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PubMed2000

[What is burnout?].

BACKGROUND: Burnout is most often described as a concept with three separate dimensions: emotional exhaustion, depersonalization (lack of empathy), and reduced accomplishments at work. We wanted to study the descriptive validity of the concept, which may be measured by the Maslach Burnout Inventory. MATERIAL AND METHODS: The Maslach Burnout Inventory was mailed to 1,476 members of the Norwegian Medical Association. The response rate was 73%. The dimensional structure of the instrument was examined by principal component analysis, and the identified factors correlated with validated measures of job satisfaction and depression. The dichotomized factors were combined in eight different ways, and the specificity of the resulting types was studied. RESULTS: The three original dimensions were reproduced, and the internal consistency of the factors was good (Cronbach's alpha ranging from 0.91 to 0.69). There were high correlations between emotional exhaustion and both job satisfaction (r = -0.54) and depression (r = 0.72). INTERPRETATION: Emotional exhaustion seems to be the least specific of the burnout dimensions. For the purpose of reasonable descriptive validity, the burnout notion should be based on both emotional exhaustion and depersonalization. With the applied dichotomization thresholds, this implies that 3% of Norwegian physicians are "burned out".

Adult↗
PubMed2001

Burnout and inequity among human service professionals: a longitudinal study.

In a composite sample of human service professionals (N = 245), longitudinal relations across 1 year were tested between equity in the professional-recipient relationship and burnout (i.e., emotional exhaustion, depersonalization, and reduced personal accomplishment). The 1st research question was whether inequity influenced burnout across time. The 2nd research question was whether longitudinal relations between equity and burnout were curvilinear, as predicted by equity theory. The results confirmed that inequity affects the central component of burnout (i.e., emotional exhaustion) and that this relation is curvilinear. Feeling more deprived and feeling more advantaged resulted in higher future emotional exhaustion levels. No indication was found for a longitudinal relation between inequity and depersonalization. A synchronous relation was found suggesting that personal accomplishment influences equity.

Adult↗
PubMed2001

[The psychopathology of severe obsessive-compulsive disorder: Zwangskrankheit and primary obsessional slowness].

In investigation obsessive-compulsive phenomena, it is important to not only regard them as a kind of symptomatology extending across a variety of diagnostic categories on the basis of faint similarities of symptoms from the cross-sectional point of view, but also to take into account how the psychopathology of a nuclear form of severe obsessive-compulsive disorder (OCD) is different from a neurotic form from the vertical-sectional point of view. In this paper, the psychopathological features of 3 cases of Zwangskrankheit and primary obsessional slowness, which are considered to be nuclear forms of severe OCD, are reported. We suggest that 'obsessive-compulsive pseudophobia' lies behind Zwangskrankheit, and 'obsessive-compulsive depersonalization' lies behind primary obsessional slowness. In both disorders, a peculiar form of avoidance behavior, called 'pathological access to safety signal' was observed in which dangerous situations were avoided by taking no other action other than a determined one. Thus never making a mistake was stressed in their actions which is a feature of adherence to extra-orderliness. Therefore, a patient with Zwangskrankheit lives a restricted life according to strict rules characteristic of ritualization of one's whole life, while a patient with primary obsessional slowness acts according to the principle of miticulousness. Thus we considered that this kind of avoidance behavior is the result of a loss of safety signal not by the existence of a danger signal. In a neurotic form of OCD, patients may attempt to superficially restore the safety signal by avoiding the danger signal. In comparing the psychopathology of OCD with agoraphobia, avoidance behavior involves space in the latter, while it is an act in the former. Obsessive-compulsive pseudophobia and obsessive-compulsive depersonalization are hypothesized to be the background of symptoms of a neurotic form of OCD, but since the patients do not experience them as phenomena and so cannot take them into the field of consciousness, then they are likely to feel them, literally 'obsessive-compulsive.'

Adult↗
PubMedDate not supplied

[Risk factors in the health care workers].

