The place of neurasthenia in the structure of mental disorders in the 21st century: a series of clinical cases and a literature review

This article presents an analysis of the historical transformation of neurasthenia – from the popular “American disease” in the 19th century to exclusion from modern classifications (DSM, ICD-11). The neurologist J. Bird associated neurasthenia with “exhaustion” due to the transition from a traditional rural lifestyle to a fast-paced urban life. He was the first to describe a wide range of both mental and somatized symptoms. Later, the concept was reinterpreted in European psychiatry through the prism of intrapersonal conflicts, and in the Russian school of I.P. Pavlov’s neurasthenia was considered as an asthenic neurosis, represented by two main clinical forms: hyposthenic (with a predominance of weakness and lethargy) and hyperesthetic (with irritability and increased excitability). In ICD-10, neurasthenia remains as a diagnosis characterized by persistent fatigue from both physical and emotional stress, vegetative disorders and emotional lability, but in recent decades its diagnostic boundaries have significantly narrowed. This is due to the development of diagnostics and conceptualization of depression, anxiety and somatoform disorders, as well as the emergence of the concept of chronic fatigue syndrome, which is especially relevant in the post-covid period. In the framework of the presented study, the authors analyze the modern scientific discourse that examines the question of the clinical validity and diagnostic value of maintaining neurasthenia as an independent nosological unit in modern classifications of mental disorders. This publication also presents three clinical cases, using the example of which it will be possible to trace the main aspects of the clinical picture, differential diagnosis and approaches to the treatment of neurasthenia and related disorders.