THE CHRONIC FATIGUE SYNDROME - PSYCHIATRI C ASPECTS

Diagnosis of the chronic fatigue syndrome depends on various somatic a nd psychopathological symptoms. Somatic symptoms of the syndrome have been subject of an extensive body of literature. In comparison, psychi atric aspects have caught relatively less attention. Psychiatric aspec ts of etiological, diagnostic, and therapeutic concepts are essential for evaluation of the syndrome. Application of CDC-criteria to a well known disease does not solve the nosological problem, but may define t he syndrome more accurately. In this respect, issues including psychia tric comorbidity and specificity of neuropathological symptoms are dis cussed. Psychological variables seem to have a high predictor value fo r time course and outcome of the symptoms. Etiological concepts emphas ize on biological or psychosocial factors. Alterations of biological p arameters including immune functions, sleep regulation, and hypothalam ic-pituary-adrenocortical function have been reported. The role of cul tural factors has been discussed extensively. Somatic and psychologica l stress may result in the same clinical syndrome via psychoimmunologi cal mechanisms. An integrated, interdisciplinary approach to further r efine diagnostic criteria, understanding of etiology and development o f adequate therapeutic measures seems necessary.