Association of strong opioids and antibiotics prescribing with GP burnout: a retrospective cross-sectional study.

BACKGROUND: Prescribing of strong opioids and antibiotics impacts patient safety, yet little is known about the effects GP wellness has on overprescribing of both medications in primary care. AIM: To examine associations between strong opioid and antibiotic prescribing and practice- weighted GP burnout and wellness. DESIGN AND SETTING: A retrospective cross-sectional study was undertaken using prescription data on strong opioids and antibiotics from the Oxford- Royal College of General Practitioners Research and Surveillance Centre linking to a GP wellbeing survey overlaying the same 4-month period from December 2019 to April 2020. METHOD: Patients prescribed strong opioids and antibiotics were the outcomes of interest. RESULTS: Data for 40 227 patients (13 483 strong opioids and 26 744 antibiotics) were linked to 57 practices and 351 GPs. Greater strong opioid prescribing was associated with increased emotional exhaustion (incidence risk ratio [IRR] 1.19, 95% confidence interval [CI] = 1.10 to 1.24), depersonalisation (IRR 1.10, 95% CI = 1.01 to 1.16), job dissatisfaction (IRR 1.25, 95% CI = 1.19 to 1.32), diagnostic uncertainty (IRR 1.12, 95% CI = 1.08 to 1.19), and turnover intention (IRR 1.32, 95% CI = 1.27 to 1.37) in GPs. Greater antibiotic prescribing was associated with increased emotional exhaustion (IRR 1.19, 95% CI = 1.05 to 1.37), depersonalisation (IRR 1.24, 95% CI = 1.08 to 1.49), job dissatisfaction (IRR 1.11, 95% CI = 1.04 to 1.19), sickness-presenteeism (IRR 1.18, 95% CI = 1.11 to 1.25), and turnover intention (IRR 1.38, 95% CI = 1.31 to 1.45) in GPs. Increased strong opioid and antibiotic prescribing was also found in GPs working longer hours (IRR 3.95, 95% CI = 3.39 to 4.61; IRR 5.02, 95% CI = 4.07 to 6.19, respectively) and in practices in the north of England (1.96, 95% CI = 1.61 to 2.33; 1.56, 95% CI = 1.12 to 3.70, respectively). CONCLUSION: This study found higher rates of prescribing of strong opioids and antibiotics in practices with GPs with more burnout symptoms, greater job dissatisfaction, and turnover intentions; working longer hours; and in practices in the north of England serving more deprived populations.

Efficacy and Safety of Cannabidiol Plus Standard Care vs Standard Care Alone for the Treatment of Emotional Exhaustion and Burnout Among Frontline Health Care Workers During the COVID-19 Pandemic: A Randomized Clinical Trial.

