Lecture 8 - Lifespan perspective (stress) Flashcards

1
Q

How is the lifespan separated into age groups? (There are 5 groups)

A

0-16 - Childhood into early adolescence
17-40 = Early adulthood
40-60 = Middle aged
60+ = Elderly

Has been argued 17-24 can be considered an additional category known as extended adolescence

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2
Q

How does development across lifespan vary?

A

Change in a range of dimensions (cognitive, language, understanding of illness & participation in health behaviours)

With age comes changes in preventative needs and goals
E.g. parents are responsible for child’s health, adults are responsible for own, elderly adults responsibility falls on children.

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3
Q

What developmental changes occur during biological maturation?

A

Includes the development of:

  • the immune system
  • the stress response system
  • cognitive understanding
  • language development
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4
Q

Define the Biopsychosocial approach to health

A

The characteristics of a person are considered with the respect to their prior development, current level and likeness for development in future.

This declines with age -
The type of illness a person is likely to contract changes with age and tends to worsen in severity due to physical limitations and longer time to recover.

E.g. children tend to suffer with colds and bugs (not life threatening) while the elderly suffer with strokes and heart attacks (risk of death)

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5
Q

Biopsychosocial approach - Biological changes

A

Changes in the physical growth (size and strength) of bodily systems from childhood to adulthood.

Declining in old age with the slowing down, reduction in stamina, longer recovery from injury.

This can be explained through the heart and lungs being less efficient and weakened muscles.

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6
Q

Biopsychosocial approach - Psychological changes

A

Cognitive process increase across childhood especially later childhood (GCSE level)

Again these cognitive capacities decline in older life

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7
Q

Biopsychosocial approach - Social changes

A

Education, career, retirement
Parenting to grandparenting
Responsibility for health changes; from parent/caregiver to parents and teachers, peers, individual, autonomy

We mark events across the life course by the occurrence of ‘social milestones’ which work as markers in life. For example the optimum time to get married or start a family.

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8
Q

How is the stress response set?

A

Early life adversity (stress exposure prenatal through to childhood)

Transactions between person and their environment

Conditioning of the endocrine & immune system

Development of coping responses & resilience

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9
Q

Define the lifecycle of stress

A

The degree the stress has an effect depends on which stage of the brain in developing at that time. If stress occurs at a particular time of development this can have a range of effects.

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10
Q

What are outcomes of post natal stress?

A

Maternal separation result in an increase in glucocoorticoids (natural steroids in the body)

Severe trauma post natal result in decreased level of glucocorticoids.

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11
Q

How can stress in the elderly effect the brain?

A

Stress in the elderly can have a worst effect the on amygdala, frontal cortex and hippocampus as there areas of the brain are declining with age.

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12
Q

What are the 3 types of responses the stress in children?

A
  1. Positive stress response - brief experience of stress that slightly increase the heart rate and may result in mild upset. For example a babysitter.
  2. Tolerable stress response - more serious however sill temporary experience of stress. The stress is buffered by having supportive relationships. For example, a parent goes to hospital but left in care of other family members.
  3. Toxic stress response - prolonged activation of the stress response system in the absence of secure and protective relationships.
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13
Q

A study investigating a naturalistic child stress experience

A

Dettling et al 2000

Investigated mild stressors in terms of childcare. Compared a large daycare centre to children who experience family based care at home.

Method - cortisol levels were taken and compared in the morning and again in the afternoon (healthy expectation is to decline over day)

Found - The greatest decline was observed in high quality care received at home.
Cortisol increased through the day: unusual
- for the children in a daycare centre
- for children with poor quality care at home

If the stress was to continue there may be a mild impact however due to being a naturalistic investigation the impact is likely to be reversible with healthy homelife and future positive schooling.

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14
Q

A study investigating children receiving high or low sensitive child care.

A

Vermeer et al 2012

Directly compared high and low quality of care

  1. large care centre
  2. small childminding service

Method - measured cortisol in saliva (high levels was a healthy expectation) because if low then the children was suppressing stress which could result in becoming unwell.

Found - it was not the size of the care that had an impact however again the quality of the care received.

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15
Q

Another naturalistic investigation into school transitioning

A

Turner-cobb 2008

Since starting school is not an extreme stressor however there would be an expectation in children showing a slight response to stress (new situation & challenges)

Method - the awakening sample of cortisol was taken

Pre - 4 months before starting school (was particular high possibly due to anticipation)
During - school still new but have settled (mounted a stress response)
Post - 6 months later found to be much lower therefore suggesting adaptation.

