Physiology of Chronic Stress

Question 1

Stressors include multiple domains. The three main domains are:

Answer 1

• emotional
• environmental
• physiological

Question 2

Stress

Answer 2

is a condition/feeling/experience when a person perceives that demands excess the personal and social resources the individual is able to mobilise

some compensation is possible for limited

Question 3

Stressors: Types:

Answer 3

• real
• imagined
• internal (spontaenous/uncosciously)
• external

Question 4

Stress is how you react to what happens. Stress is a condition that precipitates

Answer 4

behavioural adjustment

behavioural adjustments can be good, bad, indifferent, conscious and unconscious

Question 5

Quantifying Stress:

Answer 5

Holmes and Rahe Stress Scale is an inventory of 43 life events which predispose to stress-related illnesses, weighted according to their respective probability of doing so

Question 6

Holmes-Rahe Stress Scale: Scores:

Answer 6

• <151 points = relatively low amount of life
  change and low susceptibility to stress-
  induced health breakdown
• 150 -300 = 50% chance of health breakdown
  in the next 2 years
• 300+ = 80% chance of health breakdown in
  the next 2 years

can be both psychiatric illness or somatic illness

Question 7

Subtypes of Stress:

Answer 7

insert table

Question 8

Cognitive Appraisal Mechanism:

Answer 8

• stressor precipitates behavioural adjustment
• primary appraisal is the initial interpreation
  of stressor -> positive, irrelevant, potential
  danger
• if potentially dangerous
• secondary appraisal
• adequate internal/social resources to
  manage
• if insufficient resources, there is a lack of
  resolution of primary and secondary
  appraisal so stress response occurs

Question 9

Acute Stress Response:

Answer 9

• adrenal medulla secretes hormones
• integrates the fight or flight response
• sympathetic division of autonomic nervous
  system
• increases heart rate
• increases BP
• increases RR
• increases bronchial dilation
• increased pupil diameter
• decreased GI activity

Question 10

Acute Stress Response: How does it resolve?

Answer 10

• negative feedback loop
• resolves quickly
• once perceived threat is no longer
  considered dangerous

Question 11

Core structures that affect the HPA Axis:

Answer 11

• hypothalamus
• the pituitary gland
• adrenal glands
• adrenal cortex
• adrenal medulla

Question 12

HPA Axis is a complex

Answer 12

neuroendocrine axis

Question 13

Bi-directional communication between the HPA Axis and

Answer 13

the immune system via cytokine activity that can activate the HPA Axis

the HPA Axis modulates the immune response, with high levels of cortisol resulting in a suppression of immune functions

Question 14

HPA Axis: Overview:

Answer 14

• negative feedback loop
• hypothalamus secretes CRH
• binds to pituitary
• pituitary secretes ATCH
• ATCH binds to adrenal cortex
• secretes glucocorticoids (gluose,
  cortisol,steroids) but not anti-inflammatory
• which binds back to hypothalamus and
  pituitary to prevent more secretion of CRH,
  ATCH

Question 15

Evolutionary Arms Race

Answer 15

• adaptation and counter adaptation
• on a level of an organism
• on an interspecies level

Question 16

HPA Axis:

Answer 16

• interaction of HPA axis and environment
  maintain homeostasis and wellness,
  prevents allostatic overload and distress

Question 17

Optimally interactions of systems within the HPA Axis maintain homeostasis and wellness, preventing

Answer 17

allostatic overload and distress

Question 18

Chronic Stress Exposure:

Answer 18

• induces changes within endocrine and
  immune system functionality via the HPA
  Axis
• cortisol-awakening response malfunction
• always high cortisol
• immune system does not rest
• results in fatigue

Question 19

Removal of stressor will always result in return to physiological function of immune system and HPA Axis

Answer 19

no

Question 20

Allostasis

Answer 20

adaptive physiological changes due to the activation of homeostatic mechanisms in response to changing environment

can lead to allostatic overload

Question 21

Allostatic Overload: Examples:

Answer 21

• elevated catecholamines
• HPA axis dysfunction
• excessive proinflammatory cytokine activity

Question 22

Adverse Childhood Experiences can increase allostatic overload later in life and lead individuals into

Answer 22

social isolation, hostility, depression and both physical and psychiatric conditions

Question 23

Adverse Childhood Experiences increasing risk of allostatic overload later in life is considered to be

Answer 23

a fatigue response due to the high energy consumption required attempt to resolve uncertainty to preserve safety

Question 24

Hippocampus functions:

Answer 24

involved in learning and memory; damage to this structure causes cognitive impairment and interferes within the process of new learning

Question 25

Hippocampal Changes: Adverse Childhood Experiences:

Answer 25

• reduced hippocampal volume
• especially in those who have been physically
  or sexually abused

Question 26

Cortisol can both increase the ability to encode/recall memories and decrease it:

Answer 26

• acute can increase
• chronic stress response will decrease

Question 27

Stress can activated inflammatory response in the periphery.

True or False?

Answer 27

True but also in the brain

Question 28

Transplacental Properties of Cortisol:

Answer 28

elevated circulating cortisol levels in mother can lead to low birth weight and preterm delivery for the neonate