Importance: Frontline health care professionals who work with patients with COVID-19 have an increased incidence of burnout symptoms. Cannabidiol (CBD) has anxiolytic and antidepressant properties and may be capable of reducing emotional exhaustion and burnout symptoms. Objective: To investigate the safety and efficacy of CBD therapy for the reduction of emotional exhaustion and burnout symptoms among frontline health care professionals working with patients with COVID-19. Design, Setting, and Participants: This prospective open-label single-site randomized clinical trial used a 1:1 block randomization design to examine emotional exhaustion and burnout symptoms among frontline health care professionals (physicians, nurses, and physical therapists) working with patients with COVID-19 at the Ribeirão Preto Medical School University Hospital in São Paulo, Brazil. Participants were enrolled between June 12 and November 12, 2020. A total of 214 health care professionals were recruited and assessed for eligibility, and 120 participants were randomized in a 1:1 ratio by a researcher who was not directly involved with data collection. Interventions: Cannabidiol, 300 mg (150 mg twice per day), plus standard care or standard care alone for 28 days. Main Outcomes and Measures: The primary outcome was emotional exhaustion and burnout symptoms, which were assessed for 28 days using the emotional exhaustion subscale of the Brazilian version of the Maslach Burnout Inventory-Human Services Survey for Medical Personnel. Results: A total of 120 participants were randomized to receive either CBD, 300 mg, plus standard care (treatment arm; n = 61) or standard care alone (control arm; n = 59) for 28 days. Of those, 118 participants (59 participants in each arm; 79 women [66.9%]; mean age, 33.6 years [95% CI, 32.3-34.9 years]) received the intervention and were included in the efficacy analysis. In the treatment arm, scores on the emotional exhaustion subscale of the Maslach Burnout Inventory significantly decreased at day 14 (mean difference, 4.14 points; 95% CI, 1.47-6.80 points; partial eta squared [ηp2] = 0.08), day 21 (mean difference, 4.34 points; 95% CI, 0.94-7.73 points; ηp2 = 0.05), and day 28 (mean difference, 4.01 points; 95% CI, 0.43-7.59 points; ηp2 = 0.04). However, 5 participants, all of whom were in the treatment group, experienced serious adverse events: 4 cases of elevated liver enzymes (1 critical and 3 mild, with the mild elevations reported at the final 28-day assessment) and 1 case of severe pharmacodermia. In 2 of those cases (1 with critical elevation of liver enzymes and 1 with severe pharmacodermia), CBD therapy was discontinued, and the participants had a full recovery. Conclusions and Relevance: In this study, CBD therapy reduced symptoms of burnout and emotional exhaustion among health care professionals working with patients during the COVID-19 pandemic. However, it is necessary to balance the benefits of CBD therapy with potential undesired or adverse effects. Future double-blind placebo-controlled clinical trials are needed to confirm the present findings. Trial Registration: ClinicalTrials.gov Identifier: NCT04504877.

El impacto de los factores socio-laborales sobre la salud, el consumo de hipnosedantes y adictivos en España / The impact of socio-labor factors on health, the consumption of hypnosedatives and addictives in Spain

OBJETIVO: Identificar patrones de salud (general y mental) y de consumo (hipnosedantes y sustancias adictivas) en el medio laboral según factores socio-laborales estratificados por sexo. MÉTODOS: Estudio transversal con una muestra representativa de la población activa española (nº = 12.260) correspondiente a la Encuesta Nacional de Salud de 2017. Se estimaron a través de modelos de regresión logística las odds ratio ajustadas (ORa) por variables sociodemográficas y sus correspondientes intervalos de confianza del 95% (IC95%). RESULTADOS: Se identificaron dos patrones. Por un lado, las personas desempleadas refirieron un peor estado de salud autopercibido [(ORa=0,61;IC95%:0,45-0,83;para los hombre(H);Ora = 0 ,65;IC 95%: 0,45-0,94;para las mujeres (M)], mayor prevalencia de depresión [Ora = 4,19; IC 95%: 2,15-8,16(H); Ora = 1,83; IC 95%: 1,05-3,21(M)], consumo de tranquilizantes [Ora = 2,21;IC 95%:1,29-3,77(H); Ora = 1,83; IC 95%: 1,02-3,32(M)] y de tabaco [Ora = 1,66;IC95%: 1,28-2,16(H)] que los/as empresarios/as. Por otro lado, los/as directivos/as refirieron mayor estrés laboral que los/as técnicos/as no cualificados/as [Ora = 0,50; IC 95%: 0,38-0,66(H); Ora = 0,64; IC 95%: 0,50-0,84(M)] y de consumo de alcohol [ORa=0,54;IC95%:0,41-0,70(H); Ora = 0,43; IC 95%: 0,34-0,55(M)]. CONCLUSIÓN: Los resultados muestran diferentes patrones que pueden servir para la puesta en marcha programas preventivos

