The place of neurasthenia in the structure of mental disorders in the 21st century: a series of clinical cases and a literature review

This article presents an analysis of the historical transformation of neurasthenia – from the popular “American disease” in the 19th century to exclusion from modern classifications (DSM, ICD-11). The neurologist J. Bird associated neurasthenia with “exhaustion” due to the transition from a traditional rural lifestyle to a fast-paced urban life. He was the first to describe a wide range of both mental and somatized symptoms. Later, the concept was reinterpreted in European psychiatry through the prism of intrapersonal conflicts, and in the Russian school of I.P. Pavlov’s neurasthenia was considered as an asthenic neurosis, represented by two main clinical forms: hyposthenic (with a predominance of weakness and lethargy) and hyperesthetic (with irritability and increased excitability). In ICD-10, neurasthenia remains as a diagnosis characterized by persistent fatigue from both physical and emotional stress, vegetative disorders and emotional lability, but in recent decades its diagnostic boundaries have significantly narrowed. This is due to the development of diagnostics and conceptualization of depression, anxiety and somatoform disorders, as well as the emergence of the concept of chronic fatigue syndrome, which is especially relevant in the post-covid period. In the framework of the presented study, the authors analyze the modern scientific discourse that examines the question of the clinical validity and diagnostic value of maintaining neurasthenia as an independent nosological unit in modern classifications of mental disorders. This publication also presents three clinical cases, using the example of which it will be possible to trace the main aspects of the clinical picture, differential diagnosis and approaches to the treatment of neurasthenia and related disorders.

1. Costa e Silva JA, De Girolamo G. Neurasthenia: history of a concept. In: Sartorius N, Goldberg D, de Girolamo G, Costa e Silva JA, Lecrubier Y, Wittchen U. Psychological Disorders in General Medical Setting. Hogrefe & Huber; 1990.

2. Овсянников СА. История и эпистемология пограничной психиатрии. М.: Альпари; 1995. 207 с.

3. Morozov VМ. Minor psychiatry. Psychogenies – neuroses (lecture). Psikhiatriya i Psikhofarmakoterapiya. 2011;13(1):4–11. (In Russ.) Available at: https://www.elibrary.ru/nsjhqv.

4. Veltishchev DYu. Neurasthenia: history and the present. Neurology, Neuropsychiatry, Psychosomatics. 2011;3(4):9–13. (In Russ.) https://doi.org/10.14412/2074-2711-2011-338.

5. Smulevich AB, Volel BA. Modern aspects of psychopharmacotherapy of personality disorders. Psychiatry (Moscow). 2004;(5):7–13. (In Russ.) Available at: https://www.elibrary.ru/pwhfob.

6. Volel BA, Makukh EA, Lebedeva MV, Popova ES, Sholomova VA, Androsova LV et al. Clinical and laboratory markers of asthenic syndrome in patients with sarcoidosis. Vrach. 2016;27(7):74–76. (In Russ.) Available at: https://vrachjournal.ru/ru/25877305-2016-07-23.

7. Volel ВА, Troshina DV. Somatic depression with cognitive impairment in a female patient with hypertension. Neurology, Neuropsychiatry, Psychosomatics. 2017;9(4):60–64. (In Russ.) https://doi.org/10.14412/2074-2711-2017-4-60-64.

8. Fomicheva AV, Andreev DA, Volel BA. Mental Disorder in Chronic Heart Failure. Psychiatry (Moscow). 2021;19(4):109–124. (In Russ.) https://doi.org/10.30629/2618-6667-2021-19-4-109-124.

9. Карвасарский БД. Неврозы. М.: Медицина; 1995. 445 с.

10. Коркина МВ, Лакосина НД, Личко АЕ, Сергеев ИИ. Психиатрия. 4-е изд. М.: МЕДпресс-информ; 2008. 576 с.

11. Жариков НМ, Тюльпин ЮГ. Психиатрия. 2-е изд., перераб. и доп. М.: Медицинское информационное агентство; 2009. 829 с.

12. Romanov DV, Volel BA, Petelin DS. Approaches to therapy for depressions in neurology: prospects for the use of agomelatine. Neurology, Neuropsychiatry, Psychosomatics. 2018;10(4):101–110. (In Russ.) https://doi.org/10.14412/2074-2711-2018-4-101-110.

13. Petelin DS, Volel’ BA. Recent approaches to the diagnosis and therapy of monopolar depression. Zhurnal Nevrologii i Psikhiatrii imeni S.S. Korsakova. 2023;123(10):33–41. (In Russ.) https://doi.org/10.17116/jnevro202312310133.