OBJECTIVE: The research has explored the possibility of the Burnout Syndrome in a group of nurses at a general hospital (San Luis, Argentina) working in different services. METHOD: Seventy four females and eight males, aged from 30 to 60 years were interviewed. The Maslach Burnout Inventory was used to assess three areas: emotional tiresome, depersonalization and personal realization. RESULTS: Significant differences were found between the three ages groups, indicating the incidence of age on the level of depersonalization. Regarding nominal variables, it was identified that working position was important to predict the Burnout Syndrome. CONCLUSIONS: It was concluded that a reevaluation of nursing human resources is necessary in order to prevent the burnout syndrome.

Adult↗
PubMedDate not supplied

[A study of the effectiveness of the bereavement program of Severance Hospice].

Grief that is not acknowledged and worked through may manifest itself in some emotional, mental or physical problem. In recent years much as been learned about coping with grief which the hospice program can utilize to help family members cope with their grief. This study was carried out to determine the helpfulness of the bereavement care of Severance Hospice and to learn more about the grief response of the bereaved. The tools used to collect data were an assessment form used in the bereavement program and the Grief Experience Inventory developed by Sanders and revised and translated by the researcher. Data was obtained from bereaved family members (54 for the final grief assessment and 39 for the grief response assessment) receiving bereavement follow-up, from July 1989 to March 1991. Results of the study were as follows: 1. Final Grief Assessment Regarding the resolution of their grief the majority of the bereaved accepted the reality of the death of their family member, while slightly more than three-quarters were able to express their feelings toward their loss. A large majority had returned to activities of daily living well or fairly well and had reinvested their energy in a person other than the deceased. In addition, the physical condition of the majority was good or fairly good. A majority of the bereaved considered the bereavement care to be helpful and almost three-quarters were not considered to be in need of more follow-up. 2. Grief Response Assessment Age was found to have a moderately positive correlation to appetite disturbance (r = .41, P less than .01) and loss of vigor (r = .37, P less than .01) A moderately positive correlation was found between the number of contacts and sleep disturbance (r = 2.38, P less than .01) Significant differences were found between men and women in regard to guilt (t = 2.38, P less than .05), social isolation (t = 2.44, P less than .05) and depersonalization (t = 2.07, P less than .05) with men having the more intense grief. Significant differences were found in the grief responses of somatization (F = 5.82, P less than .001), physical symptoms (F = 5.87, P less than .001), appetite disturbance (F = 4.40, P less than .01), despair (3.79, P less than .01), anger (Fp2.83, P less than .05), social isolation (F = 3.61, P less than .05), guilt (F = 3.62, P less than .05) and depersonalization (F = 2.58, P less than .05).(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed2000

An examination of stress and burnout in certified athletic trainers at division I-a universities.

OBJECTIVE: A growing body of knowledge indicates that too much stress can negatively influence psychological and physical health. A model proposed by Smith to explore personal and situational variables, stress appraisal, and burnout has led to significant understanding of burnout of individuals working in service professions. We examined the relationship of hardiness, social support, and work-related issues relevant to athletic trainers to perceived stress and the relationship of perceived stress to burnout. DESIGN AND SETTING: Correlational analyses were performed to examine the relationships predicted by Smith's model. In addition, we conducted stepwise multiple regression analyses to assess the relative contributions of the personal and situational variables to perceived stress and to examine the relative impact of perceived stress on 3 burnout factors (emotional exhaustion, personal accomplishment, and depersonalization). SUBJECTS: One hundred eighteen certified athletic trainers working in National Collegiate Athletic Association Division I-A intercollegiate settings that maintain a football program. MEASUREMENTS: We assessed personal and situational variables using the Hardiness Test, the Social Support Questionnaire, and the Athletic Training Issues Survey, adapted for this study. The Perceived Stress Scale was used to assess stress appraisal, and the Maslach Burnout Inventory was used to assess 3 dimensions of burnout. RESULTS: Our results were in support of Smith's theoretical model of stress and burnout. Athletic trainers who scored lower on hardiness and social support and higher on athletic training issues tended to have higher levels of perceived stress. Furthermore, higher perceived stress scores were related to higher emotional exhaustion and depersonalization and lower levels of personal accomplishment. CONCLUSIONS: Our findings examining burnout in Division I athletic trainers were similar to those of other studies investigating coaches and coach-teachers and in support of Smith's theoretical model of stress and burnout.

Journal Article↗
PubMed2006

Physical rehabilitation and burnout: different aspects of the syndrome and comparison between healthcare professionals involved.

