E. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a physical illness/injury (e.g., hypothyroidism, diabetes, infectious disease). According to Lindsäter et al., "The diagnosis has become almost as prevalent as major depression in Swedish health care settings, and currently accounts for more instances of long-term sick-leave reimbursement than any other single diagnosis in the country. "The Royal Dutch Medical Association defined "burnout" as a subtype of adjustment disorder as part of the ICD-10 system. In the Netherlands burnout is included in handbooks and medical staff are trained in its diagnosis and treatment. A reform of Dutch health insurance resulted in adjustment disorder treatment being removed from the compulsory basic package in 2012. Practiconers were told that more serious cases of the condition may qualify for classification as depression or anxiety disorder.A new version of the ICD, ICD-11, was released in June 2018, for first use in January 2022. The new version has an entry coded and titled "QD85 Burn-out". The ICD-11 describes the condition this way:

Burn-out is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions: 1) feelings of energy depletion or exhaustion; 2) increased mental distance from one’s job, or feelings of negativism or cynicism related to ones job; and 3) reduced professional efficacy. Burn-out refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life.
Adverse effects
Adverse reactions from the use of prednisolone include:
Increased appetite, weight gain, nausea, and malaise
Increased risk of infection
Cardiovascular events
Dermatological effects including reddening of face, bruising/skin discoloration, impaired wound healing, thinning of skin, skin rash, fluid build up and abnormal hair growth
Hyperglycemia; patients with diabetes may need increased insulin or diabetic therapies
Menstrual abnormalities
Lower response to hormones, especially during stressful instances such as surgery or illness
Change in electrolytes: rise in blood pressure, increased sodium and low potassium, leading to alkalosis
GI system effects: swelling of stomach lining, reversible increase in liver enzymes, and risk of stomach ulcers
Muscular and skeletal abnormalities, such as muscle weakness/muscle loss, osteoporosis (see steroid-induced osteoporosis), long bone fractures, tendon rupture, and back fractures
Neurological effects, including involuntary movements (convulsions), headaches, and vertigo
Behavioral disturbances
Nasal septum perforation and bowel perforation (in some pathologic conditions).Withdrawal from prednisolone after long-term or high-dose use can lead to adrenal insufficiency. Pregnancy and breastfeeding
Although there are no major human studies of prednisolone use in pregnant women, studies in several animals show that it may cause birth defects including increase cleft palate. Prednisolone should be used in pregnant women when benefits outweigh the risks and children born from mothers using prednisolone during pregnancy should be monitored for impaired adrenal function. Prednisolone is found in breast milk of mothers taking prednisolone. Pharmacology
As a glucocorticoid, the lipophilic structure of prednisolone allows for easy passage through the cell membrane where it then binds to its respective glucocorticoid receptor (GCR) located in the cytoplasm.