Psychiatry Simplified - Dr Sanil Rege
Chronic Fatigue Syndrome and ME Simplified – How to Diagnose and Treat CFS | A Psychiatrist Explains
Chronic Fatigue Syndrome (CFS) or Myalgic Encephalomyelitis (ME) is a disabling and complex clinical condition characterised by unexplained and persistent post-exertional fatigue along with cognitive, immunological, endocrinological and autonomic dysfunction.
00:00 – Intro
01:06 – What is CFS?
05:47 – How is CFS Diagnosed?
07:33 – Canadian Consensus Criteria for CFS
11:08 – Treatment of CFS
Correction: 14:19 Graded Exercise Therapy NOT Graded Exposure Therapy. Graded exercise therapy is a term used in varying ways by different services supporting people with ME/CFS. (NICE). In this guideline, graded exercise therapy is defined as first establishing an individual's baseline of achievable exercise or physical activity, then making fixed incremental increases in the time spent being physically active. This definition of graded exercise therapy reflects the descriptions given in the evidence that was reviewed, and it is this approach that the guideline says should not be undertaken.
Correction: 14:25 Graded Exercise Therapy NOT Graded Exposure Therapy
Common symptoms include post-exertional fatigue, brain fog, dizziness (POTS), sleep disturbances, and wired fatigue, which significantly impact the quality of life.
There is an overlap of CFS with Long Covid in the context of Covid infection. Both conditions have infections as a trigger.
The pathogenesis of CFS and long covid involve abnormalities in immunological, inflammatory neuroendocrine, mitochondrial and HPA axis amongst other systems.
#longcovid #cfs #chronicfatiguesyndrome #myalgicencephalomyelitis #ME #POTS #Posturalorthostatictachycardiasyndrome #brainfog #fibromyalgia
The management of ME/CFS continues to remain a challenge in medical and psychiatric practice. Many pathophysiological mechanisms are involved, which requires a targeted strategy targeting multiple mechanisms.
In this video, Consultant Psychiatrist Dr Sanil Rege covers everything you need to know about CFS/ME in a simplified video. Many aspects covered in this video also apply to long covid.
The following points will be covered:
• Definition
• Risk factors
• Symptoms
• Diagnosis
• Canadian Consensus Criteria
• Treatment Options:
• Lifestyle changes
• Nutritional supplements
• Psychotherapies
• Pharmacological treatments
• Complementary therapies
• Faecal microbiota transplant
Don’t forget to subscribe and hit the notification button to know when a new video is released each week.
Read more in detail:
1. https://psychscenehub.com/video/trauma-neurobiology-ptsd-phenotypes-dr-sanil-rege/
2. https://psychscenehub.com/psychinsights/covid-19-and-the-brain-pathogenesis-and-neuropsychiatric-manifestations-of-sars-cov-2-cns-involvement/
3. https://psychscenehub.com/psychinsights/the-simplified-guide-to-the-gut-brain-axis/
Long COVID and Post-Acute COVID-19 Syndrome: Pathophysiology, Clinical Features and Management – https://psychscenehub.com/psychinsights/long-covid/
Hi Everyone! Welcome to Hub Bites! I'm Sanil Rege, Consultant Psychiatrist. If you're new to this channel, we cover all things Psychiatry and Mental Health related. So if that's your thing don't forget to subscribe! Today I'm going to be talking about a really really important disorder called Chronic Fatigue Disorder. Some may also know it as Myalgic Encephalomyelitis. Now one of the important things with chronic fatigue syndrome and more recently, there is a big overlap between the symptoms of chronic fatigue syndrome and ME and long covid. So quite a bit of what I talk about not all but quite a bit of what I talk about is sort of will be applicable to long covid as well. All right so without further ado let's jump into knowing more about chronic fatigue syndrome. So what is chronic fatigue syndrome? As I mentioned it's also referred to as Myalgic Encephalomyelitis, it is a disorder characterised by extreme fatigue or tiredness that doesn't go away with rest and can't be explained by an underlying medical condition purely, that's not to say that there aren't a number of underlying medical conditions that need to be treated. They absolutely need to be treated, so in clinical practice I do see a lot of chronic fatigue syndrome and Myalgic Encephalomyelitis. One thing I've learned is that every patient is different and every patient has a range of different risk factors, their symptoms are very different for example some may have pots, some may have prominent brain fog, some may have a combination of both, some may have infections, some may have organic conditions or medical conditions such as thyroid autoimmunity or other autoimmune disorders this is one of the most complex disorders I would say in medicine that results in a huge burden overall and to be quite honest we still don't know enough about it. The other thing is many patients can be dismissed as well, say that with diagnosis such as dysfunctional neurological disorder or conversion disorder and many patients often feel dismissed that you know being told that it's just in their head so it's really important that we do take it seriously, we recognize the limits of medicine and psychiatry as a whole and and listen carefully. We know that there are a number of aspects that can help patients in this particular condition. So again there is a lot to know about chronic fatigue syndrome I've written a detailed article on Psychscenehub.com where I go into much more detail but here I'm going to give you a snapshot of what is CFS or ME. Now what is the cause of CFS, causality in medicine is a very very complex issue so there's never one single thing that can lead that leads to CFS, there's a combination of things, but what we find when we take a history of