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Query: UMLS:C0015672 (fatigue)
 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

"Psychasthenia exists--we meet it every day". Despite this affirmation, Pierre Janet's views remain unappreciated by international psychiatry. Psychasthenia is not included in the Diagnostic and Statistical Manual of Mental Disorders (DSM III-R). This pathology, described by Janet as both benign and terrible, is presently broken into many diagnostic categories with respect to the principal symptomatology of the patient. When a mood disorder is present, these patients can have diagnostic criteria for major depression or dysthymia. Patients with prevalent anxiety, phobia or obsessive-compulsive symptoms, must also be classified in having anxiety disorders. When somatic complaints are major symptoms, the patient's disease can be, on the whole, attributed to a somatoform disorder. This scale is a global evaluation of psychasthenia. It is made up of three lists of items. The first concerns asthenia or fatigue sine materia. The items in this group allow an evaluation of the physical and mental characteristics of asthenia associated with an inability of acting. Difficulties in mental concentration are measured by items in the second list. Mental processes are associated with doubts and waverings. They are interrupted by interferences caused by obsessions with recurrent and persistent ideas, impulses or images. Physical symptoms without organic pathology or a pathophysiologic mechanism constitute the neurasthenic part of psychasthenia. In the third list, somatic complaints are spelled out in a check-list of these potential symptoms. This scale can be used as a help in the diagnosis. Items 2, 3, 5, 25, 26 and 29 have a specific reference to the history of the disorder.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A scale to assess psychasthenia]. 129 95

The effects on measures of anxiety from two doses of oral caffeine (250 and 500 mg) and placebo were compared in 12 patients with generalized anxiety disorder (GAD), 12 patients with panic disorder, and 12 normal subjects. Caffeine produced significantly less decrease in electroencephalographic alpha wave activity, greater decrease in N1-P2 auditory evoked potential amplitude, and greater increased in skin conductance level, systolic and diastolic blood pressure, critical fusion flicker frequency, and self-ratings of anxiety and sweating in patients with GAD than in normal patients. Patients with panic disorder showed different reactivity than normal patients did with respect to electroencephalographic alpha waves, N2 latency, N2-P2 auditory evoked potential amplitude, and physical tiredness but were less reactive than patients with GAD on several variables. It is concluded that patients with GAD are abnormally sensitive to caffeine and that the data support the view that panic disorder is a separable disorder from GAD.
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PMID:Anxiogenic effects of caffeine in patients with anxiety disorders. 144 24

Chronic fatigue is a common and difficult challenge in clinical practice. The majority of patients with this chief complaint have treatable mood or anxiety disorders, complicated by a tendency toward somatization. A minority of patients suffer from sleep disorders, endocrinologic abnormalities, or chronic inflammatory conditions. Prolonged recovery after viral infections is only rarely the cause of chronic fatigue. Specific pharmacologic interventions and cognitive-behavioral therapy are effective in an environment that is sensitive to the patient's interpretation of symptoms and avoids unproven medical investigations and therapies.
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PMID:Chronic fatigue syndromes in clinical practice. 148 21

The use of benzodiazepines for generalized anxiety disorder (GAD) is a safe and effective treatment; however, their potential to produce dependence and impair psychomotor and cognitive functions is a drawback. In this study the efficacy and safety of alpidem, a nonbenzodiazepine, was assessed. Thirty patients who met DSM-III-R criteria for GAD were randomized to either alpidem (225 mg), lorazepam (4.5 mg), or placebo. The primary efficacy measure was the Hamilton Rating Scale for Anxiety (HAM-A). A repeated measures multivariate analysis of variance (MANOVA) was used to determine differences in HAM-A scores over time. The results showed a trend for alpidem to be more effective. Half of the alpidem group had a decrease of 50 percent or greater in their HAM-A scores with an almost equal effect on psychic and somatic symptoms. The most common side effects with alpidem and lorazepam were lightheadedness, drowsiness, and daytime tiredness. Moreover, treatment with alpidem did not manifest any withdrawal symptoms. Thus nonbenzodiazepine treatments are effective and safe for GAD.
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PMID:A comparative study of alpidem, a nonbenzodiazepine, and lorazepam in patients with nonpsychotic anxiety. 167 74

A differentiation between the normal sensation of tiredness and the symptom "fatigue" is often difficult. Both are influenced by cultural, social, psychological and biological factors, which can lead--interactively--to symptom formation. Psychiatric disorders frequently associated with fatigue are all forms of depression, somatization and anxiety disorders, chronic pain states and drug abuse among many others. In at least 2/3 of patients with the fashionable chronic fatigue syndrome--formerly called neurasthenia--a psychiatric diagnosis can be made, most of them also suffer from many symptoms attributes to the autonomous nervous system. The clinical approach should be cautious avoiding diagnostic and therapeutic overaction and therapy should emerge from a diagnosis properly assessed.
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PMID:[Intense fatigue in humans. Psychosocial and cultural aspects]. 175 73

