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Neurasthenia in a longitudinal cohort study of young adults

Published online by Cambridge University Press:  09 July 2009

K. Merikangas  and
J. Angst
K. Merikangas*
Affiliation:
Genetic Epidemiology Research Unit, Yale University School of Medicine, New Haven, CT, USA; Psychiatric University Hospital, Zurich, Switzerland
J. Angst
Affiliation:
Genetic Epidemiology Research Unit, Yale University School of Medicine, New Haven, CT, USA; Psychiatric University Hospital, Zurich, Switzerland
*
1Address for correspondence. Dr K. Merikangas, Genetic Epidemiology Research Unit, Yale University School of Medicine, 40 Temple street, New Haven, CT 06510, USA
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Synopsis

This study examines the concept of neurasthenia in a longitudinal cohort of young adults selected from a community sample of the canton of Zurich, Switzerland. The major focus is on the validity of the case definition of neurasthenia. Close approximations of the proposed descriptive and research definitions of the ICD-10 are employed as well as the concept of ‘irritable weakness’ as described in 1831 by Kraus (1926–1932).

The prevalence of neurasthenia defined according to the ICD-10 criteria was: 1% across 10 years and 0·9% in 1988 for a duration criterion of ≥ 3 months; and 8·1% across 10 years and 12% in 1988 for a duration criterion of ≥ 1 month. The duration criterion of ≥ 3 months appeared to be excessively restrictive to represent individuals with neurasthenia in the community. Subjects with 1 month episodes of neurasthenia exhibited sufficient differences from controls and similarities to subjects with anxiety or depressive disorders to justify a 1 month duration criterion for neurasthenia in community samples.

The clinical significance of neurasthenia was indicated by the magnitude of subjective distress, and occupational and social impairment reported by the majority of the cases. Prospective assessment of the longitudinal course of neurasthenia revealed that approximately 50% of the cases continued to exhibit this disorder at follow-up. Our findings suggest that neurasthenia is equally likely to represent an early manifestation of affective illness as it is a consequence in those neurasthenic subjects who exhibited comorbid affective disorders. The magnitude, chronicity, impairment, longitudinal stability and distinction from anxiety and depression associated with this condition in the general population, suggest that neurasthenia is an important diagnostic entity for which additional validation studies should be undertaken.

Type
Original Articles
Information
Psychological Medicine , Volume 24 , Issue 4 , November 1994 , pp. 1013 - 1024
Copyright
Copyright © Cambridge University Press 1994

