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Prevalence of Fatigue and Chronic Fatigue Syndrome in a Primary Care Practice

Prevalence of Fatigue and Chronic Fatigue Syndrome in a Primary Care Practice Abstract Background: Our goals were to determine the prevalence of unusual, debilitating fatigue and the frequency with which it was associated with the chronic fatigue syndrome (CFS) or other physical or psychological illness in an outpatient clinic population. Methods: We prospectively evaluated a cohort of 1000 consecutive patients in a primary care clinic in an urban, hospital-based general medicine practice. The study protocol included a detailed history, physical examination, and laboratory and psychiatric testing. Results: Five patients who came because of CFS studies were excluded. Of the remaining 995,323 reported fatigue, and 271 (27%) complained of at least 6 months of unusual fatigue that interfered with their daily lives. Of the 271, self-report or record review revealed a medical or psychiatric condition that could have explained the fatigue in 186 (69%). Thus, 85 (8.5%) of 995 patients had a debilitating fatigue of at least 6 months' duration, without apparent cause. Of these patients, 48 refused further evaluation, and 11 were unavailable for follow-up; 26 completed the protocol. Three of the 26 were hypothyroid, and one had a major psychiatric disorder. Of the remaining 22 patients, three met Centers for Disease Control and Prevention criteria for CFS, four met British criteria, and 10 met the Australian case definition. The point prevalences of CFS were thus 0.3% (95% confidence interval [CI], 0% to 0.6%), 0.4% (95% CI, 0% to 0.8%), and 1.0% (95% CI, 0.4% to 1.6%) using the Centers for Disease Control and Prevention, British, and Australian case definitions, respectively. These estimates were conservative, because they assumed that none of the patients who refused evaluation or were unavailable for follow-up would meet criteria for CFS. Conclusions: While chronic, debilitating fatigue is common in medical outpatients, CFS is relatively uncommon. Prevalence depends substantially on the case definition used.(Arch Intern Med. 1993;153:2759-2765) References 1. Kroenke K, Wood DR, Mangelsdorff AD, Meier NJ, Powell JB. Chronic fatigue in primary care . JAMA . 1988;260:929-934.Crossref 2. Buchwald D, Sullivan JL, Komaroff AL. Frequency of 'chronic active Epstein-Barr virus infection' in a general medical practice . JAMA . 1987;257:2303-2307.Crossref 3. Holmes GP, Kaplan JE, Gantz NM, et al. Chronic fatigue syndrome: a working case definition . Ann Intern Med. 1988;108:387-389.Crossref 4. Straus SE. The chronic mononucleosis syndrome . J Infect Dis. 1988;157:405-412.Crossref 5. Komaroff AL, Buchwald D. Symptoms and signs of chronic fatigue syndrome . Rev Infect Dis. 1991;13:S8-S11.Crossref 6. Lloyd AR, Hickie I, Boughton CR, Spencer O, Wakefield D. Prevalence of chronic fatigue syndrome in an Australian population . Med J Aust. 1990;153:522-528. 7. Sharpe MC, Archard LC, Banatvala JE, et al. A report—chronic fatigue syndrome: guidelines in research . J R Soc Med. 1991;84:118-121. 8. Derogatis LR. SCL-90-R: Revised Manual . Baltimore, Md: Johns Hopkins University Press; 1983. 9. Robins LN, Helzer JE, Croughan J, Ratcliff KS. National Institute of Health Diagnostic Interview Schedule . Arch Gen Psychiatry. 1981;38:381-389.Crossref 10. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition . Washington, DC: American Psychiatric Press Inc; 1987. 