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Cognitive impairment in patients with stress-related exhaustion
Jonsdottir, I.H., Nordlund, A., Ellbin, S., Ljung, T., Glise, K., Währborg, P., & Wallin, A.
Katie Steck Alliant International University, October 2015
BURNOUT
Classic burnout characterized by:- mental exhaustion- physical fatigue- detachment from work- diminished competence- loss of energy- increased irritability and sleep- concentration problems
Historically studied mainly in context of continuous psychosocial stressors related to work
Burnout vs. Exhaustion DisorderExhaustion Disorder ICD-10: F43.8A (Under “Other reactions to severe stress)
Participants
49 Healthy controls (Mostly health care workers and social insurance officers)40 ambulatory patients who meet ED (no previous treatment for illness):
Comorbid depression/anxiety allowed45% on sick leave40% on part time sick leave38% on AntidepressantsSmoking/snuff allowed, but not on test dayExclusion criteria: Brain damage, naemia, current infection, diabetes mellitus, thyroid problems, vitamin B12 deficiency, other somatic
diseases that might influence cognition (as judged by a physician), excessive alcohol consumption, medication that could influence (temporary beta blockers, or meds with codine), fibromayalgia, chronic fatigue syndrome. Additional self reports of health and blood analyses taken of haemoglobin, erythrocyte sedimentation rate, blood glucose concentration, thyroid hormones, and homocysteine.
Demographics
The process as if you were a patient
Primary care or occupational health care center (screening and
questionnaires completed)
Health care workers and social insurance officers
Questionnaires and blood sampling
Screening
Burnout group (40) Healthy controls (49)
Boston naming test (Language)Logical memory immediate recall (Verbal Episodic Memory)Digit symbol (Speed, attention and working memory)Digit span (Attention span/working memory)Token test (Syntax comprehension)VOSP silhouettes (Perception)Stroop (Distractability)PaSMO (Mental control)Logical memory delayed recall (Verbal episodic memory)
Neuropsych testing:
Questionnaires
1. Self-reported memory (not originally part of this study)
Self-reported mental health: 2. Shirom-Melamed Burnout Questionnaire (SMBQ)3. Hospital anxiety and depression scale (HAD)
The process as if you were a patient
Primary care or occupational health care center (screening and
questionnaires completed)
Health care workers and social insurance officers
Questionnaires and blood sampling
Screening
Burnout group (40) Healthy controls (49)
Boston naming test (Language)Logical memory immediate recall (Learning and Memory)Digit symbol (Speed, attention and working memory)Digit span (Attention span/working memory)Token test (Syntax comprehension)VOSP silhouettes (Perception)Stroop (Distractability)PaSMO (Mental control)Logical memory delayed recall (Verbal episodic memory)
Neuropsych testing:
Results I - Comparing ED with healthy controls
Results II: Self-reported memory problems to actual memory problems
Split into hi/lo
Those who reported pronounced memory loss clearly affecting their life didn’t perform any differently than those who reported their memory was intact or less affected.
Results III - Comparing hi and lo burnout
Results IV: Hi and lo HAD scales
High anxiety scorers performed significantly worse on delayed recall and immediate recall
Hi depressive scorers performed significantly worse on VOSP Silhouettes
No difference between those taking antidepressants and those who were not
Considerations
Lo to hi burnout comparison- Only significant one was logical memory
delayed recall- Very last test - high burnout scorers more
affected by length of test?Self report of memory problems
- Potential misunderstanding of what “memory” entails, instrument not yet validated
Executive Functioning results- More complexity in testing might reveal subtle
differences
Limitations
- Overlap between depression, anxiety, and burnout- Allowed use of antidepressants- Timing of the tests (before or after lunch)
The End
References
Bährer-Kohler, S. (2012). Burnout for experts: Prevention in the context of living and working. Springer Science & Business Media.
Danhof-Pont, M., Van Veen, T., Zitman, F. (2011) Biomarkers in burnout: A systematic review. Journal of Psychosomatic Research, 70, p. 505-524
(Bährer-Kohler, 2012)
Neuropsych tests and cognitive domains