The mechanism by which the stress is associated with
a higher prevalence of severe fatigue in medical students
remains to be determined. At present, stress-associated
neural,34 immune-cytokine,35 and hormonal36 changes are
thought to be related to the pathophysiology of CFS. Therefore,
a plausible mechanism by which stress causes severe
fatigue may be, at least in part, based on stress-associated
neural, immune, and hormonal perturbations in medical
students.