Neurocognitive and endocrine dysfunction in women with exhaustion syndrome

Stress has emerged as one of the most important factors to consider in psychiatric diagnoses and has become a common reason for long-term sick leave (LTSL). Roughly 50% of LTSL due to psychiatric diseases are thought to be associated with work-related stress. The demarcation towards major depression...

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Main Author: Sandström, Agneta
Format: Doctoral Thesis
Language:English
Published: Umeå universitet, Institutionen för folkhälsa och klinisk medicin 2010
Subjects:
MRI
TCI
Online Access:http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-37280
http://nbn-resolving.de/urn:isbn:978-91-7459-086-9
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spelling ndltd-UPSALLA1-oai-DiVA.org-umu-372802013-01-08T13:06:48ZNeurocognitive and endocrine dysfunction in women with exhaustion syndromeengSandström, AgnetaUmeå universitet, Institutionen för folkhälsa och klinisk medicinUmeå universitet, Institutionen för strålningsvetenskaperUmeå universitet, Institutionen för integrativ medicinsk biologi (IMB)Umeå : Umeå university2010Cognitionattentionworking memoryexhaustion syndromemajor depressioncortisolHPA-axisproinflammatory cytokinespsychologyneurocognitiveendocrinefMRIMRIprefrontal cortexmultivariatewomenpersonalityTCIstressPublic health medicine research areasFolkhälsomedicinska forskningsområdenDiagnostic radiologyDiagnostisk radiologiStress has emerged as one of the most important factors to consider in psychiatric diagnoses and has become a common reason for long-term sick leave (LTSL). Roughly 50% of LTSL due to psychiatric diseases are thought to be associated with work-related stress. The demarcation towards major depression is disputed, and no international consensus exists for how to diagnose and rehabilitate these individuals. The Swedish National Board of Health has suggested the term “exhaustion syndrome” to integrate these individuals into stress-related disorders. Prominent features of this syndrome are fatigue, sleeping disorders, and cognitive dysfunction. The cognitive dysfunction may be due to an interaction between personality features, environmental factors, the biological effects of stress hormones, and dysfunction in key brain areas, notably the hippocampus and prefrontal cortex. A consistent feature of chronic stress is activation of the cortisol, or hypothalamic-pituitary-adrenal, axis, which may be linked to cognitive dysfunction. Increased glucocorticoid levels, mainly cortisol in humans, are known to impair memory performance. The aim of this thesis was to investigate whether patients with exhaustion syndrome exhibit specific alterations in an extensive set of biological, psychological and immunological variables. Patients in Study 1 had significant cognitive impairment for specific tasks assumed to tap frontal lobe functioning. In Study 2 anxiety prone, worrying, pessimistic individuals with low executive drive and a persistent personality type were more likely to develop exhaustion syndrome. Decreased reactivity was found on the pituitary level after corticotropin releasing hormone (CRH) in exhaustion syndrome patients. The cortisol/adrenocorticotropic hormone response to CRH was slightly higher in patients compared to controls, indicating increased sensitivity at the adrenal cortex level. No differences were found in hippocampal volume. In Study 3, functional imaging revealed a different pattern of brain activation in working memory tests in patients with exhaustion syndrome compared to healthy individuals and patients with depression. In summary, our data suggests an intimate link between personality and wellbeing, cognitive performance and neuroendocrine dysfunction, in exhaustion syndrome. We thus find similarities with major depression but also distinct differences between the exhaustion syndrome and major depression. Doctoral thesis, comprehensive summaryinfo:eu-repo/semantics/doctoralThesistexthttp://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-37280urn:isbn:978-91-7459-086-9Umeå University medical dissertations, 0346-6612 ; 1379application/pdfinfo:eu-repo/semantics/openAccess
collection NDLTD
language English
format Doctoral Thesis
sources NDLTD
topic Cognition
attention
working memory
exhaustion syndrome
major depression
cortisol
HPA-axis
proinflammatory cytokines
psychology
neurocognitive
endocrine
fMRI
MRI
prefrontal cortex
multivariate
women
personality
TCI
stress
Public health medicine research areas
Folkhälsomedicinska forskningsområden
Diagnostic radiology
Diagnostisk radiologi
spellingShingle Cognition
attention
working memory
exhaustion syndrome
major depression
cortisol
HPA-axis
proinflammatory cytokines
psychology
neurocognitive
endocrine
fMRI
MRI
prefrontal cortex
multivariate
women
personality
TCI
stress
Public health medicine research areas
Folkhälsomedicinska forskningsområden
Diagnostic radiology
Diagnostisk radiologi
Sandström, Agneta
Neurocognitive and endocrine dysfunction in women with exhaustion syndrome
description Stress has emerged as one of the most important factors to consider in psychiatric diagnoses and has become a common reason for long-term sick leave (LTSL). Roughly 50% of LTSL due to psychiatric diseases are thought to be associated with work-related stress. The demarcation towards major depression is disputed, and no international consensus exists for how to diagnose and rehabilitate these individuals. The Swedish National Board of Health has suggested the term “exhaustion syndrome” to integrate these individuals into stress-related disorders. Prominent features of this syndrome are fatigue, sleeping disorders, and cognitive dysfunction. The cognitive dysfunction may be due to an interaction between personality features, environmental factors, the biological effects of stress hormones, and dysfunction in key brain areas, notably the hippocampus and prefrontal cortex. A consistent feature of chronic stress is activation of the cortisol, or hypothalamic-pituitary-adrenal, axis, which may be linked to cognitive dysfunction. Increased glucocorticoid levels, mainly cortisol in humans, are known to impair memory performance. The aim of this thesis was to investigate whether patients with exhaustion syndrome exhibit specific alterations in an extensive set of biological, psychological and immunological variables. Patients in Study 1 had significant cognitive impairment for specific tasks assumed to tap frontal lobe functioning. In Study 2 anxiety prone, worrying, pessimistic individuals with low executive drive and a persistent personality type were more likely to develop exhaustion syndrome. Decreased reactivity was found on the pituitary level after corticotropin releasing hormone (CRH) in exhaustion syndrome patients. The cortisol/adrenocorticotropic hormone response to CRH was slightly higher in patients compared to controls, indicating increased sensitivity at the adrenal cortex level. No differences were found in hippocampal volume. In Study 3, functional imaging revealed a different pattern of brain activation in working memory tests in patients with exhaustion syndrome compared to healthy individuals and patients with depression. In summary, our data suggests an intimate link between personality and wellbeing, cognitive performance and neuroendocrine dysfunction, in exhaustion syndrome. We thus find similarities with major depression but also distinct differences between the exhaustion syndrome and major depression.
author Sandström, Agneta
author_facet Sandström, Agneta
author_sort Sandström, Agneta
title Neurocognitive and endocrine dysfunction in women with exhaustion syndrome
title_short Neurocognitive and endocrine dysfunction in women with exhaustion syndrome
title_full Neurocognitive and endocrine dysfunction in women with exhaustion syndrome
title_fullStr Neurocognitive and endocrine dysfunction in women with exhaustion syndrome
title_full_unstemmed Neurocognitive and endocrine dysfunction in women with exhaustion syndrome
title_sort neurocognitive and endocrine dysfunction in women with exhaustion syndrome
publisher Umeå universitet, Institutionen för folkhälsa och klinisk medicin
publishDate 2010
url http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-37280
http://nbn-resolving.de/urn:isbn:978-91-7459-086-9
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