The psychosomatic approach to neurocirculatory asthenia; a supplement to the relation of neurocirculatory asthenia to anxiety neurosis.
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The purpose of this study was to assess the prevalence of mental illness and to evaluate the quality of life of patients with neurocirculatory asthenia. A consecutive series of 80 patients who satisfied the diagnostic criteria developed by Kannel et al. for neurocirculatory asthenia was included in this study. Patients underwent a psychiatric diagnostic research interview and extensive psychometric evaluation, with both observer and self-rated scales for depression, anxiety, phobic symptoms, quality of life and abnormal illness behavior. In 47 patients (59%), a psychiatric diagnosis (mainly an anxiety disorder) antedated the onset of neurocirculatory asthenia, which was thus defined as secondary, also because cardiorespiratory symptoms were part of the mental symptoms. In the remaining 33 patients (41%) neurocirculatory asthenia was the primary disorder. Patients with secondary neurocirculatory asthenia reported significantly higher levels of anxiety, depression, social phobia, abnormal illness behavior and an impaired quality of life compared with patients with primary neurocirculatory asthenia. This latter did not significantly differ in these variables (except for depression) from healthy control subjects matched for sociodemographic variables. At a 1-year follow-up, patients with primary neurocirculatory asthenia had a much better prognosis than those with secondary neurocirculatory asthenia. The results indicate the feasibility of the primary/secondary distinction based on the time of onset of mental and cardiorespiratory symptoms in neurocirculatory asthenia. Since only about one quarter of the patients were found to suffer from decreased energy and fatigue according to specified criteria, the terms neurocirculatory asthenia and effort syndrome should probably be discarded.
In this paper, hemodynamic changes of 254 subjects were observed by using impedance cardiogram in a double-blind control method. The subjects were divided into 5 groups: heart-asthenia syndrome (98 cases), lung-asthenia syndrome (23 cases), spleen-asthenia syndrome (23 cases), kidney-asthenia syndrome (10 cases) and normal group (100 cases). The results showed that hemodynamic abnormalities occurred in the patients with heart-asthenia syndrome only, the changed regularities were that deficiency of both vital energy and Yin greater than deficiency of heart-Yang greater than deficiency of heart-energy greater than deficiency of heart-Yin. When stroke volume (SV), cardiac output (CO), cardiac index (CI), stroke volume index (SVI), heather index (HI), vascular compliance (C) and ejection fraction (EF) were decreased and total peripheral resistance (TPR) and systolic time interval (STI) were increased, the signs and heart-asthenia syndrome could be found in clinical practice. In conclusion, the above parameters had certain diagnostic value for heart-asthenia syndrome and could be subjective quantitative indices for evaluating effects of treating the heart-asthenia syndrome.
Asthenia is a very common symptom of patients with advanced cancer, but its investigation is hindered by a lack of suitable validated measuring instruments. The goal of the present study was to construct and validate a questionnaire for the study of asthenia in cancer patients, as well as to establish correlations with other symptoms and physiological and biochemical parameters. A group of 31 patients with advanced cancer and a control group of 30 healthy volunteers were examined. The proposed questionnaire, based on visual analogue scales, questions with categorical answers and on the hospital anxiety and depression scale was validated by comparing results of the patient and control groups, by the test/retest method and by comparison with the evaluation of an observer. Correlation with various physiological and biochemical parameters was performed. The questionnaire distinguished well among the patients and control groups. VAS of asthenia proved quite stable over a period of 5 days. Correlations of asthenia with lack of appetite, the hospital anxiety and depression scale, weight, heart rate and serum cortisol levels could be established. No significant correlation between asthenia and various serum markers of inflammation and cytokines, including C-reactive protein, tumour necrosis factor, interleukin-1, and interleukin-2 receptors, could be found. The proposed questionnaire for evaluation of asthenia could be validated in a patient sample of limited size and a simplified questionnaire based on visual analogue scales is being developed for further investigations.
OBJECTIVES: The purpose of this study was to assess the occurrence of stressful life events in the year before the onset of neurocirculatory asthenia. DESIGN: Case-control retrospective study. SETTING: A university medical outpatient clinic. SUBJECTS: A consecutive series of 50 patients with neurocirculatory asthenia and a control group of 50 healthy subjects, matched for sociodemographic variables, were studied. MAIN OUTCOME MEASURES: Paykel's Interview for Recent Life Events (a semistructured research interview covering 64 life events) was administered to patients and controls. RESULTS: Patients with neurocirculatory asthenia reported significantly more stressful life events than the control group (P < 0.05) and had significantly more of the following: exits (P < 0.05), undesirable (P < 0.05) and uncontrolled (P < 0.01) events. More events that had an objective negative impact (P < 0.001) and more independent events (P = 0.07) were also reported. Ratings of impact and independence were carried out by a blind rater who was unaware whether the event had occurred in patients or controls. CONCLUSIONS: The results are suggestive of a strong relationship between stressful life events and neurocirculatory asthenia. This is in agreement with a multifactorial model of pathogenesis in neurocirculatory asthenia and with current understanding of the extensive links of behavioral responses to stress with neurophysiological and biochemical processes.
Sixty-four consecutive patients with advanced breast cancer were included in a study designed to determine the prevalence of asthenia and its association with other clinical features. The Asthenia Score (AS, the average of four tests designed by our group to assess asthenia) was 59 +/- 9 for patients versus 88 +/- 7 for a group of 68 normal controls (p less than 0.001). Twenty-six patients (41%) scored below the tenth percentile of normal controls and were considered asthenics. AS was correlated with depression and the general severity index of the SCL-90 R test. No association was found between AS and nutritional status, lean body mass, tumor mass, anemia, or type of treatment. We conclude that asthenia is a frequent symptom in patients with advanced breast cancer, which, in our series, showed independent correlations only with psychological distress.
Over the past 10 years, there have been major advances in the understanding of cancer cachexia and asthenia. These common complications of cancer are now thought to be the consequences of complex interactions between host, tumour, and psychosocial factors. Cachexia and asthenia commonly coexist, but they can occur independently of each other. Recently identified tumour-derived factors cause lipolysis and protein catabolism. Cytokines produced by the host in response to tumour presence cause metabolic abnormalities, which result in decreased protein and lipid synthesis, increased lipolysis, and anorexia. Many other factors contribute to asthenia, such as anaemia, autonomic failure, and muscular abnormalities. Future research should clarify optimum management. The way forward seems to lie in a multidimensional approach with combined therapy to manage both cancer cachexia and asthenia.
OBJECTIVE: First popularized as neurasthenia in the late 1800s by American George Beard, asthenia has been viewed by Russian psychologists and flight surgeons as a major problem that affects cosmonauts participating in long-duration space missions. However, there is some controversy about whether this syndrome exists in space; this controversy is attributable in part to the fact that it is not recognized in the current American psychiatric diagnostic system. METHODS: To address this issue empirically, we retrospectively examined the data from our 4 1/2-year, NASA-funded study of crew member and mission control interactions during the Shuttle/Mir space program. Three of the authors identified eight items of stage 1 asthenia from one of our measures, the Profile of Mood States (POMS). Scores on these items from 13 Russian and American crew members were compared with scores derived from the opinions of six Russian space experts. RESULTS: Crew members' scores in space were significantly lower than the experts' scores on seven of the eight items, and they generally were in the "not at all" to "a little" range of the item scales. There were no differences in mean scores before and after launch or across the four quarters of the missions. There were no differences in response between Russian and American crew members. CONCLUSIONS: We could not demonstrate the presence of asthenia in space as operationally defined using the POMS. However, the POMS addresses only emotional and not physiological aspects of the syndrome, and the subject responses in our study generally were skewed toward the positive end of the scales. Further research on this syndrome needs to be done and should include physiological measures and measures that are specific to asthenia.
