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Medicine Year 1 - Semester 2 - Part 2 > Stress > Flashcards

Stress Flashcards

1
Q

What are the compartments of stress ?

A

Stress has both physiological and psychological compartments

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2
Q

What is stress ?

(Lazarus and Folkman, 1984)

EXAM TYPE Q

A

The perceived discrepancy between demands of the situation and the resources of the person that they appraise in a stressful situation.

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3
Q

Feelings associated with stress

A

Feeling of lack of control
Unpredictability

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4
Q

State the 3 major theories that explain stress

A
  1. Stimulus
  2. Response
  3. Transaction (person and environment)
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5
Q

Describe the theory of stress as a stimulus

A

Focus on the environment
Event or circumstance is the cause of stress

Event or circumstances are known as ‘stressors’

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6
Q

Give an example of stress as a stimulus

A

Working with chronically ill patients is stressful

OR

My illness is causing me stress

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7
Q

Describe the theory of stress as a response

A

Focus on individual’s reaction to stressors

Physiological response
Psychological response

Responses are known as ‘strain’

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8
Q

Give an example of stress as a response

A

I feel a lot of stress just before my OSCE

OR

I find breaking bad news to a patient stressful

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9
Q

Describe the theory of stress as a transaction

A

Focus on stress as a process

Relationship between the person and environment

Continuous interactions and adjustments
- ‘transactions’

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10
Q

Give an example of stress as a transaction

A

Person in the active agent who can influence the impact of stressor

‘Stress // challenge before the OSCE ??’ - coping

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11
Q

Stress Appraisal types

A

Cognitive Appraisal

  • Primary appraisal (danger?)
  • Secondary appraisal (coping)
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12
Q

What causes a primary appraisal ?

A

Stimulus

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13
Q

Pathways of primary appraisal

A

(LEADS TO NO FURTHER COPING)
Benign appraisal
Irrelevant appraisal
+ve Appraisal

(LEADS TO SECONDARY APPRAISAL - coping)
Stimulus appraised as harm, loss or threat
-> Stimulus appraised as a stressor

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14
Q

Results of secondary appraisal

A

Seeking information
Taking direct action
Doing nothing
Worrying

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15
Q

Who created the ‘Stress-coping’ paradigm ?

A

Lazarus, 1980

  • uses cognitive appraisal
  • primary and secondary appraisal
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16
Q

Key feature of stress

A

Demands are greater than the ability to cope

It is a consequence of the cognitive/thinking process

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17
Q

What do stressors impact ?

A

Stressors have an impact on the different systems

  • Physiological system
  • Psychological aspect
  • Social aspect
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18
Q

Impact of stressors on physiological system

A

Sympathetics NS
Endocrine System

Fight or Flight response
General Adaptation Syndrome

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19
Q

Impact of stressors on psychological aspect

A

Cognitive functioning
Emotion

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20
Q

Impact of stressors on social aspect

A

Social behaviour
Gender

Socio cultural differences

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21
Q

State the 2 physiological models of stress

A

Fight or Flight response (Cannon 1932)

General Adaptation Syndrome (Seyle, 1956)

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22
Q

Fight or Flight response

A

Cannon 1932
- acute/ short-term

Physiological reaction to emergencies - ‘adaptive’ response

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23
Q

Describe features of the ‘Fight or Flight’ response

A

Homeostasis threatened, disrupted
Response to acute, short lived stress

External threats elicit fight or flight response

Increased physiological arousal
Enable Fight or Flight response and restore homeostasis

BUT prolonged state of high arousal harmful to health

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24
Q

General Adaptation Syndrome

A

Seyle, 1956
- chronic/ long-term

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25
Q

Describe General Adaptation Syndrome

A

Stressor results in:

  • ALARM
    (mobilisation to fend off threat/stressor)
  • RESISTANCE
    (continued fight against stressor)
  • EXHAUSTION
    (depletion of resources, ability to resist may collapse)

[chronic/long-term]

26
Q

Stress Response features

A

2 Step Physiological response

  • Sympathetic activation
  • Hypothalamic pituitary adrenocortical (HPA) activation
27
Q

Sympathetic activation

A

Under stress; SNS activated
- catecholamines produced (adrenalin / noradrenalin)
- quick response system (within seconds)

28
Q

Hypothalamic pituitary adrenocortical activation

HPA activation

A

Increased levels of corticosteroids (cortisol)

Raised levels of brain opioids beta endorphin & enkephalin

Slower response system (minutes to hours)

29
Q

Where does short-term stress response originate from ?

