psychobiology Flashcards
what is stress
can be a stimulus - events that place high demands on us are stressors eg exams
can be a response - physiological fight/flight response, presence of -ve emotions - feeling tense, temper, difficulty concentrating - can have behavioural impacts
it is an interaction of stimulus and response as a person-situated interaction
pattern of cognitive appraisals, emotional reactions, physiological responses and behavioural tendancies that occur in response to a percieved imbalance between situational demands (primary appraisal) and the resources needed to cope with them (secondary appraisal)
describe the stress response
SNS activated with stress = high HR, dilation of skeletal bv, constriction of digestive bv, defication and urination - get rid of waste
activation of the hypothalamo-pituitary-adrenal axis = cortisal that allows mobilisation of energy and a more sustained response to stress
describe general adaption syndrome
stage 1 - alarm rn - shift to sympathetic dominance = increased arousal
stage 2 - resistance - endo system releases hormones to maintain increased arousal and adaption of immune system to deal with response = increased level of resistance to stress
stage 3 - exhaustion - adrenal glands and immune system lose their ability to function normally - depletion of resources = more vulnerable to adverse consequences - happens in carers/people who have had trauma
describe the path of appraisal of stress
primary appraisal is determining if threat is perceived from the stimulus
if there is threat - secondary appraisal is whether you have the ability to deal with the threat
if you think you do = positive stress
if you think you dont = negative stress
also need to take into account potential consequences and seriousness
also the psychological meaning of the consequences - related to your beliefs about yourself or the world - this varies between people
describe Yerkes-Dodson law
at low level of stress - increased attention and interest - a bit of arousal = increased performance
there is an optimum
too little/much arousal = poor performance
describe the effect of appraisals
they effect emotions towards possible threats which dictates the coping response
describe how stress can relate to disease
event = stress = behavioural changes
- harder to adhere when stressed
- dont do healthy behaviours - eg reduce exercise, increase smoking/drinking
- social support reduces the change in unhealthy behaviours eg smoking unchanged and alcohol reduced in stress compared to neutral if you have good support network - support is a mediator
stress = physiological changes
- for people who are vulnerable to MI - srress can act as a trigger
describe the relationship between anxiety and heart disease
anxiety = increased risk of CVD independant of traditional risk factors
therefore anxiety management could be a target for CVD risk reduction
higher cortisal activity in stressful situations is associatd with greater extent of coronary artery calcification - could be that higher calcification means more likely to have higher stress response
describe wound healing and stress response
in stressful situation wounds took 3days longer to heal - happened in all subjects
perhaps because level of IL-1 declined in times of stress
describe how personality type effects CHD
type A behaviour doubled risk of developing CHD in healthy males when cardiac risk factors are accounted for
when compared to type B (more serene and lack of time urgency) - type a alone accounted for increased risk
what is type a behaviour
time urgency
free floating hostility
hyper-aggressiveness
focus on accomplishment
competitive and goal driven
why do people with type a behaviour have a higher CHD risk
hostility is the key factor - quickness to aggression
perhaps because of poor health behaviours
or increased physiological response to stressors = endothelial dysfunction = atherosclerosis
describe type d behaviour and its health impacts
characterised by social inhibition and -ve emotions
relationship with CHD
perhaps because of underreporting of symptoms, or it is a risk factor for depression, or lack of social support
describe the relationship with depression and CHD
effect on aetiology and prognosis
pts with CHD with depression have increased risk of mortality in 2yrs
perhaps because of physiological changes (eg platelet activity) and behavioural changes (eg low levels of physical activity) - lack of drive and increased lethargy
higher predictor of mortality than having had previous MI or severity of MI
what are the different mechanisms of coping with stress
problem focused coping - useful for conditions that need long term management, counter productive when condition cant be cured - planning, active coping and problem solving, suppressing competing activities, restraint, assertive confrontation
emotion focussed - helpful in acute period - +ve reinterpretation, acceptance, denial, repression, escape-avoidance, wishful thinking, controlling feelings
seeking social support - help, emotional support, affirmation of worth, tangible aid
what does the coping style depend on
the usefulness depends on the individual and the situation
approach - activity orientated towards threat can be helpful - discuss info and treatment in detail
avoidance - activity orientated away from threat - eg denial/destraction - find it difficult to engage in discussions around illness and treatment - this can be functional
what is the placebo effect
The phenomenon in which a placebo - an inactive substance like sugar, distilled water, or saline solution can sometimes improve a patient’s condition because the person has the expectation that it will be helpful.
what is the nocebo effect
a -ve effect that occurs after therapy/med even when the treatment is inert (ie placebo)
this is because the pve expectations effect the SE - warnings about the SE make it more likely the pt will report having these effects
describe the effect of swearing as a pain reliegf
considered maladaptive because it is associated wuth -ve and unhelpful thoughts - catastrophising events - seeing the worse in situations
however - swearing during a cold pressor test showed an increase in cold-pressure latency, and HR (proxy for stress response as it signifies activation of SNS) and decrease in perceived pain - increase activation of SNS - tap into the fight/flight response and increase ability to withstand pain
describe the benefits of social support for health outcomes
increases liklihood of survival compared to those with poor or insufficient social relations
they are beneficial beyond just the psychological role ie reducing depression
the effect of a support network is comparable with quitting smoking and exceeds other risk factors
therefore there is a movement for social cure/social prescription - GP make people more socially engaged in order to reduce their health risk
describe the effect of branding medications
targeted branded medication results in better outcomes than non-marketed drugs even when placebo is used - ie placebo better than non-branded placebo
describe use of placebo as a treatment
the chronic use of medication is increasing
eg increase in opiod prescribing
when people were treated for psoriasis - give normal corticosteroids, half steroids half placebo, half vol of steroids - people with half vol had higher relapse rate than people with half and half - suggesting a dose-extending placebo effect
what is the dose extending placebo effect
body learns the response for the drugs - conditioned to have that response
therefore you can reduce the dose = reduce the SE and cost (may still have nocebo effects but wont have the biochemical SE like liver toxicity)
what is the clinical use of placebos as treatment
reduce SE
the effect of interventions may be increased by the way that they are presented - in form and manner ie if you frame the effects differently or have brand - give stimuli with unconditioned response ie the brand
can be useful in conditions with a psychological component/pain which is a subjective experience
describe the evidence for using placebos w/o deceptions
pts informed that they were taking sugar pill and that it has been shown to have effect in some patients
the symptoms and QOL were better in people who knew that they were taking a placebo
this overcomes the ethical issues of decieving the patients
what are the psychological mechanisms underlying the placebo effect
framing - same information presented in different ways alters the interpretation of risk
social learning - seeing others getting better
experiential learning - learn through the experience of the positive result in the active medication, influences the response from the simulated medication
conditioning - US = medicine, UR = therapeutic effect, CS is the placebo delivered in the same way = CR
