Neurasthenia: tracing the journey of a protean malady.

Neuresthenia has had its popularity waxing and waning over the years. This review article traces the path and trajectory of the concept of this disorder, how it changed and varied over time, to the current times, when it has been almost forgotten and the concept is heading towards oblivion. Although its place in the diagnostic systems is currently in question, neurasthenia is still part of professional conversations and practice. The concept of neurasthenia emerged at the intersections of clinical, cultural and sociological dimensions of society. A deeper examination of how neurasthenia was situated at the intersections of race, class and gender exemplifies how psychiatric diagnoses may reflect and shape societal biases. The neurasthenia label has all but disappeared from contemporary nosological frameworks, however, there is a proliferation of other disorders, e.g. chronic fatigue syndrome, fibromyalgia, that try to capture the experience of fatigue, pain, weakness, and distress even in the absence of clear-cut medical aetiologies. Only time will tell, if this concept has indeed been buried, or will rise as a phoenix in the years to come. Newer nervous fatigue syndromes are expected to emerge from the use of technology, screen time and the virtual world.

Culture, science and the changing nature of fibromyalgia.

Fibromyalgia is a common but contested illness. Its definition and content have changed repeatedly in the 110 years of its existence. The most important change was the requirement for multiple tender points and extensive pain that arose in the 1980s, features that were not required previously. By 2010, a second shift occurred that excluded tender points, allowed less extensive pain, and placed reliance on patient-reported somatic symptoms and cognitive difficulties ('fibro fog') that had never been part of past definitions or content. Fibromyalgia is closely allied with and often indistinguishable from neurasthenia, a disorder of the late 19th and early 20th centuries that lost favour when it was perceived as being a psychological illness. Fibromyalgia's status as a 'real disease', rather than a psychocultural illness, is buttressed by social forces that include support from official criteria, patient and professional organizations, pharmaceutical companies, disability access, and the legal and academic communities.

[Fatigue syndromes--an overview of terminology, definitions and classificatory concepts]. / Erschöpfungssyndrome--Eine Diskussion verschiedener Begriffe, Definitionsansätze und klassifikatorischer Konzepte.

This article aims at giving a general view of fatigue syndromes, their description, and their differentiation. The syndromes neurasthenia, chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME), and burnout are discussed. First, the historical background of fatigue classification is shortly reviewed. Each syndrome is introduced in terms of definition and classification as well as differentiation from each other. The article discusses the differentiation of the syndromes from each other as well as differentiation of CFS/ME and burnout from depression. We conclude that it is difficult to differentiate criteria due to insufficient empirical evidence. More research is needed concerning integration of the diagnoses in classification systems as well as differentiation between syndromes. High comorbidity of depression with CFS and Burnout can be shown, but diagnoses also comprise distinct symptoms.

[Visualisation methods for etheric formative forces]. / Die "bildschaffenden" Methoden der anthroposophischen Medizin (I). Eine kritische Analyse.

UNLABELLED: Rudolf Steiner, the founder of anthroposophy, suggested the development of visualisation methods for "etheric formative forces". The essential methods, their "spiritual scientific" basis and indications are described and their claims critically tested. SUMMARY: The methods are not validated, the key criteria for diagnostic tests (reproducibility, sensitivity, specifity) are not given.

Psychosocial and immunological factors in neurasthenia.

BACKGROUND: Neurasthenia is a disorder whose pathogenesis is still unknown. OBJECTIVE: The authors sought to examine the relationships between neurasthenia and possible psychosocial and immunological correlates. METHOD: A sample of 30 Chinese neurasthenic patients was compared with a matched sample of 30 control subjects for 1) the level of serum Epstein-Barr virus (EBV) gamma G immunoglobulin (IgG) and gamma M immunoglobulin (IgM); 2) scores on the Eysenck Personality Questionnaire (EPQ); 3) the Symptom Checklist-90; and 4) the Life Event Scale (LES); 27 of the 30 neurasthenia patients were treated with medication and psychotherapy for a 4-month period, with measures taken pre- and posttreatment. RESULTS: As compared with the control group, neurasthenic patients exhibited higher EPQ scores for neuroticism, higher levels of introversion, and a higher number of negative life events. Within the neurasthenia sample, scores for neuroticism and the SCL-90 Global Severity Index were significantly lower at follow-up than at baseline. CONCLUSION: As compared with control subjects, neurasthenia patients were characterized by greater neuroticism and introversion, and they reported a higher rate of negative life events. Moreover, the positive rate of EBV in neurasthenic patients was higher, which may be associated with higher EBV activation under states of stress.