A

Medulla
- neuron of sympathetic nervous system

30
Q

Where does long-term stress response originate from ?

A

Cortex
- anterior pituitary gland

31
Q

Describe long-term stress response

A

Retention of sodium and water by the kidneys

  • increased blood volume, BP
  • Increased blood sugar
  • Decreased immune system
32
Q

Describe short-term stress response

A

Increased:

  • Heart rate
  • BP
  • Metabolic rate

Changes in blood flow
Dilation of bronchioles

33
Q

Neuroendocrine cascade

A

Stress and the Adrenal gland

34
Q

State the typical signs of stress

A

Biochemical
Physiological
Behavioural
Cognitive
Emotional

35
Q

Implications of stress

A

Stress has been linked directly and indirectly to health outcome.

36
Q

Stressors

A

Stressors are events or circumstances that we perceive as threatening or harmful.

37
Q

Why do responses to stress vary ?

A

Stress moderators

38
Q

Stress moderators

A

Coping strategy
Social support
Beliefs and attitudes

Personality
Sense of control
Stress reactivity

Genetic predisposition (PTSD)
Lifestyle

39
Q

Causes of stress in junior doctors

A

Long working hours
Work load
Feeling overwhelmed

Emotionally demanding patients

40
Q

Results of junior doctor stress

A

Making mistakes
Serious treatment failures

Effects of work on personal life

41
Q

Statistics related to stress in junior doctors

A

Proportion of medics showing high stress 28% compared to other occupational groups 18%.

Moderate mistakes caused due to stress related error (around 40%)

42
Q

Burnout

A

Symptomatically similar to stress
Attributed to occupational stressors

43
Q

Features of burnout

A

Emotional exhaustion
Depersonalisation
Personal Accomplishment

44
Q

The Covid 19 pandemic and healthcare workers wellbeing

A

HCWs internationally experienced:

  • Increased depressive symptoms
  • Anxiety
  • Psychological stress
  • Poor sleep quality
45
Q

Health effects of long term stress

A

CHD
MI
Hypertension
Compromised immune function
Depression
Asthma
Headache
Eczema

Peptic ulcer

46
Q

Health behaviour

A

Risk behaviours
Health compromising behaviours
Cognitive
Emotional

47
Q

What was the leading cause of death worldwide in 2019 ?

A

Coronary Heart disease

Stress is implicated to CHD

48
Q

How is psychological stress assessed ?

A

Stress at work
Stress at home
Financial stress

Major life events in past year

49
Q

Stress and MI study

A

INTERHEART study
Rosengren et al, Lancet 2004

50
Q

Summary of results of stress and MI study

A

Evidence for association between psychosocial stress and increased risk of acute MI

Effect of stress is independent of SES, smoking
Consistent effect across geographic regions, in different age groups, and in men and women.

51
Q

Risk factor for CVD - cardiovascular disease

A

Work stress

52
Q

Risk factor for Coronary artery atherosclerosis

A

Social stress

53
Q

Stress and cardiovascular reactivity

A

Stress induced increase in catecholamine and corticosteroid release

This can damage the arteries and heart
- promote atherosclerosis, increased HR
- leads to development of hypertension
- coronary heart disease

54
Q

How is immune functioning impaired ?

A

Impaired by:

  • Physiological response to stress
  • Psychological state, emotion and beliefs
  • Psychosocial factors
55
Q

Physiological response to stress

A

Increased catecholamine and corticosteroid release
Decreased immune cell activity against antigens

Linked to development of infectious disease, cancer

56
Q

Psychological state, emotion, beliefs

A

Depression, Optimism also influence immune response

Denial, Fighting spirit predicted survival breast cancer pts

57
Q

Psychosocial factors

A

Life events, Social support, Exercise, Lifestyle…

58
Q

Stress and wound healing

A

Slowing of wound healing by psychological stress

-wound healing took 24% longer in caregivers
-caregivers reported > stress

Keicolt-Glaser et al., Lancet 1995

59
Q

Indirect effects of stress on health

A

Health-related behaviours:

  • increased substance abuse
  • increased smoking
  • poor diet
  • lack of sleep
  • poor adherence to treatment

increased engagement in reckless behaviour

60
Q

What is a peptic ulcer linked to ?

A

Psychosocial stress

Medicine Year 1 - Semester 2 - Part 2 (53 decks)

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