Exploring the association between depression and shenjing shuairuo in a population representative epidemiological study of Chinese adults in Guangzhou, China.

Traditional mental illness concepts remain prevalent in China. Shenjing shuairuo (i.e., neurasthenia), a depressive-like syndrome less favored in Western psychiatric nosology, has a long tradition of acceptance among Chinese lay people. The concept may be more easily accepted in China due to the culturally informed view of the importance of harmony between mind and body and is consistent with Traditional Chinese Medicine. The goals of this study were to estimate the prevalence of shenjing shuairuo, the overlap between shenjing shuairuo and depression, and whether these two disorders share correlates. Data was obtained from 751 Chinese adults using stratified random sampling. Spatial epidemiological methods were utilized with face-to-face interviews conducted in Guangzhou, China. The Patient Health Questionnaire (PHQ-9) and the neurasthenia criteria from ICD-10 measured depression and shenjing shuairuo. The prevalence of depression and shenjing shuairuo were 5.3% and 15.4%, respectively. Participants with depression were nearly six times more likely to have shenjing shuairuo. Women were more likely than men to have comorbid depression and shenjing shuairuo. Poorer health was reported across disorders. Those with shenjing shuairuo were more likely to report medical diagnoses. Longer sleep latency was reported for those with shenjing shuairuo and those with depression reported fewer hours of sleep and lower sleep quality. Those with depression alone reported the poorest sleep. Significant diagnostic overlap and few distinct correlates were observed. Nevertheless, the difference in prevalence and acceptance among non-professionals suggests that shenjing shuairuo is a useful category of distress among Chinese adults in Southern China.

Two-week neurasthenic major depression.

The relationship between the two syndromes neurasthenia and depression is of interest in the context of burnout, which, although not a diagnosis, is often treated in psychiatry. This study defines major depressive episodes according to DSM-5 and neurasthenia by ICD-10 symptom criteria, and both syndromes on the basis of a 2-week minimum duration. The study includes all subjects of the Zurich epidemiological study who had taken part in the last five interviews (1986-2008) and compares three groups, pure depression, pure neurasthenia and their combination (neurasthenic depression), applying nonparametric statistics. The three groups did not differ in common validators: age of onset, course, a family history for depression and anxiety/panic. Psychiatric comorbidity was also very similar, with the exception of suicide attempts and substance abuse, which were less frequent in the pure neurasthenic group. Somatic comorbidity was also highly comparable, except for stomach problems, which were more common in subjects with neurasthenic syndromes. Surprisingly, the well-known preponderance of depression in women was explained by the association with neurasthenic syndromes. The proposed new diagnosis of neurasthenic depression could help diagnose subjects treated for burnout but needs replication by other representative studies.

Cocaína: una revisión de la adicción y el tratamiento / Cocaine: A review of addiction and treatment

La cocaína es la droga responsable de más muertes en España. A pesar de una disminución del consumo en los últimos años, la prevalencia continúa siendo alta y es común hallarla en la práctica clínica. Si unimos a ello la peligrosidad del tóxico por su alta capacidad adictiva, las frecuentes y graves complicaciones que acarrea y la dificultad para su abandono, tenemos motivos de sobra para plantear una revisión tanto de su origen como de su estado actual, su abordaje clínico, y los retos para un futuro (AU)

Cocaine is the drug responsible for more deaths in Spain. Despite a decrease in consumption in recent years, the prevalence remains high and is common to find it in clinical practice. If you join it the danger of toxic because it´s addictive high capacity, frequent and serious complications involved and the difficulty of abandonment, we have every reason to propose a revision of both its origin and its present, its clinical approach, and challenges for the future (AU)

[Influence of psychological and psychopathological features of cancer patient personality on their attitudes towards the disease].

Our paper deals with psychological and psychopathological features of cancer patient personality. Our data deals with on influence of such characteristics on attitudes of cancer patients towards the disease. The impact of pre-morbid features of patients on their attitudes was established. It was shown that maladapted patients with both intra- (neurasthenia, anxiety, hypochondria, ascetism) and inter-psychic (sensitivity) features Our results may contribute to development of efficient methods of copying strategy connection which in turn may alleviate dysadaptation of cancer patients.

