Referral

• Consider referral to an appropriate specialist physician if there is uncertainty about diagnosis.
  
  
• Referral to secondary services for assessment and management of CFS depends on local provision. Services might be provided by liaison psychiatrists, infectious diseases consultants, pain clinics or rheumatologists.
  
  
• Referral to Community Mental Health Teams may be indicated in special circumstances:
  - where there is a risk of suicide
  - in cases of bipolar disorder
  - in patients with eating disorders.
  
  
• Complex and bed- or house-bound patients might need domiciliary medical and social care; a small percentage may require admission for specialized rehabilitation programmes.(ref 52,53)
  
  
• Misunderstanding about the purpose and nature of referrals is common. Explanation and shared decision-making, which may include carers, are important.

References

52 Essame C, Phelan S, Aggett P, White P. Pilot study of a multidisciplinary inpatient rehabilitation of severely incapacitated patients with chronic fatigue syndrome. J Chronic Fatigue Syndrome 1998, 4: 51-60. (CIV) This is a descriptive outcome study of multidisciplinary inpatient rehabilitation. Intervention might be effective, but the studies carried out have not been well controlled.

53 Cox, Findley L. Severe and very severe patients with chronic fatigue syndrome: perceived outcome following an inpatient programme. J Chronic Fatigue Syndrome 2000, 7: 33-47. (CIV) This is a descriptive outcome study of an inpatient unit. There is a tentative trend towards positive outcomes.

Last edited: 4/2/2004

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