Asthenia (asthenic syndrome) is a gradually developing psychopathological disorder that accompanies many diseases of the body. Asthenia is manifested by fatigue, decreased mental and physical performance, sleep disorders, increased irritability or vice versa, lethargy, emotional instability, vegetative disorders. A thorough interview of the patient, a study of his psycho-emotional and mnestic sphere allows to identify asthenia. A complete diagnostic examination is also necessary to identify the underlying disease that caused asthenia. Asthenia is treated by selecting an optimal work regime and a rational diet, using adaptogens, neuroprotectors and psychotropic drugs (neuroleptics, antidepressants).
R53 Malaise and fatigue
Asthenia is undoubtedly the most common syndrome in medicine. It accompanies many infections (ARI, influenza, food toxicoinfections, viral hepatitis, tuberculosis, etc.), somatic diseases (acute and chronic gastritis, peptic ulcer of the 12p. intestine, enterocolitis, pneumonia, arrhythmia, hypertension, glomerulonephritis, neurocirculatory dystonia, etc.), psychopathological conditions, postpartum, post-traumatic and postoperative period. For this reason, specialists in almost any field face asthenia: gastroenterology, cardiology, neurology. Disease may be the first sign of an incipient disease, accompany its height or be observed during the period of convalescence.
Pathology should be distinguished from ordinary fatigue, which occurs after excessive physical or mental stress, changing time zones or climate, non-compliance with the work and rest regime. Unlike physiological fatigue, asthenia develops gradually, persists for a long time (months and years), does not pass after a full rest and needs the intervention of a doctor.
According to many authors, asthenia is based on overstrain and exhaustion of higher nervous activity. The immediate cause of asthenia may be insufficient intake of nutrients, excessive energy expenditure or a disorder of metabolic processes. Any factors that lead to exhaustion of the body can potentiate the development of asthenia: acute and chronic diseases, intoxication, poor nutrition, mental disorders, mental and physical overwork, chronic stress, etc.
Due to the occurrence in clinical practice, organic and functional asthenia is distinguished. Organic asthenia occurs in 45% of cases and is associated with the patient’s chronic somatic diseases or progressive organic pathology. In neurology, organic asthenia accompanies infectious organic brain lesions (encephalitis, abscess, tumor), severe traumatic brain injuries, demyelinating diseases (multiple encephalomyelitis, multiple sclerosis), vascular disorders (chronic cerebral ischemia, hemorrhagic and ischemic stroke), degenerative processes (Alzheimer’s disease, Parkinson’s disease, senile chorea). Functional asthenia accounts for 55% of cases and is a temporary reversible condition. Functional asthenia is also called reactive, since it is essentially a reaction of the body to a stressful situation, physical fatigue or an acute illness.
According to the etiological factor, somatogenic, posttraumatic, postpartum, postinfectious asthenia are also distinguished.
According to the peculiarities of clinical manifestations, asthenia is divided into hyper- and hyposthenic forms. Hypersthenic asthenia is accompanied by increased sensory excitability, due to which the patient is irritable and does not tolerate loud sounds, noise, bright light. Hyposthenic asthenia, on the contrary, is characterized by a decrease in susceptibility to external stimuli, which leads to lethargy and drowsiness of the patient. Hypersthenic asthenia is a milder form and with an increase in asthenic syndrome, it can turn into hyposthenic asthenia.
Depending on the duration of the asthenic syndrome, asthenia is classified into acute and chronic. Acute asthenia is usually functional in nature. It develops after severe stress, acute illness (bronchitis, pneumonia, pyelonephritis, gastritis) or infection (measles, influenza, rubella, infectious mononucleosis, dysentery). Chronic asthenia is characterized by a long course and is often organic. Chronic functional form includes chronic fatigue syndrome.
Separately, there is asthenia associated with exhaustion of higher nervous activity — neurasthenia.
The symptom complex characteristic includes 3 components: own clinical manifestations of asthenia; disorders associated with the underlying pathological condition; disorders caused by the patient’s psychological reaction to the disease. Manifestations of the asthenic syndrome itself are often absent or poorly expressed in the morning, appear and increase during the day. In the evening, asthenia reaches its maximum manifestation, which forces patients to rest without fail before continuing work or moving on to household chores.
- Fatigue. The main complaint is fatigue. Patients note that they get tired faster than before, and the feeling of fatigue does not disappear even after a long rest. If we are talking about physical labor, then there is a general weakness and unwillingness to do their usual work. In the case of intellectual work, the situation is much more complicated. Patients complain of difficulty concentrating, memory impairment, decreased attentiveness and intelligence. They note difficulties in the formulation of their own thoughts and their verbal expression. Patients with asthenia often cannot concentrate on thinking about one particular problem, they hardly find the words to express any idea, they are absent-minded and somewhat inhibited when making decisions. In order to do the work they could before, they are forced to take breaks, to solve the task they are trying to think about it not as a whole, but by breaking it into parts. However, this does not bring the desired results, increases the feeling of fatigue, increases anxiety and causes confidence in one’s own intellectual insolvency.
