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High-quality controlled studies on burnout syndrome are lacking. A standardized and internationally accepted diagnostic instrument with a validated rating scale should be developed. There is also a need for epidemiological and health-economic studies on the prevalence, incidence, and cost of burnout. The etiology and pathogenesis of burnout should be studied with special regard to the possible role of neurobiological factors. Treatments for it should be studied systematically so that their effects can be judged at a high level of evidence. In view of the current lack of knowledge about what is called "burnout," the term should not be used as a medical diagnosis or as a basis for decisions regarding disability or other socioeconomic matters.

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Standardized heart rate analyses were performed in 60 drug-free patients with alcohol dependence, who were admitted consecutively to a psychiatric department, and in 60 healthy normal matched subjects. The procedure included time and frequency derived measurements of heart rate variability (HRV). The investigations were carried out 3 weeks after admission and treatment on a closed ward to avoid autonomic hyperexcitability during withdrawal or relapse. The patients showed a significantly increased heart rate (p < 0.05), a significant reduction in the coefficient of variation while resting (p < 0.01) and a significant decrease of the high frequency power of spectral analysis (p < 0.01) compared with the normal subjects. Cardiovascular autonomic dysfunction was found in 12 of the patients, but in only one of the normal subjects (p < 0.01). The results indicated moderate parasympathetic (vagal) alteration in alcohol-dependent patients treated in a psychiatric department. This may have implications for psychotherapeutic or psychopharmacological treatment strategies and prognosis in such patients with alcohol dependence.