Stress, work and health

Question 1

What happens when the body is in fight or flight?

Answer 1

• Autonomic nervous system (sympathetic activation)
• Neuro-endocrine effects via sympatho-adrenal-medullary system: release of catecholamines (adrenaline, NA) and hypothalamic-pituitary-adrenocortical (HPA) axis - release of corticosteroids (cortisol)

Question 2

SAM system

Answer 2

• Stressor
• Hypothalamus
• Adrenal medulla
• Catecholamines - adrenaline and NA
• Sympathetic nervous system
• Hypothalamus releases CRF
• Anterior pituitary
• ACTH released
• Adrenal cortex
• Cortisol

Question 3

Acute stress response

Answer 3

• Respiratory system - increased breathing
• CV - increased HR and BP
• Muscle tension increases
• Increased metabolism
• Immune suppression

Question 4

Prolonged stress response

Answer 4

• Alarm reaction: fight or flight
• Resistance: mobilisation of resources
• Exhaustion - burnout

Question 5

Measuring stress

Answer 5

• Mechanical (BP and respiration)
• Electrical (HR)
• Biochemical (hormones, immune system)
• Physical, behavioural etc

Question 6

Signs and symptoms of stress

Answer 6

• Physical - dry mouth, sweat, high BP
• Behavioural - crying, aggression, disrupted sleep
• Cognitive - difficulty concentrating and memory problems
• Emotional - impulsiveness, irritability, worry

Question 7

Transactional model of stress

Answer 7

• First appraisal: external - consequences, harm
• Second appraisal: internal - resources and ability to cope
• Discrepancy in demands vs ability to cope

Question 8

Observational studies

Answer 8

• Cross sectional associations of stressful events with physiological parameters and illness
• Case-control studies comparing stress in patients with disease vs healthy controls
• Cohort studies assessing stress in, then following up, initially healthy adults

Question 9

CVD mechanisms

Answer 9

• Increased BP, HR, heart size, clotting, atherosclerosis, vasoconstriction
• Arrythmias
• Endothelial dysfunction
• Altered metabolism