Soldier's heart: the forgotten circulatory neurasthenia - a systematic review.

Soldier's Heart (SH) is a former medical diagnosis, rarely mentioned nowadays, presented under several other names. Considering the controversy regarding the removal of Soldier's Heart diagnosis from DSM-5, this study aimed to conduct a systematic review to evaluate its usage in the clinical practice. Information on diagnosis, military stress, heart rate variability, treatment, and prognosis were collected from 19 studies included after a systematic literature search. Considering the lack of adequate use of Soldier's Heart diagnosis and the diagnostic overlapping with other conditions, the present systematic review supports the inclusion of Soldier's Heart under the umbrella of posttraumatic stress disorders (PTSDs). This proposal is also in line with the conception that physical symptoms are relevant features often associated with generalized anxiety disorder and PTSD. Also, it will be described the higher prevalence of cardiological comorbidities in SH and possible cardiological consequences. Pharmacotherapy based on benzodiazepines and beta-blockers, as well as biofeedback and mindfulness techniques are considered to be useful treatment options. Further studies are needed to better define psychopathological domains of this syndrome and possible novel treatment targets.

Diagnoses in and out of time: historical and medical perspectives on the diagnoses of distress.

Focusing on the medical approach to the subjective forms of distress, this article has a three-fold argument. First, the historical starting point of diagnosing distress was neurasthenia during the last two decades of the 19th century. Second, the diagnosis of neurasthenia that initially contained more somatic than mental symptoms was gradually replaced by the more psychologically conceptualized neuroses. Such a psychiatrization of neurosis gradually separated mental and somatic syndromes into two distinct diagnostic categories, those of mental and somatic. Third, when modern "neuroses" are seen in the framework of distress rather than disease, it provides tools for new kinds of interventions, in which the principal aim is to alleviate the subjective distress with all possible and reasonable means and methods. As the social context constitutes a crucial "etiology" to medicalized forms of distress, we need new, context-based approaches to both analyze and alleviate such distress. In our historical and medical approach to these "diagnoses of distress", we are guided by the belief that analyzing diagnostic categories can provide important insight into the mechanisms behind our changing conceptions of health and wellbeing.

[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.

[Asthenic disorders in children].

The present study comprised two parts. In the first part, authors attempted to work out the systematics of asthenic disorders based on our own observations of 189 children aged 7-14 years. The following clinical variants of asthenic states in children were singled out: cerebrogenic asthenia (14.3%), somatogenic (13.8%), residual (16.4%), dysontogenetic (20.1%) and neurasthenia (35.4%). In the second part, we summarized the results of treatment of neurasthenia with adaptol (32 patients) compared to pantoham (30 patients). The efficacy of adaptol was higher: the improvement was seen in 71.9% of cases compared to pantoham (56.7%). The good tolerability of adaptol which clinical efficacy is confirmed by neurophysiological and psychological studies is discussed.

[Posttraumatic cerebrasthenia and posttraumatic encephalopathy--difficulties in opinionating]. / Cerebrastenia pourazowa i encefalopatia pourazowa-- trudnosci opiniodawcze.

Post-traumatic cerebrasthenia and post-traumatic encephalopathy are the effects of a head trauma. Most physicians overuse these diagnoses. They do not perform differential diagnostic management, what leads to issuing erroneous opinions. The aim of this report is to show the symptoms of posttraumatic cerebrasthenia and posttraumatic encephalopathy and diagnostic investigations, which could be helpful for diagnosing these conditions. Cerebrasthenia (the subjective posttraumatic syndrome, subjective syndrome, posttraumatic neurosis) is usually a functional--"unorganic" disorder. It happens in the cases of many people who had brain concussion. The most common symptoms are: headache, vertigo, irritability, insomnia, attention deficits, fatigability. Posttraumatic encephalopathy is a persistent brain tissues injury which could be caused by more severe trauma (brain contusion, endocranial bleeding). The clinical picture of this disease entity is not unambiguous. The most frequently encountered form is a simple (common) form, which is similar to cerebrasthenia, but with differences in the neurological examination (focal signs) and with persistent changes in EEG.

Are somatoform disorders changing with time? The case of neurasthenia in China.