OBJECTIVE: To identify patterns of health (general and mental) and consumption (hypnotics and addictive substances) in the workplace, according to socio-labor factors stratified by sex. METHODS: Cross-sectional study with a representative sample of the Spanish Active Population (nº=12,260), corresponding to the National Health Survey of 2017. The adjusted odds ratios (ORa) by sociodemographic variables were estimated through logistic regression models, and their corresponding 95% confidence intervals (95% CI). RESULTS: Two patterns were identified. On the one hand, unemployed people reported a worse self-perceived state of health [(Ora = 0.61; 95% CI: 0.45-0.83; for men(H); Ora = 0.65; 95% CI: 0,45-0.94; for women(M)], higher prevalence of depression [Ora = 4.19;95%CI:2.15-8.16(H); Ora = 1.83; 95% CI: 1,05-3.21(M)], tranquilizer consumption [Ora = 2.21; 95% CI: 1.29-3.77 (H); Ora = 1.83; 95% CI: 1.02-3, 32 (M)], and tobacco [Ora = 1.66; 95% CI: 1.28-2.16 (H)] than the businessmen. On the other hand, the managers referred more occupational stress than unskilled technicians [Ora = 0.50; 95% CI: 0.38-0.66(H); Ora = 0.64; 95% CI: 0.50-0.84(M)] and alcohol consumption [ORa = 0.54; 95% CI: 0.41-0.70(H); Ora = 0.43; 95%;CI: 0.34-0.55 (M)]. CONCLUSION: The results show different patterns that can be used to start preventive programs

Omega-3-polyunsatured fatty acids (O3PUFAs), compared to placebo, reduced symptoms of occupational burnout and lowered morning cortisol secretion.

BACKGROUND: Occupational burnout is both a serious health concern at both public and individual levels. Treatment options are psychopharmacological, psychological and physical activity-related interventions. Here, we tested whether, compared to placebo, omega-3-polyunsaturated fatty acids (O3PUFAs) have a positive impact on burnout and morning cortisol secretion. METHOD: A total of 43 individuals (mean age: 38.4 years, 76.7% females) took part in the present double-blind and placebo-controlled intervention. Participants were randomly assigned either to the O3PUFA or to the placebo condition. At baseline and again eight weeks later, participants completed the Maslach Burnout Inventory and collected morning saliva samples for analysis of the cortisol awakening response (CAR). RESULTS: Emotional exhaustion and depersonalization decreased, and sense of personal accomplishment increased over time, but more so in the O3PUFA condition than in the placebo condition. Likewise, CAR decreased over time, but again more so in the O3PUFA condition than in the placebo condition. CONCLUSIONS: The present pattern of results suggests that, compared to placebo, administration of daily omega-3-polyunsaturated fatty acids for eight consecutive weeks positively influences both psychological and physiological markers of occupational burnout.

Supplementation with Robuvit® in subjects with burnout associated to high oxidative stress.

BACKGROUND: This supplement registry study evaluated the effect of supplementation with Robuvit® on the burnout syndrome (BOS) of patients with significant fatigue and high oxidative stress. Robuvit® (French oak wood extract) is a standardized supplement, effective in treating chronic fatigue syndrome (CFS), post-traumatic stress disorder (PTSD) and convalescence. METHODS: A group of 108 subjects with BOS, consisting of a subgroup of 42 young surgeons in training and a subgroup of 66 managers, were studied. Subjects followed a standard management (SM); one half of the subjects received 300 mg/day of Robuvit® for 4 weeks in addition to SM. RESULTS: Robuvit® was (P<0.05) more effective compared to SM in improving parameters evaluated with the aid of Maslach Burnout Inventory: dealing with patients problems, improving the relationship with patients, decreasing emotional drainage and intolerance (P<0.05). The feeling of a positive influence improved. The decrease in strain from interactions at work, the decrease in the lack of care feeling, the improved levels in interest were all positively affected with Robuvit (P<0.05) in comparison with SM. The need for giving up decreased, the level of satisfaction improved and the regrets for being in the profession decreased. BOS symptoms were positively affected by the supplement (P<0.05). Oxidative stress (388;24 Carr Units decreased to 344;22 with Robuvit®; P<0.05), SM had no influence on oxidative stress. Robuvit® was also more effective in professionals with burnout syndrome than the SM only in in decreasing emotional drainage, fatigue and intolerance (P<0.05). Robuvit® significantly improved the feeling of having a positive influence (P<0.05). Also, Robuvit® significantly decreased the strain resulting from interactions at work and improved the care for colleagues/customers (P<0.05). Interest and enthusiasm were significantly increased in subjects taking Robuvit® in comparison with controls with standard management alone (P<0.05). The mean score of the desire to give up was decreased with Robuvit® in comparison with SM (P<0.05) and job satisfaction was significantly improved (P<0.05). The feeling of regrets of being in the profession was significantly reduced with the supplement in comparison to SM (P<0.05). Robuvit® reduced oxidative stress (P<0.05) from 397;33 to 323;29 Carr Units in comparison with a low decrease with SM (from 396;19 vs. 378;27) at 4 weeks. CONCLUSIONS: In conclusion, in this registry study on BOS, Robuvit® by controlling fatigue (the primary symptom) and oxidative stress, relieves the most important 'symptoms' associated with BOS. The effects are comparable in young surgeons not accustomed to stress, as well as in professionals in management positions who are used to control stress.

