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2021 | OriginalPaper | Hoofdstuk

4. Moeheid

Auteurs : Prof. dr. H. de Vries, Dr. A. Thijs

Gepubliceerd in: Diagnostiek van alledaagse klachten

Uitgeverij: Bohn Stafleu van Loghum

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Samenvatting

Moeheid is, zowel in de vorm van ‘moe zijn’ als het ‘snel moe worden’, een veelvoorkomende klacht. Ook al blijft het meestal bij een of enkele consulten in de huisartsenpraktijk, de helft van deze patiënten heeft er na een jaar nog of opnieuw last van. De mogelijke oorzaken zijn zeer divers. Depressie is de meest gestelde diagnose. Verder blijft naast een groot aantal somatische, psychische en sociale oorzaken een belangrijk deel onverklaard. In het diagnostisch beleid dient de arts zo veel mogelijk ruimte te geven voor overleg over specifieke hulpvragen van de zijde van de patiënt. Voorgeschiedenis en anamnese leveren de belangrijkste diagnostische informatie op bij moeheid als hoofdklacht. Gezien de lage a-priorikansen op ernstige aandoeningen indien de anamnese geen aanknopingspunten oplevert, is over het algemeen een terughoudende opstelling ten aanzien van laboratoriumonderzoek en specialistische verwijzingen gewettigd. Bij patiënten ouder dan 50 jaar en bij langer dan een maand bestaande klachten kan men overwegen om een volledig lichamelijk onderzoek en een beperkt pakket eenvoudig laboratoriumonderzoek uit te voeren.
Literatuur
1.
go back to reference NANDA. Fatigue. In: MacFarland G, MacFarlane E, (red.). Nursing diagnosis and intervention. 2e druk. St. Lewis: Mosby; 1993. p. 288–92. NANDA. Fatigue. In: MacFarland G, MacFarlane E, (red.). Nursing diagnosis and intervention. 2e druk. St. Lewis: Mosby; 1993. p. 288–92.
2.
go back to reference Kenter EGH, Okkes IM. Prevalentie en behandeling van vermoeide patiënten in de huisartspraktijk; gegevens uit het Transitieproject. Ned Tijdschr Geneeskd. 1999;143:796–1. Kenter EGH, Okkes IM. Prevalentie en behandeling van vermoeide patiënten in de huisartspraktijk; gegevens uit het Transitieproject. Ned Tijdschr Geneeskd. 1999;143:796–1.
3.
go back to reference Hardy SE, Studenski SA. Fatigue predicts mortality in older adults. J Am Geriatr Soc. 2008;56:1910–4. Hardy SE, Studenski SA. Fatigue predicts mortality in older adults. J Am Geriatr Soc. 2008;56:1910–4.
4.
go back to reference Basu N, Yang X, Luben RN, et al. Fatigue is associated with excess mortality in the general population: results from the EPIC-Norfolk study. BMC Med. 2016;14:122. Basu N, Yang X, Luben RN, et al. Fatigue is associated with excess mortality in the general population: results from the EPIC-Norfolk study. BMC Med. 2016;14:122.
5.
go back to reference Sabes-Figuera R, McCrone P, Hurley M, et al. The hidden cost of chronic fatigue to patients and their families. BMC Health Serv Res. 2010;10:56. Sabes-Figuera R, McCrone P, Hurley M, et al. The hidden cost of chronic fatigue to patients and their families. BMC Health Serv Res. 2010;10:56.
6.
go back to reference Pawlikowska T, Chalder T, Hirsch SR, et al. Population based study of fatigue and psychological distress. BMJ. 1994;308:763–6. Pawlikowska T, Chalder T, Hirsch SR, et al. Population based study of fatigue and psychological distress. BMJ. 1994;308:763–6.
7.
go back to reference Bleijenberg G. Attributies en chronische vermoeidheid. Ned Tijdschr Geneeskd. 1997;141:1510–2. Bleijenberg G. Attributies en chronische vermoeidheid. Ned Tijdschr Geneeskd. 1997;141:1510–2.
8.
go back to reference Morrel DC, Wale CJ. Symptoms perceived and recorded by patients. J R Coll Gen Pract. 1976;26:192–9. Morrel DC, Wale CJ. Symptoms perceived and recorded by patients. J R Coll Gen Pract. 1976;26:192–9.
9.
go back to reference David A, Pelosi A, McDonald E, et al. Tired, weak, or in need of rest: fatigue among general practice attenders. BMJ. 1990;301:1199–202. David A, Pelosi A, McDonald E, et al. Tired, weak, or in need of rest: fatigue among general practice attenders. BMJ. 1990;301:1199–202.
10.
go back to reference Van der Windt DA, Dunn KM, Spies-Dorgelo MN, et al. Impact of physical symptoms on perceived health in the community. J Psychosom Res. 2008;64:265–74. Van der Windt DA, Dunn KM, Spies-Dorgelo MN, et al. Impact of physical symptoms on perceived health in the community. J Psychosom Res. 2008;64:265–74.
11.
go back to reference Cardol M, Bensing J, Verhaak P, Bakker D. Fatigue: determinants, course and care [Moeheid: determinanten, beloop en zorg]. Utrecht: Nivel; 2005. Cardol M, Bensing J, Verhaak P, Bakker D. Fatigue: determinants, course and care [Moeheid: determinanten, beloop en zorg]. Utrecht: Nivel; 2005.
13.
go back to reference Nijrolder I, van der Windt DA, van der Horst HE. Prognosis of fatigue and functioning in primary care: a 1-year follow-up study. Ann Fam Med. 2008;6:519–27. Nijrolder I, van der Windt DA, van der Horst HE. Prognosis of fatigue and functioning in primary care: a 1-year follow-up study. Ann Fam Med. 2008;6:519–27.
14.
go back to reference Nijrolder I, Leone SS, Van der Horst HE. Explaining fatigue: an examination of patient causal attributions and their (in)congruence with family doctorsʼ initial causal attributions. Eur J Gen Pract. 2015;1:1–6. Nijrolder I, Leone SS, Van der Horst HE. Explaining fatigue: an examination of patient causal attributions and their (in)congruence with family doctorsʼ initial causal attributions. Eur J Gen Pract. 2015;1:1–6.
15.
go back to reference Ridsdale L, Evans A, Jerrett W, et al. Patients who consult with tiredness: frequency of consultation, perceived causes of tiredness and its association with psychological distress. Br J Gen Pract. 1994;44:413–6. Ridsdale L, Evans A, Jerrett W, et al. Patients who consult with tiredness: frequency of consultation, perceived causes of tiredness and its association with psychological distress. Br J Gen Pract. 1994;44:413–6.
16.
go back to reference Kirk J, Douglas R, Nelson E, et al. Chief complaint of fatigue: a prospective study. J Fam Pract. 1990;30:33–41. Kirk J, Douglas R, Nelson E, et al. Chief complaint of fatigue: a prospective study. J Fam Pract. 1990;30:33–41.
17.
go back to reference Matthews DA, Manu P, Lane TJDA. Evaluation and management of patients with chronic fatigue. Am J Med Sci. 1991;302:269–77. Matthews DA, Manu P, Lane TJDA. Evaluation and management of patients with chronic fatigue. Am J Med Sci. 1991;302:269–77.
18.
go back to reference Zaat JOM, de Haan M, Claessen FAP. Huisarts en moeheid. Maarssen: Elsevier; 1998. Zaat JOM, de Haan M, Claessen FAP. Huisarts en moeheid. Maarssen: Elsevier; 1998.
19.
go back to reference Ruffin MT, Cohen M. Evaluation and management of fatigue. Review. Am Fam Physician. 1994;50:625–34. Ruffin MT, Cohen M. Evaluation and management of fatigue. Review. Am Fam Physician. 1994;50:625–34.
20.
go back to reference Bally K, Zeller A. Praxis. Müdigkeit – ein häufiges Symptom in der Hausarztpraxis. Praxis. 2019;108:793-8. Bally K, Zeller A. Praxis. Müdigkeit – ein häufiges Symptom in der Hausarztpraxis. Praxis. 2019;108:793-8.
22.
go back to reference Solberg LI. Lassitude. A primary care evaluation. JAMA. 1984;251:3273–6. Solberg LI. Lassitude. A primary care evaluation. JAMA. 1984;251:3273–6.
23.
go back to reference Seller RH, Symons AB. Differential diagnosis of common complaints, 6e druk. Philadelphia, PA: Saunders; 2012. Seller RH, Symons AB. Differential diagnosis of common complaints, 6e druk. Philadelphia, PA: Saunders; 2012.
24.
go back to reference Knottnerus JA, Starmans R, Vissers A. Diagnostische conclusies van de huisarts naar aanleiding van onverklaarde moeheid. Huisarts Wet. 1987;30:9–12. Knottnerus JA, Starmans R, Vissers A. Diagnostische conclusies van de huisarts naar aanleiding van onverklaarde moeheid. Huisarts Wet. 1987;30:9–12.
25.
go back to reference Fosnocht KM, Ende JE. Approach to the adult patient with fatigue. Uptodate www.uptodate.com, laatste update April 2-19, geraadpleegd 27 augustus 2020. Fosnocht KM, Ende JE. Approach to the adult patient with fatigue. Uptodate www.​uptodate.​com, laatste update April 2-19, geraadpleegd 27 augustus 2020.
26.
go back to reference Hjelm M, Wadman B. Clinical symptoms, haemoglobin concentrations and erythrocyte biochemistry. Clin Haematol. 1974;3:689–703. Hjelm M, Wadman B. Clinical symptoms, haemoglobin concentrations and erythrocyte biochemistry. Clin Haematol. 1974;3:689–703.
27.
go back to reference Verdon F, Burnand B, Stubi CL, et al. Iron supplementation for unexplained fatigue in non-anaemic women: double blind randomised placebo controlled trial. BMJ. 2003;326(7399):1124. Verdon F, Burnand B, Stubi CL, et al. Iron supplementation for unexplained fatigue in non-anaemic women: double blind randomised placebo controlled trial. BMJ. 2003;326(7399):1124.
28.
go back to reference Roy S, Sherman A, Monari-Sparks MJ, et al. Correction of low vitamin D improves fatigue: effect of correction of low vitamin D in fatigue study (EViDiF study). N Am J Med Sci. 2014;6:396–402. Roy S, Sherman A, Monari-Sparks MJ, et al. Correction of low vitamin D improves fatigue: effect of correction of low vitamin D in fatigue study (EViDiF study). N Am J Med Sci. 2014;6:396–402.
29.
go back to reference Rebekka Stadje R, Dornieden K, Baum E, et al. The differential diagnosis of tiredness: a systematic review. BMC Fam Pract. 2016;17:147. Rebekka Stadje R, Dornieden K, Baum E, et al. The differential diagnosis of tiredness: a systematic review. BMC Fam Pract. 2016;17:147.
30.
go back to reference Wessely S, Chalder T, Hirsch S, et al. Psychological symptoms, somatic symptoms, and psychiatric disorder in chronic fatigue and chronic fatigue syndrome: a prospective study in the primary care setting. Am J Psychiatry. 1996;153:1050. Wessely S, Chalder T, Hirsch S, et al. Psychological symptoms, somatic symptoms, and psychiatric disorder in chronic fatigue and chronic fatigue syndrome: a prospective study in the primary care setting. Am J Psychiatry. 1996;153:1050.
