The medical perspective on burnout.

OBJECTIVE: The aim of this study was to review recent medical findings related to burnout, its diagnosis, treatment, characteristic pathophysiological features, and preventive measures. MATERIALS AND METHODS: A systematic review of the scientific literature in PubMed/Medline was performed. The most recent and important findings were reported. RESULTS: 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. CONCLUSION: 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.

A note on relevance of diagnostic classification and rating scales used in psychiatry.

In the clinical practice of psychology and psychiatry, presence or absence of particular disorder or syndromes is based on the subjective interpretation of mental and behavioral descriptions offered by the patient. This is often done by questionnaires (also called instruments or scales) or by interviews. This subjectivity of the diagnostic decision-making process may limit the reliability of diagnosis. In the present study, a new method of scale relevance, based on double cluster analysis, is proposed as it is important to verify what we are trying to find with the proposed scale. If two data sets cluster differently, we must consider them as different.

Improving the medical scale predictability by the pairwise comparisons method: evidence from a clinical data study.

In the clinical practice of psychiatry, presence or absence of particular symptoms is based on the subjective interpretation, by the clinician, of mental and behavioural descriptions offered by the patient. However, this subjectivity that characterizes the diagnostic decision making process may limit the reliability of diagnosis. In this current study, the pairwise comparisons (PC) method is used to investigate whether the psychometric properties of a medical screening questionnaire can be improved. The pilot data described herein did indeed demonstrate that modest improvements in diagnostic accuracy could be achieved using PC, and provides early evidence that the inconsistency produced by subjective clinical ratings can be reduced using this method, thus providing impetus for further investigation.