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23ANTIOXIDANTS IN TREATMENT OF BURNOUT SYNDROME.
Shmirina K.
PhD, assistant of the Department of neurology and neurosurgery Samarkand State Medical Institute, Samarkand, Uzbekistan
Djyrabekova A.
M.D., Doctor of Sciences, Professor, Head of the Department of neurology and neurosurgery Samarkand State Medical Institute, Samarkand, Uzbekistan
Vyazikova N.
PhD, assistant of the Department of neurology and neurosurgery Samarkand State Medical Institute, Samarkand, Uzbekistan
Abstract
High rate, increased requirements for the quality of work, active lifestyle in modern realities negatively impact on the mental and somatic health of a specialist, burnout syndrome (EBS) develops. The study involved 146 office workers. From the total sample, according to the results of the Boyko method, the MBI questionnaire (K. Maslom and S. Jackson) and neurological examination, 50 people were selected with signs of EBS, who were divided into 2 groups. The first included 25 people who directly interacted with people, the second - 25 people who were technical workers, The difference in the severity of the individual phases of EBS in individuals of the first and second groups was revealed, shows the efficacy and safety of the drug Mexidol® in this syndrome.
Keywords. antioxidants, burnout syndrome, office workers.
In the process of professional activity, critical situations inevitably arise for the subjects of activity, which cause labor stresses and the manifestation of psychological deformations of the personality [8,9]. This leads to feelings of energy depletion, increased mental distance from work, cynical or negative attitudes towards work, and the development of burnout syndrome.
According to the definition of the World Health Organization, "emotional burnout syndrome" (EBS) is physical, emotional or motivational exhaustion, characterized by impaired productivity at work, fatigue, insomnia, increased susceptibility to somatic diseases [5,6].
At present, the problems of occupational stress, considered in the framework of the EBS, are highlighted in the ICD-10 in "Burnout syndrome" under the heading Z73.0 (problems associated with difficulties in managing one's own life) and is not classified as an independent disease.
According to ICD-11, burnout is a syndrome recognized as the result of chronic stress in the workplace that has not been successfully overcome. It is characterized by a number of signs: a feeling of motivational or physical exhaustion; increasing mental distance from professional duties and / or a sense of negativity or even cynicism in relation to professional duties; decreased performance and is officially recognized as a disease [1, 6]. The main manifestations of burnout syndrome are physical and emotional weakness, depersonaliza-tion, self-doubt, painfully critical attitude to the work performed and its results, and dissatisfaction with the latter. This can lead to the development of severe depression with pronounced psychosomatic disorders [1, 2].
The mechanism for the formation of the EBS has several theories: personal character, the impact of the professional environment, working conditions, constant stressful situations, etc. Psychiatrist G. Frei-denberg made a great contribution to the study of EBS,
who in 1974 introduced the concept of "Burnout syndrome". He used this syndrome to refer to observed medical personnel who showed signs of exhaustion, loss of motivation, and decreased responsibility up to the development of profound cognitive biases [4,7].
Professional activity can lead to the emergence of psychological barriers, professional fatigue, loss of skills and abilities, decreased performance. All this applies to many types of professions. But the professional activity of office workers is associated with regular communication with other people, emotional empathy and great responsibility, thereby replete with organizational and socio-psychological stress. A serious factor is irregular working hours, overtime work (disrupted work schedule), lack of prospects, limited opportunities, success and achievements. In addition, the conditions of modern life require composure, punctuality, politeness and constant self-control [2, 3, 7]. Publicity is also important and excessive openness (social network) forces you to control every step, which leads to internal instability and emotional irritation. Any negative emotions should receive their expression and discharge, if this does not happen, the emotions and energy of a person are depleted, that is, EBS is the result of accumulated tension.
The human psyche works thanks to the integrity of the neural circuits that ensure the stability of emotional reactions, when the destructive effect of stress, the chain breaks, the person loses support. The stages of the EBS: the first (stress) - manifests itself in the form of dissatisfaction with oneself, "being caged", anxiety and depression; the second (resistance) - a state of emptiness in the soul, emotional and moral disorientation, expansion of the sphere of saving emotions, reduction of professional duties; at the third stage (exhaustion) -emotional detachment and detachment from the problems of other people, psychosomatic disorders. In most cases, patients do not seek help from a doctor, and the availability of medicines allows them to indiscriminately use antidepressants and tranquilizers on their
own, which aggravates the EBS process and makes it difficult to get out of this situation.
The scientific search for ways and methods of protection from the destructive consequences of emotional stress and EBS in the present time acquires an urgent practical need.
The aim of the study. To study the effect of antioxidants on the reduction of burnout syndrome in office workers
Materials and research methods. The study involved office workers (employees of "Agrobank" in Samarkand) aged 25 to 56 years. The work experience was taken into account (from 5 to 15 years).
At the first stage, the selection of study groups was carried out, for this, using a routine method applying questionnaires and tests, a sample was formed for further observation (the total number of interviewed people was 146 persons). EBS was detected using Boyko's method in "EBS diagnostics" at the first stage, in order to clarify the factors of stress formation and the EBS phase (tension, resistance, exhaustion); and also using the MBI questionnaire (K. Maslom and S. Jackson), according to which the value of the scales is calculated (reflects the degree of employee satisfaction as a person and a professional).
At the second stage, in order to identify the level of emotional burnout, the patients were examined by a neurologist (clinical and neurological examination card), some patients underwent neurophysiological examination (EEG). Based on the results of the above questionnaires and neurological examination, a group of 50 people (34 men and 16 women) with signs of EBS and not suffering from other neurological diseases was formed from the general sample. Group 1 included 25 surveyed who directly interacted with people, group 2 consisted of 25 people who were technical workers.
At the third stage, the patients underwent therapeutic measures (with their consent) using antioxidant (the medicine Mexidol® (PHARMASOFT, NPK LLC (Russia)). Mexidol® increases the content of dopamine in the brain, which is one of the chemical factors of internal reward and serves as an important part of the brain's "reward system" as it induces feelings of pleasure (or satisfaction). Its anti-stress effect is manifested in the normalization of post-stress behavior, soma-tovegetative disorders, restoration of sleep-wakeful-ness cycles, impaired learning and memory processes, reduction of dystrophic and morphological changes in various structures of the brain.
Also, courses of massage and acupuncture were carried out, a psychologist was consulted, and the lifestyle was adjusted.
At the last fourth stage, the results of the formative research were analyzed, the effectiveness of treatment was assessed, and recommendations were developed.
The selected package of techniques made it possible to carry out diagnostics in a complex and multifac-eted manner, to process the data obtained and to establish statistically reliable results.
EEG was performed in the 1 clinic of SamMI (for individual project participants, depending on employment and on the basis of clinical and neurological data) using the Neuron-Spectrum 2 apparatus (Russia).
The results of the study. An analysis of the EBS according to Boyko and MBI method identified that office workers exposed to constant contact with people (group 1) showed symptoms of dissatisfaction with themselves, a condition associated with the inability to influence the situation, dissatisfaction with themselves, susceptibility to depression and anxiety, manifested in a lack of interest in work, a proper emotional attitude towards the client. In group 2, employees without interaction with people had dissatisfaction with the performance of their duties, a symptom of emotional reaction, emotional detachment, that is, EBS was noted in both groups.
EEG was performed on selected participants in the study. From each group, 10 employees were identified with a high and medium level of severity of EBS.
When studying the bioelectrical activity of the brain in 30% of cases (with an increased level of anxiety in both groups), the nature of the electroencephalogram was marked by the presence of an irregular deformed alpha rhythm in the occipital leads. In the frontal and temporal leads, B1 and B2 waves were recorded, with a duration of up to 1.0 s, a frequency of up to 20 Hz, and an amplitude of 10 to 30 ^V.
All patients were offered sequential therapy with Mexidol® (course of therapy: 14 injections at a dosage of 4.0 for 14 days with a switch to oral administration of 125 mg 3 times a day for 2 months). All patients tolerated the remedy well; no allergic reactions or side effects were detected in any of the cases.
Analysis of the results of treatment in both groups 1 and 2 when assessing the total severity of the manifestations of EBS according to the Boyko scale, by symptoms, by the nature of the phase (especially the phase of exhaustion) showed a decrease in fatigue, anxiety, and an improvement in mood (Fig. 1, 2).
60%
after a full course of therapy
Dissatisfaction with yourself ■ Anxiety and depression
Figure 1. Dynamics of the main symptoms prevailing in the group of office workers communicating with people
during treatment with Mexidol®
■ Before treatment ■ after 14 days ■ after a full course of therapy 76%
Dissatisfaction Anxiety and Experiencing Symptom of with yourself depression traumatic being caged
circumstances
Figure 2. Dynamics of the main symptoms prevailing in the group of office employees whose activities are not related to interactions with people during treatment with Mexidol®
Analysis of the severity and prevalence of EBS according to the MBI method in days from the start of therapy and after a full course of treatment showed a
haustion in both groups, while the middle and low levels were completely stopped. There was also a positive trend in the parameter of reduction of personal achieve-
positive dynamics of signs of high-level emotional ex- ments in both groups (Fig. 3).
Emotional exhaustion Depersonalization of personality
1st group 2nd group
52%
Before after 14 after a full Before after 14 after a full treatment days course of treatment days course of
therapy therapy
Figure 3. Dynamics of the severity and prevalence of EBS according to the MBI method against the background
of treatment with Mexidol®
When analyzing the EEG after the completion of the number of alpha waves in the parieto-occipital leads the entire course of sequential therapy with Mexidol®, increased. When evaluating the EEG after a full course
of therapy, an improvement in B2 waves was recorded in both the frontal and temporal leads of both hemispheres.
When interviewing the subjects, many, understanding their state of fatigue and depression, turned to doctors (or independently) and on an outpatient basis most often received psychotropic drugs, which gave complications in the form of inhibition, which made it difficult to fulfill their professional duties.
Thus, it was expedient to search for new reliable and safe means. The data obtained, long-term successful experience of use, as well as the accumulated scientific base have substantiated the effectiveness of Mexi-dol® as a means of antihypoxic, anxiolytic, antiis-chemic and neuroprotective effects. Our study found a statistically significant increase in the endurance threshold for increased activity and mood: a decrease in fatigue and anxiety was noted by 72% of patients. It should be noted that the manifestations of daytime sleepiness and anxiety were best controlled. There was a decrease in both the total severity of the manifestations of EBS on the Boyko scale, and the severity of symptoms characterizing its various phases, especially the phase of exhaustion.
Conclusions. Thus, this study has shown the efficacy and safety of Mexidol® in EBS. It is important that taking Mexidol® does not limit the professional and social activities of a person, is easy to use, does not cause addiction. The remedy will take its rightful place in the treatment of EBS.
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