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Innovations in Clinical Neuroscience 2023Depersonalization and derealization refer to an estranged state of mind that involves a profound feeling of detachment from one's sense of self and the surrounding...
Depersonalization and derealization refer to an estranged state of mind that involves a profound feeling of detachment from one's sense of self and the surrounding environment, respectively. The phenomena co-occur on a continuum of severity, ranging from a transient experience as a normal reaction to a traumatic event to a highly debilitating condition with persistent symptoms, formally described as depersonalization/derealization disorder (DPDR). Lack of awareness of DPDR is partly due to a limited neurobiological framework, and there remains a significant risk of misdiagnosis in clinical practice. Earlier literature has focused on several brain regions involved in the experience of depersonalization and derealization, including adaptive responses to stress via defense cascades comprising autonomic functioning, the hypothalamic-pituitary-adrenal (HPA) axis, and various other neurocircuits. Recent evidence has also demonstrated the role of more complex mechanisms that are bolstered by dissociative features, such as emotional dysregulation and disintegration of the body schema. This review intends to abridge the prevailing knowledge regarding structural and functional brain alterations associated with DPDR with that of its heterogenic manifestations. DPDR is not merely the disruption of various sensory integrations, but also of several large-scale brain networks. Although a comprehensive antidote is not available for DPDR, a holistic route to the neurobiological context in DPDR may improve general understanding of the disorder and help afflicted individuals re-establish their sense of personal identity. Such information may also be useful in the development of novel pharmacological agents and targeted psychological interventions.
PubMed: 37122581
DOI: No ID Found -
Heliyon Dec 2023This study aims to determine the prevalence and degree of Burnout during the COVID 19 pandemic in practicing Pakistani dentists.
OBJECTIVE
This study aims to determine the prevalence and degree of Burnout during the COVID 19 pandemic in practicing Pakistani dentists.
INTRODUCTION
The COVID-19 pandemic has significantly impacted dental practices worldwide, leading to increased stress and burnout among dental practitioners. Burnout, characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment, can have detrimental effects on the quality of care and patient safety. Previous studies have shown high rates of burnout among healthcare workers, including dentists. The pandemic has added new challenges, such as financial losses and increased costs due to safety protocols. Recognizing and managing burnout is crucial to mitigate its severe consequences. By understanding the prevalence of burnout in this unique context, strategies can be developed to support dental practitioners and improve their well-being.
METHODS
A cross-sectional study was conducted using a 22-items based validated Maslach Burnout Inventory. The study was conducted between July and September 2021. Practicing dentists across Pakistan were approached via social media platforms. The questions were answered on a 7-point Likert scale. The sums of the scores were used as the evaluation criteria. Data analysis was done using SPSS version 24. Shapiro Wilk test was used to check normality of data. Mann Whitney U and Kruskal Wallis tests were utilized to analyze the differences in the prevalence of burnout amongst the different demographic groups. A P-value of <0.05 was considered as statistically significant.
RESULTS
Total of 282 dentists responded with 116 (41.1 %) male and 166 (58.9 %) female. Majority of the respondents were postgraduate residents (24.8 %), 47.9 % of the practitioners had 0-3 years of work experience, 48.6 % of the respondents were practicing in the Federal region, and 62.8 % of the subjects were between the age of 25-34. Emotional exhaustion was the major dimension of burnout identified in our study with 47.5 % of the population reporting high levels, while only 23 % of the population showed high levels of depersonalization and 29.4 % showed low sense of personal accomplishment.
CONCLUSION
This study indicates a considerable percentage of burnout in the chosen sample. The mean scores of Emotional Exhaustion, Depersonalization and Diminished sense of personal accomplishment were all found to be in the moderate range, and that appropriate measures should be taken to manage it.
PubMed: 38076061
DOI: 10.1016/j.heliyon.2023.e23061 -
Urology May 2020To identify factors and stress coping mechanisms associated with burnout within the field of urology.
OBJECTIVE
To identify factors and stress coping mechanisms associated with burnout within the field of urology.
METHODS
A survey study was completed using the abbreviated Maslach Burnout Inventory to evaluate emotional exhaustion, depersonalization, and low personal achievement. Demographic information, training status, practice setting, work hours, and mechanisms used to cope with stress were evaluated. Participants were also asked to comment on contributors to burnout in an open-ended question. Univariate analysis and multivariate regression identified factors associated with measures of burnout.
RESULTS
A total of 476 survey responses from 377 practicing urologists and 99 residents/fellows were included. Burnout was identified in 49.6% of all participants. Burnout through high emotional exhaustion was seen in 40.7%, high depersonalization in 30.7%, and low personal achievement in 18.3%. Trainees exhibited higher levels of depersonalization and lower levels of personal achievement. Higher levels of emotional exhaustion were identified in urologists in the middle of their careers and those in private practice. Urologists identified documentation, insurance and reimbursement, government regulations, medical practice expectations, and patient expectations as stressors contributing to burnout. Exercising and socializing were consistently associated with lower measures of burnout whereas stress eating and alcohol use were associated with higher measures of burnout on multivariate analysis.
CONCLUSION
Burnout in urology was associated with trainee status, years in practice, and practice setting. Exercising and socializing were protective against burnout whereas stress eating and alcohol consumption were associated with higher rates of burnout.
Topics: Achievement; Adaptation, Psychological; Adult; Aged; Alcohol Drinking; Burnout, Professional; Depersonalization; Eating; Exercise; Female; Humans; Internship and Residency; Male; Middle Aged; Motivation; Practice Management, Medical; Private Practice; Regression Analysis; Social Participation; Stress, Psychological; Surveys and Questionnaires; Urologists; Urology; Young Adult
PubMed: 32032685
DOI: 10.1016/j.urology.2019.11.072 -
Journal of Clinical Psychology Apr 2022Depersonalization-derealization disorder (DDD) is characterized by diverse symptomatology overlapping with anxiety and dissociative disorders, but the sources of this...
OBJECTIVE
Depersonalization-derealization disorder (DDD) is characterized by diverse symptomatology overlapping with anxiety and dissociative disorders, but the sources of this variability are poorly understood. This study aims to determine whether symptom heterogeneity is attributable to the presence of latent subgroups.
METHOD
We applied latent profile analysis to psychometric measures of anxiety, depersonalization-derealization, and dissociation in 303 DDD patients.
RESULTS
The analysis yielded evidence for five discrete subgroups: three of varying severity levels and two moderate-to-severe classes characterized by differential dissociative symptoms. The five classes reliably differed on several nondissociative symptoms, comorbidities, and factors precipitating their diagnosis but did not significantly differ in other symptoms including anxiety.
CONCLUSION
These results suggest the presence of three distinct DDD subtypes in the upper severity range that are distinguished by differential expression of detachment and compartmentalization symptoms. Further elucidation of these subtypes has potential implications for the etiology, mechanisms, and treatment of DDD.
Topics: Anxiety; Comorbidity; Depersonalization; Dissociative Disorders; Humans; Psychometrics
PubMed: 34487354
DOI: 10.1002/jclp.23241 -
Journal of the American Pharmacists... 2021Coronavirus disease 2019 (COVID-19) has disrupted pharmacy practice. Little research has been done to assess how COVID-19 has affected pharmacists' employment, workload,...
BACKGROUND
Coronavirus disease 2019 (COVID-19) has disrupted pharmacy practice. Little research has been done to assess how COVID-19 has affected pharmacists' employment, workload, and feelings of burnout.
OBJECTIVES
The objectives of this study were to characterize the impact of COVID-19 on pharmacists' employment status, workload, and feelings of burnout, as well as to examine emotional health concerns related to COVID-19.
METHODS
Wisconsin pharmacists were surveyed using an online instrument between August 25, 2020, and September 22, 2020. The data analysis, performed in December 2020, examined employment status, 3 common burnout risk factors (workload, rewards, and social depersonalization), and emotional health concerns related to COVID-19.
RESULTS
Of the 1300 pharmacists, 439 completed the survey (33.8%). The study analysis included pharmacists in community (n = 127) and hospital or health system (n = 107) settings. With regard to employment changes and workload, hospital pharmacists (36%) were more likely to have their hours reduced than community pharmacists (13%) (P < 0.01), and, conversely, community pharmacists (19%) were more likely to have their hours increased than hospital pharmacists (8%) (P = 0.01). For the burnout domain of workload, 45% of the pharmacists reported increased feelings of physical exhaustion at work, and 53% reported increased feelings of emotional exhaustion at work, with no difference between settings. Regarding the burnout domain of rewards, 6% of the hospital pharmacists and 1% of the community pharmacists experienced a reduction in hourly wages or salaries as a result of COVID-19. For the burnout domain of depersonalization, 25% of the pharmacists reported that their ability to connect with colleagues and patients decreased during the COVID-19 pandemic. Additional emotional health concerns reported by the pharmacists included 40% experiencing more anxiety and 25% experiencing more sadness or depression during the COVID-19 pandemic, with no difference between settings.
CONCLUSION
This study found that the burnout domains related to workload, rewards, and depersonalization were negatively affected by COVID-19. Pharmacy managers need to proactively combat burnout as well as be reactive when employees show signs of burnout to maintain their workforce and meet the COVID-19-associated challenges.
Topics: Burnout, Psychological; COVID-19; Humans; Pandemics; SARS-CoV-2; Surveys and Questionnaires; Vaccines
PubMed: 33962895
DOI: 10.1016/j.japh.2021.04.009 -
Clinics in Dermatology 2021Although a dermatology residency is associated with a favorable lifestyle, nearly one in three budding dermatologists meet the criteria for burnout. The competitive...
Although a dermatology residency is associated with a favorable lifestyle, nearly one in three budding dermatologists meet the criteria for burnout. The competitive nature of dermatology residency selection may confer a predisposition to burnout. Contributing factors during residency include a high-volume clinical experience and frequent use of electronic health records. Women may face particular pressures in managing work-life balance when starting a family during dermatology residency. In addition to preventing burnout before residency, fears of professional repercussions should be alleviated to ensure resident well-being. We have focusedW focus on the causes of burnout among dermatology residents and suggest solutions to promote wellness.
Topics: Dermatology; Humans; Internship and Residency
PubMed: 34920820
DOI: 10.1016/j.clindermatol.2021.02.001 -
Journal of Multidisciplinary Healthcare 2020To determine levels of burnout among emergency medical services (EMS) professionals and the coping strategies they use to alleviate burnout and measure the association...
PURPOSE
To determine levels of burnout among emergency medical services (EMS) professionals and the coping strategies they use to alleviate burnout and measure the association between burnout vs sociodemographic and work-related characteristics and coping strategies of EMS professionals.
METHODS
This was a cross-sectional survey study conducted among 270 active-duty EMS professionals. The Maslach Burnout Inventory (MBI) - Health Services Survey was used to assess burnout. There are three scales of burnout: depersonalization, emotional exhaustion, and personal achievement. Coping Methods Checklist (CMC) was used to assess coping strategies. Univariate descriptive statistics were used to explore sociodemographic characteristics of participants, level of burnout, and coping strategies. Primary bivariate analyses were used to determine variables significantly correlated with each of the three MBI scores. Multiple linear regression models were used to explore correlation between variables measured in the survey with each of the three MBI scales (emotional exhaustion, depersonalization, and personal accomplishment).
RESULTS
EMS professionals perceived high levels of emotional exhaustion and depersonalization and low levels of personal achievement. The most frequently used coping strategies were talking with colleagues (87.4%), looking forward to being off duty (82.6%), and thinking about the positive benefits of work (81.1%). CMC7 (thinking about the positive benefits of work) contributed most to variations in emotional exhaustion, depersonalization, and personal achievement. Saudis had lower emotional exhaustion and depersonalization.
CONCLUSION
This study might provide evidence to formulate comprehensive training on how EMS workers can cope with burnout.
PubMed: 32214822
DOI: 10.2147/JMDH.S244303 -
Annals of Family Medicine May 2020In light of concerns over the potential detrimental effects of declining care continuity, and the need for connection between patients and health care providers, our...
In light of concerns over the potential detrimental effects of declining care continuity, and the need for connection between patients and health care providers, our multidisciplinary group considered the possible ways that relationships might be developed in different kinds of health care encounters.We were surprised to discover many avenues to invest in relationships, even in non-continuity consultations, and how meaningful human connections might be developed even in telehealth visits. Opportunities range from the quality of attention or the structure of the time during the visit, to supporting relationship development in how care is organized at the local or system level and in the use of digital encounters. These ways of investing in relationships can exhibit different manifestations and emphases during different kinds of visits, but most are available during all kinds of encounters.Recognizing and supporting the many ways of investing in relationships has great potential to create a positive sea change in a health care system that currently feels fragmented and depersonalized to both patients and health care clinicians.The current COVID-19 pandemic is full of opportunity to use remote communication to develop healing human relationships. What we need in a pandemic is not social distancing, but physical distancing with social connectedness.
Topics: COVID-19; Continuity of Patient Care; Coronavirus Infections; Humans; Pandemics; Physician-Patient Relations; Pneumonia, Viral; Primary Health Care; Social Isolation; Telemedicine
PubMed: 32393566
DOI: 10.1370/afm.2538 -
Clinical Gerontologist 2022Burnout contributes to high turnover rates, medical errors, and poor patient satisfaction in geriatric nursing staff. Nurses' cognitive emotion regulation (ER)...
OBJECTIVES
Burnout contributes to high turnover rates, medical errors, and poor patient satisfaction in geriatric nursing staff. Nurses' cognitive emotion regulation (ER) strategies are emerging as an important personal resource related to burnout that are modifiable with intervention. This study examined the association between cognitive ER strategies and burnout among geriatric nursing staff.
METHODS
Participants were 54 nurses (RNs, LPNs, CNA/UWs) with a mean age of 43.1 years ( = 12.2), majority female (96.3%), and racially diverse: Black (20.4%), White (63.0%), and Other (13.0%).
RESULTS
After controlling for CVs, cognitive ER strategies accounted for unique variance in depersonalization, but did not account for unique variance in emotional exhaustion or personal accomplishment. Rumination was associated with greater depersonalization, and greater refocus on planning was associated with lower depersonalization.
CONCLUSIONS
Findings suggest that depersonalization may be most impacted by ER; however, other ER strategies may be important that were not included in the current study (e.g., experiential avoidance, mindfulness). Future research is needed with additional ER strategies and larger samples.
CLINICAL IMPLICATIONS
Findings support the use of person-centered interventions, such as cognitive-behavioral and mindfulness-based techniques, to improve stress management and decrease depersonalization.
Topics: Aged; Burnout, Professional; Cognition; Emotional Regulation; Female; Geriatric Nursing; Humans; Nursing Staff
PubMed: 33090948
DOI: 10.1080/07317115.2020.1829230 -
Pediatric Emergency Care Apr 2020Burnout is a syndrome in which a reduced sense of personal accomplishment, depersonalization, and emotional exhaustion develop in response to prolonged stress. It is...
OBJECTIVE
Burnout is a syndrome in which a reduced sense of personal accomplishment, depersonalization, and emotional exhaustion develop in response to prolonged stress. It is well known that physicians suffer high rates of burnout; emergency medicine physicians experience significantly increased rates of burnout, whereas physicians in other specialties, like pediatrics, may be spared. Pediatric emergency medicine physicians are on the frontline of care for the critically ill child, which could put them at high risk for burnout. This study evaluates the rate of burnout in pediatric emergency medicine physicians.
METHODS
We conducted a survey assessing burnout using a sample of pediatric emergency medicine physicians who subscribe to an open Listserv server maintained by Brown University. Burnout was measured using a validated instrument, the Maslach Burnout Inventory-Human Services Survey, which was distributed by e-mail to the study group.
RESULTS
Respondents averaged a score of 9 (95% confidence interval [CI], 8-10), 23 (95% CI, 21-25), and 39 (95% CI, 38-40) in the subscales of depersonalization, emotional exhaustion, and personal accomplishment, respectively. This placed our cohort into the average range for all subscales. The percentage of respondents who scored in the high levels of burnout (moderate to high scores in both depersonalization and emotional exhaustion and low to moderate scores in personal accomplishment) was 25% (95% CI, 18-32).
CONCLUSIONS
Unlike previous literature showing burnout prevalence in excess of 60% in emergency medicine physicians and 38% in pediatricians, our pediatric emergency medicine physicians fared better with only 25% (95% CI, 18-32), showing elevated levels of burnout.
Topics: Adult; Aged; Burnout, Professional; Child; Depersonalization; Emergency Medicine; Emotions; Female; Humans; Male; Middle Aged; Pediatric Emergency Medicine; Pediatricians; Physicians; Prevalence; Stress, Psychological; Surveys and Questionnaires
PubMed: 29200142
DOI: 10.1097/PEC.0000000000001379