How symptom manifestations affect help seeking for mental health problems among Chinese Americans.

This study aims to examine how help-seeking behaviors of Chinese Americans are associated with the types of mental disorder, the tendency to somatize symptoms, social disruptiveness of symptoms, and comorbidity. Based on data from the Chinese American Psychiatric Epidemiological Study, we examined 246 Chinese Americans with a diagnosable major depressive disorder, anxiety disorder, or somatoform disorder, using hierarchical logistic regression analyses. Compared with respondents with somatoform disorder, those with anxiety or depressive disorder were 94% and 87% less likely to seek professional help. The tendency to somatize distress is positively related to soliciting help, especially medical help. Social disruptiveness had a very potent positive association with help seeking whereas comorbidity is nonsignificant when the symptom severity is controlled. The overall picture indicates that somatic expression of distress is a major impetus to help seeking, which happens to concur with the cultural conceptualization and subjective embodied experience of mental disorders among Chinese.

[Diagnostic categories and gender: two examples in contemporary Spanish medicine, chlorosis and neurasthenia (1877-1936)]. / Categorías diagnósticas y género: los ejemplos de la clorosis y la neurastenia en la medicina española contemporánea (1877-1936).

Chlorosis and Neurasthenia are two classical examples of pathological dissociations and the difficulties involved in approaching their diagnosis using scientific-naturalistic criteria. In the realm of those difficulties, the study examines the androcentric viewpoint and the ideological perspective of Contemporary Spanish Medicine when addressing the feminine nature and women's pathologies. Moreover, based on the similarities with present-day pain and fatigue syndromes, the study underlines the need to review the clinical approach to these illnesses by attempting to overcome the existing biomedical limitations.

[History of chronic fatigue syndrome].

Chronic fatigue syndrome (CFS) is not a new disease. Similar morbidities have been known as different names since past several centuries. For example, neurasthenia, epidemic neuromyasthenia, myalgic encephalomyelitis, Akureyri disease, Royal Free disease, chronic EBV disease, post-viral fatigue syndrome etc. Much of the recent interest in CFS was generated by incidence of infection-like outbreak at Lake Tahoe in Nevada. The Center for Disease Control (USA) realized that correlation was poor between those patients who had virologic evidence of EBV infection and those who had the symptoms of chronic fatigue. This is a review of the history of CFS. (1) Historical perspectives in chronic fatigue cases in past old period, (2) Post-viral infectious fatigue and chronic fatigue (myalgic encephalomyelitis), (3) Recent trend of CFS studies and its clinical similar situation. Finally, I would like to state that we intend to draw up a new diagnostic guideline for CFS in Japan.

Diagnostic concordance of neurasthenia spectrum disorders in Pune, India.

BACKGROUND: Clinically significant fatigue or weakness is a common but understudied clinical problem in India. The applicability and relevance of Western clinical criteria in this setting are not studied. Alternative criteria sets used in different clinical contexts suggest a range of conditions constituting neurasthenia spectrum disorders (NSDs). We therefore aimed to determine frequency of patients with these complaints in four specialty outpatient clinics of an urban general hospital. We compared the concordance of four diagnostic criteria sets of fatigue disorders among the same patients. METHODS: Patients from the clinics of Psychiatry, Medicine, Dermatology, and Ayurved were screened for clinically significant fatigue or weakness and assessed for CFS, ICD-10 neurasthenia, DSM-IV draft criteria for neurasthenia, and CCMD-2 neurasthenia. RESULTS: For 352 patients, sensitivity of CDC criteria for CFS (13.4%) was poorest. CFS was most frequent in the Medicine clinic. CCMD-2 criteria were the most frequently met (77.6%) with no significant difference across clinics. Two-way concordance of neurasthenia categories was no better than fair (< or =0.4) and few patients (8.0%) met criteria for all four categories. DISCUSSION: Four NSD criteria sets identified different clinical subgroups. CFS, considering fatigue and ignoring weakness, was least relevant for identifying NSD patients in these clinics. Poor concordance among the four diagnostic systems studied indicates the need for reviewing the nosology of these disorders. Focus on clinical significance alone is likely to avoid the discordant confusion arising from cross-cultural differences.

[Chronic fatigue syndrome--a functional somatic syndrome]. / Chronisches Erschöpfungssyndrom--eine funktionelle Störung.

