Neurasthenia and chronic fatigue syndrome: the role of culture in the making of a diagnosis

Article Abstract:

Chronic fatigue syndrome is characterized by exhaustion or fatigue, reduced activity, and a markedly reduced tolerance for even mild exertion. Muscle and joint pain may ensue, with low-grade fever, recurrent sore throats, lightheadedness, visual disturbances, irritability, depression, and anxiety. Functional capacity is often severely limited, making full-time work difficult. Chronic fatigue syndrome is strikingly reminiscent of neurasthenia, which was a popular diagnosis in the 19th century. The similarities between the disorders go beyond the clinical. For instance, both disorder arose during periods of history in which concerns of women, the economy, and material success predominated; a time when medical illness was more culturally accepted than a psychiatric illness. Neurasthenia eventually began to be recognized primarily as a psychiatric disorder rather than a medical illness, as researchers were able to identify its psychiatric and medical components. The remaining mix of somatic symptoms and psychological distress became unfashionable over time, and during the early 20th century the diagnosis disappeared altogether. It is suggested that those diagnosed with chronic fatigue syndrome are really suffering from an identifiable psychiatric disorder, psychophysiological symptoms secondary to psychosocial stress, or a form of illness behavior. This conclusion is drawn from studies that have found a high prevalence of psychiatric disorder (most often a depressive or somatization disorder) in patients with chronic fatigue syndrome. However, the term chronic fatigue syndrome still has a medical connotation. It is possible that in time chronic fatigue syndrome will fall out of fashion as a diagnosis, much like neurasthenia. Both disorders have much to teach us about the cultural components of illness and disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Demographic aspects, Chronic fatigue syndrome, Cultural psychiatry, Neurasthenia

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Characteristics of 60 adult chronic hair pullers

Article Abstract:

Trichotillomania describes a disorder characterized by pulling out one's own hair. To examine the experiential features of this disorder, and to assess co-existing clinical syndromes (comorbidity), 56 female and 4 male hair-pullers, ranging in age from 18 to 61 years, were studied. Subjects were interviewed and given an extensive inventory focusing on hair-pulling behavior, other repetitive behaviors, and clinical symptoms. The average age of onset of hair pulling was 13 years. The average duration of hair pulling was 21 years. Most (67 percent) of the subjects pulled hair primarily from the scalp; 22 percent pulled eyelashes, and 8 percent pulled eyebrows. Most (62 percent) pulled hair from two or more sites and disguised hair loss with makeup and wigs. Ninety-five percent were aware of great tension prior to hair-pulling, and 88 percent felt relieved after pulling out hair. Ninety-eight percent reported continual attempts to resist hair-pulling. Hair-pulling most frequently occurred while subjects were involved in sedentary activities (e.g., reading or watching television). Compulsive behaviors reported by 85 percent of the subjects included: nail biting, thumb sucking, lip biting, head banging, scab picking and body rocking. Most (95 percent) reported stronger urges to pull hair in the evening. The lifetime prevalence of clinical syndromes included either current or previous history of: major depression (55 percent); anxiety disorder (57 percent); panic disorder (18 percent); obsessive-compulsive disorder (10 percent); eating disorders (20 percent); and substance abuse (22 percent). In sum, the disorder seems to entail a greater lifetime prevalence of anxiety, mood, and addictive disorders than found in the general population. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Statistics, Self-destructive behavior, Self injurious behavior, Trichotillomania

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Venlafaxine for the treatment of chronic pain

Article Abstract:

Venlafaxine, a selective serotonin and norepinephrine reuptake inhibitor, was effective in treating chronic radicular back pain in a 43-year-old patient with a history of major depression. The patient had been maintained on a regimen of sertraline but had to discontinue treatment owing to reduced libido and anorgasmia. Narcotics and nonsteroidal anti-inflammatory medications had little effect on her lower back pain. Treatment with venlafaxine, however, resulted in marked decrease in pain as well as good control of her depressive symptoms.

Drug therapy, Antidepressants, Letter to the Editor, Intractable pain

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