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

Presentamos la evolución de la terminología y los criterios diagnósticos para el síndrome de fatiga crónica/encefalomielitis miálgica. Este síndrome es una entidad compleja y controvertida, de etiología desconocida, que aparece en la literatura médica en 1988, si bien desde el siglo XIX se identificaron cuadros clínicos de fatiga crónica idiopática con diferentes nombres, desde neurastenia, neuromiastenia epidémica y encefalomielitis miálgica benigna hasta la actual propuesta de enfermedad de intolerancia al esfuerzo (postesfuerzo). Todos ellos aluden a un estado crónico de fatiga generalizada de naturaleza desconocida, con limitaciones al esfuerzo físico y mental, acompañado de un conjunto de síntomas que comprometen diversos sistemas orgánicos. La Clasificación Internacional de Enfermedades (CIE-10) encuadra este síndrome en el apartado de trastornos neurológicos (G93.3), aunque todavía no se hayan encontrado hallazgos anatomopatológicos que lo clarifiquen. Se han documentado múltiples alteraciones orgánicas, pero no se ha establecido una biología común que aclare los mecanismos que subyacen a esta dolencia. Se enuncia como una disfunción neuroinmunoendocrina, con un diagnóstico exclusivamente clínico y por exclusión. Diversos autores han propuesto incluir el síndrome de fatiga crónica/encefalomielitis miálgica dentro de los síndromes de sensibilidad central, aludiendo a la sensibilización central como el sustrato fisiopatológico común para este síndrome y otros. El papel del médico de familia es clave en la enfermedad, para la detección de aquellos pacientes que presenten una fatiga de naturaleza desconocida que se prolonga de forma continua o intermitente durante más de 6 meses, al objeto de realizar un diagnóstico temprano y establecer un plan de actuación frente a una enfermedad crónica con unos altos niveles de morbilidad en la esfera física y mental. Objetivo: Realizar una revisión bibliográfica de la terminología y criterios diagnósticos del síndrome de fatiga crónica/encefalomielitis miálgica, al objeto de aclarar conceptualmente la enfermedad, como utilidad en el diagnóstico a los médicos de Atención Primaria

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

A content analysis of chronic fatigue syndrome and myalgic encephalomyelitis in the news from 1987 to 2013.

Objectives The aim of this study was to analyze the content of American newspaper articles ( n=214) from 1987 to 2013, in order to understand how the public digests information related to Chronic Fatigue syndrome, a controversial and misunderstood illness. Methods A novel codebook derived from the scientific literature was applied to 214 newspaper articles collected from Lexis Nexis Academic®. These articles were coded quantitatively and frequency tables were created to delineate the variables as they appeared in the articles. Results The etiology was portrayed as organic in 64.5% ( n=138) of the articles, and there was no mention of case definitions or diagnostic criteria in 56.1% ( n=120) of the articles. The most common comorbidity was depression, appearing in 22.9% ( n=49) of the articles. In 55.6% ( n=119) of the articles, there was no mention of prevalence rates. In 50.9% ( n=109) of the articles, there was no mention of any form of treatment for the illness. A total of 19.4% ( n=42) of the headlines mislabeled the name of the illness. Discussion Based on descriptive statistics of all 214 coded articles, media communicated mixed messages for salient variables such as the name of the illness, its etiology and treatment.

Medical constructions of long-term exhaustion, past and present.

Culture and history affect the ways in which medical knowledge is shaped, sustained and changed. The less knowledge we have, the larger the space for the cultural imprint becomes. Based on these assumptions, we ask: how have medical constructions of long-term exhaustion changed over time, and how are changing constructions related to societal change? To discuss these questions we conducted a comparative study of medical texts from two historical periods: 1860-1930 and 1970-2013. Our data are limited to two diagnoses: neurasthenia and encephalomyelitis. After comparing the two periods by identifying diverging and converging aspects, we interpreted observed continuities and interruptions in relation to historical developments. We found that in the medical literature, long-term exhaustion became transformed from a somatic ailment bred by modern civilisation to a self-inflicted psychiatric ailment. At the same time, it changed from being a male-connoted high-status condition to a female-connoted low-status condition. We interpret these changes as contingent upon culturally available modes of interpretations. Medical knowledge thereby becomes infused with cultural norms and values which give them a distinct cultural bias. The historical controversies surrounding this medically contested condition neatly display the socially contingent factors that govern the social construction of medical knowledge.

Two sides of the same coin? On the history and phenomenology of chronic fatigue and burnout.

BACKGROUND: Burnout and chronic fatigue syndrome (CFS) are two fatigue syndromes which have developed largely independently from each other, yet whose similarities in symptoms can be a source of confusion. We aim to explore the phenomenology of burnout and CFS in a historical context as this may provide some insight into the links and relationship between these conditions. METHOD: A narrative review based on literature in the fields of history, social science and medicine. RESULTS: The origins of CFS lie within medicine, whereas burnout developed in a psychological setting. As well as symptoms, burnout and CFS also share similar themes such as an overload process triggering illness onset, the need for restoration of depleted energy, external causal attributions and the characteristics of people suffering from these illnesses. However, these themes are expressed in either psychological or medical terms according to the historical background. CONCLUSION: Despite their similarities, there have been few direct comparisons of the two concepts. Culture, illness perceptions and accountability are important issues in both conditions and could contribute to their differences. Comparing burnout and CFS within one sample frame, thus looking beyond the psychology/medicine divide, could be a useful first step towards understanding their relationship.