A fadiga e seus transtornos: condições de possibilidade, ascensão e queda da neurastenia novecentista / Fatigue and its disturbances: conditions of possibility and the rise and fall of twentieth-century neurasthenia

Analisa alguns dos elementos sociohistóricos que configuraram condições de possibilidade para a emergência da neurastenia como categoria nosológica, na segunda metade do século XIX, bem como os aspectos que influenciaram seu declínio em meios médicos e leigos. Propõe breve apresentação dessa categoria médica e discussão mais detalhada sobre alguns debates em que ela encontra sustentação, tais como a ideia do desgaste do suprimento nervoso, os estudos e as preocupações novecentistas sobre a fadiga e a pressuposição da somatogênese da doença. Analisa, por fim, o processo de declínio da categoria ressaltando alguns elementos que alteraram seu estatuto e sua utilidade como diagnóstico.

The article first analyzes some of the social and historical components underlying the conditions of possibility that allowed neurasthenia to emerge as a nosological category in the latter half of the nineteenth century and then explores the elements that influenced its demise in medical and lay circles. It offers a brief introduction to this medical category and a more detailed discussion of some supporting debates, including the idea of nervous exhaustion, twentieth-century studies and concerns on fatigue, and the malady's presumed somatogenesis. The concluding analysis of how the category met its demise highlights elements that altered its status and its diagnostic usefulness.

[Fatigue and its disturbances: conditions of possibility and the rise and fall of twentieth-century neurasthenia]. / A fadiga e seus anstornos: condições de possibilidade, ascensão e queda da neurastenia novecentista.

The article first analyzes some of the social and historical components underlying the conditions ofpossibility that allowed neurasthenia to emerge as a nosological category in the latter half of the nineteenth century and then explores the elements that influenced its demise in medical and lay circles. It offers a brief introduction to this medical category and a more detailed discussion of some supporting debates, including the idea of nervous exhaustion, twentieth-century studies and concerns on fatigue, and the malady's presumed somatogenesis. The concluding analysis of how the category met its demise highlights elements that altered its status and its diagnostic usefulness.

Dimensions of fatigue in systemic lupus erythematosus: relationship to disease status and behavioral and psychosocial factors.

OBJECTIVE: To characterize the experience of fatigue in patients with systemic lupus erythematosus (SLE) using a multidimensional assessment and to delineate contributors to physical and mental dimensions of fatigue. METHODS: Fatigue in 130 women with SLE was assessed using the Multidimensional Fatigue Inventory (MFI-20). Participants completed standardized questionnaires assessing sleep quality, depressed mood, social support, and leisure-time physical activity. A clinical examination determined disease activity, cumulative damage, and whether patients fulfilled American College of Rheumatology criteria for fibromyalgia (FM). A series of hierarchical multiple regressions were computed to identify contributors to physical and mental fatigue. RESULTS: Patients scored high on all 5 MFI-20 fatigue dimensions, with general fatigue and physical fatigue having the highest scores. A hierarchical multiple regression showed that greater disease damage and disease activity, the presence of FM, depressed mood, sleep disturbance, and less participation in leisure-time physical activity contributed to higher physical fatigue scores. The results of the second model found depressed mood to be the strongest determinant of mental fatigue. Disease-related variables were not associated with mental fatigue. CONCLUSION: Fatigue in SLE is multidimensional and multidetermined, with physical and mental aspects likely having different etiologies. A multidimensional assessment of fatigue in SLE is needed to tailor and optimize interventions aimed at alleviating fatigue.

Neurasthenia: prevalence, disability and health care characteristics in the Australian community.

BACKGROUND: Neurasthenia imposes a high burden on primary medical health care systems in all societies. AIMS: To determine the prevalence of ICD-10 neurasthenia and associated comorbidity, disability and health care utilisation. METHOD: Utilisation of a national sample of Australian households previously surveyed using the Composite International Diagnostic Interview and other measures. RESULTS: Prolonged and excessive fatigue was reported by 1465 people (13.29% of the sample). Of these, one in nine people meet current ICD-10 criteria for neurasthenia. Comorbidity was associated with affective, anxiety and physical disorders. People with neurasthenia alone (<0.5% of the population) were less disabled and used less services than those with comorbid disorders. CONCLUSIONS: Fatigue is frequent in the Australian community and is common in people attending general practice. Neurasthenia is disabling and demanding of services largely because of its comorbidity with other mental and physical disorders. Until a remedy for persistent fatigue is provided, doctors should take an active psychological approach to treatment.

