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GMED2000 > Module 7- Stress, Depression and Anxiety > Flashcards

Module 7- Stress, Depression and Anxiety Flashcards

1
Q

Define stress

A

When demand exceeds a persons’ coping abilities, resulting in reactions such as disturbances of cognition, emotion and behaviour that can adversely affect well-being

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2
Q

Explain Dr. Han Selye’s view of stress

A

Viewed stress as a “biological phenomenon”
Defined stress as “the non-specific response of the body to any demand for change.”
Worked to discover a new sex hormone by injecting ovarian extracts into rats and witnessed:
- Enlargement of adrenal cortex
- Thymic atrophy
- Development of bleeding ulcers in stomach and duodenal lining
Found that body’s response to stress was the same regardless of the original type of stress e.g. cold, surgical injury, noxious stimulus - he called these stimuli stressors

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3
Q

What are stressors

A

Anything that demands a response in order to maintain homeostasis, can be noxious (e.g. pain, cold, trauma) or non-noxious (e.g. life events, exams, excitement)

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4
Q

List examples of physical stressors

A

Injury or trauma
Surgical procedures
Disease
Physical threat e.g. snake, crocodile, dog growling
Heavy exercise particularly in rough environments like severe cold

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5
Q

List examples of psychological stressors

A

Mental stressors e.g. upcoming exams, work deadline
Emotional stressors e.g. bullying, break-ups, death
Memories of stressful events

These are individualised stressors- may affect some people but not others
Can also occur in exciting situations e.g. family reunion or a surfer seeing a good swell

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6
Q

List examples of contemporary stressors

A

Housing affordability
Maintaining employment
Changing technology for older people (‘technostress’)

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7
Q

What did Dr. Selye’s call the stress response

A

Because agents caused the same response, he named the response the GENERAL ADAPTATION SYNDROME (non-specific response) [G.A.S]

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8
Q

Explain the GAS response

A

Considered a generalised response to a disturbance of homeostasis brought about by stress
This response can occur along with other changes e.g. if stressor was cold, then shivering would occur along with G.A.S response
• Coordinated by endocrine and nervous system
• There are 3 stages:
1. Alarm stage or reaction – CNS aroused so defence mechanisms mobilised (fight or flight responses)
2. Stage of resistance or adaptation – hormones extend and enhance fight or flight responses
3. Stage of exhaustion – continuous stress causes progressive breakdown of compensatory mechanisms & homeostasis

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9
Q

Describe the Alarm stage of GAS activation

A

Stressor triggers hypothalamic-pituitary-adrenal (HPA) axis which activates sympathetic nervous system to prepare for response to stressor

Sympathetic response is labelled as a ‘mass discharge’ –> all neurons in system send signal to target organs throughout body at same time
Adrenal gland stimulated to release hormones that enhance and extend SNS response
Pituitary releases hormones (adrenocorticotropic) that trigger adrenal cortex to release stress hormones
Other hormones affecting thyroid hormones, aldosterone, growth and antidiuretic hormones

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10
Q

Describe resistance stage of GAS activation

A

(if stress continues for longer period of time) begins with actions of adrenal hormones- cortisol, epinephrine and norepinephrine
Towards end of this stage SNS and hormone levels return to normal as body has adapted
If stress persists, adaptation can occur during this phase so that there is a perception change in the person e.g. move to a new house next to a noisy train line, over time you don’t notice noise as body adapted

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11
Q

Describe exhaustion stage of GAS activation

A

Occurs only if the stress continues and adaptation is not successful – onset of disease (impairment of immune response, heart failure and kidney failure)

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12
Q

Describe the sympathetic nervous system

A

Fight or flight response

Mostly controlled by CATECHOLAMINE neurotransmitter (noradrenaline mostly, and adrenaline)

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13
Q

How are sympathetic responses elongated

A

Stimulates adrenal glands to release adrenaline and some noradrenaline into blood to elongate responses, this doesn’t happen immediately (same response whether they come from neural or endocrine system)

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14
Q

Describe the hypothalamic-pituitary-adrenal-axis

A

Relationship between hypothalamus, pituitary gland and adrenal gland
• In response to stress hypothalamus releases corticotrophin-releasing hormone (CRH) which stimulates anterior pituitary to release adrenocorticotropic hormone (ACTH) which causes adrenal cortex to release glucocorticoids like cortisol from chromaffin cells