32.
go back to reference Koch H, van Bokhoven MA, ter Riet G, et al. What makes general practitioners order blood tests for patients with unexplained complaints? A cross-sectional study. Eur J Gen Pract. 2008;15:22–8. Koch H, van Bokhoven MA, ter Riet G, et al. What makes general practitioners order blood tests for patients with unexplained complaints? A cross-sectional study. Eur J Gen Pract. 2008;15:22–8.
33.
go back to reference Skapinakis P, Lewis G, Mavreas V. Temporal relations between unexplained fatigue and depression: longitudinal data from an international study in primary care. Psychosom Med. 2004;66:330–5. Skapinakis P, Lewis G, Mavreas V. Temporal relations between unexplained fatigue and depression: longitudinal data from an international study in primary care. Psychosom Med. 2004;66:330–5.
34.
go back to reference IOM (Institute of Medicine). Beyond myalgic encephalomyelitis/chronic fatigue syndrome: redefining an illness. Washington, DC: The National Academies Press; 2015. www.iom.edu/mecfs. IOM (Institute of Medicine). Beyond myalgic encephalomyelitis/chronic fatigue syndrome: redefining an illness. Washington, DC: The National Academies Press; 2015. www.​iom.​edu/​mecfs.
36.
go back to reference Nijrolder I, van der Windt D, de Vries H, van der Horst HE. Diagnoses during follow-up of patients presenting with fatigue in primary care. CMAJ. 2009;181:683–6. Nijrolder I, van der Windt D, de Vries H, van der Horst HE. Diagnoses during follow-up of patients presenting with fatigue in primary care. CMAJ. 2009;181:683–6.
37.
go back to reference Sugarman JR, Berg AO. Evaluation of fatigue in a family practice. J Fam Pract. 1984;19:643–7. Sugarman JR, Berg AO. Evaluation of fatigue in a family practice. J Fam Pract. 1984;19:643–7.
38.
go back to reference Kroenke K, Wood DR, Mangelsdorff D, et al. Chronic fatigue in primary care. Prevalence, patient characteristics and outcome. JAMA. 1988;260:929–34. Kroenke K, Wood DR, Mangelsdorff D, et al. Chronic fatigue in primary care. Prevalence, patient characteristics and outcome. JAMA. 1988;260:929–34.
39.
go back to reference Valdini A, Steinhardt S, Feldman E. Usefulness of a standard battery of laboratory tests in investigating chronic fatigue in adults. Fam Pract. 1989;6:286–91. Valdini A, Steinhardt S, Feldman E. Usefulness of a standard battery of laboratory tests in investigating chronic fatigue in adults. Fam Pract. 1989;6:286–91.
40.
go back to reference Lane TJ, Matthews DA, Manu P. The low yield of physical examinations and laboratory investigations of patients with chronic fatigue. Am J Med Sci. 1990;299:313–8. Lane TJ, Matthews DA, Manu P. The low yield of physical examinations and laboratory investigations of patients with chronic fatigue. Am J Med Sci. 1990;299:313–8.
41.
go back to reference van Weert HCPM, Grundmeijer HGLM. Vage klachten in de huisartspraktijk: epidemiologie en beleid. Bijblijven. 1993;9:38–42. van Weert HCPM, Grundmeijer HGLM. Vage klachten in de huisartspraktijk: epidemiologie en beleid. Bijblijven. 1993;9:38–42.
42.
go back to reference Bazelmans E, Vercoulen JHMM, Swanink CMA, et al. Chronic fatigue syndrome and primary fibromyalgia syndrome as recognized by GP’s. Fam Pract. 1999;16:602–4. Bazelmans E, Vercoulen JHMM, Swanink CMA, et al. Chronic fatigue syndrome and primary fibromyalgia syndrome as recognized by GP’s. Fam Pract. 1999;16:602–4.
43.
go back to reference Maaijwee NA, Arntz RM, Rutten-Jacobs LC, et al. Post-stroke fatigue and its association with poor functional outcome after stroke in young adults. J Neurol Neurosurg Psychiatry. 2015;86:1120–6. Maaijwee NA, Arntz RM, Rutten-Jacobs LC, et al. Post-stroke fatigue and its association with poor functional outcome after stroke in young adults. J Neurol Neurosurg Psychiatry. 2015;86:1120–6.