Natural way of looking at child stress - all stress levels were within a safe range.

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16
Q

How can tolerable stress turn to toxic?

A

Elevated or depressed cortisol levels observed in environmental conditions such as unstable difficult living conditions, family conflict and traumatic life events.

Evidence is found in disruptions in circadian cortisol (24 hour cortisol) was detected in children who had clinically depressed mothers, children who were physically abused or children in orphanages.

17
Q

Example of toxic stress in children in orphanages

A

Gunnar & Vazquez, 2001

Children in orphanages with poor quality care when compared with a child in a family environment found very flat cortisol profile (indicating no change through the day)

Extreme continuations can reduce the length of life.

18
Q

Long lasting effects of childhood deprivation

A

Allostatic load = accumulated lifetime stress
Measured via physiological systems e.g. cardiovascular, immune, neuroendocrine.
This is the ‘wear and tear’ on body’s physiological systems

Certain factors can predict the level of allostatic load in the future.
For example - amount of time spent in poverty in childhood and cumulative risk exposure which include housing, noise, violence and family situation.

19
Q

Relationship between early life adversity & adult biological risk profiles

A

Friedman 2015

Wanted to determine who is most at risk for poorer adult health.
1180 participants completed questionnaires

Found - early life adversity can have lasting imprint on psychological regulation midlife.
A person with 3 toxic childhood experiences would show a biological risk profile of a person aged 9 years older.
They hold a heavy allostatic load which will have consequences for overall lifespan and biomarkers creating potential for immune system to deregulate allowing for illness to develop.

20
Q

What is early life adversity?

A

Early life adversity (ELA) - which includes forms of child maltreatment such as physical abuse, sexual abuse, psychological and emotional abuse, and childhood neglect.
However, can also include factors like education and poverty.

21
Q

What are the effects of prenatal stress on the foetus?

A

Not a focus on the mother but the effects the mothers stress may have on the infant growing.

Effecting the foetus during pregnancy, on birth and the delivery outcome, on child’s later development into adolescent and adulthood.

22
Q

Evidence for pregnancy & environment transaction

A

“Neighbours” theme tune learned in the womb when pregnant mothers watched the show regularly during pregnancy.

Found - the music continued to sooth the baby after birth

Explanation -
External - Possible vibrations entering womb environment
Internal - Mother is in relaxed state = switched off stress responses system.

23
Q

What is ‘normal’ maternal endocrine environment in pregnancy?

A

Progressive increase in hormones of HPA axis including cortisol, ACTH and CRH.
There is also an increase in B endorphin which is a natural pain relief.

During pregnancy , cortisol is overproduction (opposite effect to PTSD)

Pregnancy is a transient period of relative Hypercortisolism - cortisol over-production resulting in increased adrenocortical secretion & reactivity
It is a prolonged response in terms of allostatic load

Positive HPA-placental axis feedback

24
Q

What is ‘normal’ maternal endocrine response to pregnancy?

A

Increase in hormones of HPA axis which allows for the development of the HPA placental axis with a positive feedback loop.

Cortisol inhabits CRH expression in the hypothalamus but stimulates expression of placental CRH gene

25
Q

What is the HPA placental axis?

A

The placenta is a endocrine organ (therefore is stress sensitive)
The production of placental CRH stimulates a positive feedback loop increasing CRH, ACTH, cortisol and B endorphin.

CRH system increasingly activated over the course of pregnancy, peaking prior to delivery to enable contractions and birth.

26
Q

What is the HPA axis?

A

The hypothalamic pituitary adrenal (HPA) axis is our central stress response system.
Stress causes our Hypothalamus to produce CRH which caused our pituitary glands to produce ACTH and then our adrenal cortex produces cortisol.

Post stress this system is switched off and stress levels return back to baseline
Continued stress (allostatic load) is the repeated cycle not allowing for switch off.
27
Q

What is the purpose of HPA placental axis during pregnancy?

A

During pregnancy the mother still has her HPA axis. However now her adrenal gland also stimulates the placenta to produce extra CRH (this explains the high levels during pregnancy)

This extra CRH and cortisol cause the positive feedback loop during pregnancy; the mother becomes immune to cortisol - the normal response is reduced, the mother is able to tolerate greater levels of stress without the negative feedback loop operating.

This extra cortisol is not all transferred to baby; 
11B HSD3 (enzyme) converts cortisol allowing the baby to only receive around 20/30%

Under stressful conditions the enzyme effectiveness is reduced so less conversions takes place and the active form of cortisol gets to baby through placenta.

