<s> [INST] <<SYS>> You are a responsible assistant committed to providing accurate and helpful responses. Avoid sharing harmful or biased content. Clarify any unclear or incorrect questions rather than providing false or misleading information. <</SYS>> What is Stillbirth and can you explain it in depth? [/INST] Stillbirth is typically defined as fetal death at or after 20 or 28 weeks of pregnancy, depending on the source.: Overview tab,  It results in a baby born without signs of life. A stillbirth can result in the feeling of guilt or grief in the mother. The term is in contrast to miscarriage, which is an early pregnancy loss, and Sudden Infant Death Syndrome, where the baby dies a short time after being born alive.Often the cause is unknown. Causes may include pregnancy complications such as pre-eclampsia and birth complications, problems with the placenta or umbilical cord, birth defects, infections such as malaria and syphilis, and poor health in the mother.: Causes tab,  Risk factors include a mothers age over 35, smoking, drug use, use of assisted reproductive technology, and first pregnancy. Stillbirth may be suspected when no fetal movement is felt. Confirmation is by ultrasound.Worldwide prevention of most stillbirths is possible with improved health systems.: Overview tab,  Around half of stillbirths occur during childbirth, with this being more common in the developing than developed world.: Info panel,  Otherwise, depending on how far along the pregnancy is, medications may be used to start labor or a type of surgery known as dilation and evacuation may be carried out. Following a stillbirth, people are at higher risk of another one; however, most subsequent pregnancies do not have similar problems. Depression, financial loss, and family breakdown are known complications.Worldwide in 2019, there were an estimated 2.0 million stillbirths that occurred after 28 weeks of pregnancy (about 1 for every 72 births). They occur most commonly in low income settings, particularly the Middle east and Sub-Saharan Africa.: Info panel,  In the United States, for every 167 births there is one stillbirth. Stillbirth rates have declined, though more slowly since the 2000s.

Causes
As of 2016, there is no international classification system for stillbirth causes. The causes of a large percentage of stillbirths is unknown, even in cases where extensive testing and an autopsy have been performed. A rarely used term to describe these is "sudden antenatal death syndrome", or SADS, a phrase coined in 2000. Many stillbirths occur at full term to apparently healthy mothers, and a postmortem evaluation reveals a cause of death in about 40% of autopsied cases.About 10% of cases are believed to be due to obesity, high blood pressure, or diabetes.Other risk factors include:

bacterial infection, like syphilis
malaria
birth defects, especially pulmonary hypoplasia
chromosomal aberrations
growth restriction
intrahepatic cholestasis of pregnancy
maternal diabetes
maternal consumption of recreational drugs (such as alcohol, nicotine, etc.) or pharmaceutical drugs contraindicated in pregnancy
postdate pregnancy
placental abruptions
physical trauma
radiation poisoning
Rh disease
celiac disease
female genital mutilation
umbilical cord accidents
Prolapsed umbilical cord – Prolapse of the umbilical cord happens when the fetus is not in a correct position in the pelvis. Membranes rupture and the cord is pushed out through the cervix. When the fetus pushes on the cervix, the cord is compressed and blocks blood and oxygen flow to the fetus. The mother has approximately 10 minutes to get to a doctor before there is any harm done to the fetus.
Monoamniotic twins – These twins share the same placenta and the same amniotic sac and therefore can interfere with each others umbilical cords. When entanglement of the cords is detected, it is highly recommended to deliver the fetuses as early as 31 weeks.
Umbilical cord length - A short umbilical cord (<30 cm) can affect the fetus in that fetal movements can cause cord compression, constriction, and rupture. A long umbilical cord (>72 cm) can affect the fetus depending on the way the fetus interacts with the cord. Some fetuses grasp the umbilical cord but it is yet unknown as to whether a fetus is strong enough to compress and stop blood flow through the cord. Also, an active fetus, one that frequently repositions itself in the uterus can accidentally entangle itself with the cord. A hyperactive fetus should be evaluated with ultrasound to rule out cord entanglement.
Cord entanglement - The umbilical cord can wrap around an extremity, the body or the neck of the fetus. When the cord is wrapped around the neck of the fetus, it is called a nuchal cord. These entanglements can cause constriction of blood flow to the fetus. These entanglements can be visualized with ultrasound.
Torsion – This term refers to the twisting of the umbilical around itself. Torsion of the umbilical cord is very common (especially in equine stillbirths) but it is not a natural state of the umbilical cord. The umbilical cord can be untwisted at delivery. The average cord has three twists.
Smoke Inhalation - If a pregnant woman gets trapped in a building fire, the smoke and fumes can kill an unborn child.A pregnant woman sleeping on her back after 28 weeks of pregnancy may be a risk factor for stillbirth.After a stillbirth there is a 2.5% risk of another stillbirth in the next pregnancy (an increase from 0.4%).In the United States, highest rates of stillbirths happen in pregnant women who:
are of low socioeconomic status
are aged 35 years or older
have chronic medical conditions such as diabetes, high blood pressure, high cholesterol, etc.
are African-American
have previously lost a child during pregnancy
have multiple children at a time (twins, triplets, etc.)