Depression and chronic fatigue are frequently associated with heart disease. They may precede the onset of myocardial infarction, singly or together, and increase the morbidity and mortality of patients with a history of MI. Virtually all such patients have a transient depression, usually accompanied by anxiety, with onset soon after hospitalization. Although this depression is transient and usually abates spontaneously, it frequently warrants therapeutic intervention. Psychosocial and personality factors play a significant role in the recovery of a patient with a cardiac condition. The clinician must be alert for the effects of changing roles within the family and behaviors that may lead to chronic invalidism. Anxiety disorders, often combined with depression, may mimic cardiac disease and may result from it, leading to chronic fatigue and weakness. Proper diagnosis usually leads to considerable improvement. Cardiac drugs, in addition to many others, may produce depression and fatigue that may be misdiagnosed. Often, discontinuing or changing a medication will lead to marked diminution of such symptoms. Observational and listening skills are key ingredients of the "art" of medicine; they can lead to interventions that are not only therapeutic, but which improve the "quality" of life.
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PMID:Depression and chronic fatigue in the patient with heart disease. 187 16

Bromazepam was compared with placebo and with chlorprothixene in a randomized, double-blind group-comparative multicenter trial in general practice. Two hundred and forty-five patients with generalized anxiety disorder (DSM-III 1980) were treated for 2 weeks with two daily doses of bromazepam, 3 mg or chlorprothixene, 15 mg or placebo. Median reductions in Hamilton Anxiety rating were 12 (bromazepam), 10.3 (chlorprothixene) and 7.3 (placebo). The study revealed significant superiority of bromazepam over placebo (median differences 3.3, 95% confidence limits: 0.3 and 6.1) but not over chlorprothixene (median difference 1.4, 95% confidence limits -0.8 and +3.5). Significantly higher rates of tiredness, sedation and hypersomnia were found on bromazepam and chlorprothixene compared to placebo. Tolerance was rated as "at least good" in 85.6% on bromazepam, in 86% on chlorprothixene and in 87.8% on placebo. Neither previous psychopharmacological treatment nor presence of psychosocial stress were of perceptible influence. Bromazepam and chlorprothixene are both superior to placebo in generalized anxiety states treated in general practice, but spontaneous improvements/placebo effects are substantial.
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PMID:Bromazepam in generalized anxiety. Randomized, multi-practice comparisons with both chlorprothixene and placebo. 196 72

Pooled data were analyzed for 367 female patients enrolled in a double-blind, placebo-controlled, multi-centre trial comparing buspirone, a non-benzodiazepine anxiolytic, and diazepam in the treatment of generalized anxiety disorder. After a 4 to 7-day wash-out period, patients were allocated at random to receive one or other of the trial medications or placebo over a 4-week period. Mean daily dosages were 24.5 mg for buspirone and 20.8 mg for diazepam (range 10 mg to 60 mg for both drugs). Patients were assessed on entry and at weekly intervals using the Hamilton Anxiety Rating Scale, and at the end of treatment both patients and physicians gave an overall opinion of response to treatment. Details of adverse events were also recorded. The results showed that both buspirone and diazepam were approximately equal in efficacy and superior to placebo. Menstruation and the occurrence of premenstrual tension did not alter the anxiolytic activity of either drug. Patients taking diazepam had significantly more adverse effects, i.e. drowsiness, weakness, fatigue, inco-ordination and depression, than did those in the buspirone group. In a separate commentary, the anxiety disorder and the data from the study are reviewed to place them in the overall perspective of gynaecological care.
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PMID:A pooled, double-blind comparison of the effects of buspirone, diazepam and placebo in women with chronic anxiety. 264 17

The MAOIs have been an underutilized and overly feared class of medical compounds potentially useful for a wide spectrum of disorders. At one end of the spectrum they have been found effective for several anxiety disorders, especially when phobic or panic reactions are part of the symptoms. At the other end of the spectrum, they are effective in patients with melancholic depressions, especially outpatients who have lack of energy, a history of bipolar disorder, or a nonresponse to conventional treatment with TCAs. However, their major role for psychiatric patients appears to be in the large heterogeneous group of ambulatory depressives who have symptoms of both anxiety and depression. The danger of side effects or toxicity associated with MAOIs has been exaggerated. Most side effects are relatively mild and are controllable by dose reduction or other supportive measures. The adverse reaction of most concern, hypertensive crisis, is great extent preventable with appropriate dietary restrictions. Selective and reversible MAOI's may have a better safety profile compared to classical MAOI's.
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PMID:[Indications for therapy using MAO inhibitors]. 268 53

One hundred adults with a chief complaint of chronic fatigue were evaluated in an outpatient setting to determine a possible association with somatization disorder. Somatization disorder was diagnosed in 15 patients. Eight functional somatic symptoms were reported more frequently by these patients: pain in extremities, joint paint, chest pain, other pain, shortness of breath, blurred vision, muscle weakness, and sexual indifference (p less than 0.001). Current mood disorders, anxiety disorders, and psychoactive substance use disorders were less common in patients with somatization disorders than in patients without this diagnosis (p less than 0.01).
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PMID:Somatization disorder in patients with chronic fatigue. 279 31


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