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PubMed1996

[Expert assessment of chronic fatigue syndrome].

The Chronic-Fatigue-Syndrome (CFS) has been first described in 1988 and has been also in Germany recently more frequently diagnosed. It is similar to a lot of other terms, especially to "neurasthenia", which has been introduced 1869 from Beard and is now again content of ICD-10. CFS is defined by primary and secondary criteria, which are however largely subjective. There are no objective signs. It is unknown if this syndrome represents a disease entity of its own. The explanation is either exclusive organic based on immunological and virological findings or exclusive psychogenic as a special form of anxiety psychosis. Possibly are both factors involved as part of "psycho-neuro-immunology". CFS is increased subject of medical certification. It has been tried to give a practical guidance to the assessment of CFS.

Diagnosis, Differential↗
PubMed1977

[Psychological study of the intellectual-personality characteristics of neurotic patients (according to findings from use of the experimental Vygotskii-Sakhorov method)].

The author describes some special traits in accomplishing the modified techniques for a formation of conceptions according to Vigotsky-Sakharov's test in patients with different forms of neuroses (neurasthenia, hysteria, psychasthenia). A study of conceptual thinking in such patients revealed a dissociation between the possibility of a practical mastering of the task and its verbalization on a conceptual level which is characteristic of hysteria.

Decision Making↗
PubMed1996

[Memory disorder].

Pregnant are described all gravities of congenital defect of intelligence to dementia until neurasthenia and deficiency concentration. Thereby are classified complete causes as degenerate and vascular kinds as also internal diseases, chronic intoxications until mental inactivity. Owing to the broad spectrum do not think immediately (only) of the senium and the Morbus Alzheimer!

Alzheimer Disease↗
PubMed1997

The cognitive, subjective, and physical effects of a ginkgo biloba/panax ginseng combination in healthy volunteers with neurasthenic complaints.

We evaluated the effects of a Ginkgo biloba/ginseng combination on cognitive function in this 90-day, double-blind, placebo-controlled, parallel-group study. Sixty-four healthy volunteers (aged 40 to 65 years), selected on the basis of fulfilling the ICD-10 F48.0 criteria for neurasthenia, were assigned randomly to four equal dosing groups, receiving 80, 160, or 320 mg of the combination b.i.d. or placebo. Assessments were performed on the day before dosing, and again at Days 1, 30, and 90 at 1 hour after the morning dose and 1 hour after the afternoon dose. The assessments included the Cognitive Drug Research (CDR) computerized assessment system, the Vienna Determination Unit, cycle ergometry, and various questionnaires. The treatments were well tolerated by all volunteers. On Day 90 at 1 hour post morning dosing, dose-related improvements were seen on the CDR tests, the 320 mg dose being significantly superior to placebo. These effects, however, were reversed 1 hour after the afternoon dose, possibly suggesting that a longer inter-dosing interval would be preferable. The 80-mg dose produced a significant benefit on the ergometry assessment of heart rate at maximum load. There were also several supporting changes from other assessments, including an advantage of 320 mg over placebo on the global score from the Symptom Checklist-90-revised (SCL-90-R) at Day 90.

Adult↗
PubMed1994

Common mental disorders and disability across cultures. Results from the WHO Collaborative Study on Psychological Problems in General Health Care.

OBJECTIVE: To examine the impact of common mental illness on functional disability and the cross-cultural consistency of this relationship while controlling for physical illness. A secondary objective was to determine the level of disability associated with specific psychiatric disorders. DESIGN: A cross-sectional sample selected by two-stage sampling. SETTING: Primary health care facilities in 14 countries covering most major cultures and languages. PATIENTS: A total of 25,916 consecutive attenders of these facilities were screened for psychopathology using the General Health Questionnaire (96% response). Screened patients were sampled from the General Health Questionnaire score strata for the second-stage Composite International Diagnostic Interview administered to 5447 patients (62% response). MAIN OUTCOME MEASURES: Patient-reported physical disability, number of disability days, and interviewer-rated occupational role functioning. RESULTS: After controlling for physical disease severity, psychopathology was consistently associated with increased disability. Physical disease severity was an independent, although weaker, contributor to disability. A dose-response relationship was found between severity of mental illness and disability. Disability was most prominent among patients with major depression, panic disorder, generalized anxiety, and neurasthenia; disorder-specific differences were modest after controlling for psychiatric comorbidity. Results were consistent across disability measures and across centers. CONCLUSIONS: The consistent relationship of psychopathology and disability indicates the compelling personal and socioeconomic impact of common mental illnesses across cultures. This suggests the importance of impairments of higher-order human capacities (eg, emotion, motivation, and cognition) as determinants of functional disability.