Diagnosis
It is unknown how much time is needed for a fetus to die. Fetal behavior is consistent and a change in the fetus movements or sleep-wake cycles can indicate fetal distress. A decrease or cessation in sensations of fetal activity may be an indication of fetal distress or death, though it is not entirely uncommon for a healthy fetus to exhibit such changes, particularly near the end of a pregnancy when there is considerably less space in the uterus than earlier in pregnancy for the fetus to move about. Still, medical examination, including a nonstress test, is recommended in the event of any type of any change in the strength or frequency of fetal movement, especially a complete cease; most midwives and obstetricians recommend the use of a kick chart to assist in detecting any changes. Fetal distress or death can be confirmed or ruled out via fetoscopy/doptone, ultrasound, and/or electronic fetal monitoring. If the fetus is alive but inactive, extra attention will be given to the placenta and umbilical cord during ultrasound examination to ensure that there is no compromise of oxygen and nutrient delivery.Some researchers have tried to develop models to identify, early on, pregnant women who may be at high risk of having a stillbirth.

Definition
There are a number of definitions for stillbirth. To allow comparison, the World Health Organization uses the ICD-10 definitions and recommends that any baby born without signs of life at greater than or equal to 28 completed weeks gestation be classified as a stillbirth.: Overview tab  The WHO uses the ICD-10 definitions of "late fetal deaths" as their definition of stillbirth. Other organisations recommend that any combination of greater than 16, 20, 22, 24 or 28 weeks gestational age or 350 g, 400 g, 500 g or 1000 g birth weight may be considered a stillbirth.The term is often used in distinction to live birth (the baby was born alive, even if it died shortly thereafter) or miscarriage (early pregnancy loss). The word miscarriage is often used incorrectly to describe stillbirths. The term is mostly used in a human context; however, the same phenomenon can occur in all species of placental mammals.

Constricted umbilical cord
When the umbilical cord is constricted (q.v. "accidents" above), the fetus experiences periods of hypoxia, and may respond by unusually high periods of kicking or struggling, to free the umbilical cord.  These are sporadic if constriction is due to a change in the fetus or mothers position, and may become worse or more frequent as the fetus grows. Extra attention should be given if mothers experience large increases in kicking from previous childbirths, especially when increases correspond to position changes.Regulating high blood pressure, diabetes and drug use may reduce the risk of a stillbirth.  Umbilical cord constriction may be identified and observed by ultrasound, if requested.Some maternal factors are associated with stillbirth, including being age 35 or older, having diabetes, having a history of addiction to illegal drugs, being overweight or obese, and smoking cigarettes in the three months before getting pregnant.

Treatment
Fetal death in utero does not present an immediate health risk to the pregnant woman, and labour will usually begin spontaneously after two weeks, so the pregnant woman may choose to wait and bear the fetal remains vaginally. After two weeks, the pregnant woman is at risk of developing blood clotting problems, and labor induction is recommended at this point. In many cases, the pregnant woman will find the idea of carrying the dead fetus traumatizing and will elect to have labor induced. Caesarean birth is not recommended unless complications develop during vaginal birth. How the diagnosis of stillbirth is communicated by healthcare workers may have a long-lasting and deep impact on parents. People need to heal physically after a stillbirth just as they do emotionally. In Ireland, for example, people are offered a cuddle cot, a cooled cot which allows them to spend a number of days with their child before burial or cremation.

Delivery
In single stillbirths, common practice is to induce labor for the health of the mother due to possible complications such as exsanguination. Induction and labor can take 48 hours. In the case of various complications such as preclampsia, infections, multiples(twins), emergency Cesarean may occur.

Epidemiology
The average stillbirth rate in the United States is approximately 1 in 160 births, which is roughly 26,000 stillbirths each year. In Australia, England, Wales, and Northern Ireland, the rate is approximately 1 in every 200 births; in Scotland, 1 in 167. Rates of stillbirth in the United States have decreased by about two-thirds since the 1950s.The vast majority of stillbirths worldwide (98%) occur in low and middle-income countries, where medical care can be of low quality or unavailable. Reliable estimates calculate that, yearly, about 2.6 million stillbirths occur worldwide during the third trimester. Stillbirths were previously not included in the Global Burden of Disease Study which records worldwide deaths from various causes until 2015.

Society and culture
The way people view stillbirths has changed dramatically over time; however, its economic and psychosocial impact is often underestimated. In the early 20th century, when a stillbirth occurred, the baby was taken and discarded and the parents were expected to immediately let go of the attachment and try for another baby. In many countries, parents are expected by friends and family members to recover from the loss of an unborn baby very soon after it happens. Societally-mediated complications such as financial hardship and depression are among the more common results. A stillbirth can have significant psychological effects on the parents, notably causing feelings of guilt in the mother. Further psycho-social effects on parents include apprehension, anger, feelings of worthlessness and not wanting to interact with other people, with these reactions sometimes carried over into pregnancies that occur after the stillbirth. Men also suffer psychologically after stillbirth, although they are more likely to hide their grief and feelings and try to act strong, with the focus on supporting their partner.

Legal definitions
Australia
In Australia, stillbirth is defined as a baby born with no signs of life that weighs more than 400 grams, or more than 20 weeks in gestation. They legally must have their birth registered.

Austria
In Austria, a stillbirth is defined as a birth of a child of at least 500g weight without vital signs, e.g. blood circulation, breath or muscle movements.

