Distinguishing between neurosis and psychosis: discourses on neurosis in colonial Korea.

This article analyses the origins and formation of medical and social discourses on neurosis in colonial Korea. With the introduction of Western medicine after the Opening of Korea in 1876, neurasthenia and hysteria began to be understood as neurotic diseases, and their importance was further highlighted during the colonial period of 1910-45. The article also addresses the role of neuropsychiatry in forming discourses on neurosis. In medical communities during the colonial period, the main source of these discourses gradually shifted from internal medicine to neuropsychiatry. In particular, Korean neuropsychiatrists distinguished between neurosis and psychosis as a way to reinforce their authority. Neuropsychiatrists tried to explain the temperamental and environmental factors of neurosis from a psychoanalytic standpoint.

In-Vitro Assessment of Hapten-Induced Immune Regulation in Children with Asthenoneurotic Syndrome.

The study employed in vitro assay to examine the peculiarities of immune status in children with functional disorders of the autonomic nervous system diagnosticated as asthenoneurotic syndrome. In contrast to control children without asthenoneurotic syndrome, the examined group was characterized by significantly (p<0.05) elevated hapten-specific immunological sensitization (indicated by anti-Al IgG), induction of inflammatory reactions (IL-1), activation of apoptosis (CD3+CD95+ and р53) observed against the background inhibition of adaptive immune response (CD3+, CD3+CD4+, CD3+CD8+, CD16+56+, and CD19+), as well as hyperexpression of glutamic acid, NO, and VEGF combined with deficiency of serotonin. In cultured immunocompetent cells derived from children with hapten-modified immune status, the combined application of cytokine stimulator IL-1 with hapten sensitizer aluminum or with endocrine stimulator cortisol significantly (p<0.05) up-regulated expression of IL-8 and IL-10, but down-regulated production of IL-17 in a dose-dependent manner.

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.

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.

[From neurasthenia to post-exertion disease: Evolution of the diagnostic criteria of chronic fatigue syndrome/myalgic encephalomyelitis]. / De la neurastenia a la enfermedad postesfuerzo: evolución de los criterios diagnósticos del síndrome de fatiga crónica/encefalomielitis miálgica.

Changes in the terminology and diagnostic criteria for chronic fatigue syndrome/myalgic encephalomyelitis are explained in this paper. This syndrome is a complex and controversial entity of unknown origins. It appears in the medical literature in 1988, although clinical pictures of chronic idiopathic fatigue have been identified since the nineteenth century with different names, from neurasthenia, epidemic neuromyasthenia, and benign myalgic encephalomyelitis up to the current proposal of disease of intolerance to effort (post-effort). All of them allude to a chronic state of generalised fatigue of unknown origin, with limitations to physical and mental effort, accompanied by a set of symptoms that compromise diverse organic systems. The International Classification of Diseases (ICD-10) places this syndrome in the section on neurological disorders (G93.3), although histopathological findings have not yet been found to clarify it. Multiple organic alterations have been documented, but a common biology that clarifies the mechanisms underlying this disease has not been established. It is defined as a neuro-immune-endocrine dysfunction, with an exclusively clinical diagnosis and by exclusion. Several authors have proposed to include CFS/ME within central sensitivity syndromes, alluding to central sensitisation as the common pathophysiological substrate for this, and other syndromes. The role of the family doctor is a key figure in the disease, from the detection of those patients who present a fatigue of unknown nature that is continuous or intermittent for more than 6 months, in order to make an early diagnosis and establish a plan of action against a chronic disease with high levels of morbidity in the physical and mental sphere. OBJECTIVE: To carry out a bibliographic review of the terminology and diagnostic criteria of the chronic fatigue syndrome/myalgic encephalomyelitis, in order to clarify the pathology conceptually, as a usefulness in the diagnosis of Primary Care physicians.

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.

Two-week neurasthenic major depression.

The relationship between the two syndromes neurasthenia and depression is of interest in the context of burnout, which, although not a diagnosis, is often treated in psychiatry. This study defines major depressive episodes according to DSM-5 and neurasthenia by ICD-10 symptom criteria, and both syndromes on the basis of a 2-week minimum duration. The study includes all subjects of the Zurich epidemiological study who had taken part in the last five interviews (1986-2008) and compares three groups, pure depression, pure neurasthenia and their combination (neurasthenic depression), applying nonparametric statistics. The three groups did not differ in common validators: age of onset, course, a family history for depression and anxiety/panic. Psychiatric comorbidity was also very similar, with the exception of suicide attempts and substance abuse, which were less frequent in the pure neurasthenic group. Somatic comorbidity was also highly comparable, except for stomach problems, which were more common in subjects with neurasthenic syndromes. Surprisingly, the well-known preponderance of depression in women was explained by the association with neurasthenic syndromes. The proposed new diagnosis of neurasthenic depression could help diagnose subjects treated for burnout but needs replication by other representative studies.

A historical review of trauma-related diagnoses to reconsider the heterogeneity of PTSD.

