Other symptoms and the psyche
Ad (Sandy) Macleod, Ian Maddocks in The Psychiatry of Palliative Medicine, 2018
Fatigue is the commonest symptom experienced during the course of cancer, with prevalence estimates of greater than 70–80%. Often not volunteered but upon asking, most cancer patients, as well as those with neurodegenerative disorders, complain of this debilitating symptom. Lay terms include tiredness, exhaustion, lethargy, weakness and lack of energy. If cancer-related, this symptom may be described as ‘weakness’, and if a symptom of depression or anxiety as ‘fatigue’ or ‘lack of energy’.6 However, word descriptors are likely culturally and linguistically variable. Fatigue is difficult to quantify. It is entirely a subjective symptom. It is not the same as muscle weakness, rather it is difficulty in the initiation, or sustaining, of voluntary activities.7 The medical term asthenia includes fatigue, generalised weakness and mental fatigue. It refers to decreased capacity to maintain adequate performance (tiring easily), difficulties initiating activity, impaired concentration and memory, and emotional lability.8 Poor concentration, forgetfulness, making slips of the tongue and being unable to find the correct word are typical subjective complaints of tired persons, yet on formal neuropsychological testing objective deficits are not usually confirmed.9 With advancing disease, fatigue tends to progress to such an extent that it precludes independent functioning. The concept of ‘vital exhaustion’, initially used in cardiology,10 aptly describes terminal fatigue.
Drug-induced eosinophilia and systemic symptoms
Biju Vasudevan, Rajesh Verma in Dermatological Emergencies, 2019
DRESS develops 2–6 weeks after initiation of the culprit drug on first exposure. The median time interval after drug intake is 22 days (interquartile range 17–31 days) [3]. With reexposure of the same drug there can be shorter latency. The patient may present with nonspecific symptoms in the early phase with asthenia, malaise, and fatigue. Rash and facial swelling are usually the presenting complaints. Fever and a cutaneous eruption are the most common symptoms, seen in 90% and 75% of patients, respectively [3]. Other symptoms related to the organ affected may be present at the time of presentation. Certain drugs have more propensities to affect particular organs. Phenytoin, minocycline, and dapsone can cause severe hepatic damage, while allopurinol causes renal damage. Chest pain and dyspnea should prompt detailed cardiological evaluation. Pulmonary and neurological symptoms are rarely reported. The cutaneous and visceral involvement may persist for months after drug withdrawal, and additional sites of involvement (e.g., cardiac, thyroid) may develop weeks or months later. Family history of similar rash for a similar drug can give a diagnostic clue of HLA polymorphism. Familial cases of DRESS to carbamazepine, linked to HLA-A3101, have been described [19]. The cutaneous and visceral involvement may persist for several weeks or months after drug withdrawal, and additional sites of involvement (e.g., cardiac, thyroid) may develop weeks or months later.
Fatigue
Silvia Bonino in Coping with Chronic Illness, 2020
The sense of fatigue is an inseparable companion of most chronic diseases and in some of them, such as multiple sclerosis, it can be one of the main symptoms. Asthenia, as it is defined in medical language, is not the simple fatigue that all people experience after a strenuous activity and to which a good sleep and adequate rest can remedy. Instead, it is exhaustion that makes all the actions of daily life difficult, even the simplest, and this often contributes to patient isolation: one does not have the strength to go out, to meet others, to speak, to listen, to read, sometimes not even to watch television. In a society that has made efficiency its banner, patient fatigue is one of the symptoms least accepted and most misunderstood.
Patients in general practice share a common pattern of symptoms that is partly independent of the diagnosis
Published in Scandinavian Journal of Primary Health Care, 2021
Mona Kjeldsberg, Hedda Tschudi-Madsen, Ibrahimu Mdala, Dag Bruusgaard, Bård Natvig
As expected, the mean number of symptoms increased with an increasing number of chronic conditions [14]. The differences in the number of symptoms among the most prevalent diagnoses are clinically explainable. Patients with the diagnoses asthenia and depression/anxiety report a high number of symptoms. Asthenia (A04) is a symptom diagnosis according to ICPC-2 and may be used for tiredness/asthenia symptoms alone. However, asthenia is also associated with medically unexplained symptoms [25], which in turn are strongly associated with the reporting of multiple symptoms [29]. Mental health problems are also associated with a high number of symptoms [30]. Diabetes can result in complications in several different organs, but diabetes patients in general practice are often in an early stage, have few diagnosis-specific symptoms, and report good health [31]. Hypertension among general practice patients is as much an asymptomatic risk factor as a disease diagnosis, and most patients with hypertension also rate their health as good [32]. In our study, participants with hypertension had fewer symptoms than the overall mean.
Fatigue with epidermal growth factor receptor tyrosine kinase inhibitors in cancer patients: A meta-analysis of randomized controlled trials
Published in Journal of Chemotherapy, 2018
Cancer-related fatigue is perceived by patients as a chronic feeling of tiredness or general lack of energy not alleviated by rest. Nowadays, the exact mechanisms involved in cancer-related fatigue pathophysiology are poorly understood owing to its characteristics as a complex and multifactorial phenomenon which could be induced by a variety of causes and contributing factors. To describe fatigue, health professionals may use terms such as asthenia, lassitude, prostration, lack of energy, and weakness. Besides cancer treatments and the underlying cancer illness, fatigue can be caused or aggravated by a variety of factors, such as anemia, pain, depression, anxiety, sleep disorders, nutritional status, and medication side effects. In the case of persistent grade 3–4 fatigue, dose reduction or treatment suspension may be required. Moreover, fatigue may persist even after cessation of therapy. This renders it challenging to accurately quantify the incidence of fatigue in cancer patients. In our meta-analysis, all-grade and high-grade fatigue were reported in a substantial proportion of patients in the control arms of trials in our meta-analysis, which provides a benchmark for future studies attempting to mitigate cancer-related fatigue. Moreover, EGFR-TKIs can also cause nausea, vomiting and cardiac dysfunction, which may all result in fatigue.
Anxiety, depression, and fatigue in middle-aged and older persons with spina bifida: a cross-sectional study
Published in Disability and Rehabilitation, 2022
Ingeborg Beate Lidal, Kerstin Lundberg Larsen
To our knowledge, this is the first study to address depression, anxiety, and fatigue symptomatology in persons with SB aged 50 years or older. These are the main findings: The study population had significantly higher HADS scores compared to the GP and adults with chronic (>20 years duration) SCI. In total eleven persons (36%) scored above the thresholds for clinically relevant anxiety or depression. However, few of these persons reported receiving any kind of follow-up; one person had follow-up by a psychologist, one person had followed up by a psychiatric nurse, while none reported using antidepressant medications. The results also indicated a high rate of moderate to severe fatigue, and fatigue seemed to be associated with the use of medications that have possible fatigue or asthenia side effects. The HADS-D and FSS scores were correlated, and both variables were also correlated with pain intensity experienced the past week.
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