28
Q

What are implications of increased CRH (maternal stress)?

A

Two process occur during pregnancy so the mother is protected from stress however the baby is at more risk .

Stress immunisation - normal maternal response to stress (HPA axis) is reduced as pregnancy proceeds.
Mechanism; increased threshold for stress-induced, pituitary release of ACTH & b endorphin by hypothalamic CRH (ability to stimulate pituitary decreases). Thus HPA axis response to stress lessened as pregnancy proceeds

Stress amplification -> placenta amplifies the stress signal resulting in CRH rise causing a risk of preterm delivery. Mechansim; pituitary ACTH stimulates adrenal cortisol resulting in increased placental CRH i.e. placental CRH stimulated by adrenal cortisol.

29
Q

What is the evidence for prenatal stress reactivity?

A

Blood pressure, heart rate reactivity and cortisol reactivity to laboratory stressors is diminished compared to non-pregnant women and pregnant controls (immunisation)

Effects on birth outcome and longitudinal effects in childhood though to adulthood are likely to be the best evidence for amplification
Known as intergeneration - stress on one person (mother) having an effect on another (baby)

30
Q

What happens to the immune system during pregnancy?

A

During pregnancy = Cell medicated immunity is associated with:

  • Cytokine profile (TH1) is suppressed
  • Humoral immunity (TH2) is enhanced

Post pregnancy the profiles are reversed back to normal with cortisol, progesterone and oestrogen modulate immune balance.

31
Q

What is the TH1 & TH2 immune system balance?

A

Normally balanced between the two immunities.
During chronic stress -> there is a shift towards TH2 profile and the same shift is seen during pregnancy.

This is for protection during pregnancy - shift towards a more antibody immune system.
Chronic stress model – prolonged level of cortisol (natural in pregnancy) However, if a mother is under stress – a bigger shift towards the TH2.

32
Q

What is auto immune alteration?

A

Due to the shift towards the TH2 immunity and away from TH1 profile - shows what happens to the underlying immune profile of mother during pregnancy.

  1. Increased protection
    Symptoms of pre pregnant condition may reduce during pregnancy which may flare up again post baby.
    For example - Rheumatoid arthritis.
  2. Increased susceptibility
    May develop a condition during pregnancy that can improve immediately after giving birth.
    For example - Graves thyroid disease.
33
Q

What are implications of stress on birth outcomes?

A

Maternal stress in the middle of pregnancy is linked to poorer birth outcomes including being born premature and therefore smaller in weight and length.

Maternal stress towards the end of pregnancy is associated with increased metal plasma levels of ACTH and cortisol.

34
Q

How does maternal stress effect birth outcome? (Mechanism)

A

A combination of enzymes and impaired blood flow:

11 beta HSD2 - protective enzyme that converts cortisol to an inactive cortisone to go across the placental barrier to baby during pregnancy.

Impaired / abnormal uterus blood flow, lack of oxygen circulation to foetus is affected during stress.

35
Q

What is meant by the term fatal programming?

A

Effects of fatal environment on offspring development presets the baby allostatic system.

Rates of preterm births are increasing however this might not be all due to stressed mothers but other factors including;

  • elective delivery
  • avoidance of complications due to improve medical
  • multiple births

But stress and poverty will be an explanation for a percentage of these early births.

36
Q

Human PNI evidence on birth outcomes

A

Psychoneuroimmunology (PNI), is the study of the interaction between psychological processes and the nervous and immune systems of the human body.

Life events during or even prior to pregnancy can have complications regarding birth outcome.

Research shows stress exposure in the second trimester has the greatest impact. An example is the mother experiencing a bereavement is associated with increased infant mortality.

37
Q

A study showing evidence for stress on birth outcome

A

Mothers with PTSD following the 911 terror attacks found longer gestations and smaller head circumferences at birth.
This indicates hypcortisolaemic state in mothers which is the opposite of a normal pregnancy expectation.

38
Q

Long term (longitudinal) evidence for mothers stress still impacting child

A

Infant - Stress in early pregnancy alongside a fear for giving birth is linked to impaired mental and motor development, reduced attention and adaptability in the first year of infants life.

child - Anxiety during pregnancy is associated with reductions in grey brain matter at ages 6-9 which could imply vulnerability to cognitive impairment.

Adolescence - mothers anxiety middle of pregnancy is associated with flat cortisol profile aged 14-15 and depressive symptoms in girls.