Neurasthenia: Modern Malady or Historical Relic?, 2019, Overholser et al

Paywall, https://journals.lww.com/jonmd/Abst...ia__Modern_Malady_or_Historical_Relic_.7.aspx
Sci hub, not available

 

Historically doctors needed to make up a narrative to explain symptoms, but to attribute these to stress and overwork nowadays is unforgivable.

Something goes wrong with the workings of the body and finding what it is and correcting it should be the goal of modern medicine.

 

As some of you will be aware, the ICD-10 code F48.0 Neurasthenia and its inclusion, Fatigue syndrome has been retired for ICD-11 (along with most of the ICD-10 F45.x Somatoform disorders codes) and replaced with the single new category: C620 Bodily distress disorder and three coded for severity specifiers.

Although under ICD-10, there is an Exclusion under F48.0 for the G93.3 entities, for ICD-11, there are currently no Exclusions under BDD for the 8E49 terms and BDD can be applied in the presence of general medical conditions and diseases* (as is the case with some of existing ICD-10's Somatoform disorder categories):

*"If another health condition is causing or contributing to the symptoms, the degree of attention is clearly excessive in relation to its nature and progression." https://icd.who.int/dev11/l-m/en#/http://id.who.int/icd/entity/767044268​

For ICD-11, ICD-10's R53 Malaise and fatigue is replaced with MG22 Fatigue. Under MG22 Fatigue, I did obtain the addition of Exclusions for all three 8E49 terms.


Contrary to Dr Diane O'Leary's contention that:

"Criteria* for BDD are not particularly problematic for ME patients. They are compatible with construing ME as a biological disease" [1]​

BDD remains very problematic and I have continued to push for Exclusions for the ICD-11 8E49 terms.

*NB: There are no "criteria" as such for ICD-11's BDD but a disorder description and characterization text. This allows clinicians more flexibility to use clinical judgement when assessing whether a patient meets the required features and disorder description than the more rigid DSM-5 Somatic symptom disorder (SSD) criteria set. BDD thus poses an even greater threat to patients with chronic, multiple bodily symptoms or a single chronic symptom than SSD already does for potential misdiagnosis, missed diagnoses and misapplication of an additional BDD diagnosis.

1 “BODILY STRESS SYNDROME” INFO SHEET, March 2018, Dr Diane O'Leary for Forward-ME:
http://www.forward-me.org.uk/Reports/BODILY STRESS SYNDROME INFO SHEET CORRECTED.pdf

 

https://www.sciencedirect.com/science/article/pii/S021265671930191X

Atención Primaria
Available online 8 June 2019
In Press, Corrected

From neurasthenia to post-exertion disease: Evolution of the diagnostic criteria of chronic fatigue syndrome/myalgic encephalomyelitis

ÍñigoMurgaJosé-VicenteLafuente
https://doi.org/10.1016/j.aprim.2019.04.004Get rights and content
Under a Creative Commons license

Abstract in English and Spanish

Text in Spanish

Abstract

Changes in the terminology and diagnostic criteria for chronic fatigue syndrome/myalgic encephalomyelitis are explained in this paper.

This syndrome is a complex and controversial entity of unknown origins. It appears in the medical literature in 1988, although clinical pictures of chronic idiopathic fatigue have been identified since the nineteenth century with different names, from neurasthenia, epidemic neuromyasthenia, and benign myalgic encephalomyelitis up to the current proposal of disease of intolerance to effort (post-effort). All of them allude to a chronic state of generalised fatigue of unknown origin, with limitations to physical and mental effort, accompanied by a set of symptoms that compromise diverse organic systems.

The International Classification of Diseases (ICD-10) places this syndrome in the section on neurological disorders (G93.3), although histopathological findings have not yet been found to clarify it.

Multiple organic alterations have been documented, but a common biology that clarifies the mechanisms underlying this disease has not been established. It is defined as a neuro-immune-endocrine dysfunction, with an exclusively clinical diagnosis and by exclusion.