OBJECTIVE: To examine how sociocultural factors shape the professional classification and transformation of neurasthenia (shenjing shuairuo in the Chinese language) in China. METHODS: We review the relevant literature as well as cite our own research experience on the topic. RESULTS: We identify three main periods of transformation, namely, the prereform period (before 1980) in which neurasthenia encompassed a wide range of anxiety and mood disorders; the reform period (1980s-1995) when the Diagnostic and Statistical Manual of Mental Disorders-III (DSM-III) and Kleinman's study in Hunan steadily shaped the Chinese conceptualization of nonpsychotic mental disorders; and the postreform period (after 1995) when neurasthenia has become a rarely used category of subsyndromal depression among Chinese psychiatrists. CONCLUSIONS: The dramatic transformation of neurasthenia in China speaks to the global power of the DSM system of classification, on the one hand, and the latter's failure to engage cultures in the local system of psychiatric practice, on the other. The Chinese story of neurasthenia and the social context in which the disease category is contested, marginalized, and reconstituted as the popular Western disease of depression among Chinese psychiatrists attest to the socially constructed nature of psychiatric classification. The public health implications of this transformation remain unclear.

New strategies in the assessment of psychological factors affecting medical conditions.

In this article, we examine research that may lead to a better assessment of psychological factors affecting medical conditions. We performed a review of the psychosomatic literature using both Medline and manual searches. We selected papers that were judged to be relevant to new strategies of assessment, with particular reference to the use of the Diagnostic Criteria for Psychosomatic Research. We assessed 8 areas concerned with the assessment of psychological factors in the setting of medical disease: hypochondriasis, disease phobia, persistent somatization, conversion symptoms, illness denial, demoralization, irritable mood, and Type A behavior. A new subclassification of the Diagnostic and Statistical Manual of Mental Disorders (5th ed. [DSM-V]; not yet published) category of psychological factors affecting physical conditions appears to be feasible and may provide the clinician with better tools for identifying psychological distress.

[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.

Death of neurasthenia and its psychological reincarnation: a study of neurasthenia at the National Hospital for the Relief and Cure of the Paralysed and Epileptic, Queen Square, London, 1870-1932.

BACKGROUND: The diagnosis of neurasthenia appeared in 1869 and rapidly became fashionable and highly prevalent. It disappeared almost completely, producing ongoing debates about what happened to the disease, which have not so far been informed by empirical data. AIMS: To use empirical historical hospital data from one specific hospital to explore several controversies about neurasthenia, including what happened to the disorder. METHOD: The annual reports of Queen Square Hospital were examined from 1870 to 1947. The prevalence of neurasthenia diagnoses as a proportion of total discharges was recorded. The possible diagnostic categories into which neurasthenia could have been reclassified were identified. Textbooks and writing by neurologists working at the hospital during this period were examined. RESULTS: Neurasthenia accounted for 6-11% of total discharges from the late 1890s to 1930, when it virtually disappeared. Men accounted for 33-50% of cases. CONCLUSIONS: Neurasthenia affected both the upper and working classes and both men and women. Neurologists, not psychiatrists, continued to see the disorder well into the 20th century. Neurasthenia did not disappear, but was reclassified into psychological diagnoses.

Diagnosis postponed: shenjing shuairuo and the transformation of psychiatry in post-mao China.

Building on Arthur Kleinman's seminal work in Hunan, this paper examines the social context in which shenjing shuairuo (neurasthenia), a ubiquitous psychiatric disease in China prior to 1980, is contested, marginalized, and reconstituted as the popular Western disease of depression among academic psychiatrists in urban China. It is argued that this dramatic change of diagnostic labelling is not only based on empirical evidence. Rather, it is also a product of interests and strategies that are themselves embedded in a confluence of historical, social, political, and economic forces. Specifically, China's open door policy, the hegemony of DSM discourse, the depoliticization of experience, and the transnational commercialization of suffering have all played a role in creating the new-found disease of depression. As a new social construct in China, depression may serve different social functions for different institutional groups, such as drug companies' marketing of new antidepressant therapy, and academic psychiatrists' effort to render the study of suicide more admissible to the state. Because of the government's budgetary limitations and drastic changes in health care financing, however, global diagnostic technology and markets for drugs merely reinforce people's markedly unequal access to health care, which is but one facet of the pervasive social inequity that is China nowadays.

Biologizing social facts: an early 20th century debate on Kraepelin's concepts of culture, neurasthenia, and degeneration.