Adolescent↗
PubMed2000

Neurologist or psychiatrist? The public and private domains of Jean-Martin Charcot.

The emergence of neurology as an autonomous, prestigious field in late-nineteenth-century Paris is well known. Less appreciated is the role that neurologists played vis-à-vis the cognate older field of psychiatry. Taking Jean-Martin Charcot, the most influential neurologist of his time, as a test case, this paper contrasts his attitudes and practice in the public setting of teaching and hospital work with his private practice. A staunch defender of a clear distinction between his field and psychiatry, Charcot's private practice displayed more flexibility. Treating hysteria and neurasthenia created a middle ground of nervous diseases for him to cultivate. Unpublished case histories and other materials, especially from the Charcot library, support the conception of neurologists as active agents in constituting a new psychological medicine.

Famous Persons↗
PubMed1993

Non-pharmacological approaches to treatment.

Chronic fatigue syndrome (CFS) as currently defined overlaps with other syndromes including chronic pain, fibromyalgia, anxiety and depression. It also resembles historical descriptions of neurasthenia. The role of psychological (cognitive) and behavioural therapies in CFS is examined. There are both pragmatic and theoretical arguments for their application to CFS. It is pragmatic to target obvious and treatable factors including inactivity and depression. A theoretical model in which psychological, physiological and social factors interact offers a plausible rationale for such treatment but is not yet empirically proven. While there is evidence for the efficacy of this type of therapy in related syndromes, the evidence in CFS is inconclusive. A randomized controlled trial of combined cognitive and behavioural therapy currently in progress is described. Initial results suggest that most patients receiving cognitive behaviour therapy improve, especially in terms of functional impairment. It remains to be seen whether this therapy will prove to be more effective than standard general practitioner care. In the meantime cognitive behaviour therapy offers a pragmatic and rational therapy for patients with CFS.

Behavior Therapy↗
PubMed2006

Medicalizing melancholia: exploring profiles of psychiatric professionalization.

The nineteenth century was the site of radical changes in understanding mental illness. The professionalization of psychiatry consisted primarily of the discipline's aspiration to the status of an expert medical subspecialty. While all forms of insanity were eventually reframed in medical terms, melancholia--for moral and nosological reasons--assumed a special role that made it an ideal diagnosis for conceptual reframing. Our analysis of the journal literature of the nineteenth and early twentieth centuries in North America and Germany traces several ways in which melancholia was medicalized. As the care for the insane shifted into the professional realm of physicians and medical terminology came to replace prior descriptors of mental illness, melancholia was replaced by depression. In addition, the process of delineating affective pathology assumed a distinctly medical flavor. Finally, melancholia was firmly medicalized when its boundaries blurred with neurasthenia. Differences in how ordinary affective terms became medicalized in German and North American psychiatry illustrate the importance of local historical approaches.

Affective Disorders, Psychotic↗
PubMed1996

Cultures in psychiatric nosology: the CCMD-2-R and international classification of mental disorders.

