Postviral fatigue syndrome and psychiatry.

The postviral fatigue syndrome overlaps with psychiatry at a number of points. First, there is the influence that some psychological states have on physiological processes, such as immunity. Second, psychological symptoms, particularly depression but also anxiety, are a major feature of the syndrome. Third, difficulties in the doctor-patient relationship are common. Each of these three areas are discussed in detail. Special attention is given to the possible mechanisms underlying the occurrence of psychological symptoms, which are sufficient to make a psychiatric diagnosis in at least two thirds of cases. It is concluded that the bulk of the scientific evidence points to psychiatric disturbances being primary but that this does not account for the syndrome in its entirety and other mechanisms probably operate as well. Much of the conflict between doctor and patient arises from misconceptions about the nature and cause of psychological disturbances.