14. Petelin DS, Sorokina OY, Troshina DV, Siginevich YA, Efimochkina SM, Volel BA. Anxiety disorders in general medical practice – clinical picture, diagnosis, optimized approaches to therapy. Meditsinskiy Sovet. 2023;17(3):110–118. (In Russ.) https://doi.org/10.21518/ms2023-053.

15. Рetelin DS, Sorokina OY, Galiautdinova AN, Dolgopolova YV, Volel BA. Anxiety Disorders in Clinical Practice (Clinical Observation and Literature Review). Meditsinskiy Sovet. 2024;18(12):52–60. (In Russ.) https://doi.org/10.21518/ms2024-297.

16. Volel BA. Involutional hysteria: aspects of the clinic, psychosomatic correlations, therapy. Mental Disorders in General Medicine. 2007;(3):50–54. (In Russ.) Available at: https://con-med.ru/magazines/psikhicheskie_rasstroystva_v_obshchey_meditsine/psikhicheskie_rasstroystva_v_obshchey_meditsine-03-2007/involyutsionnaya_isteriya_aspekty_kliniki_psikhosomaticheskie_korrelyatsii_terapiya/.

17. Volel BA. Non-delusional hypochondria (literature review). Mental Disorders in General Medicine. 2009;(2):49–62. (In Russ.) Available at: https://con-med.ru/magazines/psikhicheskie_rasstroystva_v_obshchey_meditsine/psikhicheskie_rasstroystva_v_obshchey_meditsine-02-2009/nebredovaya_ipokhondriya_obzor_literatury_/.

18. Volel BA, Petelin DS, Rozhkov DO. Chronic back pain and mental disorders. Neurology, Neuropsychiatry, Psychosomatics. 2019;11(2S):17–24. (In Russ.) https://doi.org/10.14412/2074-2711-2019-2S-17-24.

19. Sukiasian SG, Soldatkin VA, Snedkov EV, Tadevosian MIa, Kosenko VG. Combat-related posttraumatic stress disorder: the historical evolution of concept from “irritable heart syndrome” to “psycho-organic disorder”. Zhurnal Nevrologii i Psikhiatrii imeni S.S. Korsakova. 2019;119(6):144–151. (In Russ.) https://doi.org/10.17116/jnevro2019119061144.

20. Petelin DS, Isaeva PS, Smoleevsky AG, Tolokonin AO, Volel BA. Post-traumatic stress disorder as the most typical response to a traumatic event: clinical observation and literature review. Clinical Review for General Practice. 2023;4(6):29–35. (In Russ.) https://doi.org/10.47407/kr2023.4.5.00268.

21. Chutko LS, Surushkina SY, Nikishena IS, Yakovenko EA, Anisimova TI. Neurasthenia: State-of-the-art and therapeutic approaches. Neurology, Neuropsychiatry, Psychosomatics. 2013;5(2):42–45. (In Russ.) https://doi.org/10.14412/2074-2711-2013-2412.

22. Bested AC, Marshall LM. Review of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: an evidence-based approach to diagnosis and management by clinicians. Rev Environ Health. 2015;30(4):223–249. https://doi.org/10.1515/reveh-2015-0026.

23. Yemeli Piankeu AD, Fodouop SPC, Noubom M, Gomseu Djoumsie EB, Ful Kuh G, Gatsing D. Epidemiology and Performances of Typhidot Immunoassay and Widal Slide Agglutination in the Diagnosis of Typhoid Fever in Febrile Patients in Bafoussam City, Cameroon: A Cross-Sectional Comparative Study. Can J Infect Dis Med Microbiol. 2024;2024:6635067. https://doi.org/10.1155/2024/6635067.

24. Карвасарский БД, Ледер С. Групповая психотерапия. М.: Медицина; 1990. 384 с.

25. Краснов ВН, Гурович ИЯ (ред.). Клиническое руководство: модели диагностики и лечения психических и поведенческих расстройств. М.: МЕДпресс-информ; 1999. 224 с.

26. Bozhko S, Tyuvina N. Experience with non-drug therapies (psychotherapy, phytotherapy, reflexotherapy) for neurasthenia. Neurology, Neuropsychiatry, Psychosomatics. 2014;6(2):19–24. (In Russ.) https://doi.org/10.14412/20742711-2014-2-19-24.

27. Александровский ЮА, Незнанов НГ (ред.). Психиатрия. М.: ГЭОТАРМедиа; 2018. 1008 с.

28. Ruzinova VM, Dolgopolova YV, Petelin DS, Sorokina OY, Volel BA. The use of biofeedback techniques in clinical practice. Meditsinskiy Sovet. 2023;17(13):288–296. (In Russ.) https://doi.org/10.21518/ms2023-245.