11. Schluederberg A, Straus SE, Peterson P, et al. Chronic fatigue syndrome research: definition and medical outcome assessment . Ann Intern Med. 1992;117:325-331.Crossref 12. Komaroff AL, Straus SE, Gantz NM, Jones JF. The chronic fatigue syndrome . Ann Intern Med. 1989;110:407-408.Crossref 13. Allan FN. The differential diagnosis of weakness and fatigue . N Engl J Med. 1944;231:414-418.Crossref 14. Morrison JD. Fatigue as a presenting complaint in family practice . J Fam Pract. 1980;10:795-801. 15. Nelson E, Kirk J, McHugo G, et al. Chief complaint fatigue: a longitudinal study from the patient's perspective . Fam Pract Res J. 1987;6:175-188. 16. Solberg LI. Lassitude: a primary care evaluation . JAMA . 1984;251:3272-3276.Crossref 17. Katerndahl DA. Fatigue of uncertain etiology . Fam Med Rev. 1983;1:26-38. 18. Manu P, Lane TJ, Matthews DA. The frequency of the chronic fatigue syndrome in patients with symptoms of persistent fatigue . Ann Intern Med. 1988; 109:554-556.Crossref 19. Gunn WJ, Connell DB, Randall B. Epidemiology of chronic fatigue syndrome: the Centers for Disease Control study . In: Bock GR, Whelan J, eds. Chronic Fatigue Syndrome . New York, NY: John Wiley & Sons Inc; 1993:83-101. 20. Kruesi MJP, Dale J, Straus SE. Psychiatric diagnoses in patients who have chronic fatigue syndrome . J Clin Psychiatry. 1989;50:53-56. 21. Katon WJ, Buchwald DS, Simon GE, Russo JE, Mease PJ. Psychiatric illness in patients with chronic fatigue and those with rheumatoid arthritis . J Gen Intern Med. 1991;6:277-285.Crossref 22. Wessely S, Powell R. Fatigue syndromes . J Neurol Neurosurg Psychiatry. 1989; 52:940-948.Crossref 23. Lane TJ, Manu P, Matthews DA. Depression and somatization in the chronic fatigue syndrome . Am J Med. 1991;91:335-344.Crossref 24. Hickie I, Lloyd A, Wakefield D, Parker G. The psychiatric status of patients with the chronic fatigue syndrome . Br J Psychiatry. 1990;156:534-540.Crossref 25. Wood GC, Bentall RP, Gopfert M, Edwards RH. A comparative psychiatric assessment of patients with chronic fatigue syndrome and muscle disease . Psychol Med. 1992;21:619-628.Crossref 26. DuBois RE, Seeley JK, Brus I, et al. Chronic mononucleosis syndrome . South Med J. 1984;77:1376-1382.Crossref 27. Jones JF, Ray CG, Minnich LL, Hicks MJ, Kibler R, Lucas DO. Evidence for active Epstein-Barr virus infection in patients with persistent unexplained illnesses: elevated anti-early antigen antibodies . Ann Intern Med. 1985;102:1-7.Crossref 28. Straus SE, Tosato G, Armstrong G, et al. Persisting illness and fatigue in adults with evidence of Epstein-Barr virus infection . Ann Intern Med. 1985;102:7-16.Crossref 29. Salit IE. Sporadic postinfectious neuromyasthenia . Can Med Assoc J. 1985; 133:659-663. 30. Sigurdsson B, Sigurjonsson J, Sigurdsson JHJ, Thorkelsson J, Gudmundsson KR. A disease epidemic in Iceland simulating poliomyelitis . Am J Hyg. 1950; 52:222-238. 31. Shelokov A, Habel K, Verder E, Welsh W. Epidemic neuromyasthenia: an outbreak of poliomyelitislike illness in student nurses . N Engl J Med. 1957;257:345-355.Crossref 32. Poskanzer DC, Henderson DA, Kunkle EC, Kalter SS, Clement WB, Bond JO. Epidemic neuromyasthenia: an outbreak in Punta Gorda, Florida . N Engl J Med. 1957;257:356-364.Crossref 33. Acheson ED. The clinical syndrome variously called benign myalgic encephalomyelitis, Iceland disease and epidemic neuromyasthenia . Am J Med. 1959;4:569-595.Crossref 34. Behan PO, Behan WMH. Epidemic myalgic encephalomyelitis . In: Rose FC, ed. Clinical Neuroepidemiology . Tunbridge Wells, England: Pitman Medical Ltd; 1980:374-383. 35. Katon W, Russo J. Chronic fatigue syndrome criteria: a critique of the requirement for multiple physical complaints . Arch Intern Med. 1992;152:1604-1609.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Prevalence of Fatigue and Chronic Fatigue Syndrome in a Primary Care Practice

