[The chronic asthenia syndrome: a clinical approach]

The term asthenia comes from the Greek (centsqsneia, a: privation, without; esthénos: vigor, force), it means absence of strength, vigor or force. It is a symptom, difficult to define, with a set of vague sensations, different for each patient. It is a frequent cause of consult, almost 30% in ambulatory settings. The chronic fatigue represents up to 10% of these cases, and the 0.2-0.7% belongs to the chronic fatigue syndrome. It is very important to differentiate asthenia from weakness, dizziness or dyspnoea, since patients may confuse them. The factor time in asthenia is very useful for its characterization, it was defined to the prolonged fatigue when it lasts for more than a month and chronic when the duration is greater than 6 months. The depression is the commonest fatigue cause, representing approximately half of the cases. The most effective treatment of the asthenia is to solve the underlying cause, although up to 20% of the patients remain without diagnosis. The diagnosis of the chronic fatigue syndrome is of exclusion and the criteria of the international consensus of year 1994 are due to use. The high frequency of the symptom entails an enormous social and economic cost and it is for that reason so important for physicians to have a correct manage of this symptom.

[Asthenic disorders in children]

The present study comprised two parts. In the first part, authors attempted to work out the systematics of asthenic disorders based on our own observations of 189 children aged 7-14 years. The following clinical variants of asthenic states in children were singled out: cerebrogenic asthenia (14.3%), somatogenic (13.8%), residual (16.4%), dysontogenetic (20.1%) and neurasthenia (35.4%). In the second part, we summarized the results of treatment of neurasthenia with adaptol (32 patients) compared to pantoham (30 patients). The efficacy of adaptol was higher: the improvement was seen in 71.9% of cases compared to pantoham (56.7%). The good tolerability of adaptol which clinical efficacy is confirmed by neurophysiological and psychological studies is discussed.

Redefining Cancer-Related Asthenia-Fatigue Syndrome

BACKGROUND

Asthenia fatigue syndrome (AFS) is a common symptom perceived by patients with cancer and consists of reported pathologic fatigue, poor endurance, and impaired motor and cognitive function.

OBJECTIVE

The purpose of this study was to examine the relationship between a traditional measure of AFS, visual analogue scale (VAS) fatigue ratings, and a set of more objective functional and physiologic measures (Dietz oncology classification, C-reactive protein, serum albumin, hemoglobin, body mass index [BMI]), Motor Functional Independence Measure (FIM) Score, Cognitive FIM Score. We hypothesized a relationship could suggest the utility of alternative means of assessing and addressing AFS.

METHODS

We retrospectively examined the records of 131 patients admitted to our facility for inpatient rehabilitation because of disability-causing cancer or its treatment.

RESULTS

Of our sample, 94.7% (124 cases) indicated at least mild fatigue and 97.7% (128 cases) showed abnormal serum albumin, C-reactive protein, hemoglobin, or BMI. We used multiple regression analysis to examine the relationship between VAS fatigue ratings and the aforementioned set of functional and physiologic variables. The regression explained a significant proportion of the variability in VAS fatigue ratings (F = 2.25, df = 7,123, p = 0.03, R = 0.34, R(2) = 0.11). However, only Motor FIM Score accounted for a significant independent contribution to the variability in VAS fatigue ratings.

CONCLUSION

The data indicate physiologic and functional variables may provide an alternative, objective, and reliable operational definition of AFS. Specifically, using Motor FIM Score, as a surrogate for VAS fatigue ratings may be used to measure the efficacy of AFS treatment.

Conceptualizations of frailty in relation to older adults

AIM

The aim of this article is to discuss the concept of frailty and its adequacy in identifying and describing older adults as frail.

BACKGROUND

Despite the dramatic increase in use of the term 'frailty' over the past two decades, there is a lack of consensus in the literature about its meaning and use, and no clear conceptual guidelines for identifying and describing older adults as frail. Differences in theoretical perspectives will influence policy decisions regarding eligibility for, and allocation of, scarce health care resources among older adults.

