Tired All the Time - PowerPoint PPT Presentation

1 / 19
About This Presentation
Title:

Tired All the Time

Description:

May be used as a legitimate symptom' to consult the doctor for more awkward problems ... ESR, CRP or monospot test. TFTs. Tumour markers. Scans. Physiological Causes ... – PowerPoint PPT presentation

Number of Views:277
Avg rating:5.0/5.0
Slides: 20
Provided by: ctgp
Category:
Tags: crp | time | tired

less

Transcript and Presenter's Notes

Title: Tired All the Time


1
Tired All the Time
  • 21st November 2007

2
(No Transcript)
3
  • Tiredness- can mean drowsiness, weakness, lack of
    energy, lack of motivation etc
  • May be used as a legitimate symptom to consult
    the doctor for more awkward problems
  • Very common presenting symptoms-numbers?

4
An approach to tirednessHistory
  • Clarifying symptoms-duration, time of day, sleep
    pattern
  • Associated physical symptoms-weight changes, SOB,
    change in bowel habit, menorrhagia, polyuria,
    snoring etc
  • Associated psychiatric symptoms-low mood,
    anxiety, sleep disturbance, changes in appetite
  • Recent infections
  • Medications
  • Alcohol
  • Employment and social history

5
An approach to tirednessExamination
  • Often entirely normal and unhelpful
  • But reasonable to check for-
  • -Weight
  • -Pallor
  • -Lymphadenopathy
  • -Arrythmias
  • -Hypothyroidism
  • -Cardiac failure
  • Also mental state examination-or at least
    screening questions for depression/ anxiety

6
  • Huge potential differential diagnosis for
    tiredness
  • Brighton and Ram will look at some of the
    physical and psychological causes
  • But first, a real life consultation
  • (Cue Andys video!)

7
TIRED ALL THE TIMEHELP ME DOC?
8
TIRED ALL THE TIME
  • Beware to classify the patients as heart sink
  • Remember that there may be serious underlying
    disease.
  • Take the patients seriously
  • Be systematic and see this consultation as a
    challenge to your clinical skills rather than an
    imposition.

9
TIRED ALL THE TIME
10
TIRED ALL THE TIME
  • Only 20 to 30 cases will have a discernible
    physical disease.
  • Around 75 of cases are due to some form of
    psychological distress

11
TIRED ALL THE TIMEORGANIC CAUSES
  • Diabetes or Renal failurethirst, nocturia or
    polyuria
  • Cardiac failure---fatigue
  • Infections---bacterial, viral, GF, post viral,
    TB, HIV, Brucella, Endocarditis
  • Iatrogenic beta blockers, antidepressants,
    tranquillisers
  • Alcohol

12
TIRED ALL THE TIMEORGANIC CAUSES
  • Other endocrinehypothroid, addisons,
    hypopituitary
  • Metabolic uraemia, liver failure
  • Anaemia-consider a faulty diet (elderly)
  • Myopathies e.g. myasthenia gravis
  • Neuropathies e.g. motor neurone disease
  • Malignancy

13
TIRED ALL THE TIMEINVESTIGATIONS
  • Urinalysisglucose and albumin (DM and Renal
    disease) also blood sugar.
  • FBC anaemia (find the cause of anaemia)
  • UE and cret renal problem or low K due to
    laxative abuse
  • LFTs alcohol abuse
  • ESR, CRP or monospot test
  • TFTs
  • Tumour markers
  • Scans

14
Physiological Causes
  • After Physical activity
  • Stress Exams, Work
  • Sleep Deprivation
  • Dieting or Anorexia
  • Boredom

15
Psychological Causes
  • Depression
  • Anxiety
  • Bipolar Affective Disorder
  • Somatisation
  • Personality Disorder

16
Assessment
  • Low mood
  • Anhedonia
  • Biological Symptoms
  • Diurnal Variation
  • Recent illness
  • Identifiable life event triggers
  • Absence of physical signs
  • HADS/PHQ-9
  • Risk Assessment

17
Management
  • Counselling
  • Anti-Depressants
  • CBT
  • Exclude physical cause

18
Tips
  • If absence of volunteered symptoms unlikely to
    have physical cause
  • Longer it has been problem less likely to find
    remediable cause
  • First impressions
  • If depression suspected enquire directly
  • Investigations often more therapeutic than
    diagnostic

19
TIRED ALL THE TIMETHANK YOU!!
Write a Comment
User Comments (0)
About PowerShow.com