individuals with chronic fatigue syndrome we ask them about their past we often see certain exposures that might be present and that's where we look at certain associations or links. Now one of the things that we find very prominently is viral infections so Epstein-Barr virus glandular fever often tends to be quite a prominent part in individuals histories. So exposure to glandular fever and then onset of chronic fatigue syndrome subsequently and this is where covid comes in as well. The coronavirus exposure and long covid a very very similar pathogenesis may be involved and we know that there are you know long covid is a documented entity and many many patients now presenting with it. We then have genetics, some individuals just seem more prone to the development of chronic fatigue syndrome sometimes there's a family history as well of chronic fatigue syndrome or other pain syndromes that's present. Stress and trauma is also a risk factor in fact childhood trauma tends to be individuals childhood trauma tend to have higher rates of chronic fatigue syndrome as well. Now weakened immune system I've talked about weakened immune system because part of it is related to certain immune factors tend to be lower in individuals with chronic fatigue syndrome but on the other hand there also seems to be neural inflammation which means there's excessive release of cytokines excitotoxicity cytokines that aren't needed that affect the brain and we know that certain parts of the brain where the fatigue areas are for example where the frontal lobe the cognition is affected dopamine goes down so it's a really really complex pathogenesis all of this pathogenesis has been covered in a lot more detail. Then we have hormonal imbalances so hormonal imbalances as I mentioned the HPA axis dysfunction which is a hypothalamic pituitary adrenal axis dysfunction seems to be linked to this and there's links between HPA axis, trauma, and then chronic fatigue syndrome because we know trauma disrupts HPA axis it's something I've covered in the in the other video on Neurobiology of PTSD or Neurobiology of stress as well. So these are some of the factors that are associated with chronic fatigue syndrome. So how is chronic fatigue syndrome diagnosed I'll go through the specific canadian consensus criteria but generally let's look at some of the domains so firstly we've got a reduced ability to do usual activities for six months or more because of fatigue so fatigue is one really important chronic fatigue syndrome and so fatigue is an important part and one of the things with this fatigue it's quite peculiar because you see in depression individuals can be lethargic and feel tired but in depression individuals tend to improve with activity and that's why behavioural activation tends to be a strategy chronic fatigue syndrome individuals tend to worsen with activity and exertion many many occasions so that's one, second we have worsening of symptoms after usual physical mental activity as I mentioned could be difficulty thinking, problem sleeping, sore throat, headaches, feeling dizzy or severe tiredness. Then we have trouble falling asleep circadian rhythm dysfunction tends to be a very prominent part of chronic fatigue syndrome then there should be other things such as problems with thinking and memory individuals talk about a brain fog this is the cognitive components, then worsening of symptoms while standing or sitting upright this is the autonomic nervous system dysfunction that occurs you know diagnosis of pots for example. So in order to receive a chronic fatigue syndrome diagnosis your doctor will rule out other potential causes and review your medical history this is so so important to really go through a detailed medical history and then we talk about the main symptoms, the duration, the severity and then using the canadian consensus criteria is one of the criteria to that can be used to confirm the diagnosis so what are they and this CFS criteria is quite useful. As you can see the illness length here adults six months, children three months fatigue as I mentioned prominent, next post-exertional fatigue and malaise, then sleep dysfunction this is a characteristic individuals describe what's known as a wired fatigue they're very tired they want to fall asleep but they're wired. individuals talk often about racing thoughts they just can't sleep this is hyper arousal that is very different from individuals not being able to sleep due to other causes of insomnia and we'll talk about some of the potential medications that could address this because this sort of hyper arousal also occurs in post-traumatic stress type symptoms. then we have pain, now fibromyalgia can be comorbid with CFS right so fibromyalgia symptoms which is really fibromyalgia characterized but I'll do separate video another time but it's characterized by what's known as allodynia which is a heightened sensitivity to pain so many individual fibromyalgia will often complain of pain all over the body and can be very tender to touch all right and there's more evidence recently that particularly from long Covid where individuals have had this fibromyalgia so a type of pain a chronic fatigue syndrome where they're talking about endothelium in the vessels being affected and micro clotting so there's more to know you know and then chronic fatigue syndrome and covid as well I've done the video on Covid Neuropsychiatry as well and one of the pathogenesis with covid is this increased sticky blood type aspect very similar to what happens in anti-phospholipid syndrome increased antiphospholipid antibodies. I know i digress but it's a really fascinating sort of pathogenesis and there's overlap here as well so fibromyalgia tends to be really important often diagnosed by a rheumatologist