Chronic fatigue syndrome or neurasthenia?

The interesting study reported by Hickie et al (2002) draws attention to the prevalence of ICD-10 neurasthenia (World Health Organization, 1992) in a large sample of the Australian general population. The authors' findings are of the utmost importance for clinicians concerned with the disabling effects of fatigue but also provide food for thought in the wake of the CFS/ME Working Group (2002) report to the Chief Medical Officer. In this report, the term chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is used as an ‘umbrella term’ because of the ‘need for patients and clinicians to agree a satisfactory term as a means of communication’ but the concept of neurasthenia is not used. The report's authors state that CFS is ‘widely used among clinicians’ and seem to consider it to be a disorder more physical than psychiatric. Equally, CFS/ME is not included in DSM-IV (American Psychiatric Association, 1994) or ICD-10. On the other hand, neurasthenia as defined in the ICD-10 is a psychiatric disorder whose main feature is ‘persistent and distressing complaints of increased fatigue after mental effort, or persistent and distressing complaints of bodily weakness and exhaustion after minimal effort’. This fatigue could be associated with muscular aches, dizziness, tension headaches, sleep disturbances, irritability, dyspepsia and inability to relax. Neurasthenia includes ‘fatigue syndrome’ but excludes ‘post viral fatigue syndrome’. Using ICD-10 criteria in the general population, Hickie et al (2002) found that 1.5% of the 10 641 people who participated in the study met the criteria for neurasthenia in the past year. For females aged between 18 and 24 years, the 12-month prevalence rises to 2.4%.

If it is reasonable to compare the Australian and the British populations, we could probably expect a similar proportion of people here to be affected by this psychiatric disorder; the question here is what diagnosis is applied to them? If it is the case that CFS/ME is suggested, this would have adverse implications both for these patients essentially in need of treatment for a psychiatric disorder, and for any research on the aetiology and the treatment of CFS/ME.