Chronic fatigue can be categorized as a functional somatic syndrome (fss), because there are findings of typical preconditions, trigger mechanisms and maintaining conditions. With relevance for therapy it makes sense to see it as an medical-psychiatric interface-disorder Subsyndromal short episodes of chronic fatigue are many more frequent as three or six month during clearly diagnosed episodes of "neurasthenia" or "chronic fatigue syndrome". Their descriptions are very similar and obvious those means the same matter. For original aetiological assumptions it wasn't any evidence. But there are findings of charcteristical patterns of changed neurhumeral and immunological interactions for the chronic fatigue syndrome, common for fss. Especially changes of HPA-Axis and its interactions with other systems of functional regulation. Another importent fact are increased senzitation in neuronal and neurocognitive regulation. Increased critical appraisal of somatic funtions and dysfunctional coping strategies are maintaining factors at least. Patterns of dysfuntional coping are not a problem of patients alone. There are also experiences, that some doctors shows the same dysfunctional somatizing management of fss in general and especially for chronic fatigue. In fact, a single and specific cause of chronic fatigue doesn't exist. But the above-mentioned facts allows a starting point for a more successful treatment. There are reviews that shows a good evidence for therapeutic procedures wich are calling for acticvity by patients, such cognitive behavioral therapy and graduated activation. Antidepressants, especialy SSRI, are helpful with a small evidence. They can be used to increase treatment effects. There is no evidence for therapies without patients activation.

Dimensions of fatigue in systemic lupus erythematosus: relationship to disease status and behavioral and psychosocial factors.

OBJECTIVE: To characterize the experience of fatigue in patients with systemic lupus erythematosus (SLE) using a multidimensional assessment and to delineate contributors to physical and mental dimensions of fatigue. METHODS: Fatigue in 130 women with SLE was assessed using the Multidimensional Fatigue Inventory (MFI-20). Participants completed standardized questionnaires assessing sleep quality, depressed mood, social support, and leisure-time physical activity. A clinical examination determined disease activity, cumulative damage, and whether patients fulfilled American College of Rheumatology criteria for fibromyalgia (FM). A series of hierarchical multiple regressions were computed to identify contributors to physical and mental fatigue. RESULTS: Patients scored high on all 5 MFI-20 fatigue dimensions, with general fatigue and physical fatigue having the highest scores. A hierarchical multiple regression showed that greater disease damage and disease activity, the presence of FM, depressed mood, sleep disturbance, and less participation in leisure-time physical activity contributed to higher physical fatigue scores. The results of the second model found depressed mood to be the strongest determinant of mental fatigue. Disease-related variables were not associated with mental fatigue. CONCLUSION: Fatigue in SLE is multidimensional and multidetermined, with physical and mental aspects likely having different etiologies. A multidimensional assessment of fatigue in SLE is needed to tailor and optimize interventions aimed at alleviating fatigue.

Neurasthenia, subjective health complaints and sensitization.

Patients (n=997) visiting general practitioners in an area in Western Norway completed a battery of questionnaires related to subjective health complaints and fatigue. An additional 78 patients were referred directly to the hospital for neurasthenia. After screening the questionnaires and interviews with a selected sample, a total of 73 patients were finally accepted as 'neurasthenia' patients satisfying the ICD-10 diagnosis. These patients were compared with the remaining 1002 patients. Patients with neurasthenia had more prevalent and more severe subjective health complaints, particularly pseudoneurological and musculoskeletal complaints than the reference population of patients. They reported low levels of instrumental coping and poorer physical fitness, in spite of a comparable level of self reported physical activity and exercise. Women were over-represented in this group. This overall higher score on subjective complaints from all organ systems is in accordance with the hypothesis of an overall and general sensitization to the afferent inputs from their psychophysiological systems.

[On the history of the concept neurasthenia and its modern variants chronic-fatigue-syndrome, fibromyalgia and multiple chemical sensitivities]. / Zur Geschichte des Neurastheniekonzeptes und seiner modernen Varianten Chronic-Fatigue-Syndrom, Fibromyalgie sowie Multiple Chemische Sensitivität.

