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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

Stress

Jeffrey P Schaefer MSc MD FRCPC

February 7, 2007

objectives
Objectives

Medical Aspects of Stress

  • What is stress?
  • Stress Hormones and Actions
  • Allosteric Load
  • Effects of Stress
  • Strategies to Reduce Stress
acute stress response
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…

hans selye 1907 1982
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
the un stressed state
The ‘un-stressed’ state…
  • Homeostasis:
    • A balanced and stable internal environment.
what is stress
What is stress?
  • Stress is determined by the balance between perceived demands of the environment and the individual’s resources to meet those demands.
stress not just psychological
Stress – not just psychological
  • Stress  4 components
    • the stress stimuli
    • the experience of stress
    • the physiological stress response
    • the experience of the stress response
recipe for stress
Recipe for Stress

What makes things Stressful?

  • Novelty
  • Unpredictability
  • Threat to ego
  • Sense of loss of control
categorizing stress
Categorizing Stress
  • Absolute Stress
    • threat to life
    • earthquake, fire, physical attack…
categorizing stress15
Categorizing Stress
  • Relative Stress
    • implied threat based on interpretation
eustress vs distress
Eustress vs Distress
  • Eustress – good stress
  • Distress – bad stress
  • Cognitive Interpretation of Events effects our interpretation of events.

“Challenge vs Opportunity’

stress hormones
Stress Hormones
  • Corticosteroids
    • Cortisol
  • Catecholamines
    • Adrenaline (Epinephrine)
    • Nor-adrenaline (Nor-epinephrine)
cortisol regulation
Cortisol Regulation
  • Brain
    • emotion, pain, memory
  • Hypothalamus
    • autonomic function
  • Pituitary
    • stimulating hormone
  • Adrenal Gland
    • cortex
cortisol acute effects
Cortisol Acute Effects
  • Response to Absolute Stress
    • increase vigilance
    • respond to emotion  don’t think
    • raise blood sugar
    • increase psychomotor activity
    • obtain food
prolonged cortisol effects
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
disease states
Disease States
  • Moon facies
catecholamines
Catecholamines
  • Adrenaline (Epinephrine)
  • Nor-adrenaline (Nor-epinephrine)
effects of catecholamines
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
prolonged catecholamine
Prolonged Catecholamine
  • Pheochromocytoma
    • hypertension
    • cardiac disease
    • vascular disease
allosteric load
Allosteric Load
  • Allostasis (flight or fight response)
    • ‘good stress’  gets us out of trouble
  • Chronic Stress
    • when we don’t ‘get out of trouble’
allosteric load31
Allosteric Load

Stress Related Disease

Disease Related Stress

  • Headache
  • Irritable Bowel Syndrome
  • Obesity  Diabetes  Osteoarthritis
  • Regional Pain Syndromes & Fibromyalgia
  • Chronic Fatigue
what does the literature show
What does the literature show?
  • Acute Stress & Chronic Stress
    • studies of people (not test tubes)
acute stress in heart attack
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.
chronic stress and disease
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
selected factors
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
chronic stress immune dysfunction
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
chronic stress immune dysfunction41
Chronic Stress & Immune Dysfunction
  • Influenza Vaccination
  • 3 strains
    • 1 strain  difference
    • 2 strains  no difference
    • Lancet 1999
wound healing
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
so now what
So now what?
  • Remember, our body does not understand that’s it’s 2006 AD, not 2006 BC
dr sonia lupien
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
solving problems
Solving Problems
  • Avoid Avoidance
    • may work in short term
    • negative in the long term
two basic responses to problems
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
goodwill
Goodwill
  • Mother Theresa Effect
    • improved self-esteem
recognize the source of stress
Recognize the Source of Stress
  • Novelty
  • Unpredictability
  • Threat to Ego
  • Sense of Loss of Control

Have a Plan B

summary
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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