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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Umeå universitet, Institutionen för folkhälsa och klinisk medicin
2010
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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 |
work_keys_str_mv |
AT sandstromagneta neurocognitiveandendocrinedysfunctioninwomenwithexhaustionsyndrome |
_version_ |
1716509364748025856 |