Canada
Beginning in 1959, "the definition of a stillbirth was revised to conform, in substance, to the definition of fetal death recommended by the World Health Organization". The definition of "fetal death" promulgated by the World Health Organization in 1950 is as follows:

"Fetal death" means death prior to the complete expulsion or extraction from its mother of a product of human conception, irrespective of the duration of pregnancy and which is not an induced termination of pregnancy. The death is indicated by the fact that after such expulsion or extraction, the fetus does not breathe or show any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles. Heartbeats are to be distinguished from transient cardiac contractions; respirations are to be distinguished from fleeting respiratory efforts or gasps.

Germany
In Germany, a stillbirth is defined as the birth of a child of at least 500g weight without blood circulation or breath. Details for burial vary amongst the federal states.

Republic of Ireland
Since 1 January 1995, stillbirths occurring in the Republic of Ireland must be registered; stillbirths that occurred before that date can also be registered but evidence is required. For the purposes of civil registration, s.1 of the Stillbirths Registration Act 1994 refers to "...a child weighing at least 500 grammes, or having reached a gestational age of at least 24 weeks who shows no signs of life."

Netherlands
In the Netherlands, stillbirth is defined differently by the Central Bureau of Statistics (CBS) and the Dutch Perinatal Registry (Stichting PRN). The birth and mortality numbers from the CBS include all livebirths, regardless of gestational duration, and all stillbirths from 24 weeks of gestation and onwards. In the Perinatal Registry, gestational duration of both liveborn and stillborn children is available. They register all liveborn and stillborn children from 22, 24 or 28 weeks of gestation and onwards (dependent on the report: fetal, neonatal or perinatal mortality). Therefore, data from these institutions on (still)births can not simply be compared one-on-one.

United Kingdom
The registration of stillbirths has been required in England and Wales from 1927 and in Scotland from 1939 but is not required in Northern Ireland. Sometimes a pregnancy is terminated deliberately during a late phase, for example due to congenital anomaly. UK law requires these procedures to be registered as "stillbirths".

England and Wales
For the purposes of the Births and Deaths Registration Act 1926 (as amended), section 12 contains the definition:"still-born" and "still-birth" shall apply to any child which has issued forth from its mother after the twenty fourth week of pregnancy and which did not at any time after being completely expelled from its mother, breathe or show any other signs of life.A similar definition is applied within the Births and Deaths Registration Act 1953 (as amended), contained in s.41.
The above definitions apply within those Acts thus other legislation will not necessarily be in identical terms.
s.2 of the 1953 Act requires that registration of a birth takes place within 42 days of the birth except where an inquest takes place or the child has been "found exposed" in which latter case the time limit runs from the time of finding.
Extracts from the register of stillbirths are restricted to those who have obtained consent from the Registrar General for England and Wales.

Scotland
Section 56(1) of the Registration of Births, Deaths and Marriages (Scotland) Act 1965 (as amended) contains the definition:"still-born child" means a child which has issued forth from its mother after the twenty-fourth week of pregnancy and which did not at any time after being completely expelled from its mother breathe or show any other signs of life, and the expression "still-birth" shall be construed accordinglys.21(1) of the same Act requires that:Except so far as otherwise provided by this section or as may be prescribed, the provisions of this Part of this Act shall, so far as applicable, apply to still-births in like manner as they apply to births of children born alive.In the general case, s.14 of the Act requires that a birth has to be registered within 21 days of the birth or of the child being found.
Unlike the registers for births, marriages, civil partnerships and deaths, the register of still-births is not open to public access and issue of extracts requires the permission of the Registrar General for Scotland.

Northern Ireland
In Northern Ireland, the Births and Deaths Registration (Northern Ireland) Order 1976, as amended contains the definition:"still-birth" means the complete expulsion or extraction from its mother after the twenty-fourth week of pregnancy of a child which did not at any time after being completely expelled or extracted breathe or show any other evidence of life.Registration of stillbirths can be made by a relative or certain other persons involved with the stillbirth but it is not compulsory to do so. Registration takes place with the District Registrar for the Registration District where the still-birth occurred or for the District in which the mother is resident. A stillbirth certificate will be issued to the registrant with further copies only available to those obtaining official consent for their issue. Registration may be made within three months of the still-birth.

United States
In the United States, there is no standard definition of the term stillbirth.In the U.S., the Born-Alive Infants Protection Act of 2002 specifies that any breathing, heartbeat, pulsating umbilical cord or confirmed voluntary muscle movement indicate live birth rather than stillbirth.The Centers for Disease Control and Prevention collects statistical information on "live births, fetal deaths, and induced termination of pregnancy" from 57 reporting areas in the United States. Each reporting area has different guidelines and definitions for what is being reported; many do not use the term "stillbirth" at all. The federal guidelines suggest (at page 1) that fetal death and stillbirth can be interchangeable terms. The CDC definition of "fetal death" is based on the definition promulgated by the World Health Organization in 1950 (see section above on Canada). Researchers are learning more about the long term psychiatric sequelae of traumatic birth and believe the effects may be intergenerationalThe federal guidelines recommend reporting those fetal deaths whose birth weight is over 12.5 oz (350 g), or those more than 20 weeks gestation. Forty-one areas use a definition very similar to the federal definition, thirteen areas use a shortened definition of fetal death, and three areas have no formal definition of fetal death </s>


<s> [INST] <<SYS>> You are a responsible assistant committed to providing accurate and helpful responses. Avoid sharing harmful or biased content. Clarify any unclear or incorrect questions rather than providing false or misleading information. <</SYS>> What is Aura (symptom) and can you explain it in depth? [/INST] An aura is a perceptual disturbance experienced by some with epilepsy or migraine. An epileptic aura is a seizure.Epileptic and migraine auras are due to the involvement of specific areas of the brain, which are those that determine the symptoms of the aura. Therefore, if the visual area is affected, the aura will consist of visual symptoms, while if a sensory one, then sensory symptoms will occur.
Epileptic auras are subjective sensory or psychic phenomena due to a focal seizure, i.e. a seizure that originates from that area of the brain responsible for the function which then expresses itself with the symptoms of the aura. It is important because it makes it clear where the alteration causing the seizure is located. An epileptic aura is in most cases followed by other manifestations of a seizure, for example a convulsion, since the epileptic discharge spreads to other parts of the brain. Rarely it remains isolated. Auras, when they occur, allow some people who have epilepsy time to prevent injury to themselves and/or others when they lose consciousness.