44.
go back to reference Oerlemans S, Mols F, Issa DE, et al. A high level of fatigue among long-term survivors of non-Hodgkin’s lymphoma: results from the longitudinal population-based PROFILES registry in the south of the Netherlands. Haematologica. 2013;98:479–86. Oerlemans S, Mols F, Issa DE, et al. A high level of fatigue among long-term survivors of non-Hodgkin’s lymphoma: results from the longitudinal population-based PROFILES registry in the south of the Netherlands. Haematologica. 2013;98:479–86.
45.
go back to reference Wessely S, Chalder T, Hirsch S, et al. Postinfectious fatigue: a prospective cohort study in primary care. Lancet. 1995;345:1333–8. Wessely S, Chalder T, Hirsch S, et al. Postinfectious fatigue: a prospective cohort study in primary care. Lancet. 1995;345:1333–8.
46.
go back to reference Kapsenberg JG. Moe van de virussen. Ned Tijdschr Geneeskd. 1988;132:997–9. Kapsenberg JG. Moe van de virussen. Ned Tijdschr Geneeskd. 1988;132:997–9.
47.
go back to reference White PD, Thomas JM, Amess J, et al. Incidence, risk and prognosis of acute and chronic fatigue syndromes and psychiatric disorders after glandular fever. Br J Psychiatry. 1998;173:475–81. White PD, Thomas JM, Amess J, et al. Incidence, risk and prognosis of acute and chronic fatigue syndromes and psychiatric disorders after glandular fever. Br J Psychiatry. 1998;173:475–81.
48.
go back to reference Van Esch S, de Vries H, van de Kreeke J. Recepten voor een goed gesprek. Amsterdam: SMPVU; 2015. Van Esch S, de Vries H, van de Kreeke J. Recepten voor een goed gesprek. Amsterdam: SMPVU; 2015.
49.
go back to reference Alberts M, Smets EMA, Vercoulen JHMM, et al. Verkorte moeheidsvragenlijst: een praktisch hulpmiddel bij het scoren van vermoeidheid. Ned Tijdschr Geneeskd. 1997;141:1526–30. Alberts M, Smets EMA, Vercoulen JHMM, et al. Verkorte moeheidsvragenlijst: een praktisch hulpmiddel bij het scoren van vermoeidheid. Ned Tijdschr Geneeskd. 1997;141:1526–30.
50.
go back to reference Tiesinga LJ. Fatigue and exertion fatigue. From description through validation to application of the Dutch Fatigue Scale (DUFS) and the Dutch Exertion Fatigue Scale (DEFS) [dissertatie]. Groningen: Rijksuniversiteit Groningen; 1999. Tiesinga LJ. Fatigue and exertion fatigue. From description through validation to application of the Dutch Fatigue Scale (DUFS) and the Dutch Exertion Fatigue Scale (DEFS) [dissertatie]. Groningen: Rijksuniversiteit Groningen; 1999.
51.
go back to reference Grundmeijer HGLM, Rutten GEHM, Damoiseaux RAMJ. Het geneeskundig proces. Klinisch redeneren van klacht naar therapie. 5e druk. Amsterdam: Reed Bussiness; 2014. Grundmeijer HGLM, Rutten GEHM, Damoiseaux RAMJ. Het geneeskundig proces. Klinisch redeneren van klacht naar therapie. 5e druk. Amsterdam: Reed Bussiness; 2014.
52.
go back to reference Eulderink F, Heeren TJ, Knook DL, Ligthart GJ. Inleiding gerontologie en geriatrie. 4e druk. Houten: Bohn Stafleu van Loghum; 2004. Eulderink F, Heeren TJ, Knook DL, Ligthart GJ. Inleiding gerontologie en geriatrie. 4e druk. Houten: Bohn Stafleu van Loghum; 2004.
