Lecture
Asthenia occurs in many mental, neurological, and somatic disorders. As early as 1890, R. Krafft–Ebing defined it as “a morbid state of the nervous system whose main clinical features are abnormally easy excitability and excessively rapid exhaustion of nervous functions.” P.M. Zinoviev (1940) saw the essence of asthenia as a quantitative decline in neuropsychic activity in the absence of qualitative changes to it. According to P.M. Zinoviev, the main symptoms of asthenic syndrome are:
general lethargy;
difficulty in sustaining active exertion;
unpleasant general malaise;
lowered mood with an affect of anxiety;
heightened impressionability;
irritability with a sharply negative tone of emotional reaction;
increased general reflex and autonomic excitability;
autonomic dystonia;
various pain sensations.
In the clinical picture of asthenic syndrome, V.S. Lobzin (1989) noted two groups of phenomena: the patient’s subjective experiences and objective signs of decline in the functional capacities of the organism. To the first group he assigned fatigue, general weakness, general malaise, increased tiredness, and the experience of an inability to sustain prolonged neuropsychic strain. To the second – decreased working capacity, increased tiredness, intolerance to one or many types of activity, and the decompensating effect of specific stimuli. B.I. Laskov, V.S. Lobzin, N.K. Lipgart, and I.D. Solodovnikov (1981) define asthenic states as functional neuropsychic disturbances manifested by increased mental exhaustibility, decreased mental and physical working capacity, difficulty in quick thinking and concentration, absent-mindedness, memory impairment, mood instability, sleep disturbances, and various autonomic-vascular disorders; moreover, these states are temporary in nature, nonspecific to damage of any particular organ, and may occur in diseases of various organs and systems.
Noting the various combinations of symptoms in the clinical picture of asthenia, B.S. Bamdas (1961) distinguished hyperasthenic syndrome, irritable weakness syndrome, and hypoasthenic syndrome. S.N. Davidenkov (1963) spoke of the conventionality of this classification, emphasizing that many transitional variants exist between the forms identified.
Clinical variants of asthenic syndrome and its combinations with other syndromes
Owing to its nonspecificity and diversity, depending on the predominance of one or another symptom pattern, combinations of asthenia with other syndromes manifest in the following clinical variants:
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vital-asthenic, asthenic-subdepressive, psychasthenic-subdepressive, astheno-anergic (Glossary, 1990);
astheno-depressive, astheno-depersonalization, astheno-adynamic, asthenic confusion syndrome (Glossary, 1974);
astheno–hypochondriacal, astheno-depressive, astheno-phobic, astheno-obsessive, astheno–agrypnic (V.S. Lobzin, 1989);
depressive-asthenic, hypochondriacal-asthenic, obsessive-asthenic, dysphoric-asthenic, adynamic-asthenic (Yu.M. Saarma, L.S. Mekhilane, 1980)
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