Stress, Physical Illness and Coping Flashcards
What is Stress?
Stress is an imbalance between the dmands man on us and our personal resources to deal with these demands.
Life events - work problems or changes, debts, relationship difficulties, (divorce, birth of a child) extended family problems, house move, examinations, diagnosis of physical illness.
it’s the interpretation and meaning to an individual that causes the stress.
What is ‘Appraisal?
We appraise (interpret) our life events.
Depending on how we appraise it (what does it mean, what does it mean to us), then we respond accordingly.
Primary = appraisal of stress
Secondary = appraisal of personal coping abilities or personal resources and also the resources external to them, mainly in the immediate social network
How can physiological symptoms be misinterpreted?
- Misinterpretation of physical symptoms tends to happen to people who are more anxious, more likely to worry etc.
What are Medically Unexplained Symptoms (MUS)?
- These symptoms are not produced by unconscious mechanisms. Patients are not deliberately putting themselves on.
- Patient have varying degrees of insight or acknolwedgement that a proprtion of their symptoms are related to psychological factors.
- Most MUS are transient, but a substantial minority are more persistent and associated with medical consultation.
What are medically descriptive terms?
- IBS
- Chronic Fatigue Syndome
- Fibromyalgia
- Atypical Non-cardiac chest pain
- Non-epileptic seizures
- Multiple chemical sensitivity syndrome
- Irritable bladder
Describe the incidence of MUS
- 25% of patients in primary care have physical symptoms related to psychosocial stresses
- 40-50% of patients in hospital out-patient clinics have MUS
How is stress linked to MUS?
- Some MUS may arise from ‘normal’ bodily sensations (physiological processes) with misinterpretation.
- Some MUS may arise from minor pathology and are exaggerated at times of stress
- Other mechanisms at a neurobiological level
Describe the biophychosocial model of MUS
How can stress worsen existing conditions indirectly?
Primarily through behavioural changes:
- Poor compliance with medication.
- Increased alcohol intake = epilepsy/liver disease
- Increased smokng = heart/respiratory disease.
- Reduced excersise - heart disease
- Poor diet - diabetes.
By what direct mechanisms can stress worsen medical conditions?
- Direct stress activates the hypothalamic pituitary-adrenocortical axis (HPA) causing cortisol secretion and the sympathetic-adrenal-medullary system (SAM) causing catecholamine secretion.
- Plausible these systems are having direct effects at a cellular level but the final pathways are less clear.
Stress increases risk of heart disease. (catecholamine release which increases vascular resistance in the body which increases risk of ischaemia)
- Stress cardiomyopathy - ‘broken heart syndrome’
- Positive stress can also cause heart problems
Explain ‘broken heart syndrome’
Explain the effect of Stress on Mental Illness
- In 3-6 months preceding onset of depressing illness, 50-80% of patients will have experienced a significant life event compared to 20-30% of non-depressed patients.
What individual factors affect response to illness?
Premorbid personality - worrier, obsessional
Prior experiences of illness
Mental state
Childhood difficulties e..g early trauma
Appraisal and coping styles
What coping strategies exist?
Problem focused
More and more patients are very much aware of their condition
Patients may join support networks and support groups. Some patients however, don’t like joining support groups ‘I don’t want to see what my future is going to be like’. Other patients go and find it enormously helpful.
Some patients may participate in treatment/lifestyle changes, such as excersise and starting hobbies.
What is emotion focused coping?
Involves managing emotions and maintaining emotional equilibrium. Generally works well but only transiently. Best reserved for brief stresses or where nothing realistically can be done to modify the stress.