This paper uses an historical approach to elucidate two alternative modes of conceptualizing the relation between social factors and psychological phenomena perceived as pathological. The core features of Neo-Kraepelinian psychiatric nosology associated with the introduction of DSM-III in 1980 were also at the center of a debate in early 20th century Germany. The protagonists were Emil Kraepelin and Oswald Bumke. Kraepelin's empirical research selectively focused on somatic factors as independent variables, such as alcohol, syphilitic infection, and heredity. The ensuing nosology marginalised social factors which might contribute to the etiology and symptom formation of psychiatric conditions. For Bumke, the disorders in question (including the category of neurasthenia) did not represent qualitative deviations from normal psychological states, but quantitative variations of ubiquitous psychological functions caused by a multitude of somatic, psychological, and social factors. The main arguments of the historical debate are reconstructed, with special regard to the professional and political context. The paper illustrates the importance of context-bound pre-'scientific' decisions for the process of formulating theoretical concepts in psychiatry and related disciplines.

Interpretation of symptom presentation and distress. A Southeast Asian refugee example.

Symptom expression or the manifestation of distress is greatly influenced by one's cultural background. This exploratory study investigated symptom presentation of distress among a community sample of Vietnamese, Chinese-Vietnamese, Cambodian, and Lao refugees. The study examined whether or not the Western-designed distress measure used in the study was culturally sensitive enough to accurately capture culturally framed expressions of distress. The results of the factor analyses showed that the four Southeast Asian refugee groups did not express distress in three separate factors as devised in the original measure. Instead, a single robust factor emerged. The single factor comprised items from the depression, anxiety, somatic, and psychosocial dysfunction subscales. The items that made up the single factor strongly resemble the construct for the diagnosis of neurasthenia. Researchers have found neurasthenia to be a culturally sanctioned Asian cultural idiom of distress. The findings strongly suggested that this Southeast Asian refugee population expressed distress in a pattern of symptoms more consistent with Asian nosology. The clinical and research implications of the results of this exploratory study are also discussed.

Comparative study of diagnostic systems: Chinese Classification of Mental Disorders-Second Edition versus DSM-III-R.

We report on the diagnostic comparative study of the Chinese Classification of Mental Disorders-Second Edition (CCMD-2) and the DSM-III-R in a field trial in China. The Adult Diagnostic Interview Schedule-Second Edition (ADIS-2), a modified diagnostic interview schedule that can generate both CCMD-2 and DSM-III-R diagnoses, was used to test 254 psychiatric patients in China. It was found that the reliability and validity of the CCMD-2 and DSM-III-R are compatible in most diagnostic categories such as schizophrenia, delusional disorder, bipolar disorders, and depressive disorders. The discrepancies between Chinese and American diagnostic systems were found mainly in neurasthenia and hysterical neuroses. Such discrepancies may have resulted from frequent changes of the diagnostic terms in the West, such as the phenomenon of neurasthenia, or from creating a new disorder entity in CCMD-2, such as "Eastern gymnastic exercises-induced mental disorder. "Further cross-cultural studies focusing on these discrepant disorders are urgently needed to understand the cultural influences on diagnosis, as well as to improve the professional classification of mental disorders in different diagnostic systems.

[Neurasthenia and thymasthenia]. / La neurasthénie et la thymasthénie.

The term of depression applies to two syndromes at least; one is associated with a reduction in interests, activities and with a withdrawal; the other consists of a moral pain, a pessimism, a guilty feeling, an irritability. In each case the depressive mood corresponds to the subjective state. A first survey concerning 3,000 outpatients in general practice allowed us to identify 16.5 of depressed subjects, with 3% showing a pure painful syndrome, 7% showing a syndrome that we described as thymasthenia, and 6% showing the two syndromes (this last group consists probably of major depressive states). This new study, organized by the WHO and concerning 2,000 consecutive patients in primary care, permitted to precise the definition of thymasthenic subjects. The prevalence of current major depressive states is 13.7% and that of dysthymic disorders is 3.6%. Thymasthenia is observed in 9.2% of patients (mean age: 38 years; 60% of women). Among them, 62% show major depressive states, 18% dysthymic disorders, 16% panic disorders, and 11% pure thymasthenia, corresponding to a prevalence of 1%. It should be noted that the prevalence of neurasthenia (according to the definition given by IDC-10) is of 2.9% and that 36% of thymasthenic subjects show also neurasthenia (according to IDC-10). The qualitative content of these two syndromes will be compared.