AIM: The aim of this study is to investigate burnout syndrome among physical rehabilitation professionals focusing on the differences between 4 categories of healthcare professionals involved. METHODS: The experimental group consisted of 124 physiotherapy workers chosen among physicians, nurses, therapists, and technicians. The variables we chose to measure were: the presence of burnout (emotional exhaustion, depersonalization and lack of personal accomplishment), feelings of depression and anger, symptoms of psychological uneasiness and the level of perceived stress. RESULTS: Overall the level of burnout experienced was medium-low. Emotional exhaustion was more prevalent among physiotherapists, while depersonalization was higher among physicians. Moreover mild feelings of depression emerged among technicians. No differences were found among the 4 categories when feelings of anger were considered, although anger was present at different levels (and more or less expressed) throughout the working environment. CONCLUSIONS: Some considerations on the nature and possible causes of psychological distress emerged from the work carried out with the groups of healthcare professionals and some possible areas of intervention are suggested.

Adult↗
PubMed2006

[Reliability and validity of Burnout Questionnaire in occupational population].

OBJECTIVE: To evaluate the reliability and validity of simple Burnout Questionnaire in occupational population. METHODS: A self-administered Burnout Questionnaire comprising 19 items was developed in light of Maslash Burnout Questionnaire and used for investigating 458 employees. RESULTS: Cronbach's alpha between total items of Burnout Questionnaire and each factor fell in between 0.82 and 0.85 through the consistency test. All 19 items of Burnout Questionnaire were subjected to factor analysis, and three latent factors were identified, wherein 56.3% of total variance could be explained. According to the contents described in the items and Maslash burnout theory, they were emotional exhaustion, depersonalization, and personal accomplishment. According to the covariance and the variance analysis, there was significant difference in the integral of the type of work among the three subitems (P < 0.01); there was significant difference in the integral of depersonalization between two sexes (P < 0.01); There were significant difference in the integral of the personal achievement among different level of education (P < 0.01). CONCLUSION: The reliability and validity of Burnout Questionnaire is acceptable and can be used for assessing burnout in occupational population.

Adult↗
PubMed1991

[Consciousness and the electroencephalogram].

In the course of 12 years the authors subjected to clinical EEG and stereo-EEG (SEEG) 72 patients (66 epileptics with the diagnosis of psychomotor epilepsy and grand mal) and six psychotic patients suffering from schizophrenia. With the exception of five epileptics and two psychotic patients all subjects had epileptic foci in the amygdalohippocampal complex (AHK). After coagulation of these foci marked improvement of the fits and the mental state occurred in half the patients. During EEG and SEEG recording the authors used different activation methods (hyperventilation through the nose and mouth, sleep, listening to music) and above all direct electric stimulation (ES) of one of the AHK. Secondary epileptic foci had, as a rule, more spikes and a lower threshold for ES than primary ones which contained more delta and slow theta waves. The ES led as a rule to an emotional response, such as anxiety and fear, more rarely to illusions, depersonalization and oneiroid hallucinations and twice to a hedonic response of non-sexual character. The purpose of ES was to assess the site from where it is possible to start the original aura or typical parox. The authors considered these foci, consistent with data in the literature, as the leading focus and it was subsequently coagulated. The authors investigated the reactivity and vigility by the patient's response to sound (the patient had to press a button) and by an interview with the patient. It was revealed that in isolated discharges of the spikes and waves in the scalp electrodes, i.e. in the neocortex, reactivity is lacking. In isolated discharges in the AHK the reactivity was satisfactory, but as a rule anxiety developed. It is thus possible to divide consciousness into emotional consciousness with its site in the AHK, i.e. in the limbic system, and rational consciousness which is a function of the neocrotical system. Congenital changes of consciousness such as vigility or sleep are described as "states" of consciousness. The rational or emotional aspect of behaviour is described as "type" of consciousness. Under normal conditions the states of consciousness alternate periodically and are sharply defined, the types of consciousness are closely linked and are difficult to separate. Under pathological conditions the "states" of consciousness differ less markedly and the "types" of consciousness are in dissociation. Thus obnubilation, depersonalization, illusions, pathic affects etc. develop, as a rule as part of the epileptiform or psychotiform syndrome.