Burnout, associated comorbidities and coping strategies in French community pharmacies-BOP study: A nationwide cross-sectional study.

BACKGROUND: Work-related stress and burnout syndromes are unfortunately common comorbidities found in health professionals. However, burnout syndrome has only been partly and episodically assessed for community pharmacists whereas these professionals are exposed to patients' demands and difficulties every day. Prevalence of burnout, associated comorbidities and coping strategies were assessed in pharmacy teams (pharmacists and pharmacy technicians) in French community pharmacies. METHODS: This online survey was performed by emails sent to all French community pharmacies over 3 months. The survey assessed the prevalence of burnout (Maslach Burnout Inventory-MBI-questionnaire), anxiety, depression and strategies for coping with work-related stress. RESULTS: Of the 1,339 questionnaires received, 1,322 were completed and useable for the analysis. Burnout syndrome was detected in 56.2% of respondents and 10.5% of them presented severe burnout syndrome. Severe burnout syndrome was significantly associated with men, large urban areas and the number of hours worked. Depression and anxiety were found in 15.7% and 42.4% of respondents, respectively. These co-morbidities were significantly associated with severe burnout syndrome. Higher MBI scores were significantly associated with medical consultations and medicinal drug use. Conversely, respondents suffering from burnout syndrome declared they resorted less to non-medical strategies to manage their work-related stress (leisure, psychotherapy, holidays and time off). CONCLUSION: This study demonstrated that community pharmacists and pharmacy technicians presented high prevalence of burnout syndrome, such as many healthcare professionals. Unfortunately, burnout syndrome was associated with several comorbidities (anxiety, depression and alcohol abuse) and the consumption of health resources. The psychological suffering of these healthcare professionals underlines the necessity to deploy a strategy to detect and manage burnout in community pharmacy.

Health-related quality of life in patients with Burnout on sick leave: descriptive and comparative results from a clinical study.

PURPOSE: To explore the health-related quality of life (HRQoL), the cause of being ill, and the pharmacological treatment in patients on sick leave because of Burnout. The HRQoL among these patients was also compared with that of individuals who were working full time. METHODS: HRQoL was measured using the SWED-QUAL questionnaire, comprising 67 items grouped into 13 subscales, scored from 0 (worst) to 100 (best) points, and covering aspects of physical and emotional well-being, cognitive function, sleep, general health, social, and sexual functioning. The Burnout group (n = 94), mean age 43 years, were on 50% sick leave or more. The comparison group consisted of healthy persons (n = 88) of similar age and educational level who were working full time. RESULTS: The Burnout group had markedly low scores in general. The cause of illness was mainly work-related. Psychotropic medication was prescribed for 55%. Significantly lower scores were found in the Burnout group than in the comparison group in all subscales, p < 0.001. The median differences in scores ranged from 10 to 56 points. Differences rated by effect size were large, 0.85-2.01. CONCLUSIONS: Patients on sick leave because of Burnout rated their HRQoL as very low in general, their cause of being ill was mainly work-related, and psychotropic medication was prescribed for a majority. Their scores were markedly lower in all subscales in comparison with healthy individuals working full time. The study adds to our understanding of the situation of patients with Burnout. The results can be useful in clinical work and future research.

[The efficacy of cytoflavin in the treatment of burnout syndrome].

