Handbook of Chronic Fatigue Syndrome

Abstract

Chronic fatigue syndrome (CFS) has been recognized as an entity since the 1800s, when it was known as “neurasthenia.” A panel of experts who convened in 1994 to establish a set of diagnostic criteria for CFS described it as a syndrome that includes disabling fatigue, cognitive difficulties, nonrefreshing sleep, and myalgias. Autonomic instability, mental illness, immunologic abnormalities, and swollen lymph nodes are sometimes present in patients with CFS. It frequently coexists with fibromyalgia. The Handbook of Chronic Fatigue Syndrome summarizes the current research and clinical knowledge about this disorder. Chronic fatigue syndrome is largely a “diagnostically homeless” entity. No one medical specialty takes ownership of CFS, and it is not routinely included in medical school and residency curricula. There is much controversy surrounding its diagnosis and even its legitimacy as a medical illness. The differential diagnosis of CFS is large, making its diagnosis difficult. Endocrine, rheumatologic, neurologic, infectious, hematologic, nutritional, metabolic, and psychiatric disorders can mimic or contribute to the disorder. Profound occupational, social, and family problems can also result from the illness. A multisystem approach using the biopsychosocial model is best used in the diagnosis and management of CFS. Part I of the Handbook discusses epidemiology, differential diagnosis, sociocultural issues, immunology, and genetics; the major criteria as well as additional symptoms that constitute the diagnosis of CFS, as established by the panel of experts, are listed. Part II is about the social, individual, and family systems effects of CFS. Part III goes into specifics about the symptomatology of CFS, including sections on pain and fatigue, orthostatic intolerance, and sleep, cardiac, and neuroendo-crine dysfunction. Part IV discusses pain rating scales and other diagnostic instruments. Part V is a large section on treatments and interventions. Comprehensive treatment regimens including medical treatment, exercise, nutrition, and psychotherapy are described. Part VI discusses diagnosis and treatment of CFS in children and adolescents. The editors have succeeded in producing a comprehensive and interesting text. Although this volume, at 794 pages, stretches the definition of “handbook,” readers are rewarded with an exhaustively researched and evidence-based work that should prove to be clinically useful.