- Psycho-emotional disorders. A decrease in productivity in professional activity causes the occurrence of negative psycho-emotional states associated with the patient’s attitude to the problem that has arisen. At the same time, patients with asthenia become short-tempered, tense, picky and irritable, quickly lose their composure. They have sharp mood swings, states of depression or anxiety, extremes in assessing what is happening (unreasonable pessimism or optimism). Aggravation of the psycho-emotional disorders characteristic of asthenia can lead to the development of neurasthenia, depressive or hypochondriac neurosis.
- Vegetative disorders. Asthenia is almost always accompanied by disorders of the autonomic nervous system. These include tachycardia, pulse lability, blood pressure drops, chills or a feeling of heat in the body, generalized or local (palms, armpits or feet) hyperhidrosis, decreased appetite, constipation, pain along the bowel. With asthenia, headaches and a “heavy” head are possible. Men often have a decrease in potency.
- Sleep disorders. Depending on the form of asthenia, it can be accompanied by various sleep disorders. Hypersthenic asthenia is characterized by difficulty falling asleep, restless and intense dreams, night awakenings, early waking up and feeling overwhelmed after sleep. Some patients have a feeling that they practically do not sleep at night, although in reality this is not the case. Hyposthenic asthenia is characterized by the occurrence of daytime drowsiness. At the same time, problems with falling asleep and poor quality of night sleep remain.
Asthenia itself usually does not cause diagnostic difficulties for a doctor of any profile. In cases where asthenia is a consequence of stress, trauma, illness or acts as a harbinger of pathological changes beginning in the body, its symptoms are pronounced. If asthenia occurs against the background of an existing disease, then its manifestations may fade into the background and be not so noticeable behind the symptoms of the underlying disease. In such cases, signs of asthenia can be detected by interviewing the patient and detailing his complaints. Particular attention should be paid to questions about the patient’s mood, the state of his sleep, his attitude to work and other responsibilities, as well as to his own condition. Not every patient with asthenia will be able to tell the doctor about their problems in the field of intellectual activity. Some patients tend to exaggerate existing disorders. To get an objective picture, a neurologist, along with a neurological examination, needs to conduct a study of the patient’s mnestic sphere, assess his emotional state and response to various external signals. In some cases, it is necessary to differentiate asthenia from hypochondriac neurosis, hypersomnia, depressive neurosis.
Diagnosis of asthenic syndrome requires mandatory examination of the patient for the underlying disease that caused the development of asthenia. For this purpose, additional consultations can be conducted by a gastroenterologist, cardiologist, gynecologist, pulmonologist, nephrologist, oncologist, traumatologist, endocrinologist, infectious disease specialist and other narrow specialists. It is mandatory to pass clinical tests: blood and urine tests, coprograms, determination of blood sugar, biochemical analysis of blood and urine. The diagnosis of infectious diseases is carried out by bacteriological studies and PCR diagnostics. According to the indications, instrumental research methods are prescribed: ultrasound of the abdominal cavity, gastroscopy, duodenal probing, ECG, ultrasound of the heart, fluorography or lung x-ray, kidney ultrasound, MRI brain, ultrasound of the pelvic organs, etc.
General recommendations for asthenia are reduced to the selection of an optimal work and rest regime; refusal of contact with various harmful effects, including alcohol consumption; introduction of healthy physical activity into the daily routine; compliance with a fortified diet and corresponding to the underlying disease. The best option is a long rest and a change of scenery: vacation, spa treatment, tourist trip, etc.
Patients benefit from food rich in tryptophan (bananas, turkey meat, cheese, coarse bread), vitamin B (liver, eggs) and other vitamins (rosehip, black currant, sea buckthorn, kiwi, strawberries, citrus fruits, apples, salads of raw vegetables and fresh fruit juices). A calm working environment and psychological comfort at home are important for patients with asthenia.
Medical treatment in general medical practice is reduced to the appointment of adaptogens: ginseng, rhodiola rosea, Chinese lemongrass, eleutherococcus, pantocrine. In the USA, the practice of treating asthenia with large doses of group B vitamins has been adopted. However, this method of therapy is limited in use by a high percentage of adverse allergic reactions. A number of authors believe that complex vitamin therapy is optimal, including not only B vitamins, but also C, PP, as well as trace elements involved in their metabolism (zinc, magnesium, calcium). Often, nootropics and neuroprotectors (ginkgo biloba, piracetam, gamma-aminobutyric acid, cinnarizine + piracetam, picamelon, hopanthenic acid) are used in the treatment of asthenia. However, their effectiveness in asthenia has not been definitively proven due to the lack of major studies in this area.
In many cases, disease requires symptomatic psychotropic treatment, which can only be selected by a narrow specialist: a neurologist, psychiatrist or psychotherapist. So, on an individual basis, antidepressants are prescribed for asthenia — serotonin and dopamine reuptake inhibitors, neuroleptics (antipsychotics), procholinergic drugs (salbutyamine).
The success of the treatment resulting from any disease largely depends on the effectiveness of the latter’s treatment. If it is possible to cure the underlying disease, then the symptoms, as a rule, pass or significantly decrease. With prolonged remission of a chronic disease, the manifestations accompanying it are also minimized.