Afari Niloofar, Buchwald Dedra
Department of Psychiatry, University of Washington, Seattle, USA.
Am J Psychiatry. 2003 Feb;160(2):221-36. doi: 10.1176/appi.ajp.160.2.221.
Chronic fatigue syndrome is an illness characterized by disabling fatigue of at least 6 months, accompanied by several other symptoms. This review summarizes the current state of knowledge about chronic fatigue syndrome.
The case definition, prevalence, clinical presentation, evaluation, and prognosis of chronic fatigue syndrome are discussed. Research on the pathophysiology and treatment of chronic fatigue syndrome is reviewed.
Chronic fatigue syndrome is diagnosed on the basis of symptoms. Patients with chronic fatigue syndrome experience significant functional impairment. Pathophysiological abnormalities exist across many domains, suggesting that chronic fatigue syndrome is a heterogeneous condition of complex and multifactorial etiology. Evidence also is beginning to emerge that chronic fatigue syndrome may be familial. Although chronic fatigue syndrome has significant symptom overlap and comorbidity with psychiatric disorders, several lines of research suggest that the illness may be distinct from psychiatric disorders. Patients' perceptions, attributions, and coping skills, however, may help perpetuate the illness. Treatment for chronic fatigue syndrome is symptom-based and includes pharmacological and behavioral strategies. Cognitive behavior therapy and graded exercise can be effective in treating the fatigue and associated symptoms and disability.
Chronic fatigue syndrome is unlikely to be caused or maintained by a single agent. Findings to date suggest that physiological and psychological factors work together to predispose an individual to the illness and to precipitate and perpetuate the illness. The assessment and treatment of chronic fatigue syndrome should be multidimensional and tailored to the needs of the individual patient.
慢性疲劳综合征是一种以至少6个月的致残性疲劳为特征，并伴有其他多种症状的疾病。本综述总结了关于慢性疲劳综合征的当前知识状态。
讨论了慢性疲劳综合征的病例定义、患病率、临床表现、评估和预后。综述了慢性疲劳综合征的病理生理学和治疗研究。
慢性疲劳综合征根据症状进行诊断。慢性疲劳综合征患者存在明显的功能障碍。病理生理异常存在于多个领域，这表明慢性疲劳综合征是一种病因复杂且多因素的异质性疾病。也开始有证据表明慢性疲劳综合征可能具有家族性。尽管慢性疲劳综合征与精神障碍有显著的症状重叠和共病现象，但多项研究表明该疾病可能与精神障碍不同。然而，患者的认知、归因和应对技巧可能会使病情持续存在。慢性疲劳综合征的治疗以症状为基础，包括药物和行为策略。认知行为疗法和分级运动对治疗疲劳及相关症状和残疾可能有效。
慢性疲劳综合征不太可能由单一因素引起或维持。迄今为止的研究结果表明，生理和心理因素共同作用，使个体易患该疾病，并促使疾病发生和持续。慢性疲劳综合征的评估和治疗应是多维度的，并根据个体患者的需求进行调整。
