Aetiology

Although theories abound, the predisposing, precipitating, and perpetuating causes of the syndrome remain unclear. Course and prognosis

The 10-year follow-up study conducted by Merikangas and Angst(31> revealed that approximately 50 per cent of patients continued to exhibit symptoms. The WHO

study(32) reported that patients with a diagnosis of neurasthenia had, on average, been disabled for 8 to 7 days during the month preceding the examination. Treatment

There are no published data on any randomized double-blind controlled trials carried out on the treatment of neurasthenia. In the absence of such data the clinician will have to rely on the adage of 'When not able to do any good, avoid doing any harm'. Thus aggressive treatment and investigations should be avoided. Patients are best managed in a supportive relationship with due regard given to their psychological and psychosocial needs. General and non-specific strategies may also be used. These can include regular graded increase in exercise, promotion of sleep hygiene, cognitive techniques to break the cycle of symptoms leading to decreased activities, and improving social support.

In cultures where there is a strong influence of alternative or traditional medicine, the clinician will often be faced with a difficult dilemma when patients ask for his or her opinion. In these situations the appropriate course of action is for the clinician to engage in an open and frank dialogue with the patient. Attempts should be made to understand the patient's illness model and to explain the clinician's orientation. An open-minded approach can be helpful in cultivating a therapeutic relationship. However, the clinician should also know about the adverse effects of some of the traditional treatments and drug interactions between psychotropic medications and herbal products.

Clinicians working in an environment where people with mental illnesses are stigmatized might find it easier to accede to social demands. Clinicians work at two levels in these situations. At one level he or she will have made a diagnosis of a psychiatric disorder and have prescribed the appropriate treatment. At another level the practitioner will be using neurasthenia as an euphemism for mental illness. Therefore, until stigmatization can be reduced or abolished, this unenviable state of affairs will continue.

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