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tulated Also, the depression that follows stroke or myocardial infarction frequently presents with the complaint of fatigue rather than other signs of mood disorder Inordinate fatigue is a common complaint among patients with postconcussive syndrome, or what we have termed posttraumatic nervous instability (page 764) Severe fatigue that causes the patient consistently to go to bed right after dinner and makes all mental activity effortful should suggest an associated depression These central fatigue states and their possible mechanisms, almost all speculative, have been discussed by Chaudhuri and Behan Also, many states of disordered autonomic function in which static or orthostatic hypotension are features are commonly associated with a fatigue state Whether there is in addition a central autonomic (hypothalamic) fatigue, aside from the endocrine changes discussed below, is uncertain, but such an entity seems plausible and has been included in models of the chronic fatigue illness Systemic Diseases A wide variety of medications and other therapeutic agents, particularly when rst administered, commonly induce fatigue The main offenders in this respect are antihypertensive drugs, especially beta-adrenergic blocking agents, anticonvulsants, antispasticity drugs, anxiolytics, chemotherapy and radiation therapy, and, paradoxically, many antidepressant and antipsychotic drugs Introduction of these medications in gradually escalating doses may obviate the problem, but, just as often, an alternative medicine must be chosen The administration of betainterferon for the treatment of multiple sclerosis (and alpha-interferon for other diseases) induces fatigue of varying degree Plasma exchange for the treatment of immune neuropathies and myasthenia gravis may be followed by fatigue for a day or so; this state should not be mistaken for a worsening of the underlying disease Surgeons and nurses can testify to fatigue that comes with exposure to anesthetics in inadequately ventilated operating rooms Similarly, fatigue and headache may result from exposure to carbon monoxide or natural gas in homes with furnaces in disrepair or from leaking gas pipes (but this is also a frequent delusion in anxious, depressed, or demented patients) The sleep apnea syndrome is an important and often overlooked cause of fatigue and daytime drowsiness In overweight men who snore loudly and need to nap frequently, testing for sleep apnea is indicated (page 344) Correcting the obstructive apnea that underlies this condition leads to a dramatic reduction in fatigue Acute or chronic infection is an important cause of fatigue Everyone, of course, has at some time or other sensed the abrupt onset of exhaustion, a tired ache in the muscles, or an inexplicable listlessness, only to discover later that he was coming down with the u Chronic infections such as hepatitis, tuberculosis, brucellosis, infectious mononucleosis [Epstein-Barr virus (EBV) infection], subacute bacterial endocarditis, and perhaps the chronic effects of Lyme disease may not be evident immediately but should always be suspected when fatigue is a new symptom and disproportionate to other symptoms such as mood change, nervousness, and anxiety More often, the fatigue begins with an obvious infection (such as in uenza, hepatitis, or infectious mononucleosis) but persists for several weeks after the overt manifestations of infection have subsided; it may then be dif cult to decide whether the fatigue represents the lingering effects of the infection or the infection has been complicated by psychologic symptoms during convalescence This dif cult problem is discussed below Patients with systemic lupus, Sjogren syndrome, or polymyalgia rheumatica may com. birt code 128 Barcode using font CODE 128 — OpenText - Forums
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