Migraine
The aura of migraine is visual in the vast majority of cases, because dysfunction starts from the visual cortex. The aura is usually followed, after a time varying from minutes to an hour, by the migraine headache. However, the migraine aura can manifest itself in isolation, that is, without being followed by headache. The aura can stay for the duration of the migraine; depending on the type of aura, it can leave the person disoriented and confused. It is common for people with migraines to experience more than one type of aura during the migraine. Most people who have auras have the same type of aura every time.Auras can also be confused with sudden onset of panic, panic attacks or anxiety attacks, which creates difficulties in diagnosis </s>


<s> [INST] <<SYS>> You are a responsible assistant committed to providing accurate and helpful responses. Avoid sharing harmful or biased content. Clarify any unclear or incorrect questions rather than providing false or misleading information. <</SYS>> What is Occupational burnout and can you explain it in depth? [/INST] According to the World Health Organization (WHO), occupational burnout is a syndrome resulting from chronic work-related stress, with symptoms characterized by "feelings of energy depletion or exhaustion; increased mental distance from one’s job, or feelings of negativism or cynicism related to ones job; and reduced professional efficacy". While burnout may influence health and can be a reason for people contacting health services, it is not itself classified by the WHO as a medical condition or mental disorder. WHO additional states that "Burn-out refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life."

History
According to Wolfgang Kaskcha, "Burnout as a phenomenon has probably existed at all times and in all cultures." He notes that the condition is described in the Book of Exodus.
Gordon Parker believes the ancient European concept of acedia refers to burnout, and not depression as many others believe.It has been suggested that the first printed use of the term "burnout" in English was in one of Shakespeares sonnets in 1599, referring to a womans love burning out. The sonnet in question is one of Shakespeares most famous.
In 1869, New York neurologist George Beard used the term "neurasthenia" to describe a very broad condition caused by the exhaustion of the nervous system, which was thought to be particularly found in "civilized, intellectual communities." The concept soon became popular, and many in the United States believed themselves to have it. Some came to call it "Americanitis". The rest cure was a commonly prescribed treatment (though there were many others). Beard yet further broadened the potential symptoms of neurasthenia over time, so that almost any symptom or behaviour could be deemed to be caused by it. Don R Lipsitt would later wonder if the term "burnout" was similarly too broadly defined to be useful.In 1961, Graham Greene published the novel A Burnt-Out Case, the story of an architect who became greatly fatigued by his work, and who took much time to recover.In 1969, HB Bradley used the term "burnout" in a criminology paper to describe the fatigued staff at a centre for treating young adult offenders. This has been cited as the first known academic work to use the term for this concept.In 1974, Herbert Freudenberger, an American psychologist, used the term in his academic paper "Staff Burn-Out." The paper was based on his qualitative observations of the volunteer staff (including himself) at a free clinic for drug addicts. He characterized burnout by a set of symptoms that includes exhaustion resulting from works excessive demands as well as physical symptoms such as headaches and sleeplessness, "quickness to anger", and closed thinking. He observed that the burned-out worker "looks, acts, and seems depressed." After the publication of Freudenbergers paper, interest in the concept grew.
In 1976, Christina Maslach noted the term being used by California lawyers working with the poor, and began to study the concept.In 1981, Maslach and Susan E. Jackson published an instrument for assessing burnout, the Maslach Burnout Inventory (MBI). It was the first such instrument of its kind and the most widely used burnout instrument. The two researchers described burnout in terms of emotional exhaustion, depersonalization (feeling low-empathy towards other people in an occupational setting), and reduced feelings of work-related personal accomplishment.In 2010, the Swedish Board of Health and Welfare adopted a refined conceptualisation of severe burnout it described as "exhaustion disorder."In 2015, The World Health Organization adopted a conceptualisation of burnout that is consistent with Maslachs. It adopted a modified version of this in 2022. However, "is not itself classified by the WHO as a medical condition or mental disorder."As of 2017, nine European countries considered burnout as being a recognised medical disorder.

