Neurasthenia: Modern Malady or Historical Relic?

Neurasthenia was a popular diagnosis from 1869 through 1930. Despite being discarded, the core symptoms of neurasthenia can still be found throughout modern society. The present article reviews the symptoms, common course, proposed causes, and common treatments for neurasthenia. Similarities are seen in several familiar diagnoses, including depression, chronic fatigue syndrome, and fibromyalgia. Through reviewing the trends of neurasthenia, modern doctors may learn more about the subtleties of the diagnostic process, as well as the patient-physician relationship. The goal is to learn from the past as it relates to current problems that may be related to the stress of modern living. The history of neurasthenia is presented as it relates to problems that may remain today.

Characterization of fatigue states in medicine and psychiatry by structured interview.

CONTEXT: Unexplained fatigue states are prevalent, with uncertain diagnostic boundaries. OBJECTIVE: Patients with fatigue-related illnesses were investigated by questionnaire and a novel semistructured interview to identify discriminatory features. METHODS: Cross-sectional samples of women from specialist practices with chronic fatigue syndrome (n = 20), postcancer fatigue (PCF; n = 20), or major depression (n = 16) were recruited. Additionally, two longitudinal samples were studied: women with fatigue associated with acute infection who subsequently developed postinfective fatigue syndrome (n = 20) or recovered uneventfully (n = 21), and women undergoing adjuvant therapy for breast cancer experiencing treatment-related fatigue who subsequently developed PCF (n = 16) or recovered uneventfully (n = 16). Patients completed self-report questionnaires, and trained interviewers applied the Semi-structured Clinical Interview for Neurasthenia. The receiver operating characteristics curves of the interview were measured against clinician-designated diagnoses. Cluster analyses were performed to empirically partition participants by symptom characteristics. RESULTS: The interview had good internal consistency (Cronbach alpha "fatigue" = .83), and diagnostic sensitivity and specificity for chronic fatigue syndrome (100% and 83%) and major depression (100% and 72%), with reasonable parameters for PCF (72% and 58%). Empirical clustering by "fatigue" or "neurocognitive difficulties" items allocated most patients to one group, whereas "mood disturbance" items correctly classified patients with depression only. CONCLUSIONS: The Semi-structured Clinical Interview for Neurasthenia offers reliable diagnostic use in assessing fatigue-related conditions. The symptom domains of fatigue and neurocognitive difficulties are shared across medical and psychiatric boundaries, whereas symptoms of depression such as anhedonia are distinguishing.

Neurastenia / Neurasthenia

Apresenta a categoria médica da neurastenia, criada em solo estadunidense no fim do século XIX pelo neurologista George Beard. São apresentadas as características gerais do quadro clínico, bem como as principais hipóteses explicativas para os sintomas, e as proposições terapêuticas sugeridas nas obras do referido autor. Além disso, é discutida a recepção do diagnóstico fora dos EUA, tanto no que se refere ao seu uso na Europa quanto ao caso específico do Brasil.

The article addresses the medical category of neurasthenia, developed in the United States by neurologist George Beard at the close of the nineteenth century. Points of discussion include the principle features of the category's clinical presentation, the main hypotheses advanced to account for symptoms, and the treatment alternatives suggested in Beard's works. The article also looks at how the diagnosis was received outside the United States, both in Europe and, more specifically, in Brazil.

Unloading the trunk: neurasthenia, CFS and race.

The aetiologies of both chronic fatigue syndrome (CFS) and its predecessor neurasthenia, have been linked to technological advances in 'developed' countries. This paper discusses how this has led to a form of race thinking within discussions about fatigue which has persisted for more than a century. We review the historical development of this race thinking from neurasthenia to CFS and describe how it is manifested in both the lay- and medical literature. We also review the epidemiological literature on CFS and ethnicity to better understand the relatively low percentage of non-white patients seen in tertiary referral clinics for CFS. The aim of this paper is to act as a starting point for a debate on race and CFS.

