Stress and health


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  • HansSelye was an endocrinologist who did pioneering work in stress..he defined general adaptation syndrome and types of stress.
  • Stress is used as an umbrella term to cover the body reactions, both physiological and psychological, to any event to which a human being has to adapt.
  • These events are called stress. That means any event or circumstance which tend to disrupt the homeostasis of body i.e normal equilibrium of body.
  • Stressors basically trigger stress response in body.They can be internal or external stressors.
  • Not every life event or circumstance causes stress response. It depends upon appraisal by the individual. When a demand is placed on us there occurs primary appraisal that is evaluation of the significance of event. Then occurs secondary appraisal in which we evaluate coping resources.
  • If we feel that firstly we are in trouble and secondly there are no coping resources we are likely to experience stress response.
  • Walter canon found out that stress causes outpouring of stress hormones in the body. Whenever we perceive an immediate threat our sympathetic nervous system and endocrine systems become activated.
  • The sympathetic nervous system increases the heart rate, respiration, diverts energy from digestion, causes redistribution of glucose and lipids.
  • In modern society we seldom face by acute stress..when the stressors are present for long time 3stages occur.. Alarm stage is similar to flight and fight mechanism. Body then copes up with stress but at a higher physical cost.. Levels of stress hormones may be raised in blood.. Continuing stress then causes depletion of stress exhaustion stage. Psychosomatic illnesses set in
  • Prior to 20th century, the principal threats to health were contagious diseases caused by infectious agents. Unfortunately as we conquered these diseases chronic diseases such as heart diseases, cancer etc are conditionally rising. The traditional view of physical illness as purely biological phenomenon has been replaced by biopsychosocial model involving interaction between biological, psychological and sociocultural factors.
  • People suffering from HIV infection progress faster to AIDS if they are exposed to stress. Various auto immune diseases like eczema, rheumatoid arthritis develop in people suffering from chronic stress. Incidence of common cold, diarrhea also increases in people suffering from stress.
  • Freidman and Rosenmam followed 3000 healthy men aged 35-59years for 9 yrs. At the end of 9 yrs 257 of the men had suffered from heart attacks. Out of which 69% of heart attacks were suffered by people having type A personalities. Also none of the pure type B type men had suffered from heart attack.
  • WHO world health day theme 2013 is high blood pressure. One of three adults suffer from hypertension.
  • PTSD although recognized from post vietnam war in world.. In india emphasis on it was place after icmr conducted study on victims of latur earthquake..these people were found to have fear psychosis still thinking about other disaster hitting them.
  • These changes can be detected by the individual or family members, collegues and friends.. This can form one of the steps in primary prevention of various non communicable diseases, depression and suicides.
  • A number of decisions we make about ourselves have far reaching consequences. Eg: choosing wrong habits, unwise financial investments which can result in endless list of stressors. For this 1st we have to identify the problem at hand. Identify the alternative ..decide best option. Commit to the decided course of action.Physical exercises increases the levels of endorphins in body which help to increase serotonin levels acting as antidepressent.
  • Stress and health

    1. 1. Dr. Gulrukh Hashmi STRESS AND HEALTH
    2. 2. Stress is the spice of life….who would enjoy a life of no runs, no hits and no errors? -Hans Selye, M.D.
    3. 3. Definition  Types of stressors Types of stress Body response to stress Stress and illness Occupational stress Post traumatic stress disorders  Scales to measure stress  Stress management Summary
    4. 4. Stress is the process by which we perceive and respond to certain events that we see as threatening or challenging.
    5. 5. Any event or circumstance that causes stress is called stressor. Stressor as such does not cause stress but our perception of that event, the meaning we attach to it and the way we react to it leads to symptoms or diseases of stress. STRESSOR
    6. 6. Types of stressors
    7. 7. Biological stressors  Any illness or disease Disabilities Injuries Environmental stressors  Poverty Overcrowding Natural disasters
    8. 8.  Inability to solve a problem Coming up with creative projects Cognitive stressors Life change stressors  Death of loved ones  Divorce Trouble among family and friends
    9. 9. Types of stress
    10. 10.  Acute Stress Acute stress is the reaction to an immediate threat, commonly known as the fight or flight response. The threat can be any situation that is experienced, even subconsciously or falsely, as a danger. Common acute stressors include: • noise • crowding • hunger
    11. 11.  Chronic stress Frequently, however, modern life poses on-going stressful situations that are not short-lived and the urge to act (to fight or to flee) must be suppressed. Stress, then, becomes chronic. Common chronic stressors include: • on-going highly pressured work, • long-term relationship problems, • loneliness, and • persistent financial worries.
