Thursday, May 23, 2013

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Psychological Fatigue in MS

Fatigue is one of the most common symptoms that occur in MS, and often is the first symptom appeared on a person who decided to follow some medical investigations. 92% of people with MS exhibit this symptom, which usually is a chronic, but may precede or accompany flares of MS. Because of its increased intensity and chronicity, fatigue also, increases the disability of the MS patient and leads to changes in lifestyle and the activities carried out, reducing the quality of life.

In 1998, the Multiple Sclerosis Council for Clinical Practice Guidelines has reached an agreement regarding the definition of fatigue in MS, defining it as "a subjective lack of physical energy and / or mental which is observed by the individual or the person caregiver as interfering with normal activities or desired." So fatigue is a subjective state that is based on individual self, and refers to the perception of physical exhaustion and/or mental. It differs from chronic fatigue (lasting more than 6 weeks) and severe fatigue that lasts up to 6 weeks.

From cognitive-behavioral perspective the emphasis is on the thoughts that accompany the disease on how MS patient thinks about and interprets the experience of fatigue. There are studies that show that helplessness and somatic attribution contributes to fatigue and also increases the level of disability in MS.

Biology, emotion, cognition and behavior are influencing each other and contribute to the vicious cycle of fatigue. Demyelination and inflammation causes initial symptoms of MS. How people react to fatigue then, in terms of cognitive, emotional, behavioral and physiological results in the perpetuation or worsening fatigue. For example, people can have unhealthy thoughts related to fatigue, such as "when I feel so tired, probably terrible things are happening in my body".

This kind of thinking can lead to anxiety (emotion) and tend to take a break and to reduce activity (behavior). These consequences can in turn be interpreted negatively and exacerbate feelings of depression and anxiety. Emotional response, in turn, can lead to increased physiological activation and unsatisfying sleep (biology), which will worsen fatigue.

This vicious circle of fatigue can be determined, sometimes without being aware of this, the behavior of "all or nothing" person with MS who has a period that feels better, trying to accomplish as many activities shortly win. CONSTANT reducing effort and work as a method to cope with fatigue, deconditioning is reached (process reverse Pavlovian conditioning).

The impact of fatigue on life in MS patients

The most common type of fatigue in chronic diseases is central fatigue. Unlike neuromuscular fatigue and peripheral, central fatigue is the failure to complete tasks requiring physical and mental self-motivation and individual internal indicators. This concept of central fatigue involves the distinction between physical and mental fatigue. Studies show that
with depression and anxiety, fatigue explains much of the cognitive complaints MS patients, and especially mental fatigue. Physical fatigue does not lead to cognitive symptoms.

Although some people with Multiple Sclerosis believes that cognitive functioning is affected negative experience fatigue, not everyone makes the difference between types of fatigue that are related to physical health.
But the functioning of a person not just the cognitive side.

Physical activity can reduce both because of the physical and mental fatigue. Sometimes breaks are how to deal with this symptom, but there are cases where a form of self-sabotage, and manipulation of others. May decrease motivation and initiative to perform tasks
At the social level, fatigue sometimes lead to withdrawal from relationships with others, reducing social contacts, fewer social opportunities. Often it is the mental fatigue that lead to such behavior.
In other words, mental fatigue affects mental health and the general health.
What can you do?
* From a psychological perspective, try to notice how you interpret fatigue, and the effect it is your way of thinking on mood and behavior (see log monitoring below).
* Psychological approach is only one of the existing ones. Do not rule out a visit to a neurologist just to try to reduce fatigue that psychotherapeutic techniques.

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