Is chronic fatigue syndrome a useful diagnosis

Should the clinician ever diagnose CFS? We would say yes, but with four important caveats.

• CFS should be explicitly regarded as a presenting clinical syndrome, rather than a specific disease process. Whilst this is not to deny the possibility that there are specific pathophysiological processes underlying the symptoms, a balance must be struck between acceptance of this possibility and unjustified enthusiasm for each newly discovered aetiological agent.

• Psychiatric syndromes that have important clinical utility such as major depressive disorder should be sought, and, if present, should be included in the diagnostic statement.

• While the current case definition of CFS specifies only symptoms, patients' beliefs and behaviours (as described in Tabled) are often a prominent part of the clinical presentation and also need to be included in any useful summary of the case.

• Rather than becoming side-tracked by the question of whether CFS is 'medical' or 'psychiatric' in nature, management is likely to be more effective if both the physician and the patient adopt an open-minded and pragmatic approach.

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