Anthropophobia: its meaning and concomitant experiences.

This study investigated the essential feature and concomitant experiences of anthropophobia, a culturally specific phobic disorder in China and Japan. One hundred and fifty subjects, including 50 anthropophobic, 50 neurasthenic and 50 normal subjects, were recruited from hospitals and downtown residential areas in Beijing. Measures of anthropophobic symptoms and DSM-III-R depressive and anxiety symptoms were administered to all subjects. Nonparametric analysis of variance, analysis of variance (ANOVA and MANOVA) and Fisher's exact test were performed to examine group differences on each symptomatic item of the three measures. Results indicate that the core anthropophobic symptoms include a fear of making eye contact with others and a fear of being watched by others, which essentially express fears of others' judgement or opinion of oneself. Anxiety and depression are associated features of anthropophobia. However, these concomitants are experienced more cognitively and less somatically in the case of anthropophobia than neurasthenia.

[Treatment of asthenic disorders with tanakan]. / Lechenie tanakanom astenicheskikh rasstroistv.

AIM: To evaluate efficacy and safety of tanakan in different asthenic disorders. MATERIAL AND METHODS: Tanakan in a dose 240 mg/day was used in 60 patients with various asthenic disorders arising in neurasthenia and late after craniocerebral trauma. The response was assessed by the scale of general clinical impression, side effects and by changes in psychic and somatic status. RESULTS: The response was achieved in 90% of the patients. 78% had significant improvement regardless nosological entity of asthenia. CONCLUSION: Tanakan is safe and effective in therapy of asthenic disorders. Moreover, with tanakan asthenia can be treated without polypragmasia.

Miastenia y gestación / Myasthaenia and pregnancy

Presentando un caso personal reciente de miastenia en el curso de la gestación, los autores, después de un recuerdo de la enfermedad, intentan precisar las actitudes preconizadas para una puesta al día de esta patología en el curso del embarazo, ayudados por un repaso exhaustivo de la bibliografía. La gestación de nuestra paciente se ha desarrollado en buenas condiciones, sin agravamiento de su miastenia. De acuerdo con los datos de la bibliografía, la influencia de la gestación sobre la enfermedad es muy variable: un tercio se estabiliza, un tercio mejora y otro se agrava. El período expulsivo es de alto riesgo para la descompensación de la enfermedad, y los esfuerzos durante el mismo deben ser limitados sin, necesariamente, recurrir a la cesárea, salvo indicaciones estrictamente obstétricas. Se aconseja la anestesia epidural, pues disminuye la fatiga y facilita la realización de una extracción instrumental. La lactancia materna está autorizada salvo en caso de afectación grave con una tasa de anticuerpos muy elevada. Solamente se han descrito 5 casos de preeclampsia en pacientes miasténicas. Esta situación es de alto riesgo materno y fetal, precisando vigilancia en una unidad especializada. La afectación fetal puede presentarse de dos formas: una afectación neuromuscular de mal pronóstico, pero rara, o una miastenia neonatal en el 10-20 por ciento de los casos. La miastenia es un proceso autoinmune que afecta principalmente a la mujer joven. El obstetra no está libre, pues, de enfrentarse al problema de un embarazo que sobreviene en una mujer miasténica. El seguimiento de esta asociación rara necesita un buen conocimiento de la enfermedad y una estrecha colaboración entre los diferentes especialistas (AU)

Neurasthenia: cross-cultural and conceptual issues in relation to chronic fatigue syndrome.

The purpose of this study was to examine several conceptual and cross-cultural issues in neurasthenia, particularly in terms of their relationship to chronic fatigue syndrome. A review of this relationship led to the conclusion that these conditions are much more alike in Western countries than in countries such as China, where neurasthenia could almost be regarded as a "culture-bound syndrome." This may be a consequence of factors such as the heterogeneous nature of neurasthenia and different diagnostic practices in different countries, despite the ICD-10 definition of neurasthenia, intended for worldwide use. Likewise, there is no consensus on what the "core" characteristics of neurasthenia are, because its clinical presentation and key features in different countries are very different. Despite the finding of relatively low comorbidity rates between neurasthenia and other mental disorders, clinical experience suggests that features of neurasthenia frequently overlap with those of depression, chronic anxiety, and somatoform disorders. There is no convincing evidence that in cases of overlap or comorbidity, other diagnoses should automatically have "primacy" over neurasthenia nor should the diagnosis of neurasthenia thereby be excluded. Although some aspects of its validity have improved recently, especially its descriptive validity, the overall validity of the diagnosis of neurasthenia is still not satisfactory. Suggestions for further research, aimed at improving the diagnostic validity of neurasthenia, are offered in this paper.

