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Neurasthenia in a longitudinal cohort study of young adults

  [ 20 votes ]   [ Discuss This Article ] • November 3, 1994

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 > or = 3 months; and 8.1%
across 10 years and 12% in 1988 for a duration criterion of >
or = 1 month. The duration criterion of > or = 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.

Merikangas K, Angst J

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