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Social Psychiatry and Psychiatric Epidemiology
Published in: Social Psychiatry and Psychiatric Epidemiology 7/2007

01-07-2007 | ORIGINAL PAPER

Diagnostic concordance of neurasthenia spectrum disorders in Pune, India

Authors: Vasudeo Paralikar, Sanjeev Sarmukaddam, Mohan Agashe, Mitchell G. Weiss

Published in: Social Psychiatry and Psychiatric Epidemiology | Issue 7/2007

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Abstract

Background

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.

Methods

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.

Results

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.

Discussion

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.
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Metadata
Title
Diagnostic concordance of neurasthenia spectrum disorders in Pune, India
Authors
Vasudeo Paralikar
Sanjeev Sarmukaddam
Mohan Agashe
Mitchell G. Weiss
Publication date
01-07-2007
Publisher
D. Steinkopff-Verlag
Published in
Social Psychiatry and Psychiatric Epidemiology / Issue 7/2007
Print ISSN: 0933-7954
Electronic ISSN: 1433-9285
DOI
https://doi.org/10.1007/s00127-007-0196-x

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