Adolescent↗
PubMed1990

[Pain syndrome in children with depression].

As many as 180 children aged 4 to 14 years with depression and pain were examined. According to psychopathology senesthopathic pains, pains with vital depersonalization, hallucinatory pains, and pains marked by elements of delirious perception, and undifferentiated pains were distinguished. The authors review some typological varieties of depression and pain: somatoalgic crises associated with somatized depression and pains associated with depression and depersonalization, somatoalgic crises in depression associated with pseudoneurological disorders, somatoalgic crises in the structure of nocturnal fears in the presence of anxious depression, somatoalgic crises in the presence of short-term well-defined episodes of psychomotor excitation or stupor with fear, distress, dysphoria, hallucinations, senesthohypochondriac conditions in the presence of anxiety, somatoalgia in the structure of the depressive and delirious syndrome. Discuss problems of the disease entities, pathogenesis and therapy.

Abdominal Pain↗
PubMedDate not supplied

Interventions for nursing practice problems.

This study examined the effect of designated interventions in nursing practice problems on levels of burnout in nurses. A battery of tests measuring burnout, self-esteem, depression, personal accomplishment, depersonalization, and emotional exhaustion were given to nurses in experimental and control groups. Pre- and post-test data were gathered for both groups. The treatment included a 2-day conference which was designed as a respite experience to address problems specific to the nursing profession. Results indicate significantly less burnout, less frequency of depersonalization, and significantly greater frequency of personal accomplishment in the scores of the experimental group relative to the control group. This study shows that specific interventions can be used to benefit the emotional well-being of nurses by providing them with a respite opportunity and the skills to manage key stressors in their professional environment.

Burnout, Professional↗
PubMed1980

[Experience in using fenazepam to treat psychotic patients].

Fenazepam, a potent anxiolytic tranquillizer (7-brom-5/o-chlorphenyl/1,2-dihydro-3H-1,4-benzodiazepin-2-on) was used in the treatment of 173 psychotic patients ( schizophrenia, endogenous depressions, involutional and organic psychoses). In all cases the clinical picture was characterized by anxiety. In 37% of the patients the psychopathological symptomatology disappeared altogether, in 27% there was a significant improvement. The best results were attained in the treatment of anxious-depressive, depersonalization and affective-delusional states. Anxious-depressive conditions in endogenous depressions gave worse results during fenazepam treatment, than in schizophrenia and organic brain disorders. Affective-delusional attacks were arrested by fenazepam in the initial phases. A good effect was also seen in depersonalization.

Adjustment Disorders↗
PubMed1994

Nursing assistant burnout and the cognitively impaired elderly.

This article employs the cognitive appraisal model to examine the experience of burnout in a random sample of nursing assistants (N = 245). The three subscales of Maslach's Burnout Inventory--Emotional Exhaustion, Personal Accomplishment, Depersonalization--serve as the dependent variables in this study. The study found that both stressor and appraisal variables influence feelings of burnout. The stressor variable, frequency of disturbing patient behaviors, best explained feelings of reduced Personal Accomplishment. The appraisal variable, reaction to patient behaviors, best explained Emotional Exhaustion and contributed to the explanation of reduced Personal Accomplishment. Age, minutes spent giving physical care, appraisal of work tasks, and reaction to patient behavior, explained Depersonalization. The study found support for the cognitive appraisal model in that appraisal played an important role in determining burnout. The article concludes with some suggestions for relief of nursing assistant burnout.

Adult↗
PubMed1998

[Subtyping panic disorders according to their symptoms].

BACKGROUND: Panic disorder (PD) is a common illness associated with high levels of disability and with a high utilisation of non-psychiatric health services which is inefficient in most cases. A better understanding of the clinical subtyping of PD may improve diagnosis both in psychiatric and medical settings. The present study is aimed at assessing the frequency, factorial grouping and comorbidity of PD symptoms in a naturalistic sample of patients. PATIENTS AND METHODS: All consecutive cases of PD (n = 442) who contacted with two outpatient clinics in Barcelona (Spain) were assessed by two experienced interviewers. Assessment instrument included SCID-UP-R interview and inventory of panic symptoms based on DSM-III-R. RESULTS: Palpitations (86.7%), shortness of breath (76.5%), fear of dying (69.9%) and dizziness (63.6%) were the most frequent and intense symptoms reported by the PD patients. The principal component analysis revealed four factors which explained the 56% of the variancel "cardiorespiratory" (23.2%), "depersonalization-derealization" (15.8%), "vestibular" (10%) and "mixed" (7%). CONCLUSIONS: The frequency of presentation of symptoms was similar to other studies. However some disimilarities appeared that may be attributed to transcultural differences as well as terminological problems and the range of symptoms assessed. Factors found in the present study support the clinical subtyping of PD in 3 groups characterised by cardiorespiratory symptoms and fear of dying, cognitive symptoms (depersonalization-derealization) and vestibular symptoms such as dizziness and faintness.