[Borderline mental disorders in patients with prostate cancer]. / Pogranichnye psikhicheskie rasstroistva u bol'hykh rakom predstatel'noi zhelezy.

Sixty five patients, aged 48-87, with prostate cancer at different stages were studied. Borderline mental disorders were found in all the patients. In the majority of them, affective disorders in the form of anxiety-depressive (52.3%) and astheno-depressive (24.6%) syndromes were observed. Astheno-hypochondriacal and dysphoric syndromes were detected less frequently (in 15.4% and 7.7% of the cases, respectively).

A literature review of medical side effects from radio-frequency energy in the human environment: involving cancer, tumors, and problems of the central nervous system.

Occupational or residential exposures to radiofrequency energy (RFE), including microwaves, have been alleged to result in health problems. This paper is a review of the recent medical and scientific literature (from mid-1998 through 2002) dealing with possible effects of RFE on brain tumors and malignancies, leukemia, other cancers, and the central nervous system. A large number of studies were related to exposures from cellular telephones. On the basis of previous reviews of older literature and the current review of recent literature, one can conclude that the evidence for any proven health effects (related to the topics above) of low-level RFE exposure is minimal.

[Subjective blockage in Parkinson's disease]. / Blocages subjectifs au cours de la maladie de Parkinson.

UNLABELLED: Akinetic symptoms or off-period motor signs in patients with Parkinson's disease and motor fluctuations can be associated with subjective symptoms. A systematic interview was conducted in a series of 24 patients. Sixteen out of 24 (67 p. cent) experienced these subjective symptoms as on-off non motor symptoms that were classified in three groups: energy lost consistent with a severe asthenia, perceptive and cognitive alterations, and emotional troubles such as panic and depression. These phenomenons could be combined in some patients and were sometimes asynchron to akinesia. In some patients (six cases reported), they occurred without any akinesia but could totally inhibit patients daily activities, and so could be described as subjective off-period . Frequently, the patients did not distinguish them from motor disability. Their persistence, after subthalamic nucleus stimulation or intrastriatal transplant, could interfere with functional results, even though akinetic symptoms had disappeared. CONCLUSION: subjective phenomenons during off-periods are frequent. Their frequency is underestimated due to a non-targeted examination. Subjective off-periods are symptoms of Parkinson's disease, partly independent from off motor symptoms, and important to consider in evaluation of therapeutics, especially surgery.

Chronic fatigue syndrome and Australian psychiatry: lessons from the UK experience.

OBJECTIVE: The aim of this paper is to outline the opportunities and dangers the chronic fatigue syndrome (CFS) issue presents to Australian psychiatry. METHOD: The scientific literature of the last 50 years on CFS in adults was reviewed and samples of recent media portrayals of CFS in the UK and Australia were collected. The author has worked in both the UK and Australia managing adult CFS patients in specialist outpatient consultation-liaison (C-L) psychiatry settings. RESULTS: Chronic fatigue syndrome has been at the heart of an acrimonious debate in the UK, both within the medical profession and in the wider community. UK psychiatry has been drawn into the debate, at times being the target of strong and potentially damaging criticism, yet UK psychiatry, especially the C-L subspecialty, has played a crucial role in clarifying appropriate research questions and in devising management strategies. The issue has served to enhance and broaden psychiatry's perceived research and clinical role at the important medicine-psychiatry interface in that country. CONCLUSIONS: Handled properly, the CFS issue offers Australian psychiatry, especially C-L psychiatry, an opportunity to make a useful contribution to patient care in a clinically difficult and contentious area, while at the same time serving to help broaden psychiatry's scope in the Australian medical landscape.

[Astrocytes--anonymous cells in the brain, participating in neurasthenic symptoms]. / Astrocyterna--hjärnans doldisar, delaktiga i neurastena symtom.

