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.

Neurasthenia, Generalized Anxiety Disorder, and the Medicalization of Worry in a Vietnamese Psychiatric Hospital.

This article examines two forms of the medicalization of worry in an outpatient psychiatric clinic in Ho Chi Minh City, Vietnam. Biomedical psychiatrists understand patients' symptoms as manifestations of the excessive worry associated with generalized anxiety disorder (GAD). Drawing on an ethnopsychology of emotion that reflects increasingly popular models of neoliberal selfhood, these psychiatrists encourage patients to frame psychic distress in terms of private feelings to address the conditions in their lives that lead to chronic anxiety. However, most patients attribute their symptoms to neurasthenia instead of GAD. Differences between doctors' and patients' explanatory models are not just rooted in their understandings of illness but also in their respective conceptualizations of worry in terms of emotion and sentiment. Patients with neurasthenia reject doctors' attempts to psychologize distress and maintain a model of worry that supports a sense of moral selfhood based on notions of obligation and sacrifice.

Cocaína: una revisión de la adicción y el tratamiento / Cocaine: A review of addiction and treatment

La cocaína es la droga responsable de más muertes en España. A pesar de una disminución del consumo en los últimos años, la prevalencia continúa siendo alta y es común hallarla en la práctica clínica. Si unimos a ello la peligrosidad del tóxico por su alta capacidad adictiva, las frecuentes y graves complicaciones que acarrea y la dificultad para su abandono, tenemos motivos de sobra para plantear una revisión tanto de su origen como de su estado actual, su abordaje clínico, y los retos para un futuro (AU)

Cocaine is the drug responsible for more deaths in Spain. Despite a decrease in consumption in recent years, the prevalence remains high and is common to find it in clinical practice. If you join it the danger of toxic because it´s addictive high capacity, frequent and serious complications involved and the difficulty of abandonment, we have every reason to propose a revision of both its origin and its present, its clinical approach, and challenges for the future (AU)

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.

Death and bereavement in the First World War: the Australian experience.

The First World War was a turning point in the cultural history of death and bereavement in Australia. The mass deaths of some 60,000 soldiers overseas led to communal rituals of mourning for the war dead and minimal public expressions of private grief. The mass slaughter of so many young men and the interminable grief of so many families devalued the deaths of civilians at home and helped to create a new cultural model of suppressed and privatised grieving which deeply constrained the next two generations. Emotional and expressive grieving became less common, mourning ritual was minimised and sorrow became a private matter.

Somatoform disorders in patients with chronic pain.

OBJECTIVE: To assess the frequency and characteristics of somatoform disorders in patients with chronic pain. METHOD: The study took place in the psychiatric outpatient clinic of a rehabilitation hospital. Participants were interviewed using the World Health Organization Somatoform Disorders Schedule (WHO-SDS) version 2.0. Thirty new and 30 current attendees to the clinic were interviewed following referral by pain medicine specialists. RESULTS: Somatoform disorders were commonly co-morbid with chronic pain in the study population. Persistent somatoform pain disorder (PSPD) was the commonest somatoform disorder. There was a significant difference between women and men suffering from somatic autonomic dysfunction (SAD). CONCLUSIONS: The findings of this study confirm that somatoform disorders are common co-morbid diagnoses in patients with chronic pain. Combining psychological treatments with medication, appropriate physical treatments and attending to social issues, may indeed improve the well-being of such patients.

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.

Síndrome de fatiga crónica infanto-juvenil: revisión y actualización a propósito de un caso / Chronic fatique syndrome in children and adolescents; a systematic update and a case report

El síndrome de fatiga crónica (SFC) es una de las principales causas de absentismo escolar. Presentamos el caso de un varón de 14 años con síndrome de fatiga crónica después de una mononucleosis infecciosa; que le ocasiona gran incapacidad y preocupación sobre la enfermedad. Se discute el mal pronóstico de este paciente e hipotetizamos su posible asociación con la cronicidad de la enfermedad, la psicopatología de la familia y del paciente y el hecho de mantener la creencia de que la enfermedad se debe a una causa orgánica (AU)

Chronic fatigue syndrome (CFS) is a major cause of school absenteeism. A 14-year old boy with CFS following an infectious mononucleosis with great disability and signiicant concerns regarding the origin of the illness is presented. Factors associated with the poor prognosis such as the illness chronicity, the family psychopathology and the longstanding belief by the patient that illness has an organic origin are discussed (AU)

[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.

Phase II trial on the effects of Silexan in patients with neurasthenia, post-traumatic stress disorder or somatization disorder.