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References

Allan, F. (1944). The differential diagnosis of weakness and fatigue. New England Journal of Medicine 231, 414–418.CrossRefGoogle Scholar
American Psychiatric Association Committee on Nomenclature and Statistics (1980). Diagnostic and Statistical Manual of Mental Disorders. 3rd edn.American Psychiatric Association: Washington, DC.Google Scholar
American Psychiatric Association Committee on Nomenclature and Statistics (1987). Diagnostic and Statistical Manual of Mental Disorders, 3rd edn. Revised. American Psychiatric Association: Washington, DC.Google Scholar
Angst, J. & Clayton, P. J. (1986). Premorbid personality of depressive, bipolar, and schizophrenic patients with special reference to suicidal issues. Comprehensive Psychiatry 27, 511–532.CrossRefGoogle ScholarPubMed
Angst, J., Dobler-Mikola, A. & Binder, J. (1984). The Zurich study – a prospective epidemiological study of depressive, neurotic and psychosomatic syndromes: I. Problem, methodology. European Archives of Psychiatry and Neurological Sciences 234, 13–20.Google Scholar
Angst, J. & Koch, R. (1991). Neurasthenia in young adults. In Problems of Psychiatry in General Practice: Neurasthenia, Obsessive-Compulsive Disorder, Advances in Treatment of Depression, Teaching and Training of the GP (ed. Gastpar, M. and Kielholz, P.). pp. 37–48. Hogrefe & Huber: Toronto.Google Scholar
Beard, G. (1869). Neurasthenia, or nervous exhaustion. Boston Medical and Surgical Journal III, 217–221.CrossRefGoogle Scholar
Blakely, A. A., Howard, R. C., Sosich, R. M., Murdoch, J. C., Menkes, D. B. & Spears, G. F. S. (1991). Psychiatry symptoms, personality and ways of coping in chronic fatigue syndrome. Psychological Medicine 21. 347–362.CrossRefGoogle Scholar
Cathébras, P. J., Robbins, J. M., Kirmayer, L. J. & Hayton, B. C. (1992). Fatigue in primary care: prevalence, psychiatric comorbidity, illness behavior and outcome. Journal of General Internal Medicine 7. 276–286.CrossRefGoogle ScholarPubMed
Costa e Silva, J. A. & De Girolamo, G. (1990). Neurasthenia: history of a concept. In Psychological Disorders in General Medical Settings (ed. Sartorius, N., Goldberg, D., de Girolamo, G., Costa e Silva, J., Lecrubier, Y. and Wittchen, U.), pp. 69–81. Hogrefe & Huber: Toronto.Google Scholar
David, A., Pelosi, A., McDonald, E., Stephens, D., Ledger, D., Rathbone, R. & Mann, A. (1990). Tired, weak, or in need of rest: fatigue among general practice attenders. British Medical Journal 301, 1199–1202.CrossRefGoogle ScholarPubMed
Derogatis, R. L. (1977). Symptom Checklist 90, R-Version Manual I: Scoring, Administration and Procedures for the SCL-90. Johns Hopkins University Press: Baltimore.Google Scholar
Duncan, D. B. (1975). t-Tests and intervals for comparisons suggested by the data. Biometrics 31, 339–359.Google Scholar
Fahrenberg, J., Selg, H. & Hampel, R. (1970). Das Freiburger Persontichkeitcinventar. Hogrete: Göttingen.Google Scholar
Freud, S. (1895) On the Grounds for Detaching a Particular Syndrome from Neurasthenia under the Description ‘Anxiety Neurosis’, 3rd edn.Hogarth Press: London.Google Scholar
Goldberg, D., Bridges, K., Duncan-Jones, P. & Grayson, D. (1987). Dimensions of neuroses seen in primary care settings. Psychological Medicine 17, 461–470.Google Scholar
Griesinger, W. (1945). Die Pathologie und Therapie der psychischen Krankheiten und Zustandsbilder. Hans Huber: Vienna.Google Scholar
Hickie, I., Lloyd, A., Wakefield, D. & Parker, G. (1990). The psychiatric status of patients with the chronic fatigue syndrome. British Journal of Psychiatry 156, 534–540.Google Scholar
Holmes, G. P., Kaplan, J. E., Gantz, N. M., Komaroff, A. L., Dobois, R., Cunningham-Rundles, C., Pahwa, S., Tosato, G., Zegans, L. S., Purtilo, D. T., Brown, N., Schooley, R. T. & Brus, I. (1988). Chronic fatigue syndrome: a working definition. Annals of Internal Medicine 108, 387–389.CrossRefGoogle Scholar
