Sammanfattning
During the years 1997-2003 there was a dramatic increase in the number of cases of long-term sick-leave in Sweden, which was mainly explained by an increase in psychiatric disorders, particularly stress-induced syndromes. In this article, the classification of stress-related psychiatric disorders according to the ICD-10 is described, focusing on a condition caused by chronic stress which was recognized as a diagnostic entity by the Swedish Board of Health and Welfare in 2005, and called Exhaustion Disorder (F43.8). Exhaustion disorder is characterized by extreme fatigue, cognitive problems, and disrupted sleep, as well as by pathophysiological disturbances, particularly a subsensitive hypothalamus-pituitary-adrenal axis, as evidenced by low levels of ACTH and cortisol after administration of dexamethasone and CRH. The condition is caused by prolonged stress, often work-related, and may give rise to prodromal symptoms (for instance episodic cognitive problems, tiredness, aches and pains) for years before the onset of the illness. Onset is often dramatic and characterized; inter al., by physical and emotional symptoms and cognitive dysfunction (memory disturbance, difficulties with concentration and spatial orientation). The course is often prolonged, with residual symptoms, mainly enduring stress intolerance.