The medical perspective on burnout
The medical perspective on burnout
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DOI：
10.2478/s13382-013-0093-3
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发表时间：
2013-01-01
影响因子：
2
通讯作者：
Rutkowski, Krzysztof
中科院分区：
文献类型：
--
作者：
Kakiashvili, Tamar;Leszek, Jerzy;Rutkowski, Krzysztof
本研究的目的是回顾与倦怠相关的最新医学发现、其诊断、治疗、典型的病理生理学特征和预防措施。对 PubMed/Medline 中的科学文献进行了系统回顾。报告了最新且重要的发现。倦怠被发现是心肌梗塞和冠心病的危险因素。它还与纤溶能力降低、应对压力的能力降低以及下丘脑-垂体-肾上腺（HPA）轴活性减退有关。严重的倦怠症状与皮质醇觉醒反应 (CAR) 水平较低或增幅较小、硫酸脱氢表雄酮 (DHEAS) 水平较高、皮质醇/DHEAS 比率较低以及地塞米松抑制试验 (DST) 测量的抑制较强有关。越来越多的文献表明，HPA 轴的评估应引起初级保健医生的注意。对于评估各种 HPA 轴疾病的具体治疗和诊断措施尚未达成普遍共识。初级保健医生通过唾液样本对肾上腺激素进行成本效益评估可能会显着改变许多慢性病患者的治疗过程。精神疾病可能有类似的症状，但它们具有独特的激素特征。将倦怠视为一种医疗状况将有助于将倦怠与类似的临床综合症（例如抑郁或焦虑）区分开来，并为倦怠患者提供适当的治疗。正确的治疗对于快速全面康复至关重要。慢性压力相关疾病通常不属于“真正”疾病的范畴，通常被视为抑郁症或根本不治疗。通过唾液样本评估肾上腺激素有助于预测倦怠。需要开发倦怠筛查技术、饮食和营养指南以及改变生活方式以支持 HPA 功能。所提供的材料包括激素、饮食和药物的观点。
The aim of this study was to review recent medical findings related to burnout, its diagnosis, treatment, characteristic pathophysiological features, and preventive measures.A systematic review of the scientific literature in PubMed/Medline was performed. The most recent and important findings were reported.Burnout was found to be a risk factor for myocardial infarction and coronary heart disease. It was also related to reduced fibrinolytic capacity, decreased capacity to cope with stress and hypothalamic-pituitary-adrenal (HPA) axis hypoactivity. Severe burnout symptoms are associated with a lower level or smaller increase of the cortisol awakening response (CAR), higher dehydroepiandrosterone-sulphate (DHEAS) levels, lower cortisol/DHEAS ratios and stronger suppression as measured by the dexamethasone suppression test (DST). More and more literature works suggest that the evaluation of the HPA axis should be brought to the attention of primary care physicians. There is no universal agreement on specific treatment and diagnostic measures to evaluate the wide range of HPA axis disorders. The cost-effective evaluation of adrenal hormones via saliva samples by a primary care physician may significantly alter the course of therapy in numerous chronic disease patients. Psychiatric disorders may have similar symptoms, but they have distinctive hormonal profiles. Having burnout recognized as a medical condition would help in differentiating burnout from similar clinical syndromes, such as depression or anxiety, and provide appropriate treatment to burnout patients. Proper treatment is essential for a fast and full recovery.Chronic stress-related disorders often fall outside the category of a "true" disease and are often treated as depression or not treated at all. The evaluation of adrenal hormones via saliva samples helps to predict burnout. Burnout screening techniques, dietary and nutritional guidelines and lifestyle changes for supporting the HPA function need to be developed. The presented material includes hormonal, dietary, and pharmaceutical perspectives.