Sammanfattning
Profound and /or prolonged stress may give rise to physical as well as mental disorders. The type of psychiatric disorder depends largely on the nature of the stressor - a life crisis may give rise to an adjustment disorder, acute life-threatening stress can result in PTSD, and enduring stress without sufficient recuperation may end in an exhaustion disorder. Symptoms and course differ widely between the different stress-induced disorders. In PTSD as well as in exhaustion disorder the most clearcut pathophysiological deviation identified so far is a hyporeactivity of the hypothalamus-pituitary-adrenal axis (in contrast to major depression, which is associated with a hyperreactivity of the HPA axis). In PTSD, exposure treatment that includes controlled remembering of the trauma has a significant therapeutic effect. There is as yet no evidence-based treatment for exhaustion disorder, which often has a prolonged course, but treatments which include the workplace tend to improve return to work. Until evidence-based treatment is available, multimodal rehabilitation is recommended, including advice on life-style, stress-relieving treatments, and group psychotherapy in addition to work-related measures.