Several authors have proposed to include CFS/ME within central sensitivity syndromes, alluding to central sensitisation as the common pathophysiological substrate for this, and other syndromes.

The role of the family doctor is a key figure in the disease, from the detection of those patients who present a fatigue of unknown nature that is continuous or intermittent for more than 6 months, in order to make an early diagnosis and establish a plan of action against a chronic disease with high levels of morbidity in the physical and mental sphere.

Objective
To carry out a bibliographic review of the terminology and diagnostic criteria of the chronic fatigue syndrome/myalgic encephalomyelitis, in order to clarify the pathology conceptually, as a usefulness in the diagnosis of Primary Care physicians.


Moderator note: This paper has a thread on its own should anyone want to discuss this paper in particular.
https://www.s4me.info/threads/from-neurasthenia-to-post-exertion-disease-evolution-of-the-diagnostic-criteria-of-cfs-me-2019-murga-lafuente.11135/

 

ME was never considered idiopathic fatigue of unknown origin, neither was epidemic neuromyasthenia (the clue is in the name) The were considered as epidemic diseases which did not resolve in some people and ME was characterised by its variability. Nothing I read after I was diagnosed in 1984 made me think that fatigue was central. I never complained about it to a doctor and it was strange to me when CFS suddenly appeared.

 

I finished my transcranial magnetic stimulaion, which, together with medicines improved considerably my depression but didn't have any effect on my fatigue. I said that to my doctor, and she said, well, there may exist many causes for chronic fatigue syndrome ... to which I exclaimed "Wow, there's a doctor who has heard of chronic fatigue syndrome". She looked at me and asked if I said this with irony, to which I answered "yes" though I was really surprised. She said "The medical term for this is neurasthenia". Do you agree with this? Is neurasthenia the same as CFS. I understand they are replacing "neurasthenia" from ICD-10 with "bodily distress syndrome" in ICD-11 though I'm not familiar with details.
(Hope the authout of the thread doesn't mind sharing this here)

 

Neurasthenia (formerly coded to F48.0) is explicitly not the same as ME or CFS (coded to G93.3). Neurasthenia is more like burnout or nervous exhaustion. Your clinician is probably ill informed.

 

What @adambeyoncelowe said. I think Wessely and maybe some of the PACE authors and colleagues have repeatedly claimed that neurastenia and ME/CFS are the same, and I think that isn't grounded in science but a politically motivated form of illness denial.

If a psychiatrist believes CFS and neurasthenia are the same thing, that's probably because they're getting their information from sources influenced by this group of people.

 

Yes, she mentioned there are people who recovered from CFS and I tried to argue but as you know I'm not a doctor and my opinion doesn't matter.

 

Some people do recover. Stats suggest about 5%, so it's pretty small numbers, regardless of diagnosis. Children may have better prognosis.

 

I'm not sure that can be said.

Given that no one appears to agree on what 'it' is, then how can someone who now appears to be perfectly well be said to have recovered? When no one can be totally sure that they had 'it' in the first place?

We currently, according to something I read recently, have 40% of people diagnosed with 'it' diagnosed with depression, and it works the other way as well, how many people now diagnosed with 'it' started off being diagnosed with depression, anxiety, panic attacks etc? I know I was, for a decade or so. If your average GP doesn't know what's wrong, or if you have more than X symptoms, then they diagnose depression.

Or thoughts to that effect.

 

Until we have a biomarker, it's sort of irrelevant and impossible to answer that, unless another diagnosis is reached.

It's more realistic to ask if people with an ME diagnosis ever recover, and that includes people who may or may not have 'it'.

Since we can't tell who's got 'real' ME or not, it's a moot point. Either way, 5% recovery is appallingly low.

 

Neurasthenia is seen as psychosomatic. Associating it with ME is one of Wessely's tricks.