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15
Q

Describe role of adrenaline

A

enhances heart contractility, increases CO, elevate glucose & lipid levels as stores of glucose, lipids and proteins broken down for energy

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16
Q

Describe role of growth hormone

A

elevate glucose & lipid levels as stores of glucose, lipids and proteins broken down for energy

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17
Q

Describe role of thyroid hormone

A

increase heart rate, enhance effects of adrenaline and noradrenaline on heart, elevate glucose & lipid levels as stores of glucose, lipids and proteins broken down for energy

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18
Q

Describe role of antidiuretic hormone

A

reabsorption of water at kidneys increasing blood volume leading to elevated BP

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19
Q

Describe role of cortisol

A

elevate glucose & lipid levels as stores of glucose, lipids and proteins broken down for energy, suppresses immune system

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20
Q

Describe role of glucagon

A

elevate glucose & lipid levels as stores of glucose, lipids and proteins broken down for energy

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21
Q

Describe role of aldosterone

A

water & sodium retention at the kidneys (help from ADH)

22
Q

Define gluconeogenesis

A

Process of converting lipids and fat stores back into energy

23
Q

Which hormones can cause immune dysregulation

A

Cortisol, adrenaline, noradrenaline & growth hormones which modulate different innate & adaptive immune defences

Nervous, endocrine and immune systems all crossover

24
Q

How does inflammation relate to stress

A

Inflammatory response results in release of pro-inflammatory cytokines which stimulate innate and adaptive immune defences, the stress response regulates the levels of these cytokines
SNS causes release of catecholamines increases cytokines to enhance immune response

25
Q

How can cortisol inhibit inflammation

A

By binding to glucocorticoid receptors on immune cells to inhibit production of cytokines

Cortisol & other glucocorticoids are used therapeutically as anti-inflammatory and immunosuppressive agents i.e. for asthma patients but has bad long term effects on the body

26
Q

How can stress affect adaptive mechanisms

A

Cortisol and noradrenaline/adrenaline decrease cellular immunity by inhibiting TH1 cells (natural killer cells and T lymphocytes) and enhancing activity of TH2 cells (beta lymphocytes and antibodies) –> called the TH2 shift
This shift causes increased humoral immunity and decreased cell-mediated immunity
Results in immunosuppression (e.g. decreased activity of cells and production of new antibodies) which increases risk of infection and causing an increased antibody response

27
Q

Explain link between stress response and pain suppression

A

Beta- endorphins released in response to stressful stimuli i.e. traumatic injury
In inflamed tissue, immune cell-derived endorphins activate endorphin receptors on peripheral sensory nerves leading to pain relief (i.e. why when people get seriously hurt they sometimes say they don’t feel it)

28
Q

What is exhaustion also referred to as

A

Allostatic overload

  • Allostasis is adaptive physiological response to stressful events
  • Allostatic load is the number of stressors we have in our lives
  • Influenced by genetic makeup, lifestyle, daily events, events such as disasters
  • Brain plays key role in determining what is stressful and all responses are individualised
  • Cortisol mostly involved, but catecholamines and cytokines also play role
29
Q

How can chronic stress cause gastric ulcers

A

Increased cortisol can increase gastric acid secretion in stomach, at same time SNS causes vasoconstriction of stomach leading to decrease mucus in stomach which together, leads to gastric ulcers (Helicobacter pylori has to be present in stomach)

30
Q

What effect can chronic stress have on body

A

Increased risk infection, delayed wound healing & chronic health issues
Can exacerbate diseases such as multiple sclerosis and AIDS
Disrupts blood-brain barrier which allows substances that aren’t meant to, to cross over and alter brain activity
Cortisol affects mood, behaviour, and stress can affect appetite, sleep and sensory perception
Hippocampus (memory) can shrink (alters function of hippocampus as well as hypothalamus)
Chronic stress can cause damage to HPA axis which can lead to excessive inflammation in body tissues (may not even be a threat) which can lead to development of diseases such as osteoporosis, metabolic syndrome, depression and cardiovascular disease
Prolonged presence of cytokines can cause diseases such as CVD, type 2 diabetes, obesity
Stress can cause people to eat, drink, take drugs which can increase risk of cancers and other health issues

31
Q

What things is stress affected by

A

Affected by nature, intensity and duration of stressor, perception of stressor, appraisal and coping abilities

32
Q

Define resilience

A

The ability maintain homeostasis when exposed to stress – resilience can depend on things such as genetics and early-life experiences, also use drugs, alcohol, etc.