Based on the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders, there are 636,120 ways for an individual to qualify for a diagnosis of posttraumatic stress disorder (PTSD) (Galatzer-Levy & Bryant, 2013). To unravel this heterogeneity, we examine the historical trajectory of trauma-related diagnoses. Our review addresses four traumas (i.e., combat, natural disaster, life-threatening accident and sexual assault) that have contributed the most to conceptual models of PTSD. Although these trauma types are all subsumed under the same diagnostic label, our literature review indicates that the psychological consequences of different traumatic experiences are traditionally studied in isolation. Indeed, most research addresses hypotheses regarding specific trauma types using samples of individuals selected for their experience with that specific event. We consider the possibility that PTSD is not a single, unified construct and what this means for future research and clinical applications.

[Unexplained fatigue and irritability - differential diagnosis and practical procedures for signs of exhaustion]. / Müde und gereizt ohne ersichtlichen Grund - Differenzialdiagnose und praktisches Vorgehen bei Zeichen von Erschöpfung.

Chronic fatigue is a frequent complaint, but only leads to a medical consultation when consequences like sleep disturbance and reduced productivity become debilitating. Fear of a somatic disorder is usually prominent. However, the symptoms are usually physical and psychological signs of chronic stress. There is often a lack of awareness of stressors or conflicts, which would allow such a conclusion. Therefore, a few somatic investigations are recommended, since the list of possible somatic causes is long. Otherwise the patient should be prepared and motivated for a psychosocial counselling.

La fatigue chronique est une plainte fréquente mais qui ne conduit à une consultation médicale lorsqu'elle induit des troubles du sommeil ou diminue la productivité. La crainte de troubles somatique prédomine habituellement. Pourtant les symptômes physiques et psychologiques sont habituellement des signes de stress chronique. Il y a souvent un manque de conscience des facteurs de stress ou des conflits susceptibles de reconnaître ce problème. En conséquence peu d'investigations sont recommandées sur le plan somatique puisque la liste des causes potentielles sur ce plan est longue. Le malade doit être préparé et motivé à recevoir des conseils sur le plan psychosocial.

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.

[THE RESULTS OF CLINICAL AND PSYCHOPATHOLOGICAL AND PSYCHOLOGICAL DIAGNOSTIC INVESTIGATIONS EMPLOYEES OF FINANCIAL INSTITUTIONS WHICH WERE IDENTIFIED NEUROTIC DISORDERS].

The article presents the results of the clinical and psychopathological and psychological diagnostic, investigations mental health employees of financial institutions, description and analysis of clinical forms identified disorders.

[Asthenic disorders in children and their differentiated treatment].

OBJECTIVE: To study clinical/psychological characteristics of neurasthenia and residual asthenia and to assess the efficacy of noofen and adaptol in the treatment of these disorders. MATERIAL AND METHODS: Authors examined 30 adolescents with neurasthenia and 30 with residual asthenia. The Multidimensional Fatigue Inventory (MFI-20), A.M. Vein questionnaire, Spilberger-Khanin questionnaire, The Test of Variables of Attention (TOVA) were used. Patients were divided into two equal groups (n=30), each included 15 patients with residual asthenia and neurasthenia. Patients of the first group received adaptol in dosage 1000 mg daily and patients of the second group received noofen in dosage 500 mg daily. The duration of the study was 30 days. RESULTS AND CONCLUSION: The significantly higher levels of fatigue, inattention and exhaustibility were identified in patients with residual asthenia. Adolescents with neurasthenia were characterized by higher anxiety. The higher efficacy of adaptol in treatment of neurasthenia (80% in adolescents with neurasthenia and 60% of patients with residual asthenia) was shown. Noofen was more effective in treatment of residual asthenia (66.7% of adolescents with neurasthenia and 86.7% with residual asthenia.

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.

[Neurasthenia in Norway 1880-1920]. / Nevrasteni i Norge 1880-1920.

Neurasthenia was introduced as a diagnostic category in America in 1869, and rapidly spread to Europe. Many have drawn parallels between the historical disease entity of neurasthenia and contemporary conditions such as chronic fatigue syndrome/myalgic encephalopathy and burn-out, but we have little knowledge about the early history of neurasthenia in Norway. On the basis of Norwegian medical journals from the period 1880-1920, we have sought to study the introduction, understanding and application of the concept of neurasthenia in Norwegian medical practice, with particular emphasis on symptoms, causes, treatment, prognosis and prevalence. Results show that the term was probably used in a Norwegian medical journal for the first time in 1876, and during the 1880s there followed an increasing number of reports of people who had been diagnosed with neurasthenia. The condition was defined as a weakness of the nervous system. The symptom picture was extensive, with exhaustion as the main symptom. The causes of the symptoms could not be objectively verified or located, and theories abounded. Overexertion was a common explanation, although traumas, infections, malnutrition, heredity and sexual excesses were also assumed to be causes. The recommended treatment focused on strengthening the nervous system, for example through rest and electrotherapy. The condition was described as typical of its time, as a response to the «Zeitgeist¼ and modern life.