Questionnaire (asthenia MFI) survey of 2043 patients early in rehabilitation after ischemic stroke in the territory of the carotid arteries was made. Asthenia was detected in 81% patients with elevated total score, physical, psychic asthenia, hypoactivity and low motivation. Asthenia was secondary and correlated with social maladaptation. Rehabilitation in a specialized neurological department of health resort Ust-Kachka leads to positive changes in the above indices.
Patients with neurocirculatory asthenia share common symptoms with patients having evidence of mitral valve prolapse. A link between these two conditions has been suggested but never documented. We have evaluated the prevalence of mitral valve prolapse among 42 young soldiers suffering from the neurocirculatory asthenia syndrome, using auscultation and echocardiography to detect the mitral abnormality. Four of the 42 subjects with neurocirculatory asthenia had both auscultatory and ultrasonic evidence of mitral valve prolapse. Since a similar prevalence of mitral valve prolapse has been reported among populations of presumably healthy young males or females, we conclude that mitral valve prolapse and neurocirculatory asthenia do not appear to be related.
Asthenia in cancer patients is a highly controversial subject. A distinct definition of asthenia in medical literature is lacking as well as its prevalence and incidence. Also, no simple tools for its diagnosis are available. Moreover its etiopathogenesis is complex and multifactorial, thereby making therapeutic approaches difficult. Recently, a Spanish group has been set up for the study and treatment of asthenia in cancer patients. This paper reports on its establishment, objectives and first conclusions.
Hereditary equine regional dermal asthenia belongs to a group of inherited, congenital connective tissue dysplasias usually described as hyperelastosis cutis, cutaneous asthenia, dermatosparaxis, or Ehlers-Danlos-like syndrome. This report presents the clinical and histological features of three related Quarter horses affected with regional dermal asthenia. These horses had bilateral asymmetric lesions of the trunk and lumbar regions, where the skin was hyperextensible. Handling of the skin elicited a painful response and superficial trauma led to skin wounds. The skin was thinner than normal in the affected areas, with thickened borders and harder fibrotic masses (pseudotumours). The histopathological findings included thinner and smaller collagen fibrils, and a loose arrangement of collagen fibres in the middle, adventitial and deep dermis. Masson's trichrome and Calleja stains did not reveal any abnormality of collagen and elastic fibres. Electron microscopy showed no abnormalities. As in human patients, pseudotumour histopathological findings included fibroplasia and neovascularization. The pedigree chart of these animals supports an autosomal recessive type of inheritance, which has been suggested by other studies. This is the first report of this disease in Brazil. Its clinical and histological features resemble those described in horses affected with this condition in the United States.
We describe the electrocardiographic changes during everyday activities recorded by ambulatory electrocardiographic monitoring in 67 patients with neurocirculatory asthenia. The findings were compared with the results of ambulatory monitoring in 33 healthy controls. We observed episodes of sinus tachycardia > 120/min unrelated to effort in 60 of the patients, 35 had frequent episodes of pronounced sinus arrhythmia, 16 showed transient ST depression, and six transient ST elevation. All these changes appeared during the patients' routine activities, without any unusual exertion and frequently at rest. Periods of sinus tachycardia and sinus arrhythmia were recorded from the patients during sleep. Cardiac arrhythmias, especially ventricular premature beats, were also much more common in those with neurocirculatory asthenia than in the control subjects. These findings indicate that ambulatory electrocardiographic monitoring provides important information on the electrocardiographic characteristics of patients with neurocirculatory asthenia and helps to establish this diagnosis in obscure cases.
The examination of 76 patients recovering after acute respiratory viral disease for somatic and vegetative neurologic condition revealed postinfluenzal asthenia in nearly half of them. Three degrees of the asthenia severity have been recognized. A differential approach to patients with postinfluenzal asthenia helps in more accurate evaluation of the treatment required and temporary disability grade.
The National Cancer Institute (Canada) sponsored a workshop on symptom control in Banff, Alberta, in October 1993. This article reports on the workshop recommendations for research on one symptom complex, the cachexia-anorexia-asthenia syndrome. In addition to encouraging study generation, the recommendations provide a baseline for assessing the scope and strength of future Canadian research initiatives on cachexia-anorexia-asthenia.