[Therapy of cardio-neurotic diseases in general practice: clinical experience with atarax]. / Terapiia kardionevroticheskikh rasstroist v obshcheterapevticheskoi praktike: opyt primeneniia ataraksa.

An open study of efficiency and safety of atarax (hydroxisine) enrolled 55 outpatients (23 males and 32 females, mean age 45.91 +/- 1.91) with generalized anxious and somatoform disorders running as cardioneurosis as well as nosogenic reactions (maladaptation), manifestations of cardiovascular pathology (acute myocardial infarction, angina of effort functional class II-III, postinfarction cardiosclerosis, essential hypertension in 5, 13, 2 and 5 patients, respectively). The patients received atarax for 28 days (daily dose 50 mg). The course was completed in 54 patients. In 47 of them, the overall score value by Hamilton Anxiety Scale dropped by 10 scores, the reduction being more obvious in patients with somatic anxiety. Hydroxysine is well tolerated and safe both in patients with somatic pathology and those with cardiovascular disorders.

[Differential diagnosis of neurocirculatory asthenia (NCA)]. / K differentsial'noi diagnostike neirotsirkuliatornoi distonii.

170 patients with primary diagnosis of NCA underwent detailed examination by the therapist, neuropathologist, endocrinologist, urologist, gynecologist and psychiatrist. Primary diagnosis was confirmed only in 47 patients, the other 123 patients had different somatic, neurological or psychic disorders. These 47 and 123 patients were considered as having NCA as a syndrome and as an independent nosological entity, respectively. NCA as a syndrome was associated with blood hypertension, nervous asthenia, ischemic heart disease, spinal osteochondrosis. One third of the patients had neuropsychic disorders. The conclusion is made that all the NCA patients require detailed therapeutic, neurological and psychic examinations to exclude hypertension, asthenoneurotic states, ischemic heart disease and spinal osteochondrosis.

[Syndrome of juvenile asthenic deficiency]. / Sindrom iunosheskoi astenicheskoi nesostoiatel'nosti.

A clinical and follow-up study of 155 young adults with a symptomcomplex of "juvenile asthenic deficiency"--"endogener juveniler asthenischer Versagensyndrome" (J.Glatzel, G.Huber, 1968) was carried out. It was found that protracted states in the youth with prevalence of educational disadaptation, weakening of initiative, psychophysical fatiguability should be attributed to atypical depressions, characterized by predominance of ideatoric disturbances with obliterated thymic and motor components. Depending on the specificities of ideatoric disturbances, 3 basic typological varieties of such depressions were recognized, i.e. depressions with prevalence of inhibition, disautomatization or distortion of cognitive processes, which statistically correlated reliably with definite nosological forms (affective disorders, schizophrenia). Depending on the nosologic belonging the studied states differed also in frequency of comorbid disturbances (obsessive-phobic, depersonalization, overvalued ideas), which occurred significantly rarer in the cases of affective disorders, than in schizophrenia. On the whole, follow-up study revealed relatively favourable prognosis of youth endogenous depressions with a clinical picture of "juvenile asthenic deficiency": in cases of affective disorders the course of disease was more frequently in the form of a single cyclothymic attack, while in cases of schizophrenia it took the form of protracted atypical pubertal attack.

[The role and place of central mediators and peptide bioregulators in the pathogenesis of emotional disorders in neurotic patients]. / Rol' i mesto tsentral'nykh mediatorov i peptidnykh bioreguliatorov v patogeneze émotsional'nykh narushenii u bol'nykh nevrozom.

The accumulated evidence on central mediators indicates that they may play an important part in the maintenance of emotional activity. Their significance is also great in the pathogenesis of affective disorders, including endogenous psychoses and borderline states. But further work in this area is needed relative to interrelation of the above mediators to a new class of bioregulators, viz peptide regulators. The results obtained suggest the existence of differentiated brain mechanisms of formation of emotional disturbances in different forms of neurosis that provide criteria for the diagnosis thereof and differential diagnosis and should be considered in conducting an adequate pathogenetically validated therapy.