This essay reviews the Chinese Classification of Mental Disorders, Second Edition, Revised (CCMD-2-R, 1995), by assuming the theoretical stance that symptom recognition, disease construction, and taxonomic strategy in psychiatry reflect, and are constrained by, the cultural norms and values as well as the political and economic organizations of the society in which they are embedded. The CCMD-2-R is an ethnomedical classification grounded in both symptomatology and etiology, in which Chinese psychiatrists seek to conform with international classifications on the one hand, and to sustain a nosology with Chinese cultural characteristics on the other. Although broad similarities between the ICD-10 and CCMD-2-R are evident, their blending is legitimately incomplete. Thus, the particular additions (e.g., travelling psychosis, qigong induced mental disorders), deletions (e.g., somatoform disorders, pathological gambling, a number of personality and sexual disorders), retentions (e.g., unipolar mania, neurosis, hysteria, homosexuality), and variations (e.g., depressive neurosis, neurasthenia) reveal not only the changing notions of illness but also the shifting social realities in contemporary China. The CCMD-2-R will be widely used by Chinese psychiatrists and should standardize diagnostic practice and facilitate research, but its impact on everyday clinical work and psychiatric training remains to be evaluated. For Western researchers, it is one avenue for achieving an understanding of the Chinese social world, and should usefully be contrasted with the ICD-10 and DSM-IV as the move towards an international nosology continues.

China↗
PubMed1988

Interferon-induced organic mental disorders associated with unsuspected pre-existing neurologic abnormalities.

Eleven patients ranging in age from 52 to 80 years, undergoing treatment for cancer with various preparations of interferon received neurobehavioral evaluations after experiencing unexpectedly severe organic mental disorders. The reactions ranged from delirium to extrapyramidal symptoms, mania, and neurasthenia with catatonic episodes. Computed tomographic (CT) scans of the brain disclosed unsuspected pre-existing neurologic abnormalities in all patients, including cerebral atrophy (6/11), brain metastases (4/11), and evidence of head injury incurred 40 years earlier (1/11). These findings suggest that cancer patients with pre-existing neurologic dysfunctions are at increased risk for severe interferon neurotoxicity.

Aged↗
PubMed1980

Classification of organic brain syndromes by cluster analysis.

Cluster analysis was carried out on a sample of 92 patients with behavior disorders caused by degenerative, vascular, (alcohol) toxic, and other diseases of the brain. Rating variables of the AMDP system concerning mental state, social behavior, need for special care, sleep disorders, autonomic, physical, and neurologic symptoms were used in the absence of severe degrees of disordered consciousness such as stupor, coma, delirium tremens, and gross cerebral lesions. Results suggested the existence of four major groups of global cognitive impairment combined with neurasthenia and irritability in the first, hypochondriasis and depression in the second, withdrawal symptoms in the third, and severe disorientation in the fourth. At the seven-group level the groups were further distinguished according to severe withdrawal, amnestic syndrome, and dementia by various social and illness behaviors, sleep-wakefulness pattern, hypo- or hyperactivity, additional physical, and neurologic symptoms. Other minor types of organic brain syndromes were identified as individual cases by hallucinations or other circumscribed cognitive, psychomotor, affect, motivation, personality, and/or behavior disorder, symptomatic manic, or schizophreniform psychosis. The findings lent support to old classifications and new ones of organic mental syndromes (DSM-III).

Adult↗
PubMed1996

A century of controversy surrounding posttraumatic stress stress-spectrum syndromes: the impact on DSM-III and DSM-IV.

The authors describe historical clinical reports that preceded the development of criteria for posttraumatic stress disorder (PTSD) and influenced the formation of PTSD in DSM-IV. These reports were identified from extensive search of 19th- and 20th-century American and European medical literature. Relevant findings from the most representative reports are described and discussed. Since the mid-19th century, clinical syndromes resembling PTSD have been described. However, understanding of PTSD has been complicated by questions of nomenclature, etiology, and compensation. Nomenclature placed PTSD syndromes under existing psychiatric disorders: traumatic hysteria, traumatic neurasthenia, or traumatic neurosis. Etiological issues have been concerned often solely with organic factors, pre-existing personality impairments, intrapsychiatric conflicts, and social factors. Only after World War II and the concentration camp experiences did the role of severe trauma in PTSD become recognized. Even though controversy remains, much progress in understanding PTSD has been made.