as well by testing the pressure points. Then we have cognitive dysfunction so this is another really really important part of the chronic fatigue syndrome and in cognitive dysfunction individuals describe what's known as a brain fog and this affects memory, multitasking, affects executive function, attention, concentration can be very very disabling. and then one symptom from two of the following categories and you can see here autonomic nervous dysfunction we know that pots is closely linked with chronic fatigue syndrome sometimes the diagnosis just gets put down as pots and one just focuses on the pots but it's important to look at whether pots occurs with fibromyalgia whether it occurs with a brain fog etc. then we have neuroendocrine dysfunction this is where it becomes the HPA axis dysfunction cortisol, adrenal function, thyroid autoimmunity ruling out Addison's disease which is you know antibodies against the adrenals so many things need to be ruled out adequately and then immune dysfunction so individuals can be very prone to infections as well in this condition. now one other thing i would also bring in here individuals tend to have quite a prominent mood component here so this can you can put it either in fatigue or sleep dysfunction or cognitive but mood and often the mood tends to have a fluctuating sort of pattern. depression can present anxiety can pretend present but also mood instability can present .so how is it treated now again as in every treatment i say this is something that is general only it is not medical advice because every patient's different so crucial that you discuss this with your doctors. but what are some of the things that are evidence-based so firstly when we look at it we have lifestyle changes, so diets mito protective diets so there's some evidence that you know intermittent fasting increasing ketone levels neuroplasticity some of those things can be beneficial um lifestyle modification so again removing certain toxic elements such as alcohol say cannabis use other substances etc, then pacing really important to pace oneself and not push so in my experience I've had patients where even sometimes during the initial phases of treatment they tend to improve and then because they improve they can feel well and do a little bit too much and go a few steps back so I often mention it's crucial to pace yourself. the other thing I often find is in terms of personality factors individuals can often have higher levels of perfectionism they're driven individuals higher levels of perfectionism you previously high functioning sometimes driven and that can sometimes be a double-edged sword because when they're getting better they can really push themselves that's some a personality sort of factor that I've identified in some cases. And then energy conservation exercise, then we have nutritional supplements and here evidence-based vitamin D i would say vitamin D is so so important in treating chronic fatigue syndrome often would look a you know keeping levels at the higher end of the lab values and sometimes you know significantly over it so you know greater than 70 at least I would say. And then probiotics evidence base and this is where the gut brain axis comes in because gut brain axis is linked to Neuroinflammation as well you know I'm sure I'll do another video on the gut brain axis but I've done a short animated sort of video on that so you can check that out. but probiotics show some evidence magnesium again really important anywhere between 200 to 400 milligrams can be utilized and over the count of vitamin b12 b complex so folate is important vitamin b12 is important essential fatty acids so this is where you have the omega-3 fatty acids and we know that you know EPA eicosapentanic acid versus the DHA often the ones with higher levels of epa tend to be more evidence based on psychiatric disorders then we have coenzyme Q coenzyme q and then you know this is basically what niacin gets converted to so the nicotinamide adenosine dinucleotide nadh is evidence-based acetyl-l-carnitine and antioxidants now of course all of these on their own are unlikely in the severe cases to change things and this is where we're looking at a cumulative effect right then we have psychotherapies in psychotherapy cbt and graded exercise therapy one of the things i find here is that you know sure [ Sorry I should have said Graded Exercise Therapy] patients get referred to graded exercise therapy [ Sorry I should have said Graded Exercise Therapy] or cbt but when a person sometimes is extremely fatigued justice doesn't cut it um individuals might be experiencing autonomic dysfunction significant brain fog they might not actually be able to engage in cbt and this is where we've got a deconstruct the syndrome and address each component of the syndrome which i'll touch on in a bit then we have uh pharmacological treatments now pharmacological treatments antidepressants and and i'll talk about you know how we sort of target things now remember we have fatigue we have post-exertional fatigue or malaise we have mood components either depression or anxiety or instability we have sleep circadian rhythm dysfunction right and we have cognitive aspects we have pain right so i've got to look at all of these things when treating it now one of the things i find is addressing the hyperarousal symptoms first right which can help with the sleep and bring down the overall level of tension that individuals generally have some of the medications that can be useful here are clonidine and prazosin – the alpha 1 alpha 2 antagonists that I've covered previously [Clonidine is alpha 2 agonist/ prazosin is alpha 1 antagonist] again another video can be extremely useful in promoting sleep and reducing their hyperarousal we know that they