addition, sleep disturbances do not correlate with the severity of the disease. In general, fatigue should be clinically distinguished from drowsiness and it should be taken into account that drowsiness can both accompany chronic fatigue syndrome and be a symptom of other diseases that exclude the diagnosis of chronic fatigue (for example, sleep apnea syndrome).

Almost all patients with chronic fatigue syndrome develop social maladaptation. Approximately one third of patients are unable to work and another third prefer part-time professional employment. The average duration of the disease is 5-7 years, but symptoms can persist for more than 20 years. Often the disease proceeds in waves, periods of exacerbation (deterioration) alternate with periods of relatively good health. Most patients experience partial or complete remissions, but the disease often recurs.

Additional Symptoms Detected in Patients with Chronic Fatigue Syndrome

• Irritable bowel syndrome (abdominal pain, nausea, diarrhea or bloating).
• Chilliness and perspiration at night.
• Sensation of fog, emptiness in the head.
• Chest pain.
• Labored breathing.
• Chronic cough.
• Visual disturbances (blurred vision, intolerance to bright light, eye pain, dry eyes).
• Allergy to food, hypersensitivity to alcohol, odors, chemicals, drugs, noise.
• Difficulty maintaining an upright position (orthostatic instability, irregular heartbeat, dizziness, unsteadiness, fainting).
• Psychological problems (depression, irritability, mood swings, anxiety, panic attacks).
• Pain in the lower half of the face.
• Increase or decrease in body weight

The feeling of excessive fatigue, as well as the chronic fatigue syndrome itself, is comorbid with many functional diseases, such as fibromyalgia, irritable bowel syndrome, post-traumatic stress disorder, mandibular joint dysfunction, chronic pelvic pain, etc.

Diagnostic criteria

Chronic fatigue syndrome has been repeatedly described under various names; search for a term that most fully reflects the essence of the disease. are continuing at the present time. In the literature, the following terms were most often used: "benign myalgic encephalomyelitis" (1956), "myalgic encephalopathy", "chronic mononucleosis" (chronic Epstein-Barr virus infection) (1985), "chronic fatigue syndrome" (1988), "postviral syndrome fatigue." In ICD-9 (1975), chronic fatigue syndrome was not mentioned, but there was a term "benign myalgic encephalomyelitis" (323.9). ICD-10 (1992) introduced a new category - postviral fatigue syndrome (G93).

For the first time, the term and definition of chronic fatigue syndrome were presented by US scientists in 1988, who suggested a viral etiology of the syndrome. Epstein-Barr virus was considered as the main causative agent. In 1994, a revision of the definition of chronic fatigue syndrome was carried out and, in an updated version, it acquired international status. According to the 1994 definition, a diagnosis requires persistence (or remittance) of unexplained fatigue that is not relieved by rest and significantly limits daily activities for at least 6 months. In addition, 4 or more of the 8 following symptoms must be present.

• Impaired memory or concentration.
• Pharyngitis.
• Soreness on palpation of the cervical or axillary lymph nodes.
• Muscle soreness or stiffness.
• Joint tenderness (no redness or swelling).
• A new headache or a change in its characteristics (type, severity).
• Sleep that does not bring a sense of recovery (freshness, vivacity).
• Exacerbation of fatigue to the point of exhaustion after physical or mental effort lasting more than 24 hours.

In 2003, the International Chronic Fatigue Syndrome Study Group recommended that standardized scales be used to assess the main symptoms of chronic fatigue syndrome (impaired daily activity, fatigue, and the accompanying symptom complex).

Conditions that exclude the diagnosis of chronic fatigue syndrome are as follows:

• The presence of any current medical conditions that may explain the persistence of chronic fatigue, such as severe anemia, hypothyroidism, sleep apnea, narcolepsy, cancer, chronic hepatitis B or C, uncontrolled diabetes mellitus, heart failure, and other severe cardiovascular diseases , chronic renal failure, inflammatory and disimmune diseases, diseases of the nervous system, severe obesity, etc., as well as taking medications, the side effects of which include a feeling of general weakness.
• Mental illness (including history).
  • Major depression with psychotic or melancholic symptoms.
  • Bipolar affective disorder.
  • Psychotic states (schizophrenia).
  • Dementia.
  • Anorexia nervosa or bulimia.
• Abuse of drugs or alcohol for 2 years before the onset of fatigue and for some time after.
• Severely obese (body mass index of 45 or more).

The new definition also indicates diseases and conditions that do not exclude the diagnosis of chronic fatigue syndrome:

• Painful conditions that are diagnosed based on clinical criteria only and that cannot be confirmed by laboratory tests.
  • Fibromyalgia.
  • anxiety disorders.
  • somatoform disorders.
  • Non-melancholic depression.
  • Neurasthenia.
• Diseases associated with chronic fatigue, but the successful treatment of which has led to an improvement in all symptoms (the adequacy of therapy must be verified). For example, the success of replacement therapy for hypothyroidism should be verified by a normal level of thyroid hormones, the adequacy of the treatment of bronchial asthma - by an assessment of respiratory function, etc.
• Diseases associated with chronic fatigue and caused by a specific pathogen, such as Lyme disease, syphilis, if they were adequately treated before the onset of symptoms of chronic fatigue.
• Isolated and unexplained paraclinical abnormalities (changes in laboratory parameters, neuroimaging findings), which are not enough to rigorously confirm or rule out any disease. For example, these findings may include an increase in antinuclear antibody titers in the absence of additional laboratory or clinical evidence to reliably diagnose connective tissue disease.

