Psychological

Some doctors fear that probing emotional illness will precipitate emotional distress. It is, however, an ideal opportunity to relieve anxiety.

Explain to the patient that lassitude and tiredness can result from physical (e.g. - infection, cardiac failure) or affective problems (e.g. - depression) (1). Describe what symptoms go with which diagnoses and ask the patient's assessment of the probabilities. This allows the patient to start thinking about the things that are bothering them - patients often think their tiredness is due to infection, often without good reason.

Complaining of tiredness may be to the patient's advantage, resulting in some sort of psychological gain, allowing them they may be able to avoid unpleasant tasks or tasks they aren't good at.

Some examples of psychological causes are:

• chronic stress
• depression
• anxiety state
• obsessive compulsive disorder
• insomnia (2)

Reference:

• 1. Murtagh J. Fatigue - a general diagnostic approach. Australian Family Physician 2003;32(11)
• 2. Simon C. Tiredness, fatigue and lethargy. InnovAiT 2008 1(3):199-205