[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.

[Childhood chronic fatigue syndrome].

Chronic fatigue syndrome in childhood and adolescents(CCFS) is a complex and debilitation with severe morbidity and confusion. It is common condition with up to 3-5% of children and adolescents showing strange fatigue and confusion for more than 30 days. In this condition, four major symptoms are important: sleep disorders, easy fatigability, disturbed learning and memorization and immunological problems. Routine laboratory studies are similar to adult CFS, although abnormalities can be seen on serum pyruvic acid level, OGTT pattern, deep body temperature rhythm, hormonal secretion rhythm, and cerebral blood flow. For a diagnosis of CCFS, a research group supported by Japanese ministry of health, labor and welfare developed CCFS case definition on 2004. Treatment focused to correct disrupted circadian rhythms and supply of energy.

David Arthur John Tyrrell CBE: 19 June 1925 - 2 May 2005.

David Tyrrell is remembered by physicians and scientists principally for his discovery of the common cold viruses and elucidation of their pathogenesis, but also for his work in various other areas, including influenza, bovine spongiform encephalopathy (BSE) and chronic fatigue syndrome (CFS). David possessed a deep humanity, honesty, perseverance and a vision of collaboration as a means of making discoveries that would contribute meaningfully to the alleviation of human suffering. He also had a warmth and a mischievous sense of humour that was frequently directed at bureaucracy, which he thoroughly disliked.

The enigma of chronic fatigue.

Until new, reproducible criteria are established, the ubiquitous 'chronic fatigue state' emerges as a non-specific complaint shared by many different entities. Presently, it is neither a valid nor a verifiable medical diagnosis.

El síndrome de fatiga crónica y su diagnóstico en Medicina Interna / The chronic fatigue syndrome and its diagnosis in Internal Medicine

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Mark Twain and his family's health: Livy Clemens' neurasthenia in the gilded age and chronic fatigue syndrome of today.

Our purpose is to compare and contrast the 19th century diagnosis and disease neurasthenia with the contemporary illness known as Chronic Fatigue Syndrome. The health of Mark Twain's wife, Olivia (Livy) Clemens, will then be discussed and evaluated with respect to these two medical conditions.

[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.

Chronic fatigue syndrome: a review for clinicians.

Syndromes characterized by persistent fatigue, musculoskeletal pain, sleep disturbance, and subjective cognitive impairment have been common problems in clinical practice for decades. The chronic fatigue syndrome case definition was created to standardize the patient population in research studies and to foster a systematic and comprehensive approach to the attempt to define the etiology and pathophysiology of these syndromes. The pathogenesis of chronic fatigue syndrome remains unknown, though it does appear to be associated with subtle neuroendocrine and immunologic abnormalities. Treatment of chronic fatigue syndrome is empirical. Significant palliation is often possible, though treatment success requires skillful practice of the art of medicine.

La neurastenia y el síndrome de fatiga crónica: auge, caída y renacimiento de un concepto mórbido / The neurasthenia and the chronic fatigue syndrome: the rise, fall and renaissance of a morbid concept

Este trabajo revisa la evolución histórica del concepto de fatiga crónica, ligándolo al mucho más tradicional diagnóstico de neurastenia. Este último ya fue descrito por Hipócrates como "enfermedad de los escintios", y que se ha mantenido vigente hasta nuestros días con la sistematización que le diera Beard a fines del siglo pasado. Después de un período de desuso, al ser incorporado dentro de los cuadros depresivos como una variedad asteniforme de éstos por la clasificación psiquiátrica, ha reaparecido en la última década bajo el nombre de "síndrome de fatiga crónica, utilizado por médicos internistas y con posibles bases infecciosas o inmunológicas. Después de describirse las características de este cuadro de acuerdo a la clasificación actual de la Organización Mundial de la Salud, se presentan datos epidemiológicos acerca de la prevalencia y características de estos pacientes cuando son diagnosticados en el nivel primario de atención, constatándose que la comorbilidad con depresión era limitada (21 porciento) y que la mayoría de estos pacientes consultaban con quejas difusas y mal especificadas, y luego por enfermedades de la esfera digestiva

The history and treatment of chronic fatigue syndrome.

This article looks at chronic fatigue syndrome, a common condition affecting 1-2.5% of the population. The criteria for diagnosis are described and the nurse's role in treatment is discussed.

Did Cook's sailors have Tapanui 'flu? --chronic fatigue syndrome on the Resolution.

The 1982 publication of the Resolution journal of Johann George Reinhold Forster provided justification for his recognition as a scientist, and gave a remarkable insight into his character. It also included an account of an illness suffered by many of the sloop's crew, including Forster, after a period ashore at Queen Charlotte Sound. The symptoms of the illness were remarkably similar to those now clustered as the chronic fatigue syndrome.