Impaired cognitive functioning in stress-induced exhaustion disorder: a new tablet-based assessment, 2021, Bartfei et al

Sly Saint · Sep 19, 2021

Abstract
Background

The adverse health effects of stress induced exhaustion disorder (SED) cause increasing concern in Western societies. This disorder is characterized by severe fatigue, decreased tolerance to further stress, and attention and memory lapses. Despite subjective complaints, individual cognitive deficits are not always detected in a clinical setting, which calls for the validation of more sensitive instruments.

Aim
The objective of this study was to investigate if a short, tablet-based serial naming task, MapCog Spectra (MCS) could be used as a marker for cognitive problems in SED.

Participants
The study comprised of 39 subjects (35 females, four males) with SED. Their mean age was 46,8 years (SD 10.1; range 30–60 yrs.). All participants were healthcare professionals, with a college or university degree, doctors, registered nurses, and psychologists.

Methods
The MCS was used to assess the number of aberrant pauses during serial naming of coloured geometrical shapes. The Coding, Matrix Reasoning, Digit Span, Symbol Search of the WAIS-IV, and RUFF 2&7 tests, were administered together with a short interview.

Results
Mean values were within normal reference limits for all tests, except for the MCS, which showed a significantly higher number of aberrant pauses (p < 0,001) in the SED group, compared to normal reference values. Although subjects performed within normal limits on the RUFF 2&7, a significant difference between individuals was found in the performance strategy of the participants.

Conclusion
Here we report that subjects with SED have performance deficits on the MCS, in terms of aberrant pause times, despite average performance on WAIS-IV tests measuring inductive reasoning, processing speed, working memory, and attention. We also demonstrate that subjects use different strategies to overcome their problems. These findings add to the growing evidence of cognitive deficits in SED and that the MCS might aid neuropsychologists in disentangling cognitive markers, important to substantiate the subjective complaints of affected individuals.

https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-021-03454-1

Introduction
The adverse health effects of occupational stress have caused increasing concern in most Western countries [1]. The association between occupational stress and coronary events has been established beyond reasonable doubt [2]. The potential hazards on mental health are less well known, but there is evidence that prolonged stress may result in a state of exhaustion, characterized by symptoms reminiscent of minor brain dysfunction, i.e., a syndrome of severe fatigue, cognitive problems, and decreased tolerance to further stress [3].

This syndrome was recognized already in the late nineteenth century and called acquired neurasthenia [4]. As the term neurasthenia fell into disuse in the early twentieth century [5] the syndrome received various other diagnostic labels. It has sometimes been seen as a variety of depressive illness, exhaustion depression [6] or job stress depression [7], as well as the final stage of a professional burnout process (“severe” or “clinical” burnout). The lack of consensus about the diagnosis, the alleged vagueness of the symptomatology and absence of objective findings may have caused problems for the patients, who sometimes feel distrusted by their physicians as well as by the health insurance system.

In 2005, the Swedish Board of Health and Social Welfare recommended the term Stress-related Exhaustion Disorder (SED; 43.8A in the ICD-10) for the condition, and tentative diagnostic criteria were formulated [8]. In international literature this condition is often referred to as Burnout or Clinical burnout. Burnout is a syndrome, but not a medical condition [9,10,11,12], which is characterized by fatigue, reduced professional efficacy and cynicism rather than the cognitive problems characteristic of SED.
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eta:
I wonder if the IOM considered the possible confusion between this (SED) and SEID?

Sly Saint · Sep 20, 2021

2018

Symptoms that may be stress-related and lead to exhaustion disorder: a retrospective medical chart review in Swedish primary care

Diagnostic criteria for exhaustion disorder (Swedish National Board of Health and Welfare)

Diagnostic criteria for exhaustion disorder, ICD-10 code F 43.8A
A. Physical and mental symptoms of exhaustion during a minimum of two weeks. The symptoms have developed in response to one or more identifiable stressors which have been present for at least six months.
B. Markedly lack of mental energy, which is manifested by reduced initiative, reduced endurance, or prolonged recovery time after mental strain.
C. At least four of the following symptoms have been present most days during the same two-week period:
1) Concentration difficulties or memory problems
2) Markedly reduced ability to manage demands or to perform under time pressure
3) Emotional instability or irritability
4) Sleep disturbances
5) Marked physical weakness or fatigue
6) Physical symptoms such as pain, chest pain, palpitations, gastrointestinal symptoms, dizziness, or sensitivity to sound
D. The symptoms cause clinically significant suffering or reduced ability to function at work, socially, or in other important situations.
E. The symptoms are not related to direct physiological effects of a substance (e.g. drug abuse, medication) or somatic disease/injury (e.g. hypothyroidism, diabetes, infectious disease).
F. If the criteria for major depressive disorder, dysthymic disorder or generalized anxiety disorder concurrently are fulfilled, exhaustion disorder should be used as a secondary diagnosis.
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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6208049/

Trish · Sep 20, 2021

Is SED the same as burnout?

Sly Saint · Sep 20, 2021

Trish said: ↑

Is SED the same as burnout?
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see last paragraph in quotes of 1st post
"In 2005, the Swedish Board of Health and Social Welfare recommended the term Stress-related Exhaustion Disorder (SED; 43.8A in the ICD-10) for the condition, and tentative diagnostic criteria were formulated [8]. In international literature this condition is often referred to as Burnout or Clinical burnout. Burnout is a syndrome, but not a medical condition [9,10,11,12], which is characterized by fatigue, reduced professional efficacy and cynicism rather than the cognitive problems characteristic of SED."

Trish · Sep 20, 2021

Thanks, Sly Saint.

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Impaired cognitive functioning in stress-induced exhaustion disorder: a new tablet-based assessment, 2021, Bartfei et al

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