HPA Axis

Question 1

What is the normal response in an acute stress situation

Answer 1

a reaction associated with fear which prepares the body to flee or fight

Question 2

general steps in the HPA

Answer 2

stress –> CRH relased from the hypothalamus –> ACTH released from the pituitary into the peripheral circulation–> cortisol released by the adrenal cortex –> cortisol binds to glucocorticoid receptors taht are present in every nucleated cell

Question 3

what are the effected regions in chronic stress situations

Answer 3

the hippocampus and cerebral cortex

Question 4

what are some effects of chronic stress

Answer 4

decreased number of glucocorticoid receptors in the hypothalamus
change in size of adrenal cortex via hypertrophy
decreased number of glial cells
effect on mood control and ability to experience pleasure

Question 5

role of glial cells

Answer 5

important for controlling fear, regulating motivation and controlling impulses

Question 6

steady state and how chronic stress affects it

Answer 6

The HPA axis potentiates inhibition of actions when a new acute stressor occurs in the state of chronic stress so that when it is removed the body will stay at this new increased or decreased steady state value. Once equilibrium has been established, the body seeks to stay near this new point.

Question 7

important findings of chronic stress and depression

Answer 7

One does not lead to the other; there is just more vulnerability for depression with chronic stress. There has been hippocampal atrophy shown in individuals with depression
Those with chronic stress have difficulty changing the way they think to get out of the depression

Question 8

forms of treatment for chronic stress and depression

Answer 8

• Antidepressants are able to increase neurogenesis (increase the rate of formation of new neurons) and synaptogenesism in the hippocampus
• Exercise can improve mood and promote neurogenesis in hippocampus
o Serves as a neural protective factor
• Electroshock therapy

Question 9

what is the most effective treatment for depression and chronic stress

Answer 9

talk therapy, exercise and medication combo

Question 10

physiology of anxiety involving the prefrontal cortex

Answer 10

• The prefrontal cortex has become impaired by high levels of glucocorticoids
o Therefore stress control mechanism is damaged and any new emotional stimulus is resistant to extinction

Question 11

role of the prefrontal cortex

Answer 11

acts as a brake on the amygdala

fear modulation and emotional balance

Question 12

treatment for anxiety

Answer 12

o Treatment involves cognitive behavioral therapy that “extinguish” the underlying fear; not by getting rid of it but associating it with a good stimulus

Question 13

cause of FM

Answer 13

Genetic factors

“environmental” factors such as external stressors (man made)

Question 14

cause of chronic fatigue syndrome

Answer 14

No cause has been determined

Current theory focuses on interplay between infections, immune system and HPA

Question 15

pathophysiology of FM

Answer 15

Pathophysiology Pain or early life stress leads to HPA dysfunction/neuroendocrine abnormalities
• Childhood stressors and “adult” stresses
o Exposure amount and time increase the risk of FM
o “man-made” are more likely to trigger
o Time off from work/inactivity can trigger FM
o Victims of unavoidable accidents have higher frequency of FM
o Daily hassles are more capable of causing symptoms
• Stress response is inappropriately triggered by everyday occurrences that change the “set point”
• Absence of descending pain
o Normal EK but decreased serotonin
• Increased central sensitization
o 3x amount of substance P
o Glutamate levels 2x higher

Question 16

hallmarks of FM and chronic fatigue

Answer 16

pain and fatigue

Question 17

symptoms of FM

Answer 17

Pain
•	Diffuse
•	 waxes and wanes
•	Migratory
•	Dysthesisas/parasthesia
Fatigue 
Chronic widespread pain (primary symp)
Sleep disturbance/ waking unrefreshed
Cognitive symptoms
•	Problems with attention and memory
Diffuse hyperalgesia
     -increased pain to normally painful stimuli

Allodynia
-pain to normally nonpainful stimuli

Question 18

criteria for chronic fatigue syndrome

Answer 18

 Unexplained, persistent disabling fatigue for at least 6 months that is not alleviated by rest
 Short term memory impairments
 Sore thoart
 Tender lymph nodes
 Muscle pain without swelling or redness
 Headaches of a new type
 Unrefreshing sleep
 20-50% have one or more of the following symptoms such as abdominal pain, alcohol intolerance, bloating, chest pain…..

Question 19

prognosis for FM

Answer 19

Depends;

Some have very good while others have long-term disability

Question 20

prognosis for chronic fatigue

Answer 20

Highly variable
Some will be homebound
Some will improve so they can return to work
But full recovery is in only 5-10%

Question 21

treatment for FM

Answer 21

Strong evidence for tricyclics, SNRI/NSRI, cardiovascular exercise, cognitive behavior therapy, pt. education (some strength training is ok)
Opioids, NSAIDS, corticosteroids , acupuncture, massage therapy are NOT effective

Question 22

treatment for Chronic fatigue

Answer 22

Combination of drug and nondrug treatment

Never overdo it during exercise
Gentle stretching
Nutritional supplementation

Question 23

FM ratio

Answer 23

Women more likely in clinical samples because they tend to seek treatment more than men; overall population based samples are equal in diagnosis