Diagnostic concordance of neurasthenia spectrum disorders in Pune, India
- First Online:
- 69 Downloads
Clinically significant fatigue or weakness is a common but understudied clinical problem in India. The applicability and relevance of Western clinical criteria in this setting are not studied. Alternative criteria sets used in different clinical contexts suggest a range of conditions constituting neurasthenia spectrum disorders (NSDs). We therefore aimed to determine frequency of patients with these complaints in four specialty outpatient clinics of an urban general hospital. We compared the concordance of four diagnostic criteria sets of fatigue disorders among the same patients.
Patients from the clinics of Psychiatry, Medicine, Dermatology, and Ayurved were screened for clinically significant fatigue or weakness and assessed for CFS, ICD-10 neurasthenia, DSM-IV draft criteria for neurasthenia, and CCMD-2 neurasthenia.
For 352 patients, sensitivity of CDC criteria for CFS (13.4%) was poorest. CFS was most frequent in the Medicine clinic. CCMD-2 criteria were the most frequently met (77.6%) with no significant difference across clinics. Two-way concordance of neurasthenia categories was no better than fair (≤0.4) and few patients (8.0%) met criteria for all four categories.
Four NSD criteria sets identified different clinical subgroups. CFS, considering fatigue and ignoring weakness, was least relevant for identifying NSD patients in these clinics. Poor concordance among the four diagnostic systems studied indicates the need for reviewing the nosology of these disorders. Focus on clinical significance alone is likely to avoid the discordant confusion arising from cross-cultural differences.
Keywordsneurasthenia fatigue disorders culture-bound syndromes diagnostic criteria diagnostic sensitivities
- 2.Agashe M, Paralikar V, Weiss MG (1999) EMIC interview for study of disorders of fatigue and weakness. Maharashtra Institute of Mental Health and Swiss Tropical InstGoogle Scholar
- 3.American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders (4th edn.) (DSM-IV). APA, Washington, DCGoogle Scholar
- 9.Chinese Association of Neurology and Psychiatry (1989) Chinese classification of mental disorders, 2nd edn. Publishing House of Hunan University, Changsha, ChinaGoogle Scholar
- 12.First MB, Spitzer RL, Gibbon M, Williams JBW (1998) Structured clinical interview for DSM-IV Axis I disorders – patient edition (SCID-I/P, Version 2.0, 8/98 revision). Biometrics Research Department, New York State Psychiatric Institute, New YorkGoogle Scholar
- 16.Kirmayer LJ, Weiss M (1997) Cultural considerations for somatoform disorders. In: Widiger TA, Francis AJ, Pincus HA, Ross R, First MB, Davis W (eds) DSM-IV Sourcebook, vol 3. American Psychiatric Association, Washington DC, pp 933–941Google Scholar
- 17.Kleinman A (1980) Patients and their healers in the context of culture. University of California Press, Berkeley, CAGoogle Scholar
- 18.Maire B, Lioret S, Gartner A, et al. (2002) Nutritional transition and non-communicable diet-related chronic diseases in developing countries [Article in French] Sante. 12(1):45–55Google Scholar
- 20.Paralikar V, Agashe M, Oke M, Dabholkar H, Abouihia A, Weiss MG (in press) Prevalence of clinically significant functional fatigue or weakness in specialty outpatient clinics of Pune, India. JIMAGoogle Scholar
- 21.Patel V, Kirkwood BR, Weiss H, Pednekar S, Fernandes J, Pereira B, Upadhye M, Mabey D (2005) Chronic fatigue in developing countries: population based survey of women in India. Br Med J 330:1190, doi:10.1136/bmj.38442.636181.E0Google Scholar
- 29.Wessely S, Hotopf M, Sharpe M (1998) Epidemiology of fatigue. In: Chronic fatigue and its syndromes, Chapter 2. Oxford University Press, Oxford, p 19Google Scholar
- 31.Williams JBW (1988) The Structured Interview Guide for the Hamilton Anxiety and Depression Rating Scales (SIGH-AD). New York State Psychiatric Institute, New YorkGoogle Scholar
- 32.World Health Organization (1992a) The Tenth Revision of the International Classification of Diseases and Related Health Problems (ICD-10). WHO, GenevaGoogle Scholar