OBJECTIVE: To evaluate the efficacy of cytoflavin in the treatment of patients with burnout syndrome. MATERIAL AND METHODS: Authors performed clinical, psychological and neurophysiological examinations of 60 patients, aged 34-43 years. Results of pharmacological therapy with cytoflavin (30 patients) or ethylmethylhydroxypyridine succinate (30 patients) were compared. Control examination was conducted immediately after treatment and then after 30 days to assess the stability of the resulting effect. RESULTS AND CONCLUSION: The higher efficacy of cytoflavin (improvement in 80% of cases) as compared to ethylmethylhydroxypyridine succinate (improvement in 70% of cases) was identified. After cytoflavin treatment, the improvement was more persistent. These clinical results are confirmed by the results of psychological and neurophysiological research.

Burnout as a risk factor for antidepressant treatment - a repeated measures time-to-event analysis of 2936 Danish human service workers.

Burnout is a state of emotional exhaustion, feelings of reduced personal accomplishment, and withdrawal from work thought to occur as a consequence of prolonged occupational stress. The condition is not included in the diagnostic classifications, but is considered likely to develop into depressive disorder in some cases. We examined the prospective association between burnout and antidepressant treatment, as an indicator of clinically significant mental disorder. We further investigated potential effect-modifiers of the association, to identify factors that may prevent this progression of burnout. We used questionnaire data from a three-wave study of Danish human service workers conducted during 1999-2005, linked with national register data on purchases of antidepressants (ATC: N06A). We included 4788 observations from 2936 individuals (81% women) and analysed data by Aalens additive hazards modeling, examining the risk of entering antidepressant treatment in relation to the level of work-related burnout measured by the Copenhagen Burnout inventory. As effect-modifiers we examined both sociodemographic factors and a range of psychosocial work environment factors. The level of burnout predicted antidepressant treatment. This association was modified by sex (p < 0.01). In men, high vs. intermediate burnout was associated with a 5% increased risk of antidepressant treatment per year of follow-up. This risk difference was 1% for women. Due to the sex specific patterns, we restricted effect modification analyses to women. We found no effect-modification by the examined work environment factors, though a sensitivity analysis indicated a possible stronger association in women of lower occupational position. In conclusion, burnout predicted antidepressant treatment, with a stronger association in men than women. We found no evidence of effect-modification by any of the examined psychosocial work environment factors.

Burnout: evaluation of the efficacy and tolerability of TARGET 1® for professional fatigue syndrome (burnout).

OBJECTIVE: To study the effect of a dietary supplement (TARGET 1®: a combination of casozepine, taurine, Eleutherococcus senticosus and extramel) on burnout symptomatology. METHODS: A 12-week, double-blind, randomized, placebo-controlled trial was conducted in workers engaged in professional contact with patients, students or clients. All were affected by burnout syndrome based on a score of ≥4 on the Burnout Measure Scale (BMS-10). The primary outcome measure was the change in the BMS-10 score; secondary outcome measures included the change in the Maslach's Burnout Inventory scale-Human Service Survey (MBI-HSS) score and the Beck Depression Inventory. Five scores were evaluated. RESULTS: Eighty-seven participants were enrolled in the study: 44 received the active formulation (verum group); 43 received placebo. After 12 weeks' supplementation, the placebo group showed significant improvements in scores for BMS-10, MBI-HSS fatigue and the Beck Depression Inventory, but MBI-HSS depersonalization and task management were not improved; the verum group showed significant improvements in all five scores. The verum group consistently showed significantly greater improvements in scores than the placebo group. CONCLUSIONS: TARGET 1® significantly improved the symptoms of burnout after 12 weeks' use.

Prevalencia de consumo de hipnosedantes en población ocupada y factores de estrés laboral asociados / Prevalence of the use of hypnotics and sedatives among the working population and associated work-related stress factors

Objetivo. Explorar la prevalencia de consumo de ansiolíticos y somníferos (hipnosedantes) en una muestra de la población ocupada en España y evaluar su asociación con determinados factores de estrés relacionados con el trabajo. Métodos. Con datos de la Encuesta Domiciliaria sobre Alcohol y Drogas en España (EDADES) 2007 se analizó la distribución del consumo de hipnosedantes en el último mes entre la población ocupada de 16 a 64 años de edad (n = 13.005). Mediante regresión logística se examinó su asociación con la exposición a determinados factores de estrés relacionado con el trabajo (entorno de trabajo nocivo o peligroso, precariedad, carga de trabajo y apoyo social). Resultados. La prevalencia de consumo de hipnosedantes en el último mes fue el doble en las mujeres (6,5%) que en los hombres (3,3%). En ambos sexos el consumo se dobló entre los mayores respecto a los más jóvenes (10,2% en mujeres y 5,5% en hombres mayores de 45 años), y se cuadriplicó entre los que reportaron mala salud (18,9% en mujeres y 11% en hombres). Respecto al estrés laboral, se registró una asociación entre consumo de hipnosedantes y los niveles de precariedad moderado (odds ratio [OR]: 1,96; intervalo de confianza del 95% [IC95%]: 1,31-2,92) y alto (OR: 1,95; IC95%: 1,14-3,34) en los hombres, y moderado en las mujeres (OR: 1,43; IC95%: 1,03-1,99). Conclusiones. Se observa una alta prevalencia de consumo de hipnosedantes en mujeres y en mayores de 45 años. Sería necesario profundizar en el estudio de la relación entre el consumo de hipnosedantes y la salud de los trabajadores, y del papel de los factores de estrés laboral en esta relación (AU)

Objective. To explore the prevalence of the use of hypnotics and sedatives in a sample of the Spanish working population and to examine its association with certain work-related stress factors. Methods. Using data from the 2007 Spanish Household Survey on Alcohol and Drugs (Encuesta Domiciliaria sobre Alcohol y Drogas en España [EDADES]), we analyzed the distribution of the use of hypnotics and sedatives in the previous month in the working population aged 16 to 64 years old (n = 13,005). Associations with exposure to certain work-related stress factors (noxious working environment, precariousness, workload, and social support) were examined using logistic regression modelling. Results. The prevalence of the use of hypnotics and sedatives among women in the previous month doubled that of men (6.5% and 3.3%, respectively), while use among the oldest age group was twice that of the youngest group in both sexes (10.2% in women and 5.5% in men older than 45 years), and was four times higher among those reporting poor health (18.9% in women and 11% in men). Concerning work-related stress, exposure to moderate (OR: 1.96; 95%CI: 1.31-2.92) and high (OR: 1.95; 95%CI: 1.14-3.34) levels of precariousness in men and moderate levels in women (OR: 1.43; 95%CI: 1.03-1.99) was associated with the use of hypnotics and sedatives. Conclusions. The prevalence of the use of hypnotics and sedatives was high in women and in workers older than 45 years. Further research is needed on the relationship between the use of hypnotics and sedatives and workers’ health, and on the role that work-related stress factors play in this association (AU)

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.

Consuming an edge: ADHD, stimulant use, and psy culture at the corporate university.

We examine "psy" on the college campus. Psy refers to ways of knowing and acting on ourselves that shape everyday life psychologically. We suggest that there is an "elective affinity" between psy and the neoliberal management strategies that now dominate the "corporate university." We describe ways that psy organizes college life by drawing on the history of college health services; interviews about mental health and services at a university in Canada; and historical, social, and media accounts of student mental health and pharmaceutical drug use-both prescribed and not-on campus in the US and Canada. By the 1990s, for the first time, many students were arriving at college as already experienced consumers of psy with diagnoses and prescriptions. We approach this and the increased use of medication as an aspect of the psy-campus. We focus on stimulants, using ADHD to illustrate the blurring line between treatment and enhancement. Students who use stimulants-with or without prescription-do so in the same way: instrumentally in relation to academic demands. The blurred line between academic stress and psychiatric distress is further illustrated by "clinic notes," an institutionalized practice that enables all students to act on academic pressure as a matter of mental health. We describe the links between psy and institutional branding and marketing to illustrate the role of mental health and wellness services in the corporate university.

[Clinical and neurophysiological study of the efficacy of adaptol in the treatment of emotional burn-out].

The study aimed at therapeutic effect of adaptol on burn-out syndrome. Authors examined 32 patients aged from 25 to 45 years. Adaptol was prescribed in day dose 1500 mg during 60 days. Clinical, psychological and electroencephalographic study (EEG) was conducted before and after the treatment course. The data of adaptol positive influence on the basic clinical symptoms (reduction of asthenic and anxiety scores) is obtained. The analysis of EEG results allows to draw conclusions on normalisation of brain functional activity after therapy.

A randomised, double-blind, placebo-controlled, parallel-group study of the standardised extract shr-5 of the roots of Rhodiola rosea in the treatment of subjects with stress-related fatigue.

The aim of the study was to assess the efficacy of the standardised extract SHR-5 of roots of Rhodiola Rosea L. in the treatment of individuals suffering from stress-related fatigue. The phase III clinical trial took the form of a randomised, double-blind, placebo-controlled study with parallel groups. Participants, males and females aged between 20 and 55 years, were selected according to the Swedish National Board of Health and Welfare diagnostic criteria for fatigue syndrome. A total of 60 individuals were randomised into two groups, one ( N = 30) of which received four tablets daily of SHR-5 extract (576 mg extract/day), while a second ( N = 30) received four placebo tablets daily. The effects of the extract with respect to quality of life (SF-36 questionnaire), symptoms of fatigue (Pines' burnout scale), depression (Montgomery -Asberg depression rating scale - MADRS), attention (Conners' computerised continuous performance test II - CCPT II), and saliva cortisol response to awakening were assessed on day 1 and after 28 days of medication. Data were analysed by between-within analyses of variance. No serious side effects that could be attributed to the extract were reported. Significant post-treatment improvements were observed for both groups (placebo effect) in Pines' burnout scale, mental health (SF-36), and MADRS and in several CCPT II indices of attention, namely, omissions, commissions, and Hit RT SE. When the two groups were compared, however, significant effects of the SHR-5 extract in comparison with the placebo were observed in Pines' burnout scale and the CCPT II indices omissions, Hit RT SE, and variability. Pre- VERSUS post-treatment cortisol responses to awakening stress were significantly different in the treatment group compared with the control group. It is concluded that repeated administration of R. ROSEA extract SHR-5 exerts an anti-fatigue effect that increases mental performance, particularly the ability to concentrate, and decreases cortisol response to awakening stress in burnout patients with fatigue syndrome.

The psychobiology of burnout: are there two different syndromes?

BACKGROUND: Plasma prolactin levels are sensitive to dopamine and serotonin function, and fatigue. Low cortisol, dopamine and/or serotonin may be involved in burnout and detachment. METHODS: In this double-blind within-subject study, we treated 9 female burnout subjects and 9 controls with 35 mg cortisol and placebo orally. We measured state affect and plasma prolactin, oxytocin, cortisol and adrenocorticotropic hormone levels, and administered an attachment questionnaire. RESULTS: The burnout subjects displayed an extreme distribution of basal prolactin levels, displaying higher or lower levels compared to the controls. The low prolactin burnouts had profoundly low attachment scores and tended to have low oxytocin levels. The high prolactin burnout subjects tended to show cortisol-induced decreased prolactin and fatigue, and increased vigor. CONCLUSION: Results are consistent with the hypothesis that burnout subjects are either characterized by low serotonergic function or by low dopaminergic function, and that the latter group benefits from cortisol replacement. These preliminary results suggest that differentiating between two syndromes may resolve inconsistencies in research on burnout, and be necessary for selecting the right treatment strategy.

[Bereavement, burn out and chronic pain--symptomatic treatment with antidepressants]. / Symptomatische Therapie mit Antidepressiva bei Traurigkeit, Burn-out und Schmerzen.

Antidepressants can also be useful for non-classical indications such as bereavement, burn out and pain, if these conditions lead into a depressive episode or if additional effects like modulation of pain are of therapeutic benefit. Due to the range of side-effects and potential interactions, present medical condition, medication and the clinical appearance of the depressive episode have to be taken into account for the choice of the specific antidepressant. Patients need to be thoroughly informed and accompanied to build and sustain compliance. Patient's sceptical attitude towards antidepressants must be taken seriously and the risk of treatment needs to be considered.