[Tiredness/Fatigue-S3 guideline update].

ZFA. Zeitschrift fur Allgemeinmedizin Pub Date : 2023-01-01 Epub Date: 2023-04-24 DOI:10.1007/s44266-023-00045-z
Nele Kornder, Erika Baum, Peter Maisel, Nicole Lindner
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引用次数: 3

Abstract

Background: Fatigue is one of the most common reasons for seeking medical counseling in the family medicine (FM), often entailing diagnostic uncertainty. Patients use terms describing emotional, cognitive, physical, and behavioral aspects. A number of biological, mental, and social causes may underlie the symptom of fatigue, often in combination. This guideline describes the procedures to be applied for primary undetermined symptomatology.

Methods: The experts involved conducted a systematic search using the terms for fatigue in the context of FM in PubMed, Cochrane Library and via manual search. Concerning related guidelines, the National Institute for Health and Care Excellence (NICE) guideline was used for myalgic encephalitis/chronic fatigue syndrome (ME/CFS). In a structured consensus process, broad approval of the core recommendations/background text of the revised guideline was attained.

Most important messages: 1) Alongside gathering information concerning the symptom characteristics, the anamnesis aims to collect information about pre-existing health conditions, sleeping behavior, use of drugs and psychosocial factors. 2) Depression and anxiety as two common causes will be identified based on screening questions. The occurrence of post-exertional malaise (PEM) will be inquired. 3) The following basic diagnostics are recommended: physical examination, laboratory tests (blood glucose, full blood count, blood sedimentation/CRP, transaminases/γ-GT, TSH). 4) Further examinations should be conducted only in case of specific indications. 5) A biopsychosocial approach is to be adopted. 6) Behavioral therapy and symptom-oriented activating measures can improve fatigue in underlying diseases and undetermined fatigue. 7) In case of PEM, further ME/CFS criteria should be collected and patients have to be supervised accordingly.

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[疲劳/疲劳-S3指南更新]。
背景:疲劳是在家庭医学(FM)中寻求医疗咨询的最常见原因之一,通常会带来诊断的不确定性。患者使用描述情绪、认知、身体和行为方面的术语。许多生理、心理和社会原因可能是疲劳症状的基础,通常是综合原因。本指南描述了应用于原发性未确定症状的程序。方法:相关专家使用PubMed、Cochrane Library中FM中的疲劳术语,并通过手动搜索进行系统搜索。关于相关指南,国家健康与护理卓越研究所(NICE)指南用于肌痛性脑炎/慢性疲劳综合征(ME/CFS)。在一个结构化的协商一致过程中,经修订的准则的核心建议/背景案文获得了广泛批准。最重要的信息:1)除了收集有关症状特征的信息外,记忆还旨在收集有关先前存在的健康状况、睡眠行为、药物使用和心理社会因素的信息。2) 抑郁和焦虑是两种常见的原因,将根据筛查问题进行确定。将询问运动后不适(PEM)的发生情况。3) 建议进行以下基本诊断:体检、实验室检查(血糖、全血细胞计数、血沉/CRP、转氨酶/γ-GT、TSH)。4) 只有在出现特定症状时才应进行进一步检查。5) 将采用生物-心理-社会方法。6) 行为治疗和以症状为导向的激活措施可以改善潜在疾病的疲劳和未确定的疲劳。7) 在PEM的情况下,应收集进一步的脑脊髓炎/慢性疲劳综合征标准,并对患者进行相应的监督。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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