Diagnosis
Classification
The two main classification systems of psychological disorders are the Diagnostic and Statistical Manual of Mental Disorders (DSM, used in North America and elsewhere) from the American Psychiatric Association (APA), and the International Classification of Diseases (ICD, used in Europe and elsewhere) from the World Health Organisation (WHO).
Burnout is not recognized as a distinct mental disorder in the DSM-5 (published in 2013). Its definitions for Adjustment Disorders, and Unspecified Trauma- and Stressor-Related Disorder in some cases reflect the condition. 2022s update, the DSM-5-TR, did not add a definition of burnout.As of 2017, nine European countries considered burnout as being a recognised medical disorder. These countries classify it under one or more codes of the ICD.
The ICD-10 (current 1994–2021) classified "burn-out" as a type of non-medical life-management difficulty under code Z73.0. It was considered to be one of the "factors influencing health status and contact with health services" and "should not be used" for "primary mortality coding". It was also considered one of the "problems related to life-management difficulty". The condition is further defined as being a "state of vital exhaustion," which historically had been called neurasthenia.The ICD-10 also contained a medical condition category of "F43.8 Other reactions to severe stress."In 2010 the Swedish Board of Health and Welfare added “exhaustion disorder” (ED; F43.8A) to the Swedish version of the ICD-10, the ICD-10-SE, representing what is typically called "burnout" in English. (See also sv:Utmattningssyndrom). Swedish sufferers of severe burnout had earlier been treated as having neurasthenia.The ICD-10-SE defined exhaustion disorder as consisting of:

A. Physical and mental symptoms of exhaustion during at least two weeks. The symptoms have developed in response to one or more identifiable stressors present for at least six months.
B. The clinical picture is dominated by markedly reduced mental energy, as manifested by reduced initiative, lack of endurance, or increased time needed for recovery after mental effort.
C. At least four of the following symptoms have been present, nearly every day, during the same 2-week period:

Concentration difficulties or impaired memory
Markedly reduced capacity to tolerate demands or to work under time pressure
Emotional instability or irritability
Sleep disturbance
Marked fatigability or physical weakness
Physical symptoms such as aches and pains, palpitations, gastrointestinal problems, vertigo or increased sensitivity to soundD. The symptoms cause clinically significant distress or impairment in occupational, social or other important respects.

E. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a physical illness/injury (e.g., hypothyroidism, diabetes, infectious disease).
According to Lindsäter et al., "The diagnosis has become almost as prevalent as major depression in Swedish health care settings, and currently accounts for more instances of long-term sick-leave reimbursement than any other single diagnosis in the country."The Royal Dutch Medical Association defined "burnout" as a subtype of adjustment disorder as part of the ICD-10 system. In the Netherlands burnout is included in handbooks and medical staff are trained in its diagnosis and treatment. A reform of Dutch health insurance resulted in adjustment disorder treatment being removed from the compulsory basic package in 2012. Practiconers were told that more serious cases of the condition may qualify for classification as depression or anxiety disorder.A new version of the ICD, ICD-11, was released in June 2018, for first use in January 2022. The new version has an entry coded and titled "QD85 Burn-out". The ICD-11 describes the condition this way:

Burn-out is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions: 1) feelings of energy depletion or exhaustion; 2) increased mental distance from one’s job, or feelings of negativism or cynicism related to ones job; and 3) reduced professional efficacy. Burn-out refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life.
This condition is classified under "Problems associated with employment or unemployment" in the section on "Factors influencing health status or contact with health services." The section is devoted to reasons other than recognized diseases or health conditions for which people contact health services. In a statement made in May 2019, the WHO said "Burn-out is included in the 11th Revision of the International Classification of Diseases (ICD-11) as an occupational phenomenon. It is not classified as a medical condition."The ICDs browser and coding tool both attach the term "caregiver burnout" to category "QF27 Difficulty or need for assistance at home and no other household member able to render care." QF27 thus acknowledges that burnout can occur outside the work context.
The ICD-11 also has the medical condition "6B4Y Other specified disorders specifically associated with stress", which is the equivalent of the ICD-10s F43.8.
If, after treatment, a person with burnout continues to have persistent physical symptoms triggered by the condition, in Iceland they may be considered to have "somatic symptom disorder" (DSM-5) and "bodily distress disorder" (ICD-11).Further detail about the varied ways clinicians and others use ICD and DSM classification with burnout was published by Arno Van Dam in 2021.The US governments National Institutes of Health includes the condition as "psychological burnout" in its index of the National Library of Medicine, and provides a number of synonyms. It defines the condition as "An excessive reaction to stress caused by ones environment that may be characterized by feelings of emotional and physical exhaustion, coupled with a sense of frustration and failure."SNOMED CT includes the term "burnout" as a synonym for its defined condition of "Physical AND emotional exhaustion state," which is a subtype of anxiety disorder. The Diseases Database defines the condition as "professional burnout."

