Diagnostic concordance of neurasthenia spectrum disorders in Pune, India

Clinically significant fatigue or weakness is a common but understudied clinical problem in India. The applicability and relevance of Western clinical criteria in this setting are not studied. Alternative criteria sets used in different clinical contexts suggest a range of conditions constituting neurasthenia spectrum disorders (NSDs). We therefore aimed to determine frequency of patients with these complaints in four specialty outpatient clinics of an urban general hospital. We compared the concordance of four diagnostic criteria sets of fatigue disorders among the same patients.

Patients from the clinics of Psychiatry, Medicine, Dermatology, and Ayurved were screened for clinically significant fatigue or weakness and assessed for CFS, ICD-10 neurasthenia, DSM-IV draft criteria for neurasthenia, and CCMD-2 neurasthenia.

For 352 patients, sensitivity of CDC criteria for CFS (13.4%) was poorest. CFS was most frequent in the Medicine clinic. CCMD-2 criteria were the most frequently met (77.6%) with no significant difference across clinics. Two-way concordance of neurasthenia categories was no better than fair (< or =0.4) and few patients (8.0%) met criteria for all four categories.

Four NSD criteria sets identified different clinical subgroups. CFS, considering fatigue and ignoring weakness, was least relevant for identifying NSD patients in these clinics. Poor concordance among the four diagnostic systems studied indicates the need for reviewing the nosology of these disorders. Focus on clinical significance alone is likely to avoid the discordant confusion arising from cross-cultural differences.