title: Work-related stress disorders: variability in clinical expression and pitfalls in psychiatric diagnosis.
abstract: BACKGROUND
  Putative occupational stress-related psychiatric disorders are Adjustment Disorders (AD) and Post-Traumatic Stress Disorder (PTSD). Mood Disorders (MD) are not excluded but are unlikely to be identified as occupational diseases. The differential diagnosis between AD and MD is not easy and is based on strict categorical criteria.
  
  
  OBJECTIVE
  The aim of this study  was to explore differences in personality and mood spectrum symptoms among workers investigated for occupational stress suffering from AD or MD.
  
  
  METHODS
  Sixty-two patients with AD and 43 with MD were recruited and evaluated by means of rating scales for psychosocial occupational risk and work-related stress (WHS, CDL, OSQ), for sleep disturbances (PSQI), for personality disorders (SCID-II) and for mood spectrum symptoms (MOODS-SR).
  
  
  RESULTS
  The diagnostic groups did not differ for WHS, OSQ and PSQI scores. The duration of exposure to stressful/adversative work situations was significantly higher in the MD group (p=0.03). Positive family psychiatric history (p=0.005), personality disorders (p=0.009) and pathological personality traits (p&lt;0.0001) were significantly more frequent in the MD group. The MOODS-SR questionnaire total score (p=0.019) and the manic component score (p=0.001) but not the depressive score were significantly higher in the MD group.
  
  
  CONCLUSIONS
  The present study suggests that  positive family psychiatric history, pathological personality traits and  spectrum manic symptoms represent markers of vulnerability and low resilience for workers exposed to occupational stress. These characteristics could weaken the etiological relationship between work-related stress and an initial  major depressive episode when it is under investigation as a possible occupational disease.
authors.affiliation: Center for the Study of Occupational Health, U.O. Medicina Preventiva del Lavoro, Azienda Ospedaliero-Universitaria Pisana, Via Paradisa 2, 56124 Cisanello (Pisa), Italy. r.buselli@ao-pisa.toscana.it.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Buselli
authors.forename: Antonello
authors.initials: A
authors.lastname: Veltri
authors.forename: Sigrid
authors.initials: S
authors.lastname: Baldanzi
authors.forename: Silvia
authors.initials: S
authors.lastname: Bozzi
authors.forename: Riccardo
authors.initials: R
authors.lastname: Marino
authors.forename: Martina
authors.initials: M
authors.lastname: Chiumiento
authors.forename: Liliana
authors.initials: L
authors.lastname: Dell'Osso
authors.forename: Alfonso
authors.initials: A
authors.lastname: Cristaudo
mesh_terms: D000275:Adjustment Disorders / Q000175:diagnosis* / Q000523:psychology; D000328:Adult; D000368:Aged; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000175:diagnosis / Q000209:etiology; D009784:Occupational Diseases / Q000175:diagnosis* / Q000523:psychology; D016273:Occupational Exposure / Q000009:adverse effects*; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000209:etiology / Q000523:psychology; D013315:Stress, Psychological / Q000150:complications* / Q000209:etiology; D016526:Workload / Q000523:psychology; D017132:Workplace