Adult↗
PubMed1998

Dissociation and eating psychopathology: gender differences in a nonclinical population.

OBJECTIVE: This study investigated gender differences in the relationship between dissociation and eating psychopathology in a non-eating-disordered population. METHOD: Two hundred forty-nine male and female students completed the Dissociative Experiences Scale (DES) and the Eating Disorders Inventory (EDI). RESULTS: In both men and women, dissociative experiences were linked more with underlying ego dysfunction than with eating behaviors per se. Specific gender differences were found. Women's EDI scores were most strongly associated with experiences of depersonalization and derealization, although absorption may play an indirect role via poor impulse regulation. In contrast, men's EDI scores were most strongly associated with experiences of amnesia and imaginative absorption. DISCUSSION: The findings suggest that it is not adequate to consider dissociation as a unitary construct when examining its link to eating problems. While the findings require replication with a clinical group, the gender differences in the DES-EDI link highlight a potential need to address different defensive styles when working with male and female clients.

Adolescent↗
PubMed1986

Validity of the Maslach Burnout Inventory for family practice physicians.

This study assesses the utility of Maslach's concept of burnout for family practice physicians. Maslach Burnout Inventory (MBI) subscale correlations for the 67 residents in this sample are compared with Maslach's normative sample. The residents scored in the moderate to high range on the MBI subscales. MBI interscale correlations were similar to the pattern reported by Maslach. Significant correlations between job satisfaction and five of the six MBI subscales suggest that the construct of burnout has considerable psychological import for these physicians. The validity of the emotional exhaustion subscale is demonstrated by significant correlations with self-assessed burnout, job satisfaction, and faculty assessments of resident burnout. Independent observers were most sensitive to residents' emotional exhaustion and less likely to assess accurately the less visible aspects of burnout related to depersonalization and lack of achievement, which suggests the usefulness of multiple measures for assessing the burnout phenomenon.

Adult↗
PubMed1979

Adverse reactions to hypnotherapy in obese adolescents: a developmental viewpoint.

Hypnotherapy is a method of treatment for resistant obesity. This study was undertaken to ascertain the efficacy and/or risks it holds for adolescents. All tended to see hypnosis as a quick solution to longstanding problems. Other forms of weight control therapy had been unsuccessful. Untoward reactions occurred in many teenagers. These included: dissociated state, depersonalization, anxiety and fears. Patients who were not in a deep state of hypnosis were disappointed and viewed this as another failure experience. The severe side effects were observed in those patients in the earlier developmental phases of adolescence.

Adolescent↗
PubMedDate not supplied

Derealization and panic attacks: a clinical evaluation on 150 patients with panic disorder/agoraphobia.

One hundred fifty patients with Panic Disorder (PD) with or without Phobic Avoidance were subdivided into two groups on the basis of presence/absence of derealization and/or depersonalization (D-D) during panic attacks. D-D was found in 34.7% of the sample. By comparing the two groups, the patients with D-D were found to be younger and had an earlier onset of the disorder; they had a higher prevalence of avoidance behavior and a higher severity of the agoraphobic spectrum phobias. They were also more frequently subject to concomitant disorders such as Generalized Anxiety, Obsessive-Compulsive, and depressive symptomatology. The authors have hypothesized a correlation between the presence of D-D during panic attacks and a more frequent clinical evolution toward agoraphobia. This view is supported by finding that D-D in panic attacks corresponds to severer forms of PD, both in terms of the earlier onset of PD, and because PD shows higher levels of anxiety, depression, and disability.

Adolescent↗