This article deals with the history of the terminological and nosological development of the concept neurasthenia introduced in 1869 by George Miller Beard and in particular with its reappearance in western medicine in the 1980 s. Beginning with its predecessors in antiquity and continuing with hypochondria, which became a fashionable disease in the 18 th century, the concept neurasthenia reached a high point and world-wide medical acceptance at the end of the 19 th/beginning of the 20 th century. However, between the 1930 s and 1960 s it declined in popularity and gradually disappeared until finally it only had a rudimentary nosological role in the term "pseudoneurasthenia". In the countries of the Far East, on the contrary, the concept of neurasthenia has been in continual use since its importation in the first decades of the last century. In the 1980 s, when an interest in the symptoms of chronic fatigue was reawakened in western medicine, the concept neurasthenia reappeared, this time to define the particular form of a neurotic disorder. Parallel to these developments increasing importance was attached to clinical descriptions of illnesses which on account of their similarity to the symptoms of neurasthenia could be termed modern variants of the concept neurasthenia. These are "Chronic-Fatigue-Syndrome", "Fibromyalgia" and "Multiple Chemical Sensitivities" which have more or less adopted the organic inheritance of Beard's former concept of neurasthenia, despite the fact that so far the question of organicity could not be decisively answered in a single case. In order to clarify possible influences on the development of the concept neurasthenia and its variants, the theories and ideas of E. Shorter, medical historian at the University of Toronto, are discussed in the final part of the article, whereby the particular cultural background in each case has a decisive influence on the manifestation of the psychosomatic symptoms.

[Atypical depression and related illnesses--neurobiological principles for their treatment with Hypericum extract]. / Die atypische Depression und verwandte Erkrankungen-Neurobiologische Grundlagen für ihre Behandlung mit Johanniskraut-Extrakt.

Atypical depression, somatoform disorder, neurasthenia and fibromyalgia seem to form a spectrum of disorders, who share a common biological basis, i.e. a reduced activity of the hypothalamus-pituitary-adrenocortical (HPA)-system. This is similar to the situation in Cushing's disease, where the central part of the hypothalamus-pituitary-adrenocortical-system is decreased by an increased feedback via increased intracerebral cortisol concentration. Cushing's disease is accompanied by features of atypical depression and of somatisation. Treatment with hypericum seems to disinhibit the hypothalamus-pituitary-adrenocortical-system in healthy subjects and patients with a depression. Furthermore it decreases intracerebral corticosteroids, possibly by increasing the expression of p-glycoprotein at the blood brain barrier. Therefore hypericum might be especially effective in patients with a symptom cluster of atypical depressive features and somatisation. Clinical studies with patients with depression with atypical features like the seasonal affective disorder (SAD) and with patients with a depressive syndrome accompanied by somatic complaints or fatigue support this view.

Platelet alpha2-adrenoceptor density in humans: relationships to stress-induced anxiety, psychasthenic constitution, gender and stress-induced changes in the inflammatory response system.

BACKGROUND: This study examined the effects of psychological stress on platelet alpha2-adrenergic receptor (alpha2-AR) binding sites in relation to stress-induced anxiety and changes in the inflammatory response system (IRS). METHODS: The maximum number of binding sites (Bmax) and their affinity (Kd) for [3H]rauwolscine, a selective alpha2-AR antagonist, and the stimulated production of tumor necrosis factor-alpha (TNFalpha), the Th1-like cytokine, interferon-gamma (IFNgamma), and the Th2-like cytokines, interleukin-10 (IL-10) and IL-5, were measured in 35 university students a few weeks before (baseline) as well as on the day before a difficult, oral examination (stress condition). The State-Trait-Anxiety Inventory (STAI) was recorded during both conditions. The Minnesota Multiphase Personality Inventory (MMPI-2) was used to assess psychasthenia (Scale 7). RESULTS: Academic examination stress induced a significant increase in alpha2-AR density in students whose STAI scores increased in the stress period, in female students and in students who scored higher on psychasthenia. There were significant and positive correlations between stress-induced anxiety and changes in alpha2-AR density. Stress-induced anxiety was accompanied by a pro-inflammatory and Th1-like response, i.e. increased IFNgamma and TNFalpha production. The stress-induced changes in platelet alpha2-AR density were significantly and positively related to the production of TNFalpha, IL-10 and IL-5 and negatively to that of IFNgamma. CONCLUSIONS: Subchronic psychological stress in humans induces increased alpha2-AR density, which is related to stress-induced anxiety, an anxiety-prone constitution and female sex. Increased alpha2-AR density is accompanied by a Th2-like response and increased TNFalpha production. The results suggest that: (i) alpha2-AR density is sensitive to graded differences in stress-induced anxiety; and (ii) psychological stress is accompanied by intertwined responses in the catecholaminergic system, such as alpha2-ARs, and the IRS, such as Th1/Th2-like functions and the production of TNFalpha.

[Diagnosis of depressive disorder and so-called exhaustion depression. Self-esteem--a central concept]. / Diagnostik av egentlig depression och så kallad utmattningsdepression. Självaktning--ett centralt begrepp.

