title: Chronic fatigue syndrome in the psychiatric practice.
abstract: BACKGROUND
  Chronic fatigue syndrome (CFS) is a complex syndrome with a psychiatric comorbidity of 70-80%. A psychiatric interview is necessary in order to exclude psychiatric illness and to identify psychiatric comorbidity. Studies have demonstrated that in general medical practice and in the non-psychiatric specialist practice, physicians tend to underdiagnose psychopathology in patients with CFS. There are many questions unanswered about the treatment of CFS Aim: Typical issues for the psychiatric practice are reviewed: psychiatric comorbidity, dysregulation of the PHA-axis and the treatment of CFS.
  
  
  CONCLUSIONS
  Depression, somatization, sleeping disorders and anxiety disorders are the most important psychopathological symptoms found in CFS patients. CFS should not be regarded as a masked (somatoform) depression. Although the results from neuroendocrinological studies assessing the hypothalamic-pituitary-adrenal axis (HPA-axis) are inconsistent, they suggest that there is a subgroup of CFS patients suffering from a discrete dysregulation of the HPA-axis resulting in basal hypocortisolaemia. These findings, however, do not reveal a causal relationship. Antidepressants do not seem to have a positive influence on the symptom of fatigue, but appear to be beneficial in alleviating the symptoms of depression and social functioning. Cognitive behaviour therapy and graded exercise show a significant improvement on fatigue and other symptoms and are the only treatments available for CFS patients.
authors.affiliation: 1Psychosomatic Centre, Ghent, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Van Duyse
authors.affiliation: 2Department of Psychiatry, University Hospital, Ghent, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Mariman
authors.affiliation: 1Psychosomatic Centre, Ghent, Belgium.
authors.forename: C
authors.initials: C
authors.lastname: Poppe
authors.affiliation: 3Internal Medicine University Hospital, Ghent, Belgium.
authors.forename: W
authors.initials: W
authors.lastname: Michielsen
authors.affiliation: 4Endocrinology, University Hospital, Ghent, Belgium.
authors.forename: R
authors.initials: R
authors.lastname: Rubens