are agents that actually promote deep sleep and non REM sleep right which is important for memory consolidation to reduce the fatigue during the day now of course it's crucial to rule out medical conditions obstructive sleep apnea for example thyroid dysfunction restless leg syndrome all of these need to be treated as well because chronic fatigue syndrome can be comorbid so when we think about um this this wired fatigue we can address that but let's say a person with chronic fatigue syndrome with pots you see prescribing agents like clonidine or prazosin will drop blood pressure so that's something i won't do at that stage it can be introduced later on this is based on my clinical experience of having treated patients so what tends to happen it occurs as a balance and one of the things that i tend to do in severe cases of chronic fatigue or fibromyalgia is i consider an admission because the environmental stresses need to be taken out it is i find it extremely difficult to carry out outpatient treatment because there's so many stressors that are there i and also individuals can be very very sensitive to changes in medications so they have heightened side effects and that might be a combination of a few things allodynia the hypersensitivity the fibromyalgia components so often they're so attuned to their body that small changes can particularly be changes medication changes can be misinterpreted sometimes as side effects so there's a lot of reassurance therapeutic alliance understanding and trust that needs to be built through this treatment this is one of the most important things I've found and time is a big factor we're looking at six months to one year process the admission of course might be shorter but we're looking at it as a process because each person's different i need to see how each medication change results and how patients react so when we're thinking about antidepressants for example if the individual's got fibromyalgia i can consider antidepressants that are evidence based for pain so duloxetine for example or milnacipran now these are very very helpful in pain but duloxetine also assists with the cognition component right than some other agents such as we're looking at here antivirals now of course antivirals monoclonal antibodies this is where liaison with a rheumatologist can help right steroids same liaison with a rheumatologist can help there's some evidence for staphylococcal vaccine as well anti-inflammatories can be prescribed particularly again for pain etc there's some evidence for low-dose naltrexone really low-dose naltrexone analgesics can be prescribed again for pain but from a psychiatric component i'll talk about some of the things the strategy that tends to work so treating the wired fatigue treating the pain and sometimes using combinations so sometimes agents such as stimulants are also evidence-based and what's really really interesting is stimulants such as dexamphetamine or methylphenidate are also evidence-based in POTS with brain fog in fact a 2019 article talked about brain fog and POTS and there's very good evidence for agents such as modafinil or modafinil these also are agents that stimulate the orexin neurons which promote wakefulness right in the neurobiology of sleep I've covered orexin neurons and you know these uh wakefulness components so modafinil armodafinil can be very useful or stimulants such as methylphenidate and dexamphetamine and they actually do not cause so trials have shown no significant effects no prob problems with the pots so i've used them successfully in many cases and what happens is as the blood pressure starts going up that's when the wired fatigue can be treated by using clonidine and you get an optimal balance but this is something that needs to be done in a specialist care and of course you know in a supervised environment as well now for mood components uh mood stabilizers anti-convulsive lamotrigine can play a very big part and in the initial stages a multi-pronged effect is needed in order to provide good benefits and medication then the graded excercise therapy and cbt tends to work really well but if fatigue brain fog is so significant then there's a big barrier and that's where medication needs to come in so this is all about this is not about saying one thing will work and this is one of the things I've learnt in chronic fatigue requires a multi-pronged approach and a multi-disciplinary team as well physicians rheumatologists general practitioner nurses nurse colleagues occupational therapists physiotherapists multi-prong approach in order to address this particular condition and there is of course some evidence for complementary therapies acupuncture rehabilitation abdominal tuina and fecal microbiota transplant but all of these things are of course experimental as you can see this is you know this is from the reviews um the references down here uh that i've covered this but i hope that this has given you an understanding of how complex this particular condition is and you know everything that i've covered today i've covered it as a general sort of overview right every person's different so each aspect needs to be targeted appropriately in discussion with the doctor but i hope that this will help you and anyone else you know that might be experiencing this condition a lot of this is also relevant to long covid as well so if you've liked this video please leave us a like hit the like button of course don't forget to subscribe and i look forward to seeing you in another edition of hub bites until then take care stay safe I'll see you next time bye you
#Chronic #Fatigue #Syndrome #Simplified #Diagnose #Treat #CFS #Psychiatrist #Explains
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Why isn’t anyone referencing stem cell therapy?
