As burnout is a stress state, it has been hypothesised that the autonomous nervous system (ANS) and the hypothalamus - pituitary - adrenal axis (HPA axis) are involved. Most studies on the behaviour of these systems have focused on acute stress.
During acute stress, the sympathetic part of the ANS is activated and the parasympathetic part is down-regulated. There is an increase in both heart rate and blood pressure. The immune system is temporarily suppressed, and metabolism becomes catabolic. Among patients with burnout (adrenal fatigue), an increased incidence of common cold, flu like illness and gastroenteritis has been reported.
After stress, all processes return to normal. It is hypothesised, however, that for patients in burnout the ANS and HPA axis have become exhausted due to prolonged and recurrent stress. It has been proposed that, as a consequence, burnout will be accompanied by abnormal (low) blood levels of adrenaline and cortisol and their metabolites. In addition, vital functions, such as heart rate and blood pressure, are expected to remain over-activated, and metabolism and the immune system to be compromised. These dysfunctions would be responsible for the symptom of physical fatigue. Nonetheless, research states that it is unlikely that the foregoing biological changes are responsible for additional symptoms of burnout i.e. feelings of emotional exhaustion (EE), detachment from work, and diminished competence. The additional symptoms of burnout have been largely tied to changes in dopamine and brain derived neurotropic factor (BDNF).
In a recent study (2015) researchers from Leiden University sought to identify potential biomarkers for burnout. The biomarkers addressed included, but were not limited to: cortisol, antioxidant enzymes (SOD, catalase and Malondialdehyde), C-reactive protein, prolactin, coenzyme Q10, DHEA-S and salivary IgA. On review of the most current literature, researchers found that there is no one convincing biomarker to determine burnout, thus, assessment for a number of biomarkers may prove necessary. Moreover, that the nature of burnout is regarded as intra-individual and inter-individual, that is to say, specific to individual circumstance and influenced by environmental condition, several markers require examination.
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