Instruments
In 1981, Maslach and Jackson developed the first widely used instrument for assessing burnout, the Maslach Burnout Inventory (MBI). It remains by far the most commonly used instrument to assess the condition. Consistent with Maslachs conceptualization, the MBI operationalizes burnout as a three-dimensional syndrome consisting of emotional exhaustion, depersonalization (an unfeeling and impersonal response toward recipients of ones service, care, treatment, or instruction), and reduced personal accomplishment.The MBI originally focused on human service professionals (e.g., teachers, social workers). Since that time, the MBI has been used for a wider variety of workers (e.g., healthcare workers). The instrument or its variants are now employed with job incumbents working in many other occupations.There are other conceptualizations of burnout that differ from that suggested by Maslach and adopted by the WHO.
In 1999, Demerouti and Bakker, with their Oldenburg Burnout Inventory (OLBI), conceptualized burnout in terms of exhaustion and disengagement, linking it to the job demands-resources model. This instrument is used mainly in the United States.
Also that year, Wilmar Schaufeli and Arnold Bakker released the Utrecht Work Engagement Scale (UWES). It uses a similar conceptualisation to the MBI. However the UWES measures vigour, dedication and absorption; positive counterparts to the values measured by the MBI. It is used mainly in Germany.
In 2005, TS Kristensen et al. released the public domain Copenhagen Burnout Inventory (CBI). They argued that the definition of burnout should be limited to fatigue and exhaustion. The CBI has had some use in Germany.
In 2006, Shirom and Melamed with their Shirom-Melamed Burnout Measure (SMBM) conceptualized burnout in terms of physical exhaustion, cognitive weariness, and emotional exhaustion. An examination of the SMBMs emotional exhaustion subscale, however, indicates that the subscale more clearly embodies Maslachs concept of depersonalization than her concept of emotional exhaustion. This measure has seen little use.
In 2010, researchers from Mayo Clinic used portions of the MBI, along with other comprehensive assessments, to develop the Well-Being Index, a nine-item self-assessment tool designed to measure burnout and other dimensions of distress in healthcare workers specifically. It has been mainly used in the United States.
In 2014, Aniella Besèr et al. developed the Karolinska Exhaustion Disorder Scale (KEDS), which is used mainly in Sweden. It was designed to measure the symptoms defined by the ICD-10-SEs category for exhaustion disorder. The authors believed that those with the disorder were often initially depressed, but that this soon passed. The core symptoms of the disorder were deemed to be "exhaustion, cognitive problems, sleep disturbance". The authors also believed that the condition was clearly differentiated from both depression and anxiety.
In 2020, the Occupational Depression Inventory (ODI), was developed to quantify the severity of work-attributed depressive symptoms and establish provisional diagnoses of job-ascribed depression. The ODI covers nine symptoms, including exhaustion (burnout’s putative core). The instrument exhibits particularly robust psychometric properties. The ODI is the only instrument that assesses work-related suicidal thoughts, a particularly important symptom calling for immediate attention.
In 2021, the Sydney Burnout Measure (SBM) was released by Gordon Parker et al., which "captures domains of exhaustion, cognitive impairment, loss of empathy, withdrawal and insularity, and impaired work performance, as well as several anxiety, depression and irritability symptoms."There are still other conceptualizations as well that are embodied in other instruments, including the Hamburg Burnout Inventory, and Malach-Piness Burnout Measure.Kristensen et al. and Malach-Pines (who also published as Pines) advanced the view that burnout can also occur in connection to life outside of work. For example, Malach-Pines developed a burnout measure keyed the role of spouse.The core of all of these conceptualizations, including that of Freudenberger, is exhaustion.Maslach advanced the idea that burnout should not be viewed as a depressive condition. Recent evidence, based on factor-analytic and meta-analytic findings, calls into question this supposition. Burnout is also now often seen as involving the full array of depressive symptoms (e.g., low mood, cognitive alterations, sleep disturbance).Marked differences among researchers conceptualizations of what constitutes burnout have underlined the need for a consensus definition.

Subtypes
In 1991, Barry A. Farber in his research on teachers proposed that there are three types of burnout:

"wearout" and "brown-out," where someone gives up having had too much stress and/or too little reward
"classic/frenetic burnout," where someone works harder and harder, trying to resolve the stressful situation and/or seek suitable reward for their work
"underchallenged burnout," where someone has low stress, but the work is unrewarding.Farber found evidence that the most idealistic teachers who enter the profession are the most likely to suffer burnout.

Caregiver burnout
Burnout affects caregivers.

Relationship with other conditions
A growing body of evidence suggests that burnout is etiologically, clinically, and nosologically similar to depression. In a study that directly compared depressive symptoms in burned out workers and clinically depressed patients, no diagnostically significant differences were found between the two groups; burned out workers reported as many depressive symptoms as clinically depressed patients. Moreover, a study by Bianchi, Schonfeld, and Laurent (2014) showed that about 90% of workers with very high scores on the MBI meet diagnostic criteria for depression. The view that burnout is a form of depression has found support in several recent studies. Some authors have recommended that the nosological concept of burnout be revised or even abandoned entirely given that it is not a distinct disorder and that there is no agreement on burnouts diagnostic criteria. A newer generation of studies indicates that burnout, particularly its exhaustion dimension, problematically overlaps with depression; these studies have relied on more sophisticated statistical techniques, for example, exploratory structural equation modeling (ESEM) bifactor analysis, than earlier studies of the topic. The advantage of ESEM bifactor analysis, which combines the best features of exploratory and confirmatory factor analysis, is that it provides a granular look at item-construct relationships, without falling into traps earlier burnout researchers fell into.Liu and van Liew wrote that "the term burnout is used so frequently that it has lost much of its original meaning. As originally used, burnout meant a mild degree of stress-induced unhappiness. The solutions ranged from a vacation to a sabbatical. Ultimately, it was used to describe everything from fatigue to a major depression and now seems to have become an alternative word for depression, but with a less serious significance" (p. 434). The authors equate burnout with adjustment disorder with depressed mood.
Kakiashvili et al., however, argued that although burnout and depression have overlapping symptoms, endocrine evidence suggests that the disorders biological bases are different. They argued that antidepressants should not be used by people with burnout because the medications can make the underlying hypothalamic–pituitary–adrenal axis dysfunction worse.