Hi I’m on Bio injections – and I also am on steroids which I’m desperately trying to reduce – I can’t seem to get under 7.5 mg without feeling unwell – I also stopped smoking nearly 2 months ago and I’ve been sleeping from 9pm till 1 or 2 pm (just waking to use the bathroom / and to see if I feel like I have some energy)
Depression is not chronic fatigue syndrome. It happens but only like any long term illness. You would feel depressed eventually too.
Plz 🙏🥺
I request all of u to tell me your fasting and pp sugar level .
All of cfs patients check ur blood sugar by labs not by glucometer .
Can I block everyone who did not get straight A's in OC?
Has anyone noticed screens like Organic Chemistry grades no longer apply if you have fatigue?
Dr. , i just watched this video. You said that post exertional malaise can be seen in ME/CFS. It's actually the defining feature of ME/CFS.
Also, you stated that graded exercise therapy and cognitive behavioral therapy are effective for ME/CFS, Dr., CBT & GET have both been proven to harm ME/CFS patients. That's not new information, you might want to add a note or something
GET is NOT recommended anymore as it can make fatigue worse, sometimes permanently.
CBT is also problematic for a variety of reasons. Please edit this video!!!
How drs get rich cut paste internetting money for nuttin %$$$$$$$ no one talks about toxsick food in everything satanic NWO dor fauci gates 3 generations of eugenics gatez femily grandpa papa and lil bill new mexsicko boy in back seat caught under age cops paid off by papa gates perv epstainsvsins soggy bottom billy gztes eyeland 8n eastern europe it never changes or ends
I have found that OTC Pepcid (20mg twice a day) helps immensly with brain fog.
I cured my M.E/C.F.S with a heavy metal and candida detox. High quality Chlorophyll etc for the heavy metals. Research candida diet. May you heal. May the Gods bless you 💛
Helpful video! Integrating these tips with the ANTI-FATIGUE PACK by Planet Ayurveda can lead to increased stamina."
six months after the murderna shot, i had super high IGG antibodies for EBV and CMV. never contracted SARS COV2, as evidenced by nucleocapsid blood test.
Anyone else have swollen lymph nodes/glands constantly? Sore throat? I hate this so much… its every day…
Do not attempt to "push through" exercise. I was an athlete and now I can't even do a 5 minute light workout without exacerbating symptoms for days where I'm out of commission.
Im listening at 1:am in hopes of getting sleepy.😄 Never heard of wired tired, but it fits. Chronic childhood trauma fits. Lyme disease started it. 35 yrs of not understanding nor being understood. Saving this video in case I meet someone new who cares. Hard not to feel like a ruined human with no hope when so much has happened. Had stage 3 lymphoma too. Covid after chemo. Vaccines made me so sick I almost died all three times -Temp 105.5. It is nice to know that there are people learning, teaching and caring about the hopeless cases.
Can anyone tell me how I stop over eating or craving sweet things. And what do I do one the days I am to tired to cook a meal. I have put on so much weight over the last year as I haven’t been able to exercise much over the last year.
Blessings and Luv to you from Sandy in NZ🥰
Hii doctor…I have a cfs.can since 2019…can you help me to deal witj cfs
My battle has been 34 yrs. I hate this crap! Praying for Med Beds cure! I am a 59 yrs old female, feel 159 yrs old.
This is the best video I've seen on CFS. I've had CFS for 13 years and it's awful now. I'd like to see this guy privately!
I didn't have any type of virus before my symptoms started
I don't know what I have but I'm not tired all the time unless from medication
For me it started with a tick bite 25 years ago….. Since then my health and life has been a roller coaster…. The fatigue and constant pain is exhausting and excruciating 😢
I only hear you address symptom management versus addressing the viral reactivation or possible exposures to mold and other toxins affecting the nervous system
ME… is not about psychiatry. I was diagnosed with chronic fatigue over 30 years ago. My symptomd come back every few years. I managed to get a medicine to increase the production of ATP. The only thing that ever helped. I am so glad I never had to put up with a psychiatrist. All the symptoms are linked to a limited production of the cell's energy.