[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.

La depresión: encrucijada entre las nuevas modalidades del ser y el dispositivo farmacéutico / Depression: crossroads between the new modalities of the being and the pharmaceutical apparatus

Siguiendo la tesis del sociólogo Alain Ehrenberg, la depresión se instaló en las sociedades occidentales como una consecuencia de las nuevas modalidades del individuo. La emancipación y la soberanía individual comenzadas en el siglo de las luces trajeron consigo nuevos malestares de la mente. La neurastenia resume la primera "epidemia" mundial que muestra las consecuencias de estas mutaciones antropológicas. La neurosis y el psicoanálisis demuestran que la depresión y otras formas de sufrimiento de las personas ordinarias son el resultado de un precio a pagar por entrar en la civilización. Para Ehrenberg, la epidemia contemporánea de depresión es el rostro de un eclipse de la culpabilidad y el conflicto interior, favoreciendo una apertura de infinitas posibilidades y la consagración personal como nuevos ideales constitutivos de la personalidad y la identidad, siendo la depresión una disfunción o insuficiencia a convertirse en uno mismo. Sin embargo, las tesis de Ehrenberg no toman en cuenta el esfuerzo realizado por la industria farmacéutica y el dispositivo comercial y de mercadeo creado para modificar las costumbres y el saber médico, facilitando así la explosión diagnóstica y autodiagnóstica de este trastorno controversial.

Based on the thesis of the sociologist Alain Ehrenberg depression settled in Western societies as a result of the consequences of the new types of individuals. The emancipation and sovereignty from the beginning of the Century of Light brought new mind ailments. Neurasthenia is the first "epidemic" as a result of these anthropological mutations. Neurosis and psychoanalysis show that depression and other ailments in ordinary people are but the result of a price to pay when entering civilization. For Ehrenberg, depression which is the contemporary epidemic is the face of an eclipse between guilt and interior conflict, favoring an openness of infinite possibilities and the personal sacredness as new ideals which make the personality and the identity, depression is a dysfunction which does not allow one to become oneself. However, Ehrenberg ́s theses do not take into account the efforts of the pharmaceutical industry or the marketing strategies created to modify costumes, nor the medical knowledge, facilitating the explosion of the diagnosis and self diagnosis of this controversial illness.

Colonised and neurasthenic: from the appropriation of a word to the reality of a malaise de civilisation in urban French Vietnam.

Neurasthenia remains an important health problem in certain Asian populations, both in Asia as well as in a diasporic context. An anachronistic disease for Western observers, it has become an exotic culture-bound syndrome as well as a somatoform disorder too often hiding much more serious issues of depression. This article approaches this 'problematic' health issue from a historian's point of view and offers a colonial genealogy that will discuss neurasthenia's outline in French Vietnam. By retracing and analysing the different mentions, definitions, and uses of the term neurasthenia in the interwar period, it aims to better understand certain historical realities that might have shaped the local identity and spatiality of this problem (concentrated in colonial cities in which social change and modernity were expressed in their most salient forms), and perhaps even identify reasons that facilitated its post-colonial survival.

Prevalence of neurasthenia, comorbidity, and association with impairment among a nationally representative sample of US adults.

PURPOSE: There are no current psychiatric epidemiological studies examining prevalence estimates of neurasthenia across different racial and ethnic groups in the US. This study compares prevalence rates of International Classification of Diseases (ICD-10) lifetime and 12-month neurasthenia across racial/ethnic groups in the US (Asians, African Americans, Latinos, and non-Latino Whites) and by levels of acculturation. We examine comorbidity of neurasthenia with DSM-IV psychiatric disorders and the association between neurasthenia and impairment. METHODS: We used a pooled sample (N = 10, 118) from two nationally representative household surveys of adults ages 18 years and older: the National Comorbidity Survey-Replication (NCS-R) and the National Latino and Asian American Study (NLAAS). RESULTS: Among the total sample, the adjusted prevalence rates of lifetime and 12-month neurasthenia with exclusionary criteria were 2.22 and 1.19%. The adjusted prevalence rates for lifetime and 12-month neurasthenia without exclusionary criteria were 4.89 and 2.80%. There were significant racial/ethnic group differences in prevalence for both lifetime and past-year neurasthenia, with Asians reporting significantly lower prevalence of neurasthenia than their non-Latino White counterparts. Less acculturated individuals were at a decreased risk for lifetime and past-year neurasthenia. Lifetime neurasthenia was associated with increased odds of meeting lifetime criteria for any depressive, any anxiety, and any substance use disorder. Respondents with lifetime or past-year neurasthenia had significantly greater levels of impairment compared to those without neurasthenia. CONCLUSION: Neurasthenia is a prevalent condition deserving further research attention given its comorbidity with other psychiatric disorders and its association with functional impairment.