Unexplained chronic fatigue that does not fully meet the diagnostic criteria may be regarded as idiopathic chronic fatigue.

In 2007, the UK National Institutes of Health (NICE) published less stringent criteria for chronic fatigue syndrome, recommended for use by various professionals.

• The presence of new, persistent or recurrent fatigue (greater than 4 months in adults and 3 months in children) that:
  • cannot be explained by any other disease;
  • significantly limits the level of activity;
  • characterized by malaise or worsening fatigue after any effort (physical or mental) followed by an extremely slow recovery (over at least 24 hours, but usually within a few days).
• The presence of one or more of the following symptoms: sleep disturbance, muscle or joint pain of polysegmental localization without signs of inflammation, headache, soreness of the lymph nodes without their pathological increase, pharyngitis, cognitive dysfunction, worsening of symptoms with physical or mental stress, general malaise, dizziness and / or nausea, palpitations in the absence of organic heart disease.

The NICE criteria for chronic fatigue syndrome have been subject to considerable criticism from experts, so most researchers and clinicians continue to use the 1994 international criteria.

Along with chronic fatigue syndrome, secondary forms of this syndrome are also isolated in a number of neurological diseases. Chronic fatigue is observed in multiple sclerosis, Parkinson's disease, motor neuron diseases, chronic cerebral ischemia, strokes, post-poliomyelitis syndrome, etc. as a reaction to a neurological disease.

Diagnosis of chronic fatigue syndrome

There are no specific paraclinical tests to confirm the clinical diagnosis of chronic fatigue syndrome. At the same time, a mandatory examination is carried out to exclude diseases, one of the manifestations of which may be chronic fatigue. Clinical evaluation of patients with a leading complaint of chronic fatigue includes the following activities.

• A detailed medical history, including medications used by the patient that may be causing fatigue.
• Exhaustive examination of the somatic and neurological status of the patient. Superficial palpation of the somatic muscles in 70% of patients with chronic fatigue syndrome with gentle pressure reveals painful points localized in various muscles, often their location corresponds to that of fibromyalgia.
• Screening study of cognitive and mental status.
• Carrying out a set of screening laboratory tests:
  • general blood test (including leukocyte formula and determination of ESR);
  • biochemical analysis of blood (calcium and other electrolytes, glucose, protein, albumin, globulin, creatinine, ALT and ACT, alkaline phosphatase);
  • thyroid function assessments (thyroid hormones);
  • urine analysis (protein, glucose, cellular composition).

Additional studies usually include the determination of C-reactive protein (a marker of inflammation), rheumatoid factor, CK activity (muscle enzyme). Determination of ferritin is advisable in children and adolescents, as well as in adults if other tests confirm iron deficiency. Specific tests confirming infectious diseases (Lyme disease, viral hepatitis, HIV, mononucleosis, toxoplasmosis, cytomegalovirus infection), as well as a serological panel of tests for Epstein-Barr viruses, enteroviruses, retroviruses, herpes viruses type 6 and Candida albicans are carried out only with a history of indications of an infectious disease. On the contrary, MRI of the brain, the study of the cardiovascular system are classified as routine methods for suspected chronic fatigue syndrome. Polysomnography should be performed to rule out sleep apnea.

In addition, it is advisable to use special questionnaires that help assess the severity of the disease and monitor its course. The most commonly used are the following.

• The Multidimensional Fatigue Inventory (MFI) assesses general fatigue, physical fatigue, mental fatigue, reduction in motivation and activity. Fatigue is defined as severe if the overall fatigue score is 13 points or more (or the activity reduction scale is 10 points or more).
• SF-36 (Medical outcomes survey short form-36) questionnaire for assessing functional impairment in 8 categories (limitation of physical activity, limitation of usual role activity due to health problems, limitation of usual role activity due to emotional problems, bodily pain assessment, general health assessment, vitality assessment, social functioning and general mental health). The ideal score is 100 points. Patients with chronic fatigue syndrome are characterized by a decrease in functional activity (70 points or less), social functioning (75 points or less), and a decrease in the emotional scale (65 points or less).
• The list of CDC symptoms (CDC Symptom Inventory) for identifying and assessing the duration and severity of the accompanying fatigue symptom complex (in a minimized form is a total assessment of the severity of 8 symptoms-criteria of chronic fatigue syndrome).
• If necessary, the McGill Pain Score and the Sleep Answer Questionnaire are also used.

Differential Diagnosis

Chronic fatigue syndrome is a diagnosis of exclusion, that is, a thorough differential diagnosis is necessary to exclude many severe and even life-threatening diseases (chronic heart disease, anemia, thyroid pathology, tumors, chronic infections, endocrine diseases, connective tissue diseases, inflammatory diseases). intestines, mental disorders, etc.).

In addition, it should be remembered that feeling tired can be a side effect of certain medications (muscle relaxants, analgesics, beta-blockers, benzodiazepines, antihistamines and anti-inflammatory drugs, beta interferons).