Silexan, a novel lavender oil preparation for oral use, has been authorized in Germany for the treatment of states of restlessness during anxious mood. An open-label, exploratory trial was performed to assess the potential of the medicinal product in the treatment of restlessness caused by anxiety as related to several disorders. Outcome measures included the Symptom Checklist-90-Revised (SCL-90-R), von Zerssen's Depression Scale (D-S), the 36-item Short Form Health Survey Questionnaire (SF-36), and a sleep diary. 50 male and female patients with neurasthenia (ICD-10 F48.0), post-traumatic stress disorder (PSD; F43.1), or somatization disorder (F45.0, F45.1) were included to receive 1 × 80 mg/day Silexan over 6 weeks; 47 could be analyzed for efficacy as full analysis set. At baseline, patients suffered from restlessness (96%), depressed mood (98%), sleep disturbances (92%), or anxiety (72%). Of those, resp. 62%, resp. 57%, resp.51%, resp. 62% showed improvements during treatment (p < 0.001). For all patients, mean D-S score decreased by 32.7% and SCL-90-R Global Severity Index by 36.4% as compared to baseline, (p < 0.001), while the SF-36 Mental Health Score increased by 48.2% (p < 0.001). Waking-up frequency (p = 0.002), Waking-up duration (p < 0.001) and morning tiredness (p = 0.005) were reduced, while efficiency of sleep (p = 0.018) and mood (p = 0.03) improved. Patients suffering from neurasthenia or PSD showed comparable improvements with most outcomes. The results in this trial justify to further investigate Silexan in disorders with accompanying restlessness caused by sub-threshold anxiety. Adverse reactions, predominantly gastrointestinal complaints, were judged as mild or moderate.

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.

Cultural epidemiology of neurasthenia spectrum disorders in four general hospital outpatient clinics of urban Pune, India.

Disorders emphasizing symptoms of fatigue and/or weakness, collectively termed Neurasthenia Spectrum Disorders (NSDs), typically emphasize a biological basis in the West and social origins in East Asia. In India, explanatory concepts are diverse. To clarify, 352 outpatients in Psychiatry, Medicine, Dermatology, and Ayurved clinics of an urban hospital were interviewed with a version of the Explanatory Model Interview Catalogue. Comparisons of categories and narratives of illness experience and meaning across clinics indicated both shared and distinctive features. Explanatory models of NSDs highlighted social distress, ''tensions,'' and both general and clinic-specific physical, psychological, and cultural ideas. Findings indicate the importance of social contexts and cultural meaning in explanatory models of neurasthenia, as well as the potential clinical relevance of the construct of Neurasthenia Spectrum Disorder.

Subjective distress predicts treatment seeking for depression, bipolar, anxiety, panic, neurasthenia and insomnia severity spectra.

OBJECTIVE: To examine correlates of mental health treatment seeking such as gender, diagnosis, impairment, distress and mastery. METHOD: Longitudinal epidemiological data from the Zurich Study of common psychiatric syndromes, including unipolar and bipolar depression, panic, anxiety, neurasthenia and insomnia, were utilized. In longitudinal Generalized Estimating Equations, treatment seeking was regressed on measures of subjective distress and impairment, childhood family problems, mastery and number of comorbid diagnoses. RESULTS: Approximately half of all treated participants across all six syndromes suffered from subthreshold disorders. Meeting full or subthreshold diagnostic criteria was associated with treatment seeking for insomnia. Being female was associated with treatment seeking for depression. The only variable highly and consistently associated with treatment seeking, across all syndromes, was subjective distress. Treated participants reported high levels of distress, work and social impairment in both diagnostic and subthreshold groups. CONCLUSION: Subjective distress may be a better indicator of treatment seeking than symptom count.

[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.

Differential symptom expression and somatization in Thai versus U.S. children.

Individuals react in a variety of ways when experiencing environmental challenges exceeding their capacity to cope adaptively. Some researchers have suggested that Asian populations tend to react to excessive stress with somatic symptoms, whereas Western populations tend to respond more with affective or depressive symptoms. Other researchers, however, have suggested that such differences may represent different approaches to help seeking rather than actual variations in prevalence. The present study compared somatic versus affective symptoms in U.S. and Thai children from community and mental health clinic samples. In the clinic-referred sample, Thai children were reported to have higher levels of somatic versus depressive symptoms relative to U.S. children, whereas in the community sample, both groups were reported to have slightly higher levels of depressive than somatic symptoms. Because a primary difference between clinic-referred and community samples is that the former have been through the clinical referral process (i.e., were seeking help), these results suggest that differences in somatic versus depressive symptom presentation may be related to help-seeking behavior, at least for the samples involved in this study.

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.