Referrals to this unit
We are currently able to assess patients with a potential diagnosis of CFS and patients with fatigue associated with chronic diseases such as rheumatoid arthritis (RA), Multiple Sclerosis (MS), diabetes and chronic obstructive airways disease. We are also seeing adolescents and the elderly.
We are able to offer face to face or telephone CBT for those who can’t travel to the hospital regularly and home-based treatment for the severely affected.
For patients
If you wish to be referred to the unit, please contact your GP. Eligibility for treatment will partly depend on the funding arrangements between your Primary Care Trust (PCT) and our unit. Some PCTs require that referrals are made by a consultant, but in most cases a GP referral is appropriate.
Some GPs are reluctant to refer patients because they are not sure that the patient fulfils the diagnostic criteria for CFS/ME. However, at your first assessment at this unit we will try to work out whether you do have CFS/ME or not, so they do not have to be sure in order to refer you.
For referrers
GENERAL PRACTITIONER GUIDELINES
Diagnosis: Clinically evaluated, unexplained, persistent or relapsing chronic fatigue of new or definite onset, not the result of ongoing exertion; not substantially relieved by rest and results in substantial reduction in previous levels of occupational, educational, social, or personal activities plus the concurrent occurrence of four or more of the following symptoms, all of which must have persisted or recurred during six or more consecutive months of illness and must not have predated the fatigue:
substantial impairment in short-term memory or concentration
sore throat
tender lymph nodes
muscle pain
headaches of a new type, pattern or severity
unrefreshing sleep
post-exertional malaise lasting more than twenty four hours
multi-joint pain without joint swelling or redness.
Aetiology: Elusive. Viral triggers common, especially EBV. Research has focused on genetic links, endocrine abnormalities, immunology, neuroimaging, virology and infectious processes, sleep disruption, exercise, somatisation, depression and anxiety disorder. None can alone fully explain illness. No compelling evidence for viral persistence, allergy or nutritional deficit.
Investigation: No diagnostic test.
Please send copies of the following investigations (which should be carried out within 2 months of referral) together with the referral letter to the address below:
All patients: FBC, ESR or CRP, U & Es, LFT, calcium, albumin, creatine kinase, thyroid function tests (TSH and free T4), local coeliac screen (e.g. IgA endomysial autoantibodies), random blood glucose, urinalysis for blood, glucose and protein.
Can be helpful: EBV serology, Chest X-ray, Rheumatoid factor, ANF, CMV, toxoplasmosis, HIV serology.
Not helpful: Enteroviral serology, VP-1, neuroimaging.
Medical referrals: As clinically indicated
Management: Explanation of illness often of value; set treatment goals; self-help guides i.e. ‘Coping with Chronic Fatigue’ by Trudie Chalder; avoidance of excessive rest or excessive exercise or activity and/or sudden changes in activity - plan regular, predictable, consistent activity to combat deconditioning, restore confidence and self-control; cognitive behaviour therapy if available; regular follow-up; no current evidence that allergy, immune or dietary manipulation helpful. Antidepressants are principally of value where there is a co-morbid depressive illness or clear cut depressive symptoms.
Referral to normal psychiatric services: As clinically indicated.
Referral to PPS Clinic (King’s College Hospital): Indications:- failure to respond to above measures; special circumstances (young children, job at risk); more than six months’ illness; marked disability; adolescent referrals accepted for 11-18 year olds. Please note that we do not accept referrals where the sole purpose is for second opinion for pending benefits claims.
Other options: rheumatologist with interest in fibromyalgia; clinical psychologist; clinical nurse specialist (cognitive behaviour therapy).
Referrals for adult patients:
Unit Administrator
Persistent Physical Symptoms Research and Treatment Unit
Mapother House, 1st Floor
De Crespigny Park
Denmark Hill
London SE5 8AZ
Referrals for adolescents:
Professor Trudie Chalder
Persistent Physical Symptoms Research and Treatment Unit
Mapother House, 1st Floor
De Crespigny Park
Denmark Hill
London SE5 8AZ
What to expect after referral
When we receive your referral we will read the referral letter to see whether we think we might be able to help you. We will also check whether our unit has suitable funding arrangements with your Primary Care Trust. If both of these conditions are met, you will be offered an appointment to come to the unit for assessment.
Your first assessment will be with one of our doctors or senior cognitive behaviour therapists. It may last up to 2½ hours but you are free to stop the assessment at any time or have a break in the middle if you wish. The purpose of the assessment is to check whether we think you have CFS/ME and if so, whether we think that you might benefit from treatment at our Unit.
If we think that you might benefit from cognitive behaviour therapy, you will be offered an appointment with a cognitive behaviour therapist or clinical psychologist. Cognitive behaviour therapy (CBT) involves sessions lasting about 50 minutes, which usually take place fortnightly.