Clinical validity of ICD-10 neurasthenia.
BACKGROUND
Neurasthenia was defined over a century ago. In view of a questionable clinical validity, it was omitted from the 3rd edition of the American Psychiatric Association's DSM, while it remains as an own diagnostic category in the WHO's ICD-10. The purpose of this study was, therefore, to examine the clinical validity of ICD-10 neurasthenia in a consecutive sample of chronic pain patients.


METHODS
We included 193 patients (mean age 45.1, SD +/- 10.2, 63% females) in the study. Psychiatric diagnoses were established by the use of ICD-10 Diagnostic Criteria for Research. In addition, the Screening List for Somatization Symptoms was administered: self-rating of 53 medically unexplained somatic symptoms, and 11 additional screening questions concerning weakness after slight mental or physical exertion and disease conviction.


RESULTS
Thirty-three percent of the patients who fulfilled the criteria of ICD-10 neurasthenia also fulfilled the criteria of ICD-10 somatization disorder, 69% the criteria of ICD-10 undifferentiated somatoform disorder, 14% the criteria of ICD-10 hypochondriacal disorder, 66% the criteria of ICD-10 somatoform autonomic dysfunction, 85% the criteria of ICD-10 persistent somatoform pain disorder and 14% the criteria for sexual dysfunction not caused by organic disorder or disease. The symptom profile of ICD-10 neurasthenia was not clearly distinguishable from the symptom profiles of ICD-10 somatoform disorders and ICD-10 sexual dysfunction.


CONCLUSIONS
Due to this substantial diagnostic overlap, the clinical validity of ICD-10 neurasthenia remains questionable.
Bankier
B
B
Department of Psychiatry, Division of Social Psychiatry, University of Vienna, Austria.
Aigner
M
M
Bach
M
M
D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009440:Neurasthenia / Q000175:diagnosis* / Q000453:epidemiology; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013001:Somatoform Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology