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JAMA Sep 2018Burnout is a self-reported job-related syndrome increasingly recognized as a critical factor affecting physicians and their patients. An accurate estimate of burnout... (Review)
Review
IMPORTANCE
Burnout is a self-reported job-related syndrome increasingly recognized as a critical factor affecting physicians and their patients. An accurate estimate of burnout prevalence among physicians would have important health policy implications, but the overall prevalence is unknown.
OBJECTIVE
To characterize the methods used to assess burnout and provide an estimate of the prevalence of physician burnout.
DATA SOURCES AND STUDY SELECTION
Systematic search of EMBASE, ERIC, MEDLINE/PubMed, psycARTICLES, and psycINFO for studies on the prevalence of burnout in practicing physicians (ie, excluding physicians in training) published before June 1, 2018.
DATA EXTRACTION AND SYNTHESIS
Burnout prevalence and study characteristics were extracted independently by 3 investigators. Although meta-analytic pooling was planned, variation in study designs and burnout ascertainment methods, as well as statistical heterogeneity, made quantitative pooling inappropriate. Therefore, studies were summarized descriptively and assessed qualitatively.
MAIN OUTCOMES AND MEASURES
Point or period prevalence of burnout assessed by questionnaire.
RESULTS
Burnout prevalence data were extracted from 182 studies involving 109 628 individuals in 45 countries published between 1991 and 2018. In all, 85.7% (156/182) of studies used a version of the Maslach Burnout Inventory (MBI) to assess burnout. Studies variably reported prevalence estimates of overall burnout or burnout subcomponents: 67.0% (122/182) on overall burnout, 72.0% (131/182) on emotional exhaustion, 68.1% (124/182) on depersonalization, and 63.2% (115/182) on low personal accomplishment. Studies used at least 142 unique definitions for meeting overall burnout or burnout subscale criteria, indicating substantial disagreement in the literature on what constituted burnout. Studies variably defined burnout based on predefined cutoff scores or sample quantiles and used markedly different cutoff definitions. Among studies using instruments based on the MBI, there were at least 47 distinct definitions of overall burnout prevalence and 29, 26, and 26 definitions of emotional exhaustion, depersonalization, and low personal accomplishment prevalence, respectively. Overall burnout prevalence ranged from 0% to 80.5%. Emotional exhaustion, depersonalization, and low personal accomplishment prevalence ranged from 0% to 86.2%, 0% to 89.9%, and 0% to 87.1%, respectively. Because of inconsistencies in definitions of and assessment methods for burnout across studies, associations between burnout and sex, age, geography, time, specialty, and depressive symptoms could not be reliably determined.
CONCLUSIONS AND RELEVANCE
In this systematic review, there was substantial variability in prevalence estimates of burnout among practicing physicians and marked variation in burnout definitions, assessment methods, and study quality. These findings preclude definitive conclusions about the prevalence of burnout and highlight the importance of developing a consensus definition of burnout and of standardizing measurement tools to assess the effects of chronic occupational stress on physicians.
Topics: Burnout, Professional; Compassion Fatigue; Depersonalization; Humans; Job Satisfaction; Physicians; Prevalence; Surveys and Questionnaires
PubMed: 30326495
DOI: 10.1001/jama.2018.12777 -
Neuropsychopharmacology : Official... Oct 2017All modern clinical studies using the classic hallucinogen lysergic acid diethylamide (LSD) in healthy subjects or patients in the last 25 years are reviewed herein.... (Review)
Review
All modern clinical studies using the classic hallucinogen lysergic acid diethylamide (LSD) in healthy subjects or patients in the last 25 years are reviewed herein. There were five recent studies in healthy participants and one in patients. In a controlled setting, LSD acutely induced bliss, audiovisual synesthesia, altered meaning of perceptions, derealization, depersonalization, and mystical experiences. These subjective effects of LSD were mediated by the 5-HT receptor. LSD increased feelings of closeness to others, openness, trust, and suggestibility. LSD impaired the recognition of sad and fearful faces, reduced left amygdala reactivity to fearful faces, and enhanced emotional empathy. LSD increased the emotional response to music and the meaning of music. LSD acutely produced deficits in sensorimotor gating, similar to observations in schizophrenia. LSD had weak autonomic stimulant effects and elevated plasma cortisol, prolactin, and oxytocin levels. Resting-state functional magnetic resonance studies showed that LSD acutely reduced the integrity of functional brain networks and increased connectivity between networks that normally are more dissociated. LSD increased functional thalamocortical connectivity and functional connectivity of the primary visual cortex with other brain areas. The latter effect was correlated with subjective hallucinations. LSD acutely induced global increases in brain entropy that were associated with greater trait openness 14 days later. In patients with anxiety associated with life-threatening disease, anxiety was reduced for 2 months after two doses of LSD. In medical settings, no complications of LSD administration were observed. These data should contribute to further investigations of the therapeutic potential of LSD in psychiatry.
Topics: Hallucinogens; History, 20th Century; History, 21st Century; Humans; Lysergic Acid Diethylamide; Mental Disorders
PubMed: 28447622
DOI: 10.1038/npp.2017.86 -
PloS One 2018Burnout is a psychological syndrome that is very common among medical residents. It consists of emotional exhaustion (EE), depersonalization (DP) and reduced personal... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Burnout is a psychological syndrome that is very common among medical residents. It consists of emotional exhaustion (EE), depersonalization (DP) and reduced personal accomplishment (PA).
OBJECTIVE
To estimate burnout among different medical residency specialties.
METHODS
A systematic review with meta-analysis was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search of bibliographic databases and grey literature was conducted, from inception to March 2018. The following databases were accessed: Embase, PubMed, Web of Science, Google Scholar and Scopus, and 3,575 studies were found. Methodological quality was evaluated by Agency for Healthcare Research and Quality Methodology Checklist for Cross-Sectional/Prevalence Study. In the final analysis, 26 papers were included. Their references were checked for additional studies, but none were included.
RESULTS
4,664 medical residents were included. High DP, EE and low PA proportions were compared. Specialties were distributed into three groups of different levels of burnout prevalence: general surgery, anesthesiology, obstetrics/gynecology and orthopedics (40.8%); internal medicine, plastic surgery and pediatrics (30.0%); and otolaryngology and neurology (15.4%). Overall burnout prevalence found for all specialties was 35.7%.
CONCLUSION
The prevalence of burnout syndrome was significantly higher among surgical/urgency residencies than in clinical specialties.
PROSPERO REGISTRATION
CRD42018090270.
Topics: Burnout, Psychological; Depersonalization; Humans; Internal Medicine; Internship and Residency; Physicians; Prevalence; Specialties, Surgical
PubMed: 30418984
DOI: 10.1371/journal.pone.0206840 -
Psychiatria Danubina Mar 2018French expression standing for the phrase "already seen" is a déjà vu. It is thought that as much as 97% of the population have experienced déjà vu at least once in... (Review)
Review
French expression standing for the phrase "already seen" is a déjà vu. It is thought that as much as 97% of the population have experienced déjà vu at least once in their lifetime and 67% experience it regularly. The explanations of this phenomenon in novels and poems include reincarnation, dreams, organic factors, and unconscious memories. In this narrative review connection between déjà vu and various other conditions has been mentioned: false memories, temporal lobe epilepsy and other neurological conditions. In psychiatric patients déjà vu phenomenon is more often seen in patients with anxiety and people with derealisation/ depersonalization. It seems that temporal region is the origin of déjà vu phenomena in both healthy individuals and in individuals with neurological and psychiatric conditions, but the exact mechanism of this phenomenon is however still unknown. More attention should also be given to déjà vu from philosophical and religious perspectives as well. Déjà vu is still an enigma which could only be revealed with multidisciplinary approach through cooperation between neurologists, brain scientists, psychiatrists and experimental psychologists.
Topics: Adult; Brain; Deja Vu; Depersonalization; Epilepsy, Temporal Lobe; Humans; Interdisciplinary Communication; Intersectoral Collaboration; Male; Neurocognitive Disorders; Repression, Psychology
PubMed: 29546854
DOI: 10.24869/psyd.2018.21 -
International Journal of Medical... Oct 2016To describe levels of burnout and impostor syndrome (IS) in medical students, and to recognize demographic differences in those experiencing burnout and IS.
OBJECTIVES
To describe levels of burnout and impostor syndrome (IS) in medical students, and to recognize demographic differences in those experiencing burnout and IS.
METHODS
Anonymous survey administered online in 2014 that included demographic data, the Maslach Burnout Inventory and an IS screening questionnaire. Main outcome measures were level of burnout, and presence or absence of imposter syndrome. The presence of IS and burnout components were analyzed across age, gender, race, year of training, intention to pursue fellowship training, and greater than one year of work experience outside of medicine using chi-squared tests. The association between burnout and IS was also compared using chi-squared tests.
RESULTS
One hundred and thirty-eight students completed the questionnaire. Female gender was significantly associated with IS (χ=10.6, p=0.004) with more than double the percentage of females displaying IS than their male counterparts (49.4% of females versus 23.7% of males). IS was significantly associated with the burnout components of exhaustion (χ =5.9, p=0.045), cynicism (χ=9.4, p=0.004), emotional exhaustion (χ=8.0, p=0.018), and depersonalization (χ =10.3, p=0.006). The fourth year of medical school was significantly associated with IS (χ=10.5, p=0.015).
CONCLUSIONS
Almost a quarter of male medical students and nearly half of female students experience IS and IS was found to be significantly associated with burnout indices. Given the high psychological morbidity of these conditions, this association cannot be ignored. It behooves us to reconsider facets of medical education (i.e. shame-based learning and overall teaching style) and optimize the medical learning environment.
Topics: Adolescent; Adult; Burnout, Professional; Cross-Sectional Studies; Depersonalization; Female; Humans; Male; Mass Screening; Middle Aged; Pilot Projects; Stress, Psychological; Students, Medical; Surveys and Questionnaires; Syndrome; United States; Young Adult
PubMed: 27802178
DOI: 10.5116/ijme.5801.eac4 -
Comprehensive Psychiatry 1999The differentiation of three types of panic attacks is proposed to be significant for understanding the course and etiology of panic and other psychiatric disorders and... (Comparative Study)
Comparative Study
The differentiation of three types of panic attacks is proposed to be significant for understanding the course and etiology of panic and other psychiatric disorders and physical illnesses. The present investigation is based on longitudinal data from the Epidemiologic Catchment Area (ECA) Study of 1980 to 1981 and its 1994 to 1996 follow-up. Multidimensional scaling (MDS) of panic symptoms identified three types of panic which were consistent over time and for which reliable scales were constructed to measure derealization, cardiac panic, and respiratory panic. Unlike panic disorder, none of the three types of panic attacks predicted the incidence of depression. Derealization was associated with a broader variety of psychiatric disorders than the other two types of panic, including simple phobias, but was not associated with physical diseases. Cardiac panic attacks were associated with a history of heart disease and predicted the incidence of agoraphobia but were not comorbid with depression, unlike the other two forms of panic. Respiratory panic attacks were consistently symptomatic of dysthymia and predicted a higher risk of hospitalization for breast cancer and myocardial infarction (MI).
Topics: Adult; Breast Neoplasms; Catchment Area, Health; Cross-Sectional Studies; Depressive Disorder; Female; Follow-Up Studies; Humans; Male; Myocardial Infarction; Panic Disorder; Psychiatric Status Rating Scales; Respiration Disorders; Retrospective Studies; Severity of Illness Index
PubMed: 10579380
DOI: 10.1016/s0010-440x(99)90092-5 -
Journal of the American Academy of... Dec 2017The purpose of this study was to examine the co-occurrence of posttraumatic stress disorder (PTSD) and dissociation in a clinical sample of trauma-exposed adolescents by...
OBJECTIVE
The purpose of this study was to examine the co-occurrence of posttraumatic stress disorder (PTSD) and dissociation in a clinical sample of trauma-exposed adolescents by evaluating evidence for the depersonalization/derealization dissociative subtype of PTSD as defined by the DSM-5 and then examining a broader set of dissociation symptoms.
METHOD
A sample of treatment-seeking, trauma-exposed adolescents 12 to 16 years old (N = 3,081) from the National Child Traumatic Stress Network Core Data Set was used to meet the study objectives. Two models of PTSD/dissociation co-occurrence were estimated using latent class analysis, one with 2 dissociation symptoms and the other with 10 dissociation symptoms. After model selection, groups within each model were compared on demographics, trauma characteristics, and psychopathology.
RESULTS
Model A, the depersonalization/derealization model, had 5 classes: dissociative subtype/high PTSD; high PTSD; anxious arousal; dysphoric arousal; and a low symptom/reference class. Model B, the expanded dissociation model, identified an additional class characterized by dissociative amnesia and detached arousal.
CONCLUSION
These 2 models provide new information about the specific ways PTSD and dissociation co-occur and illuminate some differences between adult and adolescent trauma symptom expression. A dissociative subtype of PTSD can be distinguished from PTSD alone in adolescents, but assessing a wider range of dissociative symptoms is needed to fully characterize adolescent traumatic stress responses.
Topics: Adolescent; Child; Depersonalization; Dissociative Disorders; Female; Humans; Male; Models, Psychological; Models, Statistical; Psychiatric Status Rating Scales; Stress Disorders, Post-Traumatic
PubMed: 29173740
DOI: 10.1016/j.jaac.2017.09.425 -
Frontiers in Human Neuroscience 2022Depersonalization (DP) and derealization (DR) refer to states of dissociation in which one feels a sense of alienation in relation to one's self and environment,...
Depersonalization (DP) and derealization (DR) refer to states of dissociation in which one feels a sense of alienation in relation to one's self and environment, respectively. Whilst transient episodes often diminish without treatment, chronic experiences of DP and DR may last for years, with common treatments lacking a strong evidence base for their efficacy. We propose a theoretical explanation of DP and DR based on interoceptive predictive coding, and discuss how transient experiences of DP and DR may be induced in the non-clinical population using virtual reality. Further, we review the use of heartbeat evoked potentials in detecting the neural correlates of DP and DR allowing for an objective measure of these experiences in the non-clinical population. Finally, we discuss how the induction and detection of transient experiences of DP and DR in the non-clinical population could shed light on how the brain constructs one's sense of self and reality.
PubMed: 35321264
DOI: 10.3389/fnhum.2022.744487 -
AIMS Neuroscience 2021The temporal-parietal junction (TPJ) is a key structure for the embodiment, term referred to as the sense of being localized within one's physical body and is a... (Review)
Review
Targeting temporal parietal junction for assessing and treating disembodiment phenomena: a systematic review of TMS effect on depersonalization and derealization disorders (DPD) and body illusions.
The temporal-parietal junction (TPJ) is a key structure for the embodiment, term referred to as the sense of being localized within one's physical body and is a fundamental aspect of the self. On the contrary, the sense of disembodiment, an alteration of one's sense of self or the sense of being localized out of one's physical body, is a prominent feature in specific dissociative disorders, namely depersonalization/derealization disorders (DPD). The aims of the study were to provide: 1) a qualitative synthesis of the effect of Transcranial Magnetic Stimulation (TMS), taking into account its use for therapeutic and experimental purposes; 2) a better understanding on whether the use of TMS could support the treatment of DPD and other clinical conditions in which depersonalization and derealization are displayed. To identify suitable publications, an online search of the PubMed, Cochrane Library, Web of science and Scopus databases was performed using relevant search terms. In addition, an in-depth search was performed by screening review articles and the references section of each included articles. Our search yielded a total of 108 records through multiple databases searching and one additional record was identified through other sources. After duplicates removal, title and abstract reading, we retained 16 records for the assessment of eligibility. According to our inclusion criteria, we retained 8 studies. The selected studies showed that TMS targeting the TPJ is a promising technique for treating disembodiment phenomena DPD and for inducing reversible disembodiment states in healthy subjects. These data represent the first step towards a greater understanding of possible treatments to be used in disembodiment disorders. The use of TMS over the TPJ appears to be promising for treating disembodiment phenomena.
PubMed: 33709023
DOI: 10.3934/Neuroscience.2021009