33
Q

Define psychological distress

A

General state of unpleasantness after life events that manifests as physiological, emotional, behavioural and cognitive changes

34
Q

Define coping

A

Managing stressful demands and challenges that are appraised as taxing or exceeding the resources of the person

35
Q

Define mood

A

A sustained emotional state

36
Q

Define affective states

A

Brief emotional feelings – euphoria, joy, surprise, fear, sadness, becomes a disorder when the sate becomes persistent e.g. sadness

37
Q

List categories of affective states

A

Unipolar (also called major depression/clinical depression) and bipolar disorder (mania and depression)

Mania- feelings of excitement, euphoria, etc.
Depression- sadness, dejection

38
Q

What is the cause of depression

A

Results due to complex interaction between neurotransmitters and other systems in brain (mainly hormonal systems)

39
Q

What is the difference between anxiety and fear

A

Anxiety is when there is no real focus, compared to fear which is when there is a focus on specific danger e.g. snake

40
Q

What hormones mainly control anxiety response

A

Response mainly by SNS releasing mostly adrenaline and some noradrenaline, parasympathetic would release acetylcholine

41
Q

What brain structure determines importance of stimulus’

A

Amygdala

42
Q

Difference between anxiety and stress

A

Anxiety is a sustained mental disorder, whereas stress is short-term response

43
Q

Describe mild anxiety

A
  • Tension associated with day to day living
  • Person is more alert, and the perceptual field is increased
  • The person hears, sees and grasps more than usual
  • This kind of anxiety motivates learning
44
Q

Describe moderate anxiety

A
  • Person focuses on the immediate concern, involves narrowing of the perceptual field
  • The person hears, sees and grasps less
  • The person blocks out selected areas but can attend if directed to
45
Q

Describe severe anxiety

A
  • Person’s anxiety marked by significant reduction in perceptual field
  • The person focuses on specific detail – blocks out all other stimuli
  • All behaviours are aimed at relieving anxiety
46
Q

Describe panic state

A
  • Associated with awe, dread and terror
  • Person unable to accomplish any task even with direction. Can become paralysed with fear
  • Increased motor activity decreased ability to relate to others, distorted perceptions, loss of rational thought. Unable to communicate and functioning
  • Incompatible with life – prolonged panic can cause exhaustion and death
47
Q

What neurotransmitters are associated with anxiety response

A

dopamine, GABA, glutamate, acetylcholine, norepinephrine and serotonin

Anxiety said to linked between imbalance of norepinephrine and other neurotransmitters

48
Q

What is the dopamine hypothesis

A

States that psychosis occurs due to excessive amounts of dopamine in the brain –> antipsychotics block dopamine receptors

49
Q

What are monoamines

A

dopamine, noradrenaline, adrenaline and serotonin balance the effects of acetylcholine

50
Q

What neurotransmitters do people with depression have an decrease of

A

decreased serotonin and noradrenaline so effects of acetylcholine are enhanced

51
Q

Describe role of Gammaaminobutyric acid (GABA)

A
  • Controls firing rates of neurons in the brain
  • Major inhibitory (slows cell acitivty) neurotransmitter in the brain
  • Benzodiazepines used to treat anxiety act by making the receptor more sensitive to GABA – increases inhibition – especially in the limbic system (Amygdala and hippocampus)
  • These areas of brain responsible for emotions and memory
52
Q

Describe role of serotonin

A
  • Anxiety thought to be due to dysregulation of serotonin as people experiencing this have hypersensitive 5HT receptors
  • Drugs that regulate serotonin (especially SSRIs) have been shown to be effective in treating anxiety
  • Serotonin has a role in regulation of other neurotransmitters

GMED2000 (7 decks)

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