The diagnosis and phenomenology of neurasthenia. A Shanghai study

Neurasthenia is one of the commonest diagnostic terms in psychiatric practice in China, but it is employed less and less by psychiatrists in the Western world. In order to investigate what diagnoses would be given in terms of modern Western standard diagnostic systems, 40 patients who were diagnosed as suffering from neurasthenia by two Chinese psychiatrists were rediagnosed according to ICD-9 descriptive criteria, using the Catego computerized system based upon PSE findings and DSM-III criteria based on findings of the Diagnostic Interview Schedule (DIS). Furthermore a set of self-report or observer rating scales, including the SAS, SDS, HAMA, HAMD and BPRS, were administered to evaluate their psychopathological characteristics. The main findings are the following: (1) the distribution of the results of rediagnosis is widely dispersed from mild character disorder to severe affective disorder; (2) most of these patients are diagnosed as having an anxiety or depressive illness in different diagnostic systems; (3) the majority of diagnoses belong to the field of neurosis in all systems except DIS/DSM-III; (4) there is a group of patients who do not belong to any diagnostic entity in these systems; (5) the prominent psychopathological features are anxiety and depression and often a combination of both, which adds to the complexity of the clinical picture; and (6) these patients tend to over-report their suffering or symptoms, which results in a discrepancy of findings between objective assessment and self-reporting. The author suggests that the term neurasthenia represents a disease spectrum and should be refined in future study, but that it seems too early to discard it from psychiatric nosology.