Neurocirculatory asthenia or DaCosta's syndrome is a condition characterized by shortness of breath (dyspnea), fatigue, rapid pulse, and irregular or pounding heartbeats (palpitations) and chest pain. It occurs mostly with exertion and is not due to physical disease of the heart, but is associated with exhaustion and emotional strain and may have a psychological basis. In psychiatry, there is a tendency to view neurocirculatory asthenia as a form of anxiety disorder or panic disorder, yet it does not appear in the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision). It is often associated with hyperventilation and respiratory acidosis that is measurable by arterial blood gas. It has classically been described in soldiers exposed to combat and is now thought to overlap with post-traumatic stress disorder and/or chronic fatigue syndrome.
Specific causes are not known, although stress appears to play a role. Symptoms usually start in adolescence or the early twenties but may also present in middle age. The condition tends to be chronic with recurrent acute exacerbations. The resulting weakness may produce isolation from social situations, similar to social anxiety disorder, and may be associated with agoraphobia.Risk: Risk factors are basically the same as for any chronic anxiety condition, and may be related to past or present stress. Symptoms are twice as common in women as in men. |
Source: Medical Disability Advisor
History: Individuals may complain of the inability to take a deep breath, a smothering sensation upon taking a breath, a choking sensation, the feeling of being short of breath (dyspnea), the sensation of a racing heart (palpitations) and/or a pulse rate of over 100 beats per minute (tachycardia), chest pain or discomfort, undue fatigue or limitation of activities, excessive sweating, insomnia, irritability, and feelings of nervousness, dizziness, faintness, or discomfort in crowds. Physical exam: A psychiatric interview, mental status exam, and neurologic exam are needed for diagnosis of this disorder. Diagnosis is often difficult. On physical exam, an increased respiratory rate of greater than 24 breaths per minute, shallow respirations, or sighing respirations may be evident. Pulse may be irregular or rapid. Tests: Psychological tests such as the Minnesota Multiphasic Personality Inventory and their interpretation can be helpful. Cardiac evaluation is needed to exclude physical diseases with similar symptoms such as mitral valve prolapse. Often the individual will go through exhaustive medical workups to eliminate physical causes of symptoms. Measurement of blood oxygenation by arterial blood gas may reflect a respiratory acidosis. |
Source: Medical Disability Advisor
| The treatment of neurocirculatory asthenia is challenging since many individuals may receive secondary gain of attention and sympathy for their symptoms, and tend to seek help from medical specialists rather than psychiatrists. Psychotherapy may be useful to focus on feelings of anxiety and explores ways to decrease anxiety levels. Medication therapy (beta-blockers or anti-anxiety agents) may be used to control symptoms of anxiety. Fatigue may indicate a need for stimulants. Stimulants, however, may worsen symptoms of anxiety and should be avoided if possible. |
Source: Medical Disability Advisor
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| ACOEM's Practice Guidelines, the gold standard in effective medical treatment of occupational injuries and illnesses, are provided in this section to complement the disability duration guidelines.* |
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| * The relationship between the MDGuidelines (MDA) content and ACOEM's guidelines is approximate and does not always link identical diagnoses. The user should consult the diagnostic codes in both guidelines, as well as the clinical descriptions, before assuming an equivalence. |
Source: ACOEM Practice Guidelines
| The expected outcome for neurocirculatory asthenia is guarded, particularly if it is chronic. Treatment is difficult, and the individual most often avoids psychiatric help insisting there is an organic reason for the symptoms. The outcome can be positive if the individual accepts treatment aimed toward relieving the symptoms of anxiety such as medication or psychotherapy. |
Source: Medical Disability Advisor
In addition to psychotherapy and pharmacotherapy treatments, occupational therapy may be helpful. Supportive therapies such as expressive therapies (i.e., art, music, or dance therapy) or relaxation techniques may be helpful to certain individuals. Physical therapy that addresses relaxation through use of breathing relaxation techniques may also prove helpful.
Mild exercises such as calisthenics incorporated and supervised by rehabilitation professionals can also be helpful in decreasing anxiety and promoting relaxation. Physical and occupational therapists often use biofeedback techniques to help reduce anxiety. Biofeedback machines allow individuals to be consciously aware of any changes in their heart rate with visual and/or audio stimulation. The therapist can then address specific exercises that help individuals control their heart rate and anxiety.
Since medication therapy is one of the primary treatments for individuals with neurocirculatory asthenia, rehabilitation may need to be modified in accordance to any side effects from medication. |
Source: Medical Disability Advisor
| Neurocirculatory Asthenia may complicate the diagnosis and treatment of other psychiatric disorders involving mood, anxiety, substance abuse or dependence, and personality disorders. |
Source: Medical Disability Advisor
| Accommodations may include modifying identifiable work situations that provoke symptoms of fatigue, dizziness, or muscle weakness; decreasing workplace stimulants such as noise, cigarette smoke, or noxious chemicals; introducing the individual to stressful situations gradually under close supervision and support; providing flexibility with work schedule to accommodate medical or psychiatric appointments; allowing break time according to individual's needs rather than a fixed schedule; arranging for meetings among the employer, supervisor, and job coach to discuss other possibilities; temporarily adjusting highly stressful activities such as operating machinery; and modifying the work space to reduce noise or visual distractions. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Does individual have shortness of breath, fatigue, rapid pulse, and palpitations?
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Has individual previously been diagnosed with post-traumatic stress disorder and/or chronic fatigue syndrome?
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Have physical disorders been ruled out as the cause of symptoms?
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Has diagnosis of neurocirculatory asthenia been confirmed?
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Does individual have an underlying condition such as psychiatric illness, personality disorders, substance abuse/dependence, or the presence of a cardiac or respiratory illness that may impact recovery?
Regarding treatment:
- Is individual willing to seek help from both medical specialists and psychiatrists?
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Is individual taking medication as prescribed? Are the side effects from medication preventing use or benefit from that particular medication?
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Would individual benefit from more frequent therapeutic encounters?
Regarding prognosis:
- If symptoms have persisted despite medication, is individual now willing to explore psychotherapy?
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What are the individual's expectations?
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Source: Medical Disability Advisor
| CitedFrances, Allen, ed. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). 4th ed. Washington, DC: American Psychiatric Association, 2000. |
Source: Medical Disability Advisor
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