[The neurobiology of burnout: the hypothalamus-pituitary-adrenal gland axis and other findings]. / Tükenmisligin nörobiyolojisi: hipotalamus-pituiter-adrenal ekseni ve diger bulgular.

OBJECTIVE: This review aimed to present an overview of neurobiological research on the etiology of burnout and to evaluate the proposed arguments. METHOD: A retrospective literature review of the relevant studies conducted within the last 17 years. For this purpose a literature search was conducted via internet-based search engines, including PubMed, Science-Direct, Medline, GoogleScholar, ULAKBIM Turkish Medicine Index, and Turkish Psychiatry Index, using the key words, burnout, cortisol, the hypothalamus-pituitary-adrenal gland (HPA)-axis, stress, neurobiology, neurogenesis, BDNF, immunology, and etiology, in different combinations. RESULTS: The pioneering studies that focused on the relationship between burnout and dysregulation of the HPA-axis have yielded inconsistent results. Data from subsequent studies with improved designs suggest there is no HPA-axis dysregulation in burnout, but the results do not lead to more concrete interpretations. There is some evidence of impaired immunity function in burnout as compared with controls. Although there is strong evidence of a relationship between stress and impairment in hippocampal neurogenesis, there is no study of burnout in the field. Data about monoaminergic involvement in burnout, which is one of the probable pathways, is scarce. CONCLUSION: In future research the essential guidelines for evaluating HPA-axis functioning (i.e. timing of collecting samples from saliva or blood and controlling for possible influencing factors on HPA-axis functioning) in patients clinically diagnosed with burnout should be taken into account, and in addition to the HPA-axis, evaluation of hippocampal neurogenesis, neurotrophins, immunity functioning, and the monoaminergic system will provide more data on the neurobiology of burnout.

The role of BDNF and HPA axis in the neurobiology of burnout syndrome.

Chronic stress is known to affect the HPA axis. The few clinical studies which have been conducted on HPA-axis function in burnout have produced inconsistent results. The etiological relationship between sBDNF and burnout has not yet been studied. The aim of the current study was to investigate the role of BDNF and HPA axis in the neurobiology of burnout. In the current study 37 clinically diagnosed burnout participants were compared with 35 healthy controls in terms of BDNF, HPA axis, burnout symptoms, depression, anxiety and psychosomatic complaints. Basal serum cortisol, sBDNF and cortisol level after 1 mg DST was sampled. We found no significant differences in terms of HPA-axis function (for basal serum cortisol, p=0.592; for cortisol level after 1 mg DST, p=0.921), but we did find lowered sBDNF levels in burnout group (88.66+/-18.15 pg/ml) as compared to healthy controls (102.18+/-20.92 pg/ml) and the difference was statistically significant (p=0.005). Logistic Regression Analysis revealed that emotional exhaustion (p=0.05), depersonalization (p=0.005) and depression (p=0.025) were significantly associated with burnout. sBDNF levels correlated negatively with emotional exhaustion (r=-,268, p=0.026), depersonalization (r=-,333, p=0.005) and correlated positively with competence (r=0.293, p=0.015) sub-scales of burnout inventory. However, there were no significant relationships between cortisol levels and sBDNF levels (r=0.80, p=0.51), depression, anxiety, psychosomatic complaints and burnout inventory. Our results suggest that low BDNF might contribute to the neurobiology of burnout syndrome and it seems to be associated with burnout symptoms including altered mood and cognitive functions.

[Psychosocial aspects of pain]. / Agrinin psikososyal yönü.

Though pain is a warning friend, it also is a life disturbing and hurting symptom. We need to consider psychological aspects of pain together with the physiological aspects, in order to be able to understand, to differentiate the etiology and to treat completely. In this review, we will discuss psychological aspects of pain patients, psychiatric patients who apply to pain clinics with pain symptoms, primarily psychological and psychiatric treatments of chronic pain patients.

[Effects of surgery type on body image, sexuality, self-esteem, and marital adjustment in breast cancer: a controlled study]. / Meme Kanserinde Ameliyat Tipinin Beden Algisi, Cinsel Islevler, Benlik Saygisi ve Es Uyumuna Etkileri: Kontrollü Bir Calisma.

OBJECTIVE: To examine the effects of surgery type on body image, sexuality, self-esteem and marital adjustment, and to determine the most frequent sexual dysfunction seen among breast cancer survivors. METHOD: A total of 75 breast cancer survivors (50 patients underwent total mastectomy alone and 25 underwent total mastectomy with breast reconstruction), and 50 healthy volunteers were recruited. All subjects were given the Rosenberg Self-esteem Scale (RS), Body Cathexis Scale (BCS), Golombok Rust Inventory of Sexual Satisfaction (GRISS), and Dyadic Adjustment Scale (DAS) after the Structured Clinical Interview Diagnosis for DSM-III-R, Non-Patient Form (SCID-NP) had been applied. RESULTS: The mean scores obtained from GRISS and DAS were similar, but there was a significant statistical difference in terms of the mean scores of the RS and BCS between the three groups. The sexual functioning profile of the subjects was examined by transforming the subscales scores of GRISS into standardized stanine scores. A significant statistical difference in non- communication and avoidance areas of sexual relations was found between the subjects. CONCLUSION: Surgery type had no effect on sexual satisfaction or marital adjustment. Total mastectomy had a negative impact on breast perception and self-esteem. Avoidance and non-communication areas of sexual relations were the most frequent sexual dysfunctions seen among breast cancer survivors. Young patients preferred breast reconstruction more widely.