During rehabilitation after brain damage due to stroke or trauma, or after meningitis, patients often suffer from mental fatigue and decreased capacity for concentration and learning. We hypothesize that one pathogenic cause of these symptoms could be a failure on the part of astroglia to remove glutamate and K+ from synaptic regions during glutamatergic transmission. As astroglial support of neuronal glutamate transmission has been shown to be of utmost importance, such an astroglial failing might lead to a decreased signal-to-noise ratio in glutamatergic neurotransmission, especially when the transmission is intense for a considerable time period. Three aspects of astroglial failing are focused upon: decreased capacity of the astroglial glutamate transporters, depolarization of the astroglial network, and uncoupling of the gap junction coupled astroglial network. It has been shown that several neuroactive substances, present within the nervous system even long after damage or infection, influence upon these three astroglial properties.

[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.

[Effects of electromagnetic radiation from cellular telephone handsets on symptoms of neurasthenia].

In order to study the effects of electromagnetic radiation from cellular telephone handsets on symptoms of neurasthenia, 115 and 101 persons with or without handsets were selected. The subjects were investigated by questionnaire on their general health, lifestyle, habit, mental stress, the frequency of using the handsets, living and working environment, the cases of suffered from diseases and symptoms of neurasthenia. The data were analyzed by Chi-square test and Logistic regression statistics. The results showed that the time of using handset was positively associated with depression (P < 0.05), nausea (P < 0.01) and loss of appetite(P < 0.05). The results showed that long time use of cellular telephone handset could induce the symptoms of neurasthenia.

[Observations of changes in neurobehavioral functions in workers exposed to high-frequency radiation].

OBJECTIVE: To study the effects of exposure to high-frequency radiation on neurobehavioral function of the exposed workers and its measurement in evaluating occupational hazards caused by it. METHODS: Four neurobehavioral functions were tested for the workers exposed to high-frequency radiation with Neurobehavioral Core Tests Battery recommended by WHO. RESULTS: Scores for various indicators in exposed workers were significantly lower than those in controls, and correlated to the detection of neurasthenia in the exposed workers, to certain extent. CONCLUSION: Changes in neurobehavioral function in workers exposed to high-frequency radiation can reflect its important adverse effects.

[Etiology of isolated general malaise]. / Etiología del malestar general aislado.

Isolated general malaise (IGM) is defined as an imprecise sensation of feeling bad, without any other signs or symptoms that suggest even a diagnostic orientation. 137 patients who demanded medical help for IGM were selected and divided into three groups, according to their evolution: IGM of banal or benign cause; IGM of easy or attainable diagnosis; and IGM of difficult or prolonged diagnosis. The 37 patients of the latter group were integrated under the title of Unexplained General Malaise Syndrome (UGMS). The criteria of these syndromes are defined. The patients with UGMS were studied in order to make a diagnosis of its unknown disease, which was achieved in all cases except two. The non-specific symptoms that the patients with UGMS manifest and their relation to final diagnosis are described. When the final diagnosis was made, the number of diagnostic tests used, the time of hospitalisation and the derived economic cost was estimated in each case compared to the corresponding mean data, obtained. Depression as the most frequent aetiology detected in the patients with UGMS, should be the first consideration made in any evaluation.

[Research about fatigue in France over the past 20 years]. / Les recherches sur la fatigue en France dans les vingt dernières années.

The author reported the works of the "Fatigue Studies Group" founded 20 years ago to explore the different dimensions of "fatigue" complaint. The emphasis is placed on the asthenic syndromes evaluation instrument created by the group, which takes into account the socio-demographic data of the patient, clinical signs and their severity as well as the potential etiological factors. Its first version (GEF-3) enabled to isolate 4 groups of asthenia (overworking, somatic, psychosomatic and psychic), each of them requesting a specific treatment. An ulterior version (GEF-4) has been elaborated to describe better the psychiatric semeiology. Finally, a simplified version (GEF-10) was used as an evaluation instrument in different therapeutic researches. At the same time, the group continued its researches on the fatigue psychosocial dimensions and its nosographic status, especially in comparison with dysthymic disorders.