Idiopathic chronic fatigue

Idiopathic chronic fatigue (ICF), is characterized by unexplained fatigue that lasts at least six consecutive months.[2] It widely understood to have a profound effect on the lives of patients who experience it.[2]

This page does not refer to self-reported fatigue, fatigue caused by chronic fatigue syndrome or another medical condition.
Idiopathic Chronic Fatigue
Other namesICF, Asthenia[1]
SpecialtyFamily medicine, Internal medicine, Musculoskeletal
SymptomsChronic fatigue
Usual onsetAges 15-24, or over 60 years old[2]
DurationAt least six consecutive months
CausesUnknown
Risk factorsFemale gender
Diagnostic methodBased on symptoms, Diagnosis of exclusion
Differential diagnosisFatigue, chronic fatigue due to a known medical condition, post-viral fatigue, chronic fatigue syndrome, Occupational burnout
TreatmentSymptomatic
Frequency6.2 to 64.2 per 1000[3]

ICF is a common illness of unknown origin,[1] and remains poorly understood.

Classification

Idiopathic chronic fatigue is classified as a physical medical condition of unknown origin by the World Health Organization.[1][4]

Diagnosis

ICF is fatigue of unknown origin, persisting or relapsing for a minimum of six consecutive months, and failing to meet the criteria for chronic fatigue syndrome. There is no agreed upon international criteria for idiopathic chronic fatigue however the CDC's 1994 Idiopathic Chronic Fatigue criteria, known as the Fukuda criteria, is commonly used.[2]

Signs and symptoms
  • Clinically evaluated fatigue
  • New or definite onset (not lifelong)
  • Not resulting from exertion
  • Fatigue persists or is relapsing for six consecutive months or longer
  • Fails to meet the criteria for chronic fatigue syndrome
  • The cause is unknown[2][5]

Exclusions

Common medical causes of fatigue

These must be ruled out before a diagnosis of ICF can be made.

  • Infectious diseases including viruses and TB
  • Vascular diseases (affecting heart and circulation)
  • Toxins and drug effects including poisons and substance use (addiction)
  • Diseases affecting the lungs, including chronic obstructive pulmonary disease (COPD)
  • Endocrine and metabolic problems, e.g., thyroid diseases and diabetes
  • Diseases involving benign or cancerous tumours, including cancer fatigue
  • Psychological or psychosocial conditions, including major depression
  • Anaemia, Lupus and certain autoimmune or neurological diseases
  • Occupational stress or other life stress and burnout
  • Domestic violence[2]

Management

Idiopathic chronic fatigue is typically managed in general medicine rather than by referral to a specialist. There is no cure, no approved drug, and treatment options are limited.[6] Management may involve a form of counseling, or antidepressant medication, although some patients may prefer herbal or alternative remedies.[2]

Counseling

A form of counseling known as cognitive behavioral therapy may help some people manage or cope with idiopathic chronic fatigue.[2]

Medication

There are no approved drugs for ICF.[6]

Anti-depressants

Antidepressants drugs such as tricyclic antidepressants (TCAs) or selective serotonin reuptake inhibitors (SSRIs) may be appropriate.[2]

Alternative and complementary treatments

Only limited trials had been conducted for alternative and complementary treatments; there is no clear evidence of these treatments being effective for ICF due to a lack of randomized controlled trials.[6]

Prognosis

Over half of patients remain fatigued after one year.[2]

Epidemiology

Fatigue is common in the general population and often caused by overwork, too much activity or a specific illness or disease. Around 20% of patients who visit their clinician report fatigue.[2] Prolonged fatigue is fatigue that persists for more than a month, and chronic fatigue is fatigue that lasts at least six consecutive months.[2]

Idiopathic chronic fatigue affects between 0.62% and 6.42% of patients, with females more likely to be affected than men.[2] Age at onset is typically between age 15 and 24, or over 60 years of age.[2] A significant number of patients present with idiopathic chronic fatigue as part of a mix of symptoms, while others present with a primary problem of fatigue alone.[2]

See also

References
  1. "ICD-10 Version:2016 | R53". World Health Organization. Retrieved 2020-05-29.
  2. Saultz, J (2002-09-23). "Care of the Patient with Fatigue". In Taylor, Robert (ed.). Family Medicine: Principles and Practice. Springer Science & Business Media. pp. 465–469. ISBN 978-0-387-95400-4.
  3. Kim, Tae-Hun; Kim, Do-Hoon; Kang, Jung Won (2020-04-01). "Medicinal herbs for managing fatigue symptoms in patients with idiopathic chronic fatigue: A PRISMA compliant updated systematic review and meta-analysis of randomized controlled trials based on the GRADE approach". European Journal of Integrative Medicine. 35: 101069. doi:10.1016/j.eujim.2020.101069. ISSN 1876-3820.
  4. "ICD-11 - Mortality and Morbidity Statistics | MG22 Fatigue". World Health Organization. 2019. Retrieved 2020-05-31.
  5. Fukuda, K.; Straus, S. E.; Hickie, I.; Sharpe, M. C.; Dobbins, J. G.; Komaroff, A. (1994-12-15). "The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group". Annals of Internal Medicine. American College of Physicians. 121 (12): 954–957. doi:10.7326/0003-4819-121-12-199412150-00009. ISSN 0003-4819. PMID 7978722. S2CID 510735.
  6. Adams, Denise; Wu, Taixiang; Yang, Xunzhe; Tai, Shusheng; Vohra, Sunita (2009). "Traditional Chinese medicinal herbs for the treatment of idiopathic chronic fatigue and chronic fatigue syndrome". Cochrane Database of Systematic Reviews (4): CD006348. doi:10.1002/14651858.CD006348.pub2. ISSN 1465-1858. PMID 19821361.
Classification
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