In Reply.—In the October 1988 issue of the Archives, Manu and others1 performed a prospective psychiatric evaluation on patients presenting to their internal medicine outpatient clinic with the chief complaint of chronic fatigue. In their findings, 66 of 100 adult patients were found to have one or more psychiatric disorders; 5 patients had other medical conditions, and chronic fatigue was unexplained in 31 patients. In their review, they noted the relative infrequency of chronic fatigue among general internists and family practitioners. In another reported study of their patient population, 2 6 (4%) of 135 patients fulfilled the criteria for the chronic fatigue syndrome with 91 (67%) of 135 being found to have a primary psychiatric diagnosis, and 7 (5%) of 135 to have a medical diagnosis.
In our rheumatology and allergy/ immunology clinics, the problem of chronic fatigue, with or without other medical diagnoses, is a very common