Diagnosis-Related Groups↗
PubMed1993

The Zurich study. XX. Social phobia and agoraphobia.

The problems in association with agoraphobia and social phobia were examined in an 11-year prospective longitudinal study of a Swiss cohort of young adults. The weighted prevalence rates according to DSM-III were 2.9% for agoraphobia and 3.8% for social phobia. Although the problem of agoraphobia was greater in females, an equal sex ratio was observed for social phobia. There was a significant degree of comorbidity between the two subtypes of phobia, with females exhibiting a significantly greater frequency of co-occurrence of both disorders than males. The course of the two disorders was quite similar. In general, subjects with both disorders reported a more severe course. Assessment of comorbidity of phobias and other disorders revealed that agoraphobia was most significantly associated with extended neurasthenia, sexual problems, and the consumption of cannabis. On the other hand, social phobia was associated with other disorders than agoraphobia, with the strongest associations emerging for simple phobia, extended insomnia, and alcohol abuse. These findings support the validity of the distinction between different subtypes of phobia. The longitudinal analysis revealed that also phobia in general was not stable at the diagnostic level phobic symptoms were quite persistent across time.

Adolescent↗
PubMed1996

The giver of oxygen: Hercules Sanche and the Oxydonor.

During the late nineteenth and early twentieth centuries, gas-pipes were among the most popular therapeutic devices available to an unhealthy public. Spurred on by the explosion of print advertising, mail-order gas-pipes were questionable remedies promoted for such diverse conditions as pneumonia and neurasthenia. Though they are an interesting part of the social history of questionable therapeutics, no historian has recently looked in depth at these devices. This paper examines the clinical, social, and economic environment that facilitated the success of the most ubiquitous gas-pipe, the Oxydonor, and its proprietor, Hercules Sanche.

History, 19th Century↗
PubMed1996

[Chronic fatigue syndrome. Definition, diagnostic measures and therapeutic possibilities].

This article reviews the chronic fatigue syndrome (CFS), a disorder whose etiology is unknown. The diagnostic criteria proposed in 1994 by the CDC and the International Chronic Fatigue Syndrome Study Group are introduced. In contrast to widespread belief, there are no laboratory tests available to underpin the diagnosis of CFS; the diagnosis is made solely on the basis of clinical criteria. In the differential diagnosis, the exclusion of other conditions that can cause chronic fatigue, such as neuropsychiatric or sleep disorders, is of critical importance. In this context, the question as to whether CFS is a clinical entity that can be differentiated from psychiatric diagnoses, such as depression, somatoform disorder, or neurasthenia, is discussed. At the moment, there is no specific therapy for CFS. Therefore, therapeutic approaches are limited to symptomatic management of the concomitant sleep disturbances, pain, or psychiatric symptoms, such as depression. Patients may benefit from cognitive behavioral therapy, as this may help then to identify and exclude factors contributing to and maintaining chronic fatigue. An integrated medical and psychological approach should be adopted, with the aim of preventing significant secondary negative results of the illness, such as interpersonal conflicts or chronic disability.

Adaptation, Psychological↗
PubMed1999

Somatic distress as a distinct psychological dimension.

BACKGROUND: Somatoform disorders such as neurasthenia and chronic fatigue are characterized by a combination of prolonged fatigue and disabling neuropsychological and neuromuscular symptoms. However, the debate concerning the theoretical underpinnings of somatic disorders resembles the perennial dispute over the taxonomy of anxiety and depression. The objective of this study is to analyse the dimensional structure of items measuring anxiety, depression, phobic anxiety, somatic distress, and insomnia. It is anticipated that somatic distress should emerge as empirically distinct from measures of anxiety and depression, thereby lending support to proponents of the construct as independent of both anxiety and depression symptomatology. METHODS: A 33-item self-report symptom inventory derived from the SCL-90 and DSSI/sAD scales was used to measure recently experienced psychiatric distress in the form of depression, anxiety, phobic anxiety, somatic distress, and insomnia. SCL and DSSI/sAD items were measured on a four-point distress scale from 1 'not-at-all' to 4 'unbearably'. The inventory was administered to a community-based sample of 3468 Australian twins between the ages of 18 and 28. RESULTS: Factor analysis using Polychoric correlations and a Promax rotation criterion produced four factors: depression, phobic anxiety, somatic distress, and sleep disturbance. CONCLUSION: Results from the current factor analysis, together with the documented prevalence of somatic disorders, including evidence regarding the genetic and biological independence of somatic symptomatology, lend support to the argument that somatic symptoms, although correlated, are independent of anxiety and depression.