Depressive disorders can be recognized by the loss of self-esteem; this contrasts with mourning and neurasthenic reactions, in which self-esteem remains intact. Just as depression can result from the gradual reduction and eventual loss of self-esteem, mourning and neurasthenic reactions can evolve into true depressive states. "Exhaustion depression", a new diagnostic category connected to "burnout" situations, should be applied only when criteria for depressive disorder are fulfilled, including loss of self-esteem. When these criteria are lacking we should refer only to an exhaustion state provoked by stress. Neurotic mechanisms may represent a special class of relevant stress factors, but are not seen in manifest neurasthenic reactions and exhaustion depression.

[Complaints as reflection of psychic status in patients with duodenal ulcer exacerbation]. / Zhaloby kak otrazhenie psikhicheskogo statusa bol'nykh pri retsidive iazvennoi bolezni dvenadtsatiperstnoi kishki.

AIM: Study of relationship between leading complaints of patients with duodenal ulcer (DU) exacerbation and their psychic status, attitude to the disease and quality of life. MATERIALS AND METHODS: Psychological questionnaire surgery enrolled 94 males with endoscopically revified uncomplicated recurrence of DU. RESULTS: Patients complaining of dull epigastric pains only demonstrated minimal psychological changes. Their attitude to the disease is primarily ergopathic, sensitive and anosognosic. Nausea and vomiting complains come along with neurotization, maladaptation (anxiety, neurasthenia, egocentric attitude) and deterioration of quality of life. CONCLUSION: Patients with nausea and vomiting complaints need correction of psychic status to achieve psychological compensation in remission of DU.

The genetic aetiology of somatic distress.

BACKGROUND: Somatoform disorders such as neurasthenia and chronic fatigue syndrome are characterized by a combination of prolonged mental and physical fatigue. This study aimed to investigate the heritability of somatic distress and determine whether this dimension is aetiologically distinct from measures of depression and anxiety. METHOD: Measures of anxiety, depression, phobic anxiety, somatic distress and sleep difficulty were administered in a self-report questionnaire to a community-based sample of 3469 Australian twin individuals aged 18 to 28 years. Factor analysis using a Promax rotation, produced four factors: depression, phobic anxiety, somatic distress and sleep disturbance. Multivariate and univariate genetic analyses of the raw categorical data scores for depression, phobic anxiety and depression were then analysed in Mx1.47. RESULTS: Univariate genetic analysis revealed that an additive genetic and non-shared environmental (AE) model best explained individual differences in depression and phobic anxiety scores, for male and female twins alike, but could not resolve whether additive genes or shared environment were responsible for significant familial aggregation in somatic distress. However, multivariate genetic analysis showed that an additive genetic and non-shared environment (AE) model best explained the covariation between the three factors. Furthermore, 33 % of the genetic variance in somatic distress was due to specific gene action unrelated to depression or phobic anxiety. In addition, 74% of the individual environmental influence on somatic distress was also unrelated to depression or phobic anxiety. CONCLUSION: These results support previous findings that somatic symptoms are relatively aetiologically distinct both genetically and environmentally from symptoms of anxiety and depression.

Neurasthenia: cross-cultural and conceptual issues in relation to chronic fatigue syndrome.

The purpose of this study was to examine several conceptual and cross-cultural issues in neurasthenia, particularly in terms of their relationship to chronic fatigue syndrome. A review of this relationship led to the conclusion that these conditions are much more alike in Western countries than in countries such as China, where neurasthenia could almost be regarded as a "culture-bound syndrome." This may be a consequence of factors such as the heterogeneous nature of neurasthenia and different diagnostic practices in different countries, despite the ICD-10 definition of neurasthenia, intended for worldwide use. Likewise, there is no consensus on what the "core" characteristics of neurasthenia are, because its clinical presentation and key features in different countries are very different. Despite the finding of relatively low comorbidity rates between neurasthenia and other mental disorders, clinical experience suggests that features of neurasthenia frequently overlap with those of depression, chronic anxiety, and somatoform disorders. There is no convincing evidence that in cases of overlap or comorbidity, other diagnoses should automatically have "primacy" over neurasthenia nor should the diagnosis of neurasthenia thereby be excluded. Although some aspects of its validity have improved recently, especially its descriptive validity, the overall validity of the diagnosis of neurasthenia is still not satisfactory. Suggestions for further research, aimed at improving the diagnostic validity of neurasthenia, are offered in this paper.