Despite its name, depression with atypical features, which is seen in the above table, is not a rare form of depression. The cortisol profile in atypical depression, in contrast to that of melancholic depression, is similar to the cortisol profile found in burnout. Commentators advanced the view that burnout differs from depression because the cortisol profile of burnout differs from that of melancholic depression; however, as the above table indicates, burnouts cortisol profile is similar to that of atypical depression.It has previously been hypothesised that Chronic Fatigue Syndrome (CFS), also known as Myalgic Encephalomyelitis (ME), is caused by burnout. It is suggested that the "burning out" of the bodys stress symptom (by any of a wide range of causes) can lead to chronic fatigue. However, the very nomenclature of "Chronic Fatigue Syndrome" is viewed as problematic by both patients and healthcare professionals specialising in the condition, as it fails to encompass the wide range of non-fatigue related symptoms present in ME/CFS, or to differentiate between the so-named condition and the symptom of chronic fatigue which is present in many unrelated conditions or diseases. Furthermore, more up-to-date research has shown that ME/CFS is a multi-systemic condition that is not psychological in etiology and so comparison to occupational burnout is now less prudent.Overtraining syndrome is also known as "chronic fatigue," "burnout" and "overstress" in athletes. It has been conceptualised as adjustment disorder, a common diagnosis for those burnt out.Recovering alcoholics often have a blunted cortisol response to stress, as do some cancer patients and survivors. This symptom is a particular feature of people suffering burnout. Altered cortisol response is experienced by up to 80% of people with depression.

Risk factors
Evidence suggests that the etiology of burnout is multifactorial, with personality factors playing an important, long-overlooked role. Cognitive dispositional factors implicated in depression have also been found to be implicated in burnout. One cause of burnout includes stressors that a person is unable to cope with fully.Burnout is thought to occur when a mismatch is present between the nature of the job and the job the person is actually doing. A common indication of this mismatch is work overload, which sometimes involves a worker who survives a round of layoffs, but after the layoffs the worker finds that he or she is doing too much with too few resources. Overload may occur in the context of downsizing, which often does not narrow an organizations goals, but requires fewer employees to meet those goals. The research on downsizing, however, indicates that downsizing has more destructive effects on the health of the workers who survive the layoffs than mere burnout; these health effects include increased levels of sickness and greater risk of mortality.The job demands-resources model has implications for burnout, as measured by the Oldenburg Burnout Inventory (OLBI). Physical and psychological job demands were concurrently associated with the exhaustion, as measured by the OLBI. Lack of job resources was associated with the disengagement component of the OLBI.
Maslach, Schaufeli and Leiter identified six risk factors for burnout in 2001: mismatch in workload, mismatch in control, lack of appropriate awards, loss of a sense of positive connection with others in the workplace, perceived lack of fairness, and conflict between values.Although job stress has long been viewed as the main determinant of burnout, recent meta-analytic findings indicate that job stress is a weak predictor of burnout. These findings question one of the most central assumptions of burnout research.
In a systematic literature review in 2014, the Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU) found that a number of work environment factors could affect the risk of developing exhaustion disorder or depressive symptoms:

People who experience a work situation with little opportunity to influence, in combination with too high demands, develop more depressive symptoms.
People who experience a lack of compassionate support in the work environment develop more symptoms of depression and exhaustion disorder than others. Those who experience bullying or conflict in their work develop more depressive symptoms than others, but it is not possible to determine whether there is a corresponding connection for symptoms of exhaustion disorder.
People who feel that they have urgent work or a work situation where the reward is perceived as small in relation to the effort develops more symptoms of depression and exhaustion disorder than others. This also applies to those who experience insecurity in the employment, for example concerns that the workplace will be closed down.
In some work environments, people have less trouble. People who experience good opportunities for control in their own work and those who feel that they are treated fairly develop less symptoms of depression and exhaustion disorder than others.
Women and men with similar working conditions develop symptoms of depression as much as exhaustion disorder.Negative consequences of burnout on both the employee and the organization call for preventive measures in order to reduce the impact of the risk factors. Burnout prevention strategies, either addressing to the general working population (primary prevention) or the occupational groups which are more vulnerable (secondary prevention), are focused on reducing the impact of risk factors. Reviews of healthcare professionals‟ burnout focusing on identifying risk factors have been conducted previously.

Effects
Some research indicates that burnout is associated with reduced job performance, coronary heart disease, and mental health problems. Examples of emotional symptoms of occupational burnout include a lack of interest in the work being done, a decrease in work performance levels, feelings of helplessness, and trouble sleeping. With regard to mental health problems, research on dentists and physicians suggests that what is meant by burnout is a depressive syndrome. Thus reduced job performance and cardiovascular risk could be related to burnout because of burnouts tie to depression. Behavioral signs of occupational burnout are demonstrated through cynicism within workplace relationships with coworkers, clients, and the organization itself.
Other effects of burnout can manifest as lower energy and productivity levels, with workers observed to be consistently late for work and feeling a sense of dread upon arriving. They can suffer concentration problems, forgetfulness, increased frustration, and/or feelings of being overwhelmed. They may complain and feel negative, or feel apathetic and believe they have little impact on their coworkers and environment. Occupational burnout is also associated with absenteeism, other time missed from work, and thoughts of quitting.Chronic burnout is also associated with cognitive impairments in memory and attention. (See also Effects of stress on memory.)
Research suggests that burnout can manifest differently between genders, with higher levels of depersonalisation among men and increased emotional exhaustion among women. Other research suggests that people revealing a history of occupational burnout face future hiring discrimination.When it happens in the context of volunteering, burnout can often lead to volunteers significantly reducing their activities or stopping volunteering altogether. Likewise, academic stress, as it has been called, or academic burnout is a process originated from the inciting element, which implies the subjection to events that from the students perspective can be considered as stressors.Burnout might result in learned helplessness.Burnout has been found to be associated with spiritual health.

