Burnout syndrome is a state of physical and mental exhaustion with a significantly reduced performance, caused by long-term stress at work. Private problems are rarely the sole trigger but are often added as a result of chronic stress in the professional environment. Burnout syndrome was already described in 1974 by Herbert J. Freudenberger, an U.S. American psychologist, but recognized as a disease by the WHO (World Health Organization) only in 2019. It is not a “fashion disease”. In its fullest form, burnout syndrome is closely associated with depression, neurasthenia (physical symptoms without an organic cause) and the adjustment disorder. The number of affected people has increased rapidly in recent years. Burnout syndrome is highly disabling for patients and very often leads to long-term (to permanent) incapacity to work. The necessary multimodal therapies over longer periods lead to increasing costs for the healthcare system.

Causes
The main cause is an ongoing stress situation in the professional environment. This can be caused by excessive demands at the workplace, stress, poor organization at the workplace, unclear hierarchies and tasks within the workplace and/ or mobbing. In what extent stress in the workplace leads to burnout syndrome in a person depends to their individual vulnerability, their personal stress tolerance, physical health (lifestyle, presence of concomitant diseases), private stress (children, nursing case in the family), the presence of a personal social network (family, partner, friends).

Warning signs and symptoms
One of the first symptoms is the sleep disturbance. These results from the increasing inability to disconnect. The problems of the workplace are taken home and become part of preoccupations and recurrent thoughts. The result is that the patients are less recovered and so less productive during the day, which leads to further problems at work and everyday life. Symptoms of depressed mood are increasingly observed up to the full picture of depression with the typical symptoms of listlessness, a feeling of inner emptiness and impotence. In other cases, increasing aggressiveness can be observed. These symptoms are usually accompanied by unspecific psychosomatic complaints such as indigestion, headache and backpain, difficulty concentrating, increased susceptibility to infections, skin problems, weight loss or weight gain, sexual disorders, tinnitus. Some patients develop symptoms of anxiety disorder with panic attacks. After all, the full picture of a burnout syndrome can hardly be distinguished from depression.

Therapy and prevention
The burnout syndrome should be treated as quickly as possible. Otherwise it could lead to serious secondary diseases such as depression and anxiety disorders like already mentioned above. If warning signal appear, you should seek professional help. The first contact person normally is the family doctor. In the therapy, the first priority is the elimination of the causes, which can mean a change of the working place, in case of work-related burnout syndrome. Here, of course, one has to consider the realistic possibilities of finding a new job with better conditions. Finding a new job with better conditions is not always possible. A job loss due to recommendations or as a result of longer sickness can lead to additional stress for the patient due to economic problems and thus aggravate the general situation. Rather, after an appropriate, but not too long, rest period, the patient should be given psychotherapeutic support to learn how to deal differently with the given situation. The time-out should bring sufficient recovery but should not take too long. Experience shows that the longer the patients has been taken out of work, the more difficult is the reenter. All this could not be possible in case of mobbing.
The pillar of therapy should be psychotherapy. Cognitive behavioral therapy has shown to be the most suitable. However, other forms of psychotherapy are available. If it seems realistic, the patient should be helped in finding a new job. The personal professional goals should be reconsidered and, if necessary, more flexible working time models should be considered. If a change of job is not possible, the patient has to learn to deal better with the given situation. This includes paying more attention to our own needs, learning strategies for stress reduction, using social resources (partner, family, friends) and cultivating hobbies. The situation in the workplace should be improved, if possible in cooperation with the superiors, by better time management and adjustment of career planning to more realistic goals. Accompanying the patient should be instructed by the attending doctor how he can strengthen his health through a healthy lifestyle. Regular physical activity, adherence to rest breaks, healthy eating and sufficient sleep make us more resistant to psychological stress and the development of burnout syndrome and other psychological disorders. The use of psychotropic drugs should be limited to very severe cases and should only be used for a short time.