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.
