Chmiel James, Kurpas Donata
Institute for Neurofeedback and tDCS, 3 Maja 27, 70-215 Szczecin, Poland.
Faculty of Health Sciences, Department of Family and Pediatric Nursing, Wrocław Medical University, 51-618 Wrocław, Poland.
Int J Mol Sci. 2025 Aug 28;26(17):8379. doi: 10.3390/ijms26178379.
Occupational burnout is ubiquitous yet still debated as a disease entity. Previous reviews surveyed multiple biomarkers but left their neural substrate unclear. We therefore asked: What, if any, reproducible magnetic-resonance signature characterises burnout? Following PRISMA principles adapted for mechanistic synthesis, two reviewers searched PubMed, Scopus, Google Scholar, ResearchGate and Cochrane from January 2000 to May 2025 using "MRI/fMRI" AND "burnout". After duplicate removal and multi-stage screening, 17 clinical studies met predefined inclusion criteria (English language, MRI outcomes, validated burnout diagnosis). In total, ≈1365 participants were scanned, 880 with clinically significant burnout and 470 controls. Uniform Maslach Burnout Inventory thresholds defined cases; most studies matched age and sex, and all excluded primary neurological disease. Structural morphometry (8/17 studies) revealed consistent amygdala enlargement-predominantly in women-and grey-matter loss in dorsolateral/ventromedial prefrontal cortex and striatal caudate-putamen, while hippocampal volume remained unaffected, distinguishing burnout from PTSD or depression. Resting-state and task fMRI (9/17 studies) showed fronto-cortical hyper-activation, weakened amygdala-ACC coupling, and progressive fragmentation of rich-club networks, collectively indicating compensatory executive overdrive and global inefficiency. Two longitudinal cohorts and several intervention sub-studies demonstrated partial reversal of cortical thinning and limbic hyper-reactivity after mindfulness, exercise, cognitive-behavioural therapy, neurofeedback, or rTMS, underscoring plasticity. Across heterogeneous paradigms and populations, MRI converges on a coherent, sex-modulated but reversible brain-networkopathy that satisfies objective disease criteria. These findings justify early neuro-imaging-based triage, circuit-targeted therapy, and formal nosological recognition of burnout as a mental disorder, with policy ramifications for occupational health and insurance parity.
职业倦怠普遍存在，但作为一种疾病实体仍存在争议。以往的综述调查了多种生物标志物，但其神经基础尚不清楚。因此，我们提出问题：职业倦怠是否具有可重复的磁共振特征？遵循适用于机制性综合的PRISMA原则，两名综述作者于2000年1月至2025年5月在PubMed、Scopus、谷歌学术、ResearchGate和Cochrane中检索，检索词为“MRI/fMRI”和“职业倦怠”。经过重复文献去除和多阶段筛选，17项临床研究符合预先设定的纳入标准（英文、MRI结果、经过验证的职业倦怠诊断）。总共对约1365名参与者进行了扫描，其中880名有临床显著职业倦怠，470名作为对照。采用统一的马氏职业倦怠量表阈值定义病例；大多数研究匹配了年龄和性别，所有研究均排除原发性神经系统疾病。结构形态学研究（17项研究中的8项）显示杏仁核持续增大——主要见于女性——以及背外侧/腹内侧前额叶皮质和纹状体尾状核壳核灰质减少，而海马体积未受影响，这将职业倦怠与创伤后应激障碍或抑郁症区分开来。静息态和任务功能磁共振成像研究（17项研究中的9项）显示额叶皮质过度激活、杏仁核-前扣带回耦合减弱以及富俱乐部网络逐渐碎片化，共同表明存在代偿性执行过度驱动和整体效率低下。两项纵向队列研究和几项干预子研究表明，在进行正念、运动、认知行为疗法、神经反馈或重复经颅磁刺激后，皮质变薄和边缘系统高反应性有部分逆转，突出了可塑性。在不同的研究范式和人群中，磁共振成像结果趋同于一种连贯的、性别调节但可逆的脑网络病变，符合客观疾病标准。这些发现证明了基于神经影像学的早期分诊、针对特定脑回路的治疗以及将职业倦怠正式确认为一种精神障碍的合理性，这对职业健康和保险平等政策具有影响。
