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by Joyce J, Hotopf M, Wessely S
March 12, 1997
The prognosis of chronic fatigue syndrome and chronic fatigue has
been studied in numerous small case series. We performed a
systematic review of all studies to determine the proportion
of individuals with the conditions who recovered at
follow-up, the risk of developing alternative physical
diagnoses, and the risk factors for poor prognosis. A
literature search of all published studies which included a
follow-up of patients with chronic fatigue syndrome or
chronic fatigue were performed. Of 26 studies identified,
four studied fatigue in children, and found that 54-94% of
children recovered over the periods of follow-up. Another five
studies operationally defined chronic fatigue syndrome in
adults and found that < 10% of subjects return to pre-morbid
levels of functioning, and the majority remain significantly
impaired. The remaining studies used less stringent criteria
to define their cohorts. Among patients in primary care with
fatigue lasting < 6 months, at least 40% of patients
improved. As the definition becomes more stringent the
prognosis appears to worsen. Consistently reported risk
factors for poor prognosis are older age, more chronic
illness, having a comorbid psychiatric disorder and holding a
belief that the illness is due to physical causes.
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