# Saltrabook/Clinical diagnostic guidelines/Mental stress

Stress (adjustment disorder, stress disorder), work-related

### Definition

By adjustment disorder is defined as a clinical condition that Occurs in connection to severe or prolonged psychosocial stress Is characterized by anxiety, aversion and the experience of loss of self-control It is assumed that the non-specific symptoms do not occur in the context of depression, anxiety disorder, functional illness, substance abuse, personality disorder or physical illness Differentiation from normal psychological reactions to life and work are blurred and depends primarily on the duration of symptoms (weeks / months) and consistency (incapacity) Stress disorder is used to describe a long-term mental disorder (up to 2 years) Stress disorders are transient states, although they may be lengthy. If no improvement is seen, the diagnosis should be reconsidered Burn-out syndrome perceived as a stress condition caused by long-term, frequent and intense emotional impact and social interactions in working with people with help, care and service is central. Once the syndrome has developed, it is characterized by emotional exhaustion, emotional distancing and reduced personal performance. The relationship between particular exposures in the workplace and this condition are poorly documented. There are many kasusistiske and theoretical studies, but no controlled studies in part due to diagnosis regard to its cause. Sweden has defined a fatigue syndrome regardless of the cause and found no evidence of correlation with psychosocial work conditions such as high demands and low decision http://www.sbu.se/upload/Publikationer/Content0/1/arbetsmiljo_depression/Arbetsmiljo_depression_fulltext.pdf

### Occurrence

Over the past 10-15 years have seen a gradual increase in the number of work-related mental health problems that are reported to the National Board. In 2013 was supposed stress-related conditions about 25% of all reported work-related illnesses The reasons are not known. We do not know if there is a real increase in the incidence of work-related psychological difficulties or increased focus and interest in the media and among different actors contribute to uncovering previously hidden problems or 'relabeling' of conditions previously went by a different name The notified work-related mental health problems are a heterogeneous group of conditions, but most can probably best be classified as diagnostic adaptation or stress disorders Stress disorders are common in primary care and is associated with high sickness absence but details of incidence in the population and the proportion that have their roots in working conditions, lack of

### Risk Factors

There is no international consensus on the definition and operationalization of psychosocial conditions in the workplace and beyond. Stress Theories based on job strain and effort-reward Imbalance models have gained much ground in research, but have only limited application in clinical practice A pragmatic and simple but undocumented classification based on the experience of the Danish occupational medical practice operates with three main types of work-related problems that can result in stress disorder, or perhaps in the most severe cases depressive disorder Events that can be ratified in time and place (accidents causing death or mutilation, violence, verbal threats, humiliation in the presence of others, repeated serious reprimands, unwanted sexual advances, demotion, disregarding, unwanted transfer or termination, critical media exposure). Employees of the prison service, police, defense and social care sector are like drivers and emergency workers particularly vulnerable to some of these issues, while others occur in any industry Claims quantitatively and / or qualitatively exceeds the personal resources and / or skills. The key is the scope of work (too many tasks) or character (tasks that can not be resolved). The imbalance between demands and resources may be due to mismanagement, lack or unrealistic planning, own requirements and expectations. These conditions typically occur in connection with executive functions, organizational changes and projects with deadlines Conflicts with interpersonal tension and emotional stress. The key is uncomfortable conversations, open hand, personal likes and dislikes and protracted emotionally challenging conflicts, whereas the tasks in itself is not the source of the problems. Long-term cooperation conflicts can be stressful for both employee satisfaction and productivity and are often accompanied by high absenteeism, which further compromises the work environment

### Clinic and diagnostics

The condition develops gradually over weeks to months but may by sudden severe psycho-trauma occur faster The symptoms are nonspecific and include sadness, sleep disturbance, crying, feeling prohibitive care, poor self-esteem, fatigue, irritability, forgetfulness and difficulty concentrating Often, a specific event like a daunting workload or an unpleasant confrontation to mental breakdown with crying and sick leave There are no diagnostic paraclinical tests. Stress hormones, cardiovascular markers and blood pressure can not be used in clinical practice Psychological testing of cognitive function and personality tests and tests for depressive disorder may be helpful differential diagnostic The process can be long lasting (months / years), but are in most cases self-limiting. If the condition does not improve within one year's time, the other diagnosis considered

### Causation

Evaluation of the causal relationship between psychosocial trauma and clinical condition based on history, possibly supplemented by information from work colleagues and / or relatives Are the psychological reactions in a reasonable onset plausible relation to the nature and intensity of the effects or situations the patient has been in? It's a judgment call, the result of more based on

### Consensus than on research evidence

Cause assessment is complicated by the considerable variation in personal vulnerability or resilience. One factor that increases the vulnerability is neuroticism If, prior to the mode's start is an unremarkable work and private life without depression, anxiety or alcohol abuse or current problems in the private sphere, causing diagnosis and causality assessment rarely difficulties

### Workers' Compensation

Stress disorders are not covered by occupational list and will usually not be recognized under workers' compensation law

### Vocational guidance and prevention

It is crucial to support the patient in structuring and solving the problems that led up to the state It should earliest possible clarified whether to rely on the same or another workplace. Assessment of this issue is important to shorten the further process and reduce the risk of transition to long-term absence and in the worst case loss of associated labor It speaks for maintaining current employment, to a shift in itself is an extra burden in a situation where self-esteem is reduced. This is often possible in situations dominated by congestion where the problems can be addressed by appropriate organizational or resource initiatives At harassment and workplace conflict, changing jobs can be the best option Some studies show that supportive cognitive therapy has a beneficial effect on the course. This includes training in practical problem solving related to the specific work. Offers of this nature can be found at some of Occupational Medicine