Neurasthenia is
characterized by general lassitude, irritability, lack of concentration,
worry, and hypochondria. The term was introduced into psychiatry in
1869 by G. M. Beard, an American neurologist. Neurasthenia covers
a wide spectrum of symptoms, including painful sensations or numbness
in parts of the body, chronic fatigue, anxiety, and fainting. Some
medical historians believe that neurasthenia may actually be the same
as the modern day disorder of chronic fatigue syndrome.
Also known as:
Primary Neurasthenia, Cardiac Neurosis, Chronic Asthenia, Da Costa's
Syndrome, Effort Syndrome, Functional Cardiovascular Disease, Soldier's
Heart and Subacute Asthenia.
Diagnostic criteria
for neurasthenia include:
Persistent and distressing symptoms of exhaustion after minor mental
or physical effort including general feeling of malaise, combined
with a mixed state of excitement and depression.
Accompanied by one or
more of these symptoms: muscular aches and pains, dizziness, tension
headache, sleep disturbance, inability to relax and irritability.
Inability to recover
through rest, relaxation or enjoyment.
Disturbed and restless,
unrefreshing sleep, often troubled with dreams.
Duration of over three
months.
Does not occur in the
presence of organic mental disorders, affective disorder, panic or
generalized anxiety disorder.
Sub Types:
Cerebral.
- Headaches are the prominent symptom. Insomnia is quite characteristic,
and the patient arises unrefreshed; there is more or less despondency;
the patient is anxious, worried, and fearful, anxious of some impending
danger. A continued tired feeling is generally present.
Spinal.
- . Backache, with tenderness along the spine, is characteristic.
Other manifestations may include tingling, crawling, or burning sensation,
or certain parts will feel hot or cold.
Gastro-Intestinal
- Gastric disturbances are the chief characteristics of this form.
Hyperacidity, waterbrash, nausea, retching, and vomiting. The patient
sleeps poorly, has unpleasant dreams, and develops an irritable disposition.
There is flatulency, rumbling of the bowels, constipation may alternated
with diarrhea, and a sense of weight or soreness over the abdomen.
Cardiac
- While there is no organic reason, the person may experience palpitations
and sometimes sharp pain similar to angina.
Urinary
- The quantity of urine expelled is usually small. The patient becomes
irritable, and experience dull headaches.
Sexual
- A fear of becoming impotent preys upon the mind, the patient is
depressed, sleeps poorly, has nocturnal emissions, complains of pain
or crawling sensations in the testicles, has perverted sexual desires,
and frequently masturbates.
Associated
Features:
May experience
rapid intense heartbeat that may be irregular (palpitations, tachycardia).
Cold extremities, clammy hands and feet.
Abnormally rapid breathing (hyperventilating).
Dizziness or faintness.
Periodic sighing
Sweating for no apparent reason.
Be restless fidgeting.
Over-sensitivity.
Differential
Diagnosis:
Some disorders have similar symptoms. The clinician, therefore, in
his diagnostic attempt, has to differentiate against the following
disorders which need to be ruled out to establish a precise diagnosis.Many
medical disorders can cause fatigue therefore a through medical examination
and review of medical history is necessary.
Depression.
Generalized Anxiety Disorder.
Somatic Complaints.
Other psychosomatic
conditions.
Cause:
The cause of Neurasthenia
remain unknown however like most disorders, certain predisposing factors
may play an important part, chief of which may be mentioned heredity
factors, occupation (high stress occupations), age (tends to occurs
between 20 and 55 years of age), and sex (predominantly see in males).
Treatment:
No physical treatment has been
established. If other mental or physical disorders are present, these
may require treatment.
Counseling
and Psychotherapy [ See
Therapy Section ]:
Until a remedy
for persistent fatigue is provided, doctors should take an active
psychological approach to treatment.
Pharmacotherapy
[ See Psychopharmacology
Section ] :
Amitriptyline
(for pain and sleep regularization).
Celexa.
Effexor.
Buspirone.