53.
go back to reference Harrison M. Pathology testing in the tired patient a rational approach. Aust Fam Physician. 2008;37:908–10. Harrison M. Pathology testing in the tired patient a rational approach. Aust Fam Physician. 2008;37:908–10.
54.
go back to reference Ridsdale L, Evans A, Jerrett W, et al. Patients with fatigue in general practice: a prospective study. BMJ. 1993;307:103–6. Ridsdale L, Evans A, Jerrett W, et al. Patients with fatigue in general practice: a prospective study. BMJ. 1993;307:103–6.
55.
go back to reference Gialamas A, Beilby JJ, Pratt NL, et al. Investigating tiredness in Australian general practice. Do pathology tests help in diagnosis? Aust Fam Physician. 2003;32:663–6. Gialamas A, Beilby JJ, Pratt NL, et al. Investigating tiredness in Australian general practice. Do pathology tests help in diagnosis? Aust Fam Physician. 2003;32:663–6.
56.
go back to reference Koch H, van Bokhoven A, ter Riet G, et al. Ordering blood tests for patients with unexplained fatigue in general practice: what does it yield? Results of the VAMPIRE trial. Br J Gen Pract. 2009;59:93–100. Koch H, van Bokhoven A, ter Riet G, et al. Ordering blood tests for patients with unexplained fatigue in general practice: what does it yield? Results of the VAMPIRE trial. Br J Gen Pract. 2009;59:93–100.
58.
go back to reference Zaat JOM, Schellevis FG, Kluijt I, et al. Laboratoriumonderzoek bij de klacht moeheid in de huisartspraktijk. Huisarts Wet. 1992;35:183–7. Zaat JOM, Schellevis FG, Kluijt I, et al. Laboratoriumonderzoek bij de klacht moeheid in de huisartspraktijk. Huisarts Wet. 1992;35:183–7.
59.
go back to reference Van der Meer JWM, Rijken PM, Bleijenberg G, et al. Aanwijzingen voor het beleid bij langdurige lichamelijk onverklaarde moeheidsklachten. Ned Tijdschr Geneeskd. 1997;141:1516–9. Van der Meer JWM, Rijken PM, Bleijenberg G, et al. Aanwijzingen voor het beleid bij langdurige lichamelijk onverklaarde moeheidsklachten. Ned Tijdschr Geneeskd. 1997;141:1516–9.
60.
go back to reference Jurado RL. Why shouldn’t we determine the erythrocyte sedimentation rate? Clin Infect Dis. 2001;33:548–9. Jurado RL. Why shouldn’t we determine the erythrocyte sedimentation rate? Clin Infect Dis. 2001;33:548–9.
61.
go back to reference Dinant GJ, Knottnerus JA, van Wersch JWJ. Het onderscheidend vermogen van de BSE-bepaling in de dagelijkse praktijk. Huisarts Wet. 1992;35:197–224. Dinant GJ, Knottnerus JA, van Wersch JWJ. Het onderscheidend vermogen van de BSE-bepaling in de dagelijkse praktijk. Huisarts Wet. 1992;35:197–224.
62.
go back to reference Houben PHH, van der Weijden T, Winkens RAG, Grol RPTM. Cascade effects of laboratory testing are found to be rare in low disease probability situations: prospective cohort study. J Clin Epidemiol. 2010;63:452–8. Houben PHH, van der Weijden T, Winkens RAG, Grol RPTM. Cascade effects of laboratory testing are found to be rare in low disease probability situations: prospective cohort study. J Clin Epidemiol. 2010;63:452–8.
Metagegevens
Titel
Moeheid
Auteurs
Prof. dr. H. de Vries
Dr. A. Thijs
Copyright
2021
Uitgeverij
Bohn Stafleu van Loghum
DOI
https://doi.org/10.1007/978-90-368-2620-4_4