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Behandling av stressrelaterade sjukdomar, med fokus på maladaptiv stressreaktion och utmattningssyndrom
Är du patient/anhörig? Har du frågor om egna eller anhörigas sjukdomar – kontakta din vårdgivare eller handläggare.
Den stressrelaterade psykiska ohälsan har de senaste decennierna ökat i såväl Sverige som övriga västvärlden. För två stressrelaterade sjukdomar, maladaptiv stressreaktion (anpassningsstörning) och utmattningssyndrom (utbrändhet) är diagnos i många fall svår att ställa och det är oklart vilka behandlingsmetoder som är effektiva.
Dessa stressrelaterade sjukdomar leder ofta till nedsatt funktionsförmåga och sjukskrivning.
Fråga till SBU:s upplysningstjänst
Finns det studier som undersöker effekten av behandling inom primärvård för personer med maladaptiv stressreaktion eller utmattningssyndrom?
Sammanfattning av Upplysningstjänstens svar
Upplysningstjänsten har totalt identifierat en systematisk översikt, en förstudie till en HTA-rapport (Health Technology Assessment), en klinisk riktlinje baserad på en systematisk litteratursökning, tre randomiserade kontrollerade studier samt två kontrollerade studier, som alla utvärderar behandlingar av personer med maladaptiv stressreaktion. De behandlingar som undersöks är bland annat psykodynamisk terapi och meditation.
En tysk HTA-rapport från år 2012 hittades som tar upp behandling av utmattningssyndrom. I rapporten ingår 17 primärstudier som bland annat utvärderar effekten av kognitiv beteendeterapi (KBT), rosenrot, qigong och meditation.
Sammantaget finns det endast ett fåtal studier där effekten av olika behandlingar utvärderas för personer med maladaptiv stressreaktion och fler studier behövs för att kunna kartlägga vilka metoder som har effekt. När det gäller behandling av utmattningssyndrom finns en HTA-rapport från år 2012. Författarna till HTA-rapporten drar slutsatsen att KBT är effektivt men ingen effektstorlek anges.
SBU har inte tagit ställning i sakfrågan eftersom de enskilda studiernas kvalitet inte bedömts och resultaten inte vägts samman. Här redovisas därför endast de enskilda författarnas slutsatser.
Detta är en uppdatering av SBU:s upplysningstjänsts svar från 2012 på en avgränsad medicinsk fråga. Observera att det kan ha tillkommit nya studier efter litteratursökningsdatum: 2015-05-06.
Identifierad litteratur
Systematiska översikter
- Arends, I. et al. Prevention of recurrent sickness absence in workers with common mental disorders: Results of a cluster-randomised controlled trial. Occupational and Environmental Medicine, 2014. 71(1): p. 21-29.
- Korczak, D., M. Wastian, and M. Schneider. Therapie des Burnout-Syndroms. 2012, Deutschen Institut für Medizinische Dokumentation und Information (DIMDI): Köln.
Primärstudier
- Stein, D.J. Etifoxine versus alprazolam for the treatment of adjustment disorder with anxiety: a randomized controlled trial. Adv Ther, 2015. 32(1): p. 57-68.
- Ben-Itzhak, S., et al. The Effectiveness of Brief Versus Intermediate Duration Psychodynamic Psychotherapy in the Treatment of Adjustment Disorder. Journal of Contemporary Psychotherapy, 2012: p. 1-8.
- Srivastava, M., U. Talukdar, and V. Lahan. Meditation for the management of adjustment disorder anxiety and depression. Complement Ther Clin Pract, 2011. 17(4): p. 241-5.
- Altenhöfer, A., et al. Psychotherapie von Anpassungsstörungen. Psychotherapeut, 2007. 52(1): p. 24-34.
- van der Klink, J.J.L. and F.J.H. van Dijk. Dutch practice guidelines for managing adjustment disorders in occupational and primary health care. Scandinavian Journal of Work, Environment & Health, 2003. 29(6): p. 478-487.
- Nguyen, N., et al. Efficacy of etifoxine compared to Lorazepam monotherapy in the treatment of patients with adjustment disorders with anxiety: A double-blind controlled study in general practice. Human Psychopharmacology: Clinical and Experimental, 2006. 21(3): p. 139-149.
Publiceringsdatum
2015-06-16
Programchef
Jan Liliemark
Ansvarig utredare
Idha Kurtsdotter
Jessica Dagerhamn
Övriga medarbetare
Madelene Lusth Sjöberg
Litteratursökning till och med 2015-05-06
Databaser
PubMed via NLMk CRD, The Cochrane Library, The Cochrane Library via Wiley, Databas via ebsco, Embase via embase
Söktermer
The search result, usually found at the end of the documentation, forms the list of abstracts [MeSH] = Term from the Medline controlled vocabulary, including terms found below this term in the MeSH hierarchy hierarchy * = Truncation “ “ = Citation Marks; searches for an exact phrase |
||
Search terms | tems found | |
Population: | ||
1. | (((((("Adjustment Disorders"[Mesh]) OR Stress Disorder[Title/Abstract]) OR burnout[Title/Abstract]) OR "burn out"[Title/Abstract]) OR Reactive AND Disorder*[Title/Abstract]) OR Adjustment AND Disorder*[Title/Abstract]) OR Reactive AND Depression*[Title/Abstract] | 8179 |
Intervention: | ||
2. | ((("Family Practice"[Mesh]) OR "Primary Health Care"[Mesh]) OR "Physicians, Primary Care"[Mesh]) OR "General Practitioners"[Mesh] | 122869 |
3. | ((((((general practi*[Title/Abstract]) OR family practi*[Title/Abstract]) OR family care[Title/Abstract]) OR primary health[Title/Abstract]) OR primary care[Title/Abstract]) OR gp[Title/Abstract]) OR health cent*[Title/Abstract] | 160085 |
4. | 2 OR 3 | 221059 |
Final | 1 AND 4 | 362 |
Search terms | Items found | |
Population: | ||
1. | MeSH DESCRIPTOR Adjustment Disorders EXPLODE ALL TREES OR (Stress Disorder) OR (burnout) OR ("burn out") OR (Reactive AND Disorder*) OR (Adjustment AND Disorder*) OR (Reactive AND Depression*) |
331 |
Intervention: | ||
2. | MeSH DESCRIPTOR General Practice EXPLODE ALL TREES OR MeSH DESCRIPTOR General Practitioners EXPLODE ALL TREES OR MeSH DESCRIPTOR Family Practice EXPLODE ALL TREES OR MeSH DESCRIPTOR Primary Health Care EXPLODE ALL TREES OR MeSH DESCRIPTOR Physicians, Primary Care EXPLODE ALL TREES |
902 |
3. | ( general practi*) OR (family practi*) OR ( family care) OR (primary health) OR (primary care) OR ( gp) OR ( health cent*) | 5660 |
4. | 2 OR 3 | 5746 |
Final | 1 AND 4 | 58 |
The search result, usually found at the end of the documentation, forms the list of abstracts [MeSH] = Term from the Medline controlled vocabulary, including terms found * = Truncation “ “ = Citation Marks; searches for an exact phrase |
The search result, usually found at the end of the documentation, forms the list of abstracts [MeSH] = Term from the Medline controlled vocabulary, including terms found below this term in the MeSH hierarchy [TI] = Title [TIAB] = Title or abstract [KW] = Key Word * = Truncation “ “ = Citation Marks; searches for an exact phrase CDSR = Cochrane Database of Systematic Review DARE = Database Abstracts of Reviews of Effects, “other reviews” EED = Economic Evaluations HTA = Health Technology Assessments |
||
Search terms | Items found | |
Population: | ||
1. | MeSH descriptor Adjustment Disorders explode all trees or (Stress Disorder):ti,ab,kw or (burnout):ti,ab,kw or (Reactive AND Depression*):ti,ab,kw or (Reactive AND Disorder*):ti,ab,kw or (Adjustment AND Disorder*):ti,ab,kw or "burn out":ti,ab,kw | 3667 |
Intervention: | ||
2. | MeSH descriptor General Practice explode all trees OR MeSH descriptor Primary Health Care explode all trees OR MeSH descriptor General Practitioners explode all trees | 4815 |
3. | general practi*:ti,ab,kw or family practi*:ti,ab,kw or family care:ti,ab,kw or primary health:ti,ab,kw or primary care:ti,ab,kw or gp:ti,ab,kw or health cent*:ti,ab,kw | 28092 |
4. | 2 OR 3 | 28358 |
Final | 1 AND 4 | 423 CDSR: 30 DARE: 2 HTA: 1 EED: 4 |
The search result, usually found at the end of the documentation, forms the list of abstracts AB = Abstract DE = Term from the thesaurus TI = Title * = Truncation “ “ = Citation Marks; searches for an exact phrase |
||
Search terms | Items found | |
Population: | ||
1. | DE "Adjustment Disorders" OR TI burnout OR TI "burn out" OR TI ( Reactive AND Disorder* ) OR TI ( Adjustment AND Disorder* ) OR TI ( Reactive AND Depression* ) OR AB burnout OR AB "burn out" OR AB ( Reactive AND Disorder* ) OR AB ( Adjustment AND Disorder* ) OR AB ( Reactive AND Depression* ) |
15270 |
Intervention: | ||
2. | (DE "General Practitioners") OR (DE "Primary Health Care") | 14080 |
3. | TI general practi* OR TI family practi* OR TI family care OR TI primary health OR TI primary care OR TI gp OR TI health cent* OR AB general practi* OR AB family practi* OR AB family care OR AB primary health OR AB primary care OR AB gp OR AB health cent* |
59776 |
4. | 2 OR 3 | 61761 |
Final | 1 AND 4 | 509 |
The search result, usually found at the end of the documentation, forms the list of abstracts [MeSH] = Term from the Medline controlled vocabulary, including terms found below this term in the MeSH hierarchy * = Truncation “ “ = Citation Marks; searches for an exact phrase |
||
Search terms | Items found | |
Population: | ||
1. | ((((("Adjustment Disorders"[Mesh]) OR burnout[Title/Abstract]) OR "burn out"[Title/Abstract]) OR Reactive AND Disorder*[Title/Abstract]) OR Adjustment AND Disorder*[Title/Abstract]) OR Reactive AND Depression*[Title/Abstract] | 5314 |
Intervention: | ||
2. | ("Psychotherapy"[Mesh]) OR "Cognitive Therapy"[Mesh] | 139061 |
3. | (*therap*[Title/Abstract]) AND cognitive[Title/Abstract] | 25603 |
4. | 2 OR 3 | 156198 |
Final | 1 AND 4 limit "2007/08/01"[PDat] : "2012/08/27"[PDat] | 192 |
The search result, usually found at the end of the documentation, forms the list of abstracts [MeSH] = Term from the Medline controlled vocabulary, including terms found below this term in the MeSH hierarchy * = Truncation “ “ = Citation Marks; searches for an exact phrase |
||
Search terms | Items found | |
Population: | ||
5. | MeSH DESCRIPTOR Adjustment Disorders EXPLODE ALL TREES OR (burnout) OR ("burn out") OR (Reactive AND Disorder*) OR (Adjustment AND Disorder*) OR (Reactive AND Depression*) | 212 |
Intervention: | ||
6. | MeSH DESCRIPTOR Cognitive Therapy EXPLODE ALL TREES OR MeSH DESCRIPTOR Psychotherapy EXPLODE ALL TREES OR MeSH DESCRIPTOR Psychotherapy, Brief EXPLODE ALL TREES OR MeSH DESCRIPTOR Psychotherapy, Group EXPLODE ALL TREES | 1339 |
7. | (Cognitive AND Therapy ) OR (Psychotherapy) OR (psychoeducation) OR (group AND therapy) | 9725 |
8. | 2 OR 3 | 9961 |
Final | 1 AND 4 | 35 |
The search result, usually found at the end of the documentation, forms the list of abstracts [MeSH] = Term from the Medline controlled vocabulary, including terms found below this term in the MeSH hierarchy [TI] = Title [AB] = Abstract [KW] = Title or abstract [TW] = Text Word * = Truncation “ “ = Citation Marks; searches for an exact phrase CDSR = Cochrane Database of Systematic Review CRM = Method Studies DARE = Database Abstracts of Reviews of Effects, “other reviews” EED = Economic Evaluations |
||
Search terms | Items found | |
Population: | ||
9. | MeSH descriptor Adjustment Disorders explode all trees or (burnout):ti,ab,kw or (Reactive AND Depression*):ti,ab,kw or (Reactive AND Disorder*):ti,ab,kw or (Adjustment AND Disorder*):ti,ab,kw or "burn out":ti,ab,kw | 1479 |
Intervention: | ||
10. | MeSH descriptor Cognitive Therapy explode all trees or MeSH descriptor Psychotherapy, Brief explode all trees or MeSH descriptor Psychotherapy, Group, this term only | 5109 |
11. | (Cognitive AND Therapy ):ti,ab,kw or (Psychotherapy):ti,ab,kw or (psychoeducation):ti,ab,kw or (group AND therapy):ti,ab,kw | 66173 |
12. | 2 OR 3 | 66173 |
Final | 1 AND 4 from 2007 to 2012 | 133 CDSR: 7 HTA: 0 EED:2 |
The search result, usually found at the end of the documentation, forms the list of abstracts AB = Abstract DE = Term from the thesaurus TI = Title * = Truncation “ “ = Citation Marks; searches for an exact phrase |
||
Search terms | Items found | |
Population: | ||
13. | DE "Adjustment Disorders" OR TI burnout OR TI "burn out" OR TI ( Reactive AND Disorder* ) OR TI ( Adjustment AND Disorder* ) OR TI ( Reactive AND Depression* ) OR AB burnout OR AB "burn out" OR AB ( Reactive AND Disorder* ) OR AB ( Adjustment AND Disorder* ) OR AB ( Reactive AND Depression* ) |
15309 |
Intervention: | ||
14. | (DE "Cognitive Behavior Therapy") OR (DE "Psychotherapy") | 47433 |
15. | TI ( Cognitive AND Therapy ) OR TI Psychotherapy OR TI psychoeducation OR TI ( group AND therapy ) OR AB ( Cognitive AND Therapy ) OR AB Psychotherapy OR AB psychoeducation OR AB ( group AND therapy ) | 115414 |
16. | 2 OR 3 | 128127 |
Final | 1 AND 4 Limiters - Published Date from: 20070801-20120831 | 255 |
The search result, usually found at the end of the documentation, forms the list of abstracts [MeSH] = Term from the Medline controlled vocabulary, including terms found below this term in the MeSH hierarchy * = Truncation “ “ = Citation Marks; searches for an exact phrase |
||
Search terms | Items found | |
Population: | ||
17. | "Adjustment Disorders"[Mesh] | 3881 |
18. | burnout, professional[MeSH Terms] | 7651 |
19. | (((((stress disorder[Title/Abstract]) OR burnout[Title/Abstract]) OR "burn out"[Title/Abstract]) OR ((reactive[Title/Abstract]) AND disorder*[Title/Abstract])) OR ((adjustment[Title/Abstract]) AND disorder*[Title/Abstract])) OR ((reactive[Title/Abstract]) AND depression*[Title/Abstract]) | 43001 |
20. | 1 OR 2 OR 3 | 50225 |
Intervention: | ||
21. | ((family practice[MeSH Terms]) OR primary health care[MeSH Terms]) OR general practitioners[MeSH Terms] | 138648 |
22. | ((((general practi*[Title/Abstract]) OR family practi*[Title/Abstract]) OR family care[Title/Abstract]) OR primary health[Title/Abstract]) OR primary[Title/Abstract] | 1121137 |
23. | 5 OR 6 | 1188892 |
Final | 4 AND 7 AND ("2012/08/06"[Date - Publication] : "3000"[Date - Publication]) | 977 |
The search result, usually found at the end of the documentation, forms the list of abstracts [MeSH] = Term from the Medline controlled vocabulary, including terms found below this term in the MeSH hierarchy [TI] = Title [AB] = Abstract [KW] = Title or abstract [TW] = Text Word * = Truncation “ “ = Citation Marks; searches for an exact phrase CDSR = Cochrane Database of Systematic Review CRM = Method Studies DARE = Database Abstracts of Reviews of Effects, “other reviews” EED = Economic Evaluations |
||
Search terms | Items found | |
Population: | ||
24. | MeSH descriptor: [Adjustment Disorders] explode all trees OR MeSH descriptor:[Burnout, Professional] explode all trees OR stress disorder:ti,ab,kw Publication Year from 2012 to 2015 (Word variations have been searched) OR "burnout":ti,ab,kw Publication Year from 2012 to 2015 (Word variations have been searched) OR "burn out":ti,ab,kw Publication Year from 2012 to 2015 (Word variations have been searched) OR reactive and disorder*:ti,ab,kw Publication Year from 2012 to 2015 (Word variations have been searched) OR adjustment and disorder*:ti,ab,kw Publication Year from 2012 to 2015 (Word variations have been searched) OR reactive and depression:ti,ab,kw Publication Year from 2012 to 2015 (Word variations have been searched) | 2173 |
Intervention: | ||
25. | MeSH descriptor: [Family Practice] explode all trees or MeSH descriptor: [Primary Health Care] explode all trees or MeSH descriptor: [General Practitioners] explode all trees or general practi*:ti,ab,kw Publication Year from 2012 to 2015 (Word variations have been searched) or family practi*:ti,ab,kw Publication Year from 2012 to 2015 (Word variations have been searched) or family care:ti,ab,kw Publication Year from 2012 to 2015 (Word variations have been searched) or primary health:ti,ab,kw Publication Year from 2012 to 2015 (Word variations have been searched) or gp:ti,ab,kw Publication Year from 2012 to 2015 (Word variations have been searched) or health cent*:ti,ab,kw Publication Year from 2012 to 2015 (Word variations have been searched) | 13549 |
Final | 1 AND 2 | 253 CDSR: 29 DARE: 2 EED: 3 |
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Search terms | Items found | |
Population: | ||
26. | 'adjustment disorder'/exp OR 'burnout'/exp | 12797 |
27. | stress AND disorder:ab,ti AND [embase]/lim OR 'burnout':ab,ti AND [embase]/lim OR 'burn out':ab,ti AND [embase]/lim OR reactive AND disorder*:ab,ti AND [embase]/lim OR adjustment AND disorder*:ab,ti AND [embase]/lim OR 'reactive depression':ab,ti AND [embase]/lim OR | 68651 |
28. | 1 OR 2 | 76818 |
Intervention: | ||
29. | 'general practice'/exp OR 'primary health care'/exp OR 'general practitioner'/exp OR 'family medicine'/exp | 227255 |
30. | general AND practi*:ab,ti AND [embase]/lim OR family AND practi*:ab,ti AND [embase]/lim OR family AND care:ab,ti AND [embase]/lim OR primary AND health:ab,ti AND [embase]/lim OR 'gp':ab,ti AND [embase]/lim | 695340 |
31. | 4 OR 5 | 822543 |
Final | 3 AND 6 AND [2012-2015]/py | 2774 |
Search terms | Items found | |
Population: | ||
32. | (DE "Adjustment Disorders") OR (DE "Occupational Stress") | 17273 |
33. | (TI stress disorder OR AB stress disorder) OR (TI burnout OR AB burnout) OR (TI "burn out" OR AB "burn out") OR (TI reactive disorder* OR AB reactive disorder*) OR (TI adjustment disorder* OR AB adjustment disorder*) OR (TI reactive depression OR AB reactive depression) | 38807 |
34. | 1 OR 2 | 49428 |
Intervention: | ||
35. | (((DE "Primary Health Care")) OR (DE "General Practitioners")) OR (DE "Family Physicians") | 18661 |
36. | (TI general practi* OR AB general practi*) OR (TI family practi* OR AB family practi*) OR (TI family care OR AB family care) OR (TI primary health OR AB primary health) OR (TI gp OR AB gp) OR (TI health cent* OR AB health cent*) | 60079 |
37. | 4 OR 5 | 68946 |
Final | 3 AND 6 AND DT 2012-2015 | 298 |
The search result, usually found at the end of the documentation, forms the list of abstracts AB = Abstract DE = Term from the thesaurus TI = Title * = Truncation “ “ = Citation Marks; searches for an exact phrase |