    12. 12. Eustress  It is the “good” kind of stress Something pleasing will result at the end of the stressful situation Examples: • Planning a wedding • Planning a party • Completing your last semester before graduation
    13. 13. Distress  It is a displeasing kind of stress It is the “bad” kind of stress It causes the most harm to the body Examples: Death of a loved one  Natural disasters like earthquakes, floods Financial problems
    14. 14.  Stress resides neither in the person alone nor in the situation alone, but rather in a transaction between the two. Subjective (cognitive) interpretation of stressful events or life changes Transaction model
    15. 15. Fight /flight mechanism Walter Cannon (1932)  When an organism perceives threat systems of the body get activated.
    16. 16. Responses to stress
    17. 17. Seyle’s general adaptation syndrome There are 3 stages: 1. Alarm stage :- occurs when person recognizes threat and mobilizes resources. 2. Resistance :- occurs when the stress is prolonged 3. Exhaustion :- occurs when body‟s resources are depleted.
    18. 18. Stress and illnesses  PSYCHOSOMATIC DISEASES are defined as physical ailments with a genuine organic basis that are caused in part by psychological factors, especially emotional distress… hypertension, ulcers, asthma, eczema, and migraine headaches  EMOTIONAL PROBLEMS like anger, panic, fatigue, sleep disorders, depression, suicide/attempted suicides.
    19. 19. Two fold effects of stress
    20. 20.  Stress weakens the immune system by diverting the energy required for its functioning to deal with the stress.  Cortisol, a hormone released during stressful situations, affects the immune system greatly by preventing the production of cytokines.  During chronic stress, cortisol is over produced, causing fewer receptors to be produced on immune cells so that inflammation cannot be ended. Stress and immunity
    21. 21. Clogging of the vessels that nourish the heart muscles.  Chronic stress causes - increase in the levels of lipids - blood to become stickier (possibly in preparation of potential injury), increasing the likelihood of an artery-clogging blood clot. Stress and chronic heart diseases
    22. 22. TYPE B  Easygoing  Relaxed TYPE A  Competitive  Hard driving  Impatient  Verbally aggressive  Anger prone Types of personalities
    23. 23.  Essential Hypertension is a condition in which there is chronic high blood pressure, usually with no known biological cause.  . An individual that shows an exaggerated cardiac response to a variety of stimuli is more likely to develop hypertension. Stress and hypertension
    24. 24. Stress and diabetes mellitus  Cortisol causes increase in blood sugar level to help boost energy.  This may be compounded by unhealthy eating habits.
    25. 25. The hormones released during stress response can alter the numbers and types of immune cells, such as T-cells and natural killer (NK) cells produced by the body and also increase inflammation.  Since immunity and inflammation affect cancer, stress is extrapolated to affect cancer on this basis. Stress and cancer
    26. 26.  There is intense constriction of blood vessels supplying to brain.  This is followed by distension to allow blood to flow back to the brain.  These distended blood vessel pushes on the nerve causing headaches Stress and headaches
    27. 27. • Asthma: Chronic inflammatory disease of the airways in the lungs, in which the airways become constricted, making it difficult to empty the lungs and therefore reducing the amount of air that can be inhaled. • Psychological factors Stressful situations Negative family environment Emotional arousal Stress and asthma
    28. 28.  It has been suggested that there occurs disturbance in gut-brain axis.  The large intestine becomes irritated, and its muscular contractions are spastic rather than smooth and wave like. The abdomen is bloated and the patient experiences cramping and alternating periods of constipation and diarrhea. Stress and irritable bowel syndrome
    29. 29.  Ulcers  Chronic Fatigue Syndrome  Menstrual cycle disorders  Memory loss  Insomnia  Kidney disorders Other stress related disorders
    30. 30. Social problems like 1. Drug and alcohol use 2. Gambling 3. Broken/ problem families 4. Accidental injuries 5. Suicides
    31. 31.  Childhood experiences  Personality traits  Genetic traits  Immunological diseases like rheumatoid arthritis  Older adults  Caregivers  Divorced or widowed individuals Risk factors for stress
    32. 32. Occupational stress Work-related stress is the response people may have when presented with work demands and pressures that are not matched to their knowledge and abilities and which challenge their ability to cope
    33. 33. Competition and rivalries Excessive work , long hours of work or night shift work Drab and monotonous jobs, job insecurity. Lack of opportunities for advancement Unpleasant physical conditions at work. Causes:
    34. 34. Apart from health related problems there can be Increased absenteeism Industrial accidents Irresponsibility and violence Effects of occupational stress
    35. 35. It is a disorder that follows exposure to a life threatening or other extreme event that caused feelings of horror or helplessness.  Common after  Sexual assault, rape,  robbery, aggravated assault  Combat veterans  Survivors of disasters Post traumatic stress disorder
    36. 36. Symptoms include