Stages
Drozdstoj Stoyanov et al. believe burnout has three stages:

Flame out - trying to deal with excessive stress, causing depression and anxiety.
Genuine burn out - a process of increasing emotional exhaustion.
Rust out - being completely alienated from other people, cynical and ineffective.

Treatment and prevention
Health condition treatment and prevention methods are often classified as "primary prevention" (stopping the condition occurring), "secondary prevention" (removing the condition that has occurred) and "tertiary prevention" (helping people live with the condition).
In addition to interventions that can address and improve conditions on the work side of work-life balance, the ways in which people spend their non-work time can help to prevent burnout and improve health and well-being.

Primary prevention
Maslach believes that the only way to truly prevent burnout is through a combination of organizational change and education for the individual.Maslach and Leiter postulated that burnout occurs when there is a disconnection between the organization and the individual with regard to what they called the six areas of worklife: workload, control, reward, community, fairness, and values. Resolving these discrepancies requires integrated action on the part of both the individual and the organization. With regard to workload, assuring that a worker has adequate resources to meet demands as well as ensuring a satisfactory work–life balance could help revitalize employees energy. With regard to values, clearly stated ethical organizational values are important for ensuring employee commitment. Supportive leadership and relationships with colleagues are also helpful.One approach for addressing these discrepancies focuses specifically on the fairness area. In one study employees met weekly to discuss and attempt to resolve perceived inequities in their job. The intervention was associated with decreases in exhaustion over time but not cynicism or inefficacy, suggesting that a broader approach is required.Hätinen et al. suggest "improving job-person fit by focusing attention on the relationship between the person and the job situation, rather than either of these in isolation, seems to be the most promising way of dealing with burnout." They also note that "at the individual level, cognitive-behavioural strategies have the best potential for success."
Burnout prevention programs have traditionally focused on cognitive-behavioral therapy (CBT), cognitive restructuring, didactic stress management, and relaxation. CBT, relaxation techniques (including physical techniques and mental techniques), and schedule changes are the best-supported techniques for reducing or preventing burnout in a health-care setting. Mindfulness therapy has been shown to be an effective preventative for occupational burnout in medical practitioners. Combining both organizational and individual-level activities may be the most beneficial approach to reducing symptoms. A Cochrane review, however, reported that evidence for the efficacy of CBT in healthcare workers is of low quality, indicating that it is no better than alternative interventions.For the purpose of preventing occupational burnout, various stress management interventions have been shown to help improve employee health and well-being in the workplace and lower stress levels. Training employees in ways to manage stress in the workplace have also been shown to be effective in preventing burnout. One study suggests that social-cognitive processes such as commitment to work, self-efficacy, learned resourcefulness, and hope may insulate individuals from experiencing occupational burnout. Increasing a workers control over his or her job is another intervention has been shown to help counteract exhaustion and cynicism in the workplace.Additional prevention methods include: starting the day with a relaxing ritual; yoga; adopting healthy eating, exercising, and sleeping habits; setting boundaries; taking breaks from technology; nourishing ones creative side, and learning how to manage stress.Barry A. Farber suggests strategies like setting more achievable goals, focusing on the value of the work, and finding better ways of doing the job, can all be helpful ways of helping the stressed. People who dont mind the stress but want more reward can benefit from reassessing their work–life balance and implementing stress reduction techniques like meditation and exercise. Others with low stress, but are underwhelmed and bored with work, can benefit from seeking greater challenge.In one trial, workers taking a high-dose Vitamin B complex "reported significantly lower personal strain and a reduction in confusion and depressed/dejected mood after 12 weeks."In another trial, doctors undertaking a program involving "mindfulness, reflection, shared experience, and small-group learning" for 9 months had a much lessened propensity to burn out. Another trial with medical interns found a ten-week mindfulness program reduced the incidence of burnout.

Secondary and tertiary prevention (aka treatment and management)
Hätinen et al. list a number of common treatments, including treatment of any outstanding medical conditions, stress management, time management, depression treatment, psychotherapies, ergonomic improvement and other physiological and occupational therapy, physical exercise and relaxation. They have found that is more effective to have a greater focus on "group discussions on work related issues", and discussion about "work and private life interface" and other personal needs with psychologists and workplace representatives.Jac JL van der Klink and Frank JH van Dijk suggest stress inoculation training, cognitive restructuring, graded activity and "time contingency" (progressing based on a timeline rather than patients comfort) are effective methods of treatment.Kakiashvili et al. said that "medical treatment of burnout is mostly symptomatic: it involves measures to prevent and treat the symptoms." They say the use of anxiolytics and sedatives to treat burnout related stress is effective, but does nothing to change the sources of stress. They say the poor sleep often caused by burnout (and the subsequent fatigue) is best treated with hypnotics and CBT (within which they include "sleep hygiene, education, relaxation training, stimulus control, and cognitive therapy"). They advise against the use of antidepressants as they worsen the hypothalamic–pituitary–adrenal axis dysfunction at the core of burnout. They also believe "vitamins and minerals are crucial in addressing adrenal and HPA axis dysfunction," noting the importance of specific nutrients. Omega-3 fatty acids may be helpful. DHA supplementation may also be useful for moderating norepinephrine </s>