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Chronic fatigue syndrome or neurasthenia?

Published online by Cambridge University Press:  02 January 2018

L. Bailly*
Affiliation:
University College London Medical School, Department of Psychiatry & Behavioural Sciences, 41 Riding House Street, London W1N 8AA, UK
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Abstract

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Columns
Copyright
Copyright © Royal College of Psychiatrists, 2002 

The interesting study reported by Hickie et al (Reference Hickie, Davenport and Issakidis2002) draws attention to the prevalence of ICD-10 neurasthenia (World Health Organization, 1992) in a large sample of the Australian general population. The authors' findings are of the utmost importance for clinicians concerned with the disabling effects of fatigue but also provide food for thought in the wake of the CFS/ME Working Group (2002) report to the Chief Medical Officer. In this report, the term chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is used as an ‘umbrella term’ because of the ‘need for patients and clinicians to agree a satisfactory term as a means of communication’ but the concept of neurasthenia is not used. The report's authors state that CFS is ‘widely used among clinicians’ and seem to consider it to be a disorder more physical than psychiatric. Equally, CFS/ME is not included in DSM-IV (American Psychiatric Association, 1994) or ICD-10. On the other hand, neurasthenia as defined in the ICD-10 is a psychiatric disorder whose main feature is ‘persistent and distressing complaints of increased fatigue after mental effort, or persistent and distressing complaints of bodily weakness and exhaustion after minimal effort’. This fatigue could be associated with muscular aches, dizziness, tension headaches, sleep disturbances, irritability, dyspepsia and inability to relax. Neurasthenia includes ‘fatigue syndrome’ but excludes ‘post viral fatigue syndrome’. Using ICD-10 criteria in the general population, Hickie et al (Reference Hickie, Davenport and Issakidis2002) found that 1.5% of the 10 641 people who participated in the study met the criteria for neurasthenia in the past year. For females aged between 18 and 24 years, the 12-month prevalence rises to 2.4%.

If it is reasonable to compare the Australian and the British populations, we could probably expect a similar proportion of people here to be affected by this psychiatric disorder; the question here is what diagnosis is applied to them? If it is the case that CFS/ME is suggested, this would have adverse implications both for these patients essentially in need of treatment for a psychiatric disorder, and for any research on the aetiology and the treatment of CFS/ME.

References

American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders (4th edn) (DSM—IV). Washington, DC: APA.Google Scholar
CFS/ME Working Group (2002) A Report of the CFS/ME Working Group. Report to the Chief Medical Officer of an Independent Working Group. London: Department of Health. http.//www.doh.gov.uk/cmo/cfsmereport/cfsmereport.pdf Google Scholar
Hickie, L., Davenport, T., Issakidis, C., et al (2002) Neurasthenia: prevalence, disability and health care characteristics in the Australian community. British Journal of Psychiatry, 181, 5661.Google Scholar
World Health Organization (1992) International Classification of Diseases and Related Disorders (ICD–10). Geneva: WHO.Google Scholar
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