NEURAESTHENIA REVISITED - ICD-10 AND DSM-III-R PSYCHIATRIC SYNDROMES IN CHRONIC FATIGUE PATIENTS AND COMPARISON SUBJECTS

Background. Different definitions of chronic fatigue syndrome (CFS) ha ve different psychiatric exclusion criteria and this affects the type and frequency of associated psychiatric morbidity found. The operation al criteria for neuraesthenia in ICD-10 vary in this and other respect s from the Centers for Disease Control and Prevention (CDC) criteria f or CFS. Neuraesthenia and associated psychiatric morbidity in CDC-defi ned CFS are evaluated. Method. CFS subjects and controls were intervie wed with the Schedule for the Clinical Assessment of Neuropsychiatry ( SCAN). The computerised scoring program for SCAN (CATEGO5) facilitates the assignment of operational definitions according to DSM-III-R and ICD-10. Subjects were re-interviewed with SCAN an average of 11 months later. No specific treatments or interventions were given during this period. Results. The majority of subjects fulfilled ICD-10 operationa l criteria for neuraesthenia and had two and a half times the rate of psychiatric morbidity as the healthy comparison group according to the CATEGO5 Index of Definition (ID). Approximately 80% of subjects fulfi lled both DSM-III-R and ICD-10 criteria for sleep disorders. There was a significant fall in the number of subjects fulfilling criteria for depression and anxiety disorders and a significant increase in the num ber of subjects with no diagnosis for DSM-III-R criteria over time. Th ere were no significant changes over time for any diagnosis according to ICD-10 criteria or for overall levels of psychopathology as reflect ed in CATEGO5 ID levels. Conclusions. The ICD-10 'neuraesthenia' defin ition identifies almost all subjects with CDC-defined CFS. Fifty per c ent of CFS subjects also had depressive or anxiety disorders, some cat egories of which remit spontaneously over time.