To the Editor.—Manu and colleagues1 present interesting data in their study of patients presenting with a chief complaint of chronic fatigue. Of 100 patients with this complaint, they concluded that a psychiatric disorder was a major cause of the fatigue in 66%. In 5 patients the chronic fatigue was related to a medical condition, and in 31 it remained idiopathic. In the multicenter study of 2234 patients presenting with a complaint of excessive somnolence conducted by Coleman et al,2 fewer than 5% were felt to be due to psychiatric disease after a sleep disorders center evaluation. Admit(Continued on p 1118.) (Continued from p 1116.) tedly, chronic fatigue and excessive somnolence are not one and the same. Since patients often have trouble making the subtle distinction between fatigue and sleepiness, 3 it is likely that these studies did evaluate similar patients.
This remarkable disparity in percentage of cases attributed to