Adult↗
PubMed2005

Atypical depressive syndromes in varying definitions.

BACKGROUND: Atypical depression (AD) exhibits distinct patterns of gender,bipolar-II disorder, genetic, and neuro-biological measures. Using prospective data from a community sample, this paper identifies criteria (and correlates) for an AD syndrome that maximizes the association with female sex and bipolar-II. METHODS: The Zurich cohort study is composed of 591 subjects selected from a population-based cohort of young adults in the canton of Zurich in Switzerland, screened in 1978 and followed with six interviews through 1999. Seven definitions of atypical depression were tested, using varying combinations of vegetative symptoms and mood reactivity. RESULTS: The atypical definitions using 2 of 3 (fatigue, overeating, oversleeping) or 2 of 2 (overeating, oversleeping) vegetative symptoms showed the strongest association with gender, bipolarity, and family history of mania. The 2/3 definition was chosen for further analysis due to its high sensitivity for identifying these characteristics. This syndrome had cumulated weighted prevalence of 16.4% (males 9.7%, females 23%); when associated with major depressive episodes, 8.2% (males 3.2%, females 15.1%). AD patients were characterized by high treatment rates, severity, and work impairment, early age of onset and long illness. AD was comorbid with social phobia, binge eating, neurasthenia, migraine headache, and subjective cognitive impairment.

Adult↗
PubMed2004

Pioneers of movement disorders: Georges Gilles de la Tourette.

Georges Albert Edouard Brutus Gilles de la Tourette (1857-1904), a French neurologist and pupil of Jean Martin Charcot at the Salpêtrière hospital in Paris, has gained common recognition through his description of the 'Maladie des Tics'. This complex neuropsychiatric disorder, later known as the 'Tourette's syndrome', nowadays is accepted as a specific entity of movement disorders. Gilles had started working under Charcot (1825-1893), the first physician to occupy a designated chair of neurology of neuropsychiatric history, in 1884. Then the Salpêtrière hospital was a centre of intensive research with an emphasis on hysteria and hypnosis. Tourette took an interest in hysteria, but also dedicated himself to various other neuropsychiatric disorders and to neuropathology. He published scientific works on epilepsia, neurasthenia and syphilitic myelitis. Although he devoted much time to his neuropsychiatric research and the publication of articles in medical journals, his career did not make significant progress, despite Charcot's unrestricted support. One reason was, that he disregarded questions, answers and problems, which were outside his interest fields. Hence, he was accused for having acquired an extremely filtered and one-sided knowledge. Also, his alienated and critical behaviour, which had not helped him to find many friends over the years, prevented him from professional promotion. In 1893 an assassination attempt on Gilles de la Tourette raised considerable public interest: Gilles was shot in his appartement in the Rue de l'Université 39 by a young woman, who had been his patient in the Salpêtrière and who claimed that she had been hypnotized without her agreement and thereby had lost her mental health. However, the patient was diagnosed with a disease nowadays called paranoid schizophrenia and therefore hypnosis was not attributed to any part of the disease. Due to episodes of melancholia and phases of delusions of grandeur and megalomania Gilles de la Tourette was forced to leave his hospital appointment in 1901. These symptoms and the corresponding neurological signs were attributed to the paretic neurosyphilis. He was institutionalized to the psychiatric hospital Cery near Lausanne, Switzerland. In the course of the following three years he became increasingly psychotic and demented, suffered from epileptic seizures and finally died in hospital on 22nd May 1904.

France↗