Current usage

In ICD-10,(26) neurasthenia is classified as a neurotic disorder in which two main, but overlapping, types of neurasthenia are described:

• the predominant symptom is increased fatigue after mental effort

• predominant feelings of bodily or physical weakness and exhaustion after only minimal efforts. For a definite diagnosis ICD-10 requires the following:

a. either persistent and distressing complaints of increased fatigue after mental effort, or persistent and distressing complaints of bodily weakness and exhaustion after minimal effort;

b. at least two of the following:

• feelings of muscular aches and pains

• tension headaches

• sleep disturbances

• inability to relax

• irritability

c. any autonomic or depressive symptoms present are not sufficiently persistent and severe to fulfil the criteria for any of the more specific disorders in this classification.

The following are excluded:

• asthenia not otherwise specified

• malaise and fatigue

• postviral fatigue syndrome

• psychasthenia.

DSM-IV does not include neurasthenia as a nosological entity. Instead, it is replaced by 'Undifferentiated somatoform disorder' (see Chaptei.,5,2J.).

In the second revised edition of the Chinese Classification of Mental Disorders(2I) neurasthenia is classified under 'Neurosis and neurogenic mental disorders'. The criteria for diagnosis have been made more stringent, requiring three symptoms out of five non-hierarchical groups of symptoms which include weakness, emotionality, excitement, nervous pain, and sleep disturbances—the duration of the symptoms should be at least 3 months. Other psychiatric disorders have to be excluded. Because of the different connotations of fatigue and weakness in Chinese culture, fatigue is not included in the list of symptoms. (28)

Since the deletion of neurasthenia from DSM-III and the introduction of more stringent diagnostic criteria in ICD-10, usage of the term neurasthenia by psychiatrists has declined. This trend is seen in China, Eastern Europe, and other Asian countries where the term neurasthenia was once commonly used. The case of China is especially striking. Shu and Wang (29> reported only one case out of 233 patients who were treated at the Shanghai Mental Health Center from January to December 1996. Despite this decline, neurasthenia remains deeply entrenched in the lay and traditional medical vocabulary of the Chinese.

In Japan, the term is used by the lay public to represent all forms o mental disorders. Japanese doctors, bowing to the stigma attached to mental illness, often consciously enter neurasthenia as a disguised form of diagnostic label in their notes and medical reports. (39

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