Katon, W. J. & Walker, E. A. (1993). The relationship of chronic fatigue to psychiatric illness in community, primary care, and tertiary care samples. In Chronic Fatigue Syndrome, pp. 193–211. (Ciba Foundation Symposium 173.) Wiley: Chichester.Google Scholar
Kielholz, P. (1957). Diagnostik und Therapie der depressiven Zustandsbilder. Schweizerische Medizinische Wochenschrift 87, 107.Google Scholar
Kraus, L. A. (1926–1932). Kridisch-Etymologisches Medicinisches Lexikon, 2nd edn.R. Deuerlich: Göttingen.Google Scholar
Kroenke, K., Wood, D. R., Mangelsdorff, A. D., Meier, N. J. & Powell, J. B. (1988). Chronic fatigue in primary care: prevalence, patient characteristics, and outcome. Journal of the American Medical Association 260, 929–934.CrossRefGoogle Scholar
Kruesi, M. J. P., Dale, J. & Straus, S. E. (1989). Psychiatric diagnosis in patients who have chronic fatigue syndrome. Journal of Clinical Psychiatry 50, 53–56.Google Scholar
Lewis, G. & Wessely, S. (1992). The epidemiology of fatigue: more questions than answers. Journal of Epidemiology and Community Health 46, 92–97.CrossRefGoogle ScholarPubMed
Lloyd, A., Hickie, I., Boughton, C. R., Spence, O. & Wakefield, D. (1990). Prevalence of chronic fatigue syndrome in an Australian population. Medical Journal of Australia 153, 522–528.CrossRefGoogle Scholar
Manu, P., Matthews, D. A. & Lane, T. J. (1988). The mental health of patients with a chief complaint of chronic fatigue: a prospective evaluation and follow-up. Archives of Internal Medicine 148, 2213–2217.CrossRefGoogle ScholarPubMed
Merikangas, K. R., Angst, J. & Isler, H., (1990). Migraine and psychopathology: results of the Zurich cohort study of young adults. Archives of General Psychiatry 47, 849–853.CrossRefGoogle ScholarPubMed
Mirouze, J. (1962). Problèmes psychosomatiques et hormonaux de la fatigue. Assisses de Médecine 3, 1–4.Google Scholar
Möbius, P. (1894). Neurologische Beitrage. Abel: Leipzig.Google Scholar
Nystrom, S. & Lindegard, B. (1975). Predisposition for mental syndromes: a study comparing predisposition for depression, neurasthenia and anxiety state. Acta Psychiatrica Scandinavica 51. 69–76.CrossRefGoogle ScholarPubMed
Reinhardt, P. & Winston, X. (1985). SAS Supplemental Library User's Guide. SAS Institute: Cary, NC.Google Scholar
Roccatagliata, G. (1973). Storia della Psichiatria Antica. Hoepli: Milan.Google Scholar
Straus, S. E. (1988). The chronic mononucleosis syndrome. Journal of Infectious Diseases 57, 405–412.CrossRefGoogle Scholar
Swartz, M. N. (1988). The chronic fatigue syndrome – one entity of many (editorial)? New England Journal of Medicine 319, 1726–1728.Google Scholar
Taerk, G. S., Toner, B. B., Salit, I. S., Garfinkel, P. E. & Ozersky, S. (1987). Depression in patients with neuromyasthenia (benign myalgic encephalomyelitis). International Journal of Psychiatric Medicine 17. 49–56.Google Scholar
Tobi, M., Morag, A., Ravid, Z.Chowers, I., Feldman-Weiss, V., Michaeli, Y., Ben-Chetrit, E., Shalit, M. & Knobler, H. (1982). Prolonged atypical illness associated with serologic evidence of Epstein-Barr virus infection. Lancet i, 61–64.Google Scholar
Vittoz, R. (1913). Treatment of Neurasthenia by Means of Brain Control, 2nd edn.Longmans, Green and Co: London.Google Scholar
Wessely, S. (1991). History of postviral fatigue syndrome. British Medical Bulletin 47, 919–941.CrossRefGoogle ScholarPubMed
Wessely, S. & Powell, R. (1989). Fatigue syndromes: a comparison of chronic ‘post-viral’ fatigue with neuromuscular and affective disorders. Journal of Neurology, Neurosurgery and Psychiatry 42, 940–948.CrossRefGoogle Scholar
Wilson, D. R., Widmer, R. B., Cadoret, R. J. & Judiesch, K. (1983). Somatic symptoms: a major feature of depression in a family practice. Journal of Affective Disorders 5, 199–207.CrossRefGoogle Scholar
World Health Organization (1993). The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. World Health Organization: Geneva.Google Scholar