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Academic Highlights: Recognition and Assessment of Shift Work Disorder

J Clin Psychiatry 2011;72(2):248-257
10.4088/JCP.10062ah1
First page of Academic Highlights: Recognition and Assessment of Shift Work Disorder.

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It is estimated that almost 15% of full-time wage and salary workers (over 14 million workers) work evening, night, or rotating shifts and that 10% of these individuals suffer from shift work disorder. This disorder can cause serious impairments in individuals' ability to function at work and at home and to drive safely, and can place great stress on personal relationships. Yet this disabling disorder is frequently missed by clinicians. This article provides guidance for clinicians on how to recognize and assess shift work disorder in their day-to-day practices. It begins with an overview of the human circadian rhythm, its anatomy and genetics, and the important effects it has on sleep, wakefulness, and overall health. This is followed by an overview of circadian rhythm sleep disorders, with a detailed focus on one of the most common types, shift work disorder, and its diagnostic criteria, clinical features, and health consequences. Shift work disorder is associated with increased rates of gastrointestinal disorders (eg, ulcers, functional bowel disorders), hypertension, depression, on-the-job and automobile accidents, and decreased productivity. The article concludes with practical guidance for clinicians on how to recognize and assess shift work disorder in clinical settings, including clinical clues that suggest a circadian rhythm problem, how to take a sleep history, tools for assessing sleep disturbances, practical strategies to help patients shift their biological clocks, and when to consider more aggressive treatment and/or a referral for a specialized sleep consultation.

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