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Neurasthenia in a longitudinal cohort study of young adults

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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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