Death of neurasthenia and its psychological reincarnation: a study of neurasthenia at the National Hospital for the Relief and Cure of the Paralysed and Epileptic, Queen Square, London, 1870-1932.
BACKGROUND: The diagnosis of neurasthenia appeared in 1869 and rapidly became fashionable and highly prevalent. It disappeared almost completely, producing ongoing debates about what happened to the disease, which have not so far been informed by empirical data. AIMS: To use empirical historical hospital data from one specific hospital to explore several controversies about neurasthenia, including what happened to the disorder. METHOD: The annual reports of Queen Square Hospital were examined from 1870 to 1947. The prevalence of neurasthenia diagnoses as a proportion of total discharges was recorded. The possible diagnostic categories into which neurasthenia could have been reclassified were identified. Textbooks and writing by neurologists working at the hospital during this period were examined. RESULTS: Neurasthenia accounted for 6-11% of total discharges from the late 1890s to 1930, when it virtually disappeared. Men accounted for 33-50% of cases. CONCLUSIONS: Neurasthenia affected both the upper and working classes and both men and women. Neurologists, not psychiatrists, continued to see the disorder well into the 20th century. Neurasthenia did not disappear, but was reclassified into psychological diagnoses. (+info)
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. (+info)
Outcome in severe irritable bowel syndrome with and without accompanying depressive, panic and neurasthenic disorders.
BACKGROUND: Irritable bowel syndrome often leads to impaired functioning. AIMS: To assess the contribution of psychiatric disorders to impaired outcome in severe irritable bowel syndrome. METHOD: Patients with severe irritable bowel syndrome entering a psychological treatment trial (n=257) were interviewed using the Schedules for Clinical Assessment in Neuropsychiatry. Outcomes were number of days of restricted activity, role limitation (physical) score of the Short Form Health Survey and costs. RESULTS: At baseline, depressive disorder (29% of patients), panic (12%) and neurasthenia (35%) were associated with impairment; number of psychiatric disorders was associated in a dose-response fashion (P=0.005). At follow-up, depressive disorder and neurasthenia were associated with role limitation score. Improved depression was associated with improved role functioning. CONCLUSIONS: Depressive, panic and neurasthenic disorders contribute to poor outcomes in severe irritable bowel syndrome, and appropriate treatment should be available to these patients. (+info)
Cognitive-behavioural therapy v. mirtazapine for chronic fatigue and neurasthenia: randomised placebo-controlled trial.
The piano plague: the nineteenth-century medical critique of female musical education.
The role of music in nineteenth-century female education has been seen primarily in the context of the middle class cult of domesticity, and the relationship of music to medicine in the period has generally been viewed in terms of music therapy. Nevertheless, for much of the century there was serious medical discussion about the dangers of excessive music in girls' education. Many of the leading psychiatrists and gynaecologists of the nineteenth century argued that music could over-stimulate the nervous system, playing havoc with vulnerable female nerves and reproductive organs, and warned of the consequences of music lessons on the developing bodies of teenage girls. Two rival models of music's effects competed and were combined. One suggested that music led to illness by provoking sensuality, imagination and sexuality; the other argued that it was a source of neurasthenic fatigue because of intellectual strain. (+info)