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Semester 2 Year 1 > Stress > Flashcards

Stress Flashcards

1
Q

what are the three theories that explain stress?

A

Stress as a stimulus
Stress as a response
Stress as a transaction

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2
Q

Describe stress as a stimulus

A

• Focus on the environment
• Event or circumstance is the cause of stress
• Events or circumstances are known as ‘stressors’
Example: ‘working with chronically ill pts is stressful’ ‘my illness is causing me stress’

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3
Q

Describe stress as a response

A

• Focus on individual’s reaction to stressors
• Psychological response
• Physiological response
• Responses are known as ‘strain’
Example: ‘I feel a lot of stress just before my OSCE’
‘I find breaking bad news to a patient stressful’

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4
Q

Describe stress as a transaction

A

• Focus on stress as a process
• Relationship between the person and environment
• Continuous interactions and adjustments – ‘transactions’
Example: person is the active agent who can influence impact of stressor
‘stress // challenge before the OSCE ??’ – coping

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5
Q

Define stress

A

Med school lol

‘The perceived discrepancy between demands of the situation and the resources of the person that they appraise in a stressful situation’
(Lazarus & Folkman, 1984)
- feeling of lack of control
- unpredictability
N.B: for Post Traumatic Stress Disorder, see DSM 5 criteria (link on galen)

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6
Q

How is stress appraised?

A

• ‘Stress - coping’ paradigm (Lazarus, 1980)

• Cognitive appraisal
Primary appraisal (danger?) Secondary appraisal (coping)
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7
Q

Summarise stress

A
  • Demands are greater than ability to cope
  • Consequence of the cognitive/ thinking process
  • Cognitive appraisal – primary and secondary
  • Feeling of lack of control, unpredictability
  • Individual/ situational differences
  • Process – continuous interactions and adjustments
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8
Q

What are 3 things stress impacts on

A

Physiological system
Psychological aspect
Social Aspect

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9
Q

What are the physiological modes of stress?

A

• Fight or flight response (Cannon 1932)
– acute/ short term

• General Adaptation Syndrome (Selye, 1956)
– chronic/ long term

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10
Q

Describe fight or flight response due to stress

A

Physiological reaction to emergencies - ‘adaptive’ response
• Homeostasis threatened, disrupted
• Response to acute, short lived stress
• External threats elicit fight or flight response
• greater physiological arousal
• Enable fight or flight response and restore homeostasis
• BUT prolonged state of high arousal harmful to health

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11
Q

Describe the different aspects of general adaptation syndrome

A

Chronic/long term
Stressor ->
Alarm! mobilisation against stressor->
Resistance continued fight against stressor ->
Exhaustion - depletion of resources, ability to resist may collapse

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12
Q

What is the two step physiological response of the stress response

A

• Sympathetic activation
– under stress: sympathetic nervous system stimulated – catecholamines produced (adrenalin & noradrenalin) – quick response system (within seconds)
• Hypothalamic-pituitary-adrenocortical (HPA) activation
– raised levels of corticosteroids (glucocorticoids e.g. cortisol) – raised levels of brain opioids beta endorphin & enkephalin – slower response system (minutes to hours)

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13
Q

What is the impact of long term stress response from the cortex?

A

• retention of sodium & water by kidneys
• increased blood vol, BP
• P, F converted to glucose/ broken down for energy
• increased blood sugar
• decreased immune system
Neuroendocrine cascade: stress and the adrenal gland

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14
Q

What is the impact of short term stress response in the medulla

A
  • increased heart rate
  • increased BP
  • increased metabolic rate
  • changes in blood flow
  • dilation of bronchioles
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15
Q

What are the typical categories of signs of stress?

A
  • biochemical
  • physiological
  • behavioural
  • cognitive
  • emotional
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16
Q

Why do responses to stress vary?

A 
Stress moderators
such as:
• coping strategy
• social support
• beliefs and attitudes
• personality
• individual differences....
• sense of control
• stress reactivity
• genetic predisposition (PTSD – see galen)
• gender
• certainty / uncertainty 
• lifestyle
17
Q

Are junior doctors stressed?

A

Ye

18
Q

What impacts can stress have in junior docs?

A

Most mistakes are stress related so a lot, mostly moderate mistakes

19
Q

What is burnout?

A

Symptomatically similar to stress, attributed to occupational stressors
(Maslach et al., 1996)

20
Q

What are some reasons that long term stress should carry a health warning?

A

• Health behaviour
– risk behaviours, health compromising behaviours, cognitive,
emotional
• Physiology
– ↑SNS, catecholamine, corticosteroid release
CHD, MI, hypertension, compromised immune function, depression, asthma, peptic ulcer, headache, eczema, growth problems…

21
Q

Is stress implicated in coronary heart disease?

A

Ye

22
Q

How is stress linked to cardiovascular reactivity?

A

• Individual’s exhibit stable cardiovascular reactivity
• But individual variation in ‘reactivity’
• Stress induced increase in catecholamine and corticosteroid release can damage the arteries and heart
– promote atherosclerosis, increased heart rate
– lead to development of hypertension, CHD

23
Q

What are three stress factors that impact the immune system?

A

• Physiological response to stress
– increased catecholamine & corticosteroid release
– decreased immune cell activity (T and B cells) against antigens
– linked to development of infectious disease, cancer

• Psychological state, emotion, beliefs
– depression, optimism also influence immune response
– denial, fighting spirit predicted survival breast cancer pts(Greer1979)

• Psychosocial factors
– life events, social support, exercise, lifestyle

24
Q

Does stress impact wound healing?

A

Ye
• Wound healing took 24% longer in caregivers c.f. controls
• Caregivers reported > stress c.f controls p< 0.002

25
Q

What are some indirect effects of stress on health?

A

• Health-related behaviours:
– increased substance abuse (alcohol, drugs)
– increased smoking
– poor diet
– lack of sleep
– lack of exercise
– poor adherence to treatment
– less likely to take preventative health measures
– increased engagement in reckless behaviour -> injury

26
Q

What are the key points of stress in health?

A

 Stress is the perceived discrepancy between the demands and resources appraised by the individual
 Cognitive appraisal of a threat involves primary and secondary appraisal
 Stressors are events or circumstances that we perceive as threatening or harmful
 Stress leads to changes in biochemistry, physiology, behaviour, cognition and emotional state
 IMPLICATIONS: stress has been linked directly and indirectly to health outcome

Semester 2 Year 1 (82 decks)

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