METHOD

The article presents a literature review and synthesis of definitions and conceptual models of frailty in relation to older adults. The first part of the paper is a summary of the synonyms, antonyms and definitions of the term frailty. The second part is a critical evaluation of conceptual models of frailty. Six conceptual models are analysed on the basis of four main categories of assumptions about: (1) the nature of scientific knowledge; (2) the level of analysis; (3) the ageing process; (4) the stability of frailty. The implications of these are discussed in relation to clinical practice, policy and research.

CONCLUSION

The review gives guidelines for a new theoretical approach to the concept of frailty in older adults: (1) it must be a multidimensional concept that considers the complex interplay of physical, psychological, social and environmental factors; (2) the concept must not be age-related, suggesting a negative and stereotypical view of ageing; (3) the concept must take into account an individual's context and incorporate subjective perceptions; (4) the concept must take into account the contribution of both individual and environmental factors.

Adjuvant role of vitamin B analogue (sulbutiamine) with anti-infective treatment in infection associated asthenia

AIMS OF THE STUDY

Asthenic symptoms such as weakness accompany illness. This study investigates whether the centrally acting cholinergic agent, vitamin B analogue (sulbutiamine), is effective and acceptable in relieving these symptoms in infectious disease when combined with specific anti-infective treatment.

METHODOLOGY

In a prospective uncontrolled, non-randomised, commercial, observational study, 1772 patients with an infectious disease and asthenic symptoms, drawn from the practice of 350 randomly selected physicians throughout India, received vitamin B analogue (sulbutiamine) in addition to specific anti-infective treatment for 15 days. The primary outcome variable was complete resolution of asthenic symptoms with treatment.

RESULTS

The number (%, 95% confidence interval) of patients with complete resolution of all asthenic symptoms was 916 (51.7, 49.4-54). In the remaining patients, severe asthenia was reduced but persisted in 11 (0.6, 0-26); and moderate asthenia in 94 (5.3, 0-17.6). The response was greater in patients with acute infection and symptoms more related to cerebral function. Side effects occurred in 10 (0.6%), patients and well being improved significantly.

CONCLUSIONS

Vitamin B analogue (sulbutiamine) may be a useful adjunct to specific anti-infective treatment.

[Diagnosis of depressive disorder and so-called exhaustion depression. Self-esteem--a central concept]

Depressive disorders can be recognized by the loss of self-esteem; this contrasts with mourning and neurasthenic reactions, in which self-esteem remains intact. Just as depression can result from the gradual reduction and eventual loss of self-esteem, mourning and neurasthenic reactions can evolve into true depressive states. "Exhaustion depression", a new diagnostic category connected to "burnout" situations, should be applied only when criteria for depressive disorder are fulfilled, including loss of self-esteem. When these criteria are lacking we should refer only to an exhaustion state provoked by stress. Neurotic mechanisms may represent a special class of relevant stress factors, but are not seen in manifest neurasthenic reactions and exhaustion depression.

Subsyndromes of chronic schizophrenia: a phenomenological study

Statistical grouping of clinical symptoms and signs is one method of classifying schizophrenia. This study attempted to find factors of symptoms generated through clinical ratings on three scales, namely the Scale for the Assessment of Positive Symptoms (SAPS), the Scale for the Assessment of Negative Symptoms (SANS) and the Comprehensive Psychopathological Rating Scale (CPRS) in a sample of 80 stable chronic schizophrenics diagnosed by DSM-III-R. It was found that the positive-negative dichotomy could not be replicated. Inappropriate affect was found to be a clear misfit in the cluster of negative symptoms. Inclusion of CPRS led to the generation of a factor loading high on depressive and asthenic items, and this could be clearly distinguished from the factor of negative symptoms. This factor had not hitherto been identified.