Neurasthenia in a longitudinal cohort study of young adults

Abstract

SynopsisThis 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.

Unique genetic and environmental determinants of prolonged fatigue: a twin study

“…Co-morbidity and longitudinal data from community and clinical settings support the notion that the common forms of anxiety and depression are underpinned by common vulnerability factors (Kessler et al 1994 ;Merikangas & Angst, 1994 ;Hunt & Andrews, 1995 ;Andrews, 1996). Previous twin data suggest largely that one common genetic factor, which acts in combination with differing environmental factors, determines the clinical phenotypes of anxiety and depression (Kendler et al 1987).…”

“…Patients with CFS do not show a specific response to antidepressant pharmacotherapy (Wilson et al 1994 ;Vercoulen et al 1996) and longitudinal data sets confirm that patients with prolonged fatigue\neurasthenia tend to maintain their unique characteristics over time (Merikangas & Angst, 1994 ;. Therefore, on the basis of epidemiological, longitudinal and treatment data it has been argued (see Hickie et al 1997 b) that such fatigue syndromes are worthy of specific investigation.…”

The spectra of neurasthenia and depression: course, stability and transitions

“…But it is plausible that a large number of patients also suffer from acute, shorter and impairing fatigue syndromes, as shown by earlier reports from the Zurich Study [1,7,21]. Such a dimensional neurasthenia spectrum was also proposed early by Sharpe et al [28] and Pawlikowska et al [23].…”

“…Our spectrum concept arose from the systematically collected data in all syndromal sections of the interview; after the stem questions and list of symptoms, the duration (maximum, average) and frequency of neurasthenic episodes were assessed for the last 12 months as well as the estimated number of days/year with neurasthenic symptoms. Neurasthenia subgroups were formed according to different duration, frequency and severity criteria and the resulting spectrum was validated using clinical indicators such as treatment and suicide attempt rates, comorbidity, work and social impairment [2,7,21].…”

Chronic fatigue syndrome

“…This is partly a political solution to current diagnostic controversies, allowing those who follow either psychiatric or organic models to incorporate the diagnosis in their formulations. 1 ' Modern epidemiological studies are starting to determine the prevalence of operationally defined neurasthenia, which is common in the community, 32 and could be diagnosed in virtually everyone who attends a specialist CFS clinic. 33 Rather than attempting ever more fine tuned distinctions between CFS and neurasthenia a population perspective is likely to conclude that both lie in dimensional space on an axis somewhere between anxiety and depression, 34 and that both are so closely intertwined that separating them makes little clinical, epidemiological and statistical sense.…”