title: The medical perspective on burnout.
abstract: OBJECTIVE
  The aim of this study was to review recent medical findings related to burnout, its diagnosis, treatment, characteristic pathophysiological features, and preventive measures.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Sudbury Therapy, Psychotherapy, Ontario, Canada, info@SudburyTherapy.com.
authors.forename: Tamar
authors.initials: T
authors.lastname: Kakiashvili
authors.forename: Jerzy
authors.initials: J
authors.lastname: Leszek
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Rutkowski
mesh_terms: D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D002055:Burnout, Professional / Q000175:diagnosis* / Q000188:drug therapy* / Q000378:metabolism / Q000517:prevention & control; D019587:Dietary Supplements; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D007030:Hypothalamo-Hypophyseal System / Q000378:metabolism; D009784:Occupational Diseases / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D010913:Pituitary-Adrenal System / Q000378:metabolism; D011795:Surveys and Questionnaires
chemical_list: D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents; D006993:Hypnotics and Sedatives