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Publisher
American Medical Association
Copyright
Copyright © 1993 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1993.00410240067007
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Abstract

Abstract Background: Our goals were to determine the prevalence of unusual, debilitating fatigue and the frequency with which it was associated with the chronic fatigue syndrome (CFS) or other physical or psychological illness in an outpatient clinic population. Methods: We prospectively evaluated a cohort of 1000 consecutive patients in a primary care clinic in an urban, hospital-based general medicine practice. The study protocol included a detailed history, physical examination, and laboratory and psychiatric testing. Results: Five patients who came because of CFS studies were excluded. Of the remaining 995,323 reported fatigue, and 271 (27%) complained of at least 6 months of unusual fatigue that interfered with their daily lives. Of the 271, self-report or record review revealed a medical or psychiatric condition that could have explained the fatigue in 186 (69%). Thus, 85 (8.5%) of 995 patients had a debilitating fatigue of at least 6 months' duration, without apparent cause. Of these patients, 48 refused further evaluation, and 11 were unavailable for follow-up; 26 completed the protocol. Three of the 26 were hypothyroid, and one had a major psychiatric disorder. Of the remaining 22 patients, three met Centers for Disease Control and Prevention criteria for CFS, four met British criteria, and 10 met the Australian case definition. The point prevalences of CFS were thus 0.3% (95% confidence interval [CI], 0% to 0.6%), 0.4% (95% CI, 0% to 0.8%), and 1.0% (95% CI, 0.4% to 1.6%) using the Centers for Disease Control and Prevention, British, and Australian case definitions, respectively. These estimates were conservative, because they assumed that none of the patients who refused evaluation or were unavailable for follow-up would meet criteria for CFS. Conclusions: While chronic, debilitating fatigue is common in medical outpatients, CFS is relatively uncommon. Prevalence depends substantially on the case definition used.(Arch Intern Med. 1993;153:2759-2765) References 1. Kroenke K, Wood DR, Mangelsdorff AD, Meier NJ, Powell JB. Chronic fatigue in primary care . JAMA . 1988;260:929-934.Crossref 2. Buchwald D, Sullivan JL, Komaroff AL. Frequency of 'chronic active Epstein-Barr virus infection' in a general medical practice . JAMA . 1987;257:2303-2307.Crossref 3. Holmes GP, Kaplan JE, Gantz NM, et al. Chronic fatigue syndrome: a working case definition . Ann Intern Med. 1988;108:387-389.Crossref 4. Straus SE. The chronic mononucleosis syndrome . J Infect Dis. 1988;157:405-412.Crossref 5. Komaroff AL, Buchwald D. Symptoms and signs of chronic fatigue syndrome . Rev Infect Dis. 1991;13:S8-S11.Crossref 6. Lloyd AR, Hickie I, Boughton CR, Spencer O, Wakefield D. Prevalence of chronic fatigue syndrome in an Australian population . Med J Aust. 1990;153:522-528. 7. Sharpe MC, Archard LC, Banatvala JE, et al. A report—chronic fatigue syndrome: guidelines in research . J R Soc Med. 1991;84:118-121. 8. Derogatis LR. SCL-90-R: Revised Manual . Baltimore, Md: Johns Hopkins University Press; 1983. 9. Robins LN, Helzer JE, Croughan J, Ratcliff KS. National Institute of Health Diagnostic Interview Schedule . Arch Gen Psychiatry. 1981;38:381-389.Crossref 10. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition . Washington, DC: American Psychiatric Press Inc; 1987. 11. Schluederberg A, Straus SE, Peterson P, et al. Chronic fatigue syndrome research: definition and medical outcome assessment . Ann Intern Med. 1992;117:325-331.Crossref 12. Komaroff AL, Straus SE, Gantz NM, Jones JF. The chronic fatigue syndrome . Ann Intern Med. 1989;110:407-408.Crossref 13. Allan FN. The differential diagnosis of weakness and fatigue . N Engl J Med. 1944;231:414-418.Crossref 14. Morrison JD. Fatigue as a presenting complaint in family practice . J Fam Pract. 1980;10:795-801. 15. Nelson E, Kirk J, McHugo G, et al. Chief complaint fatigue: a longitudinal study from the patient's perspective . Fam Pract Res J. 1987;6:175-188. 16. Solberg LI. Lassitude: a primary care evaluation . JAMA . 1984;251:3272-3276.Crossref 17. Katerndahl DA. Fatigue of uncertain etiology . Fam Med Rev. 1983;1:26-38. 18. Manu P, Lane TJ, Matthews DA. The frequency of the chronic fatigue syndrome in patients with symptoms of persistent fatigue . Ann Intern Med. 1988; 109:554-556.Crossref 19. Gunn WJ, Connell DB, Randall B. Epidemiology of chronic fatigue syndrome: the Centers for Disease Control study . In: Bock GR, Whelan J, eds. Chronic Fatigue Syndrome . New York, NY: John Wiley & Sons Inc; 1993:83-101. 20. Kruesi MJP, Dale J, Straus SE. Psychiatric diagnoses in patients who have chronic fatigue syndrome . J Clin Psychiatry. 1989;50:53-56. 21. Katon WJ, Buchwald DS, Simon GE, Russo JE, Mease PJ. Psychiatric illness in patients with chronic fatigue and those with rheumatoid arthritis . J Gen Intern Med. 1991;6:277-285.Crossref 22. Wessely S, Powell R. Fatigue syndromes . J Neurol Neurosurg Psychiatry. 1989; 52:940-948.Crossref 23. Lane TJ, Manu P, Matthews DA. Depression and somatization in the chronic fatigue syndrome . Am J Med. 1991;91:335-344.Crossref 24. Hickie I, Lloyd A, Wakefield D, Parker G. The psychiatric status of patients with the chronic fatigue syndrome . Br J Psychiatry. 1990;156:534-540.Crossref 25. Wood GC, Bentall RP, Gopfert M, Edwards RH. A comparative psychiatric assessment of patients with chronic fatigue syndrome and muscle disease . Psychol Med. 1992;21:619-628.Crossref 26. DuBois RE, Seeley JK, Brus I, et al. Chronic mononucleosis syndrome . South Med J. 1984;77:1376-1382.Crossref 27. Jones JF, Ray CG, Minnich LL, Hicks MJ, Kibler R, Lucas DO. Evidence for active Epstein-Barr virus infection in patients with persistent unexplained illnesses: elevated anti-early antigen antibodies . Ann Intern Med. 1985;102:1-7.Crossref 28. Straus SE, Tosato G, Armstrong G, et al. Persisting illness and fatigue in adults with evidence of Epstein-Barr virus infection . Ann Intern Med. 1985;102:7-16.Crossref 29. Salit IE. Sporadic postinfectious neuromyasthenia . Can Med Assoc J. 1985; 133:659-663. 30. Sigurdsson B, Sigurjonsson J, Sigurdsson JHJ, Thorkelsson J, Gudmundsson KR. A disease epidemic in Iceland simulating poliomyelitis . Am J Hyg. 1950; 52:222-238. 31. Shelokov A, Habel K, Verder E, Welsh W. Epidemic neuromyasthenia: an outbreak of poliomyelitislike illness in student nurses . N Engl J Med. 1957;257:345-355.Crossref 32. Poskanzer DC, Henderson DA, Kunkle EC, Kalter SS, Clement WB, Bond JO. Epidemic neuromyasthenia: an outbreak in Punta Gorda, Florida . N Engl J Med. 1957;257:356-364.Crossref 33. Acheson ED. The clinical syndrome variously called benign myalgic encephalomyelitis, Iceland disease and epidemic neuromyasthenia . Am J Med. 1959;4:569-595.Crossref 34. Behan PO, Behan WMH. Epidemic myalgic encephalomyelitis . In: Rose FC, ed. Clinical Neuroepidemiology . Tunbridge Wells, England: Pitman Medical Ltd; 1980:374-383. 35. Katon W, Russo J. Chronic fatigue syndrome criteria: a critique of the requirement for multiple physical complaints . Arch Intern Med. 1992;152:1604-1609.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Dec 27, 1993

References