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Stress

Stress. Jeffrey P Schaefer MSc MD FRCPC February 7, 2007. Objectives. Medical Aspects of Stress What is stress? Stress Hormones and Actions Allosteric Load Effects of Stress Strategies to Reduce Stress. What’s Stress  Popular Definition. “Not enough time…” . Acute Stress Response.

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Stress

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  1. Stress Jeffrey P Schaefer MSc MD FRCPC February 7, 2007

  2. Objectives Medical Aspects of Stress • What is stress? • Stress Hormones and Actions • Allosteric Load • Effects of Stress • Strategies to Reduce Stress

  3. What’s Stress  Popular Definition • “Not enough time…”

  4. Acute Stress Response • The body’s adaptive response to stress. • flight or fright response See Grizzly Bear See Dick Run See Jane Run Run, Run, Run…

  5. Hans Selye (1907-1982) General Adaptation Syndrome • observed effects of negative events he called ‘Stressors’  Stress • Proposed 3 phase to chronic stress: • alarm  prepare for ‘flight / fright’ • adaptation  resistance to stress • exhaustion  inability to cope

  6. The ‘un-stressed’ state… • Homeostasis: • A balanced and stable internal environment.

  7. What is stress? • Stress is determined by the balance between perceived demands of the environment and the individual’s resources to meet those demands.

  8. Stress – not just psychological • Stress  4 components • the stress stimuli • the experience of stress • the physiological stress response • the experience of the stress response

  9. Stress Stimuli

  10. Experience the stimuli

  11. Physiological Response

  12. Experience of thePhysiological Response

  13. Recipe for Stress What makes things Stressful? • Novelty • Unpredictability • Threat to ego • Sense of loss of control

  14. Categorizing Stress • Absolute Stress • threat to life • earthquake, fire, physical attack…

  15. Categorizing Stress • Relative Stress • implied threat based on interpretation

  16. Eustress vs Distress • Eustress – good stress • Distress – bad stress • Cognitive Interpretation of Events effects our interpretation of events. “Challenge vs Opportunity’

  17. Stress Hormones • Corticosteroids • Cortisol • Catecholamines • Adrenaline (Epinephrine) • Nor-adrenaline (Nor-epinephrine)

  18. Cortisol

  19. Cortisol Regulation • Brain • emotion, pain, memory • Hypothalamus • autonomic function • Pituitary • stimulating hormone • Adrenal Gland • cortex

  20. Cortisol Acute Effects • Response to Absolute Stress • increase vigilance • respond to emotion  don’t think • raise blood sugar • increase psychomotor activity • obtain food

  21. Prolonged Cortisol Effects • bone calcium loss • muscle wasting • insomnia • irritability • depressed mood • memory loss* • immune dysfunction • 2006 > Negative fx • increase appetite • increase blood sugar • increase fat stores • redistribute fat • salt retention  BP + • thinning of skin • reduce acid barrier • interferes with menstrual cycle • male impotence

  22. Pituitary Tumor & Cushing’s Disease

  23. Disease States • Moon facies

  24. Catecholamines • Adrenaline (Epinephrine) • Nor-adrenaline (Nor-epinephrine)

  25. Effects of Catecholamines • increase heart rate • increase cardiac force of contraction • narrows blood vessels • increase blood pressure • dilates pupils • dilates airways • reduces flow of blood to GI tract • reduces saliva production • increases platelet adherence ‘stickiness’ • increases sweat production

  26. Prolonged Catecholamine • Pheochromocytoma • hypertension • cardiac disease • vascular disease

  27. Allosteric Load • Allostasis (flight or fight response) • ‘good stress’  gets us out of trouble • Chronic Stress • when we don’t ‘get out of trouble’

  28. Allosteric Load Stress Related Disease Disease Related Stress • Headache • Irritable Bowel Syndrome • Obesity  Diabetes  Osteoarthritis • Regional Pain Syndromes & Fibromyalgia • Chronic Fatigue

  29. every disease has a psychological component

  30. What does the literature show? • Acute Stress & Chronic Stress • studies of people (not test tubes)

  31. Acute Stress in Heart Attack • Mortality in Widowers • 40% increase within 6 mo of spouses death • Myocardial Infarction Onset Study • among heart attack victims, there was a 14 times increase in death of significant person last 6-12 mo • INTERHEART Study • 11,000 first MI vs 13,000 matched controls 52 countries • Stress Events • 16.1% vs 13.0 % (OR 1.48; 95% CI 1.33-1.64) • marital separation or divorce, loss of job or retirement, loss of crop or business failure, violence, major intrafamily conflict, major personal injury or illness, death or major illness of a close family member, death of a spouse, or other major stress.

  32. Triggering an Acute MI

  33. Chronic Stress and Disease • Cohort of 13,609 mean age 45 yr  measured chronic stress • High 15% Risk of first MI, Stroke, ACS 14% higher men • Mod 6% • Low 80% • Social isoation, self-blame, and avoidance higher in a group a 130 MI patients when compared to 102 controls

  34. Selected Factors Hostility • Hostility was measured in 1,877 employed men • Observed 10 year incidence of MI / CHD death • Adjusted for age, bp, chol, cig use, etoh Results • 42% increase in death from lowest to highest quintiles • Risk of death / MI was 0.68 for low score group

  35. Anger in Young Men Medical Students

  36. Chronic Stress & Immune Dysfunction • Care Giver of Dementia Pts • 50 spouses • 67 controls • Emotional distress higher in care givers • Salivary Cortisol levels higher in care givers

  37. Chronic Stress & Immune Dysfunction • Influenza Vaccination • 3 strains • 1 strain  difference • 2 strains  no difference • Lancet 1999

  38. Wound Healing • Lancet 1995 • Punch Biopsies • 13 Care Givers vs 13 Controls • Complete wound healing • Caregivers 48.7 vs 39.3 days (9 day diff) • Age and income did not effect outcome

  39. So now what? • Remember, our body does not understand that’s it’s 2006 AD, not 2006 BC

  40. Dr. Sonia Lupien • Work on yourself • methods of resolving problems • learn to appreciate others • learn to appreciate yourself • practice goodwill • Work on your Body • breathe • move • power of laughter and smiles

  41. Solving Problems • Avoid Avoidance • may work in short term • negative in the long term

  42. Two Basic Responses to Problems • Emotional Response • primary instinct  biological factors • danger of incorrect interpretation • predisposes to hostility • risk factor for CV disease • Cognitive Response • analyze • problem solve • gain control

  43. Goodwill • Mother Theresa Effect • improved self-esteem

  44. Recognize the Source of Stress • Novelty • Unpredictability • Threat to Ego • Sense of Loss of Control Have a Plan B

  45. Summary • Stress is physiological / psychological • Novelty, Unpredictability, Threat, Control • Hormones are the stress messengers • Allosteric load has negative consequences • Strategies to reduce stress are important

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