Psychiatry Research EG

Although psychopathological change after stress is relatively common, it is noted that it is the exception rather than the rule. Even after significant exposures to stress or trauma, most people do not develop lasting psychopathology. Increasing interest in stress resilience has led to research on the neurobiological basis of protective factors as will risk factors for developing psychopathological changes. Resilience has been defined as having either no symptoms or only one symptom after stress or trauma and also as a measure of coping and qualities that allow individuals and communities to grow in the face of adversity [1]. Resilience and recovery need to be differentiated. Bonanno [2] defined resilience as the ability of adults in otherwise normal circumstances who are exposed to an isolated and potentially highly disruptive event such as the death of a close relation or a violent or life-threatening situation to maintain relatively stable, healthy levels of psychological and physical, as well as the capacity for generative experiences and positive emotions, whereas recovering individuals often experience transient perturbations in normal functioning (e.g. several weeks of sporadic preoccupations or restless sleep), but generally exhibit a stable trajectory of health functioning across time [3]. We are only beginning to understand why some people exposed to chronic stress develop psychopathology and some people do not [4]. Special populations such as women, children, and adolescents, individuals with preexisting health problems, and the poor are at increasing risk for psychological morbidity [5]. Chronic stress accounts for a substantial proportion of disease disability and burden. The burden associated with chronic stress and mental disorders is projected to increase over the coming years. Burnout syndrome (BOS) is a psychological term for the experience of long-term exhaustion and diminished interest. It is often observed in work-related stress as for example, among general practitioners, teachers, social service employees, police, and military men. Burnout is recognized in the International classification of diseases- 10 as ‘problems related to life management difficult’ although it is not recognized in DSM [6,7]. The characteristics of the BOS are: (a) emotional exhaustion: protracted feelings of tension and emotional exhaustion in the relationships with other people; (b) depersonalization: negative or uncivil reply to people requiring or receiving professional services or a treatment; and (c) reduced personal satisfaction: while working with other people, one feels that one’s competence and desire for success is failing [8]. Burnout shows a number of similarities to other psychosomatic disorders, for example, chronic fatigue syndrome (CFS). In CFS, symptoms also include physical exhaustion, fatigue, loss of energy, increased irritability, reduced accomplishment, nonspecific pain, and sleep andconcentration difficulties. In contrast to burnout, the occurrence of CFS is not restricted to social service professionals [9,10]. There are three levels of experienced feelings: (a) high degree of burnout: high scores on the Emotional Exhaustion and Depersonalization subscales and low scores on the Personal Satisfaction subscale; (b) average degree of burnout: average scores on all three subscales; and (c) low degree of burnout: low scores on the Emotional Exhaustion and Depersonalization subscales and high scores on the Personal Satisfaction subscale. The consequences of burnout are potentially very serious, which suggest that burnout can lead to deterioration in the quality of work or service that is provided by the staff. It appears to be a factor in job turnover, absenteeism, and low morale. Furthermore, burnout seems to be correlated with various self-reported indices of personal distress, increased use of alcohol and drugs, and marital and family problems [11]. There is a complex interplay between physio/medical and psychological symptoms that may be presented by patients with a history of chronic stress disorder and BOS. As regards dysregulation of hypothalamic- pituitary-adrenal (HPA) is less clear for acute versus chronic stress state. Chronic stress has been associated with increased as well as decreased HPA activation [12]. Lower cortisol stress responses to a laboratory stress task were observed in individuals suffering from chronic work stress. This finding could be explained by the fact that adaptation and coping processes are invoked, and that the personality of the participants might determine how HPA regulation is affected by the stressor [13]. With regard to burnout, some authors proposed that burnout might result in lower basal HPA activity, in as much as the emotional exhaustion seen in burnout is similar to the fatigue seen in CFS. However, the often stressful work conditions of persons afflicted by burnout could also be regarded as a state of chronic stress, although no empirical proof for these hypotheses has been presented [12]. Increasing interest in stress resilience has led to research on the neurobiological basis for protective as well as risk factors for burnout psychopathology. Dehydroepiandrosterone (DHEA) is a steroid hormone that is synthesized de novo from cholesterol in the adrenal gland, central nervous system, and gonads. DHEA and its sulfated derivative, DHEA-S, were originally thought to be produced in situ in brain tissue but at present it is believed that its source is from the periphery; it is the most abundant circulating steroid in humans and is referred to as a neurosteroid [14,15]. In humans, data indicate that DHEA-S is a potential neurobiological resilience and stress-protective factor [16]. As most DHEA and its derivatives are produced by the zona reticularis of the adrenal cortex, it is argued that there is a role in the immune and stress response. DHEA is a cortisol antagonist and research studies indicate that DHEA supplementation has an antidepressant effect and protects from increased cortisol level over long time scales [17]. In addition, DHEA-S prevents corticosterone-induced performance decrements; thus, these finding suggest that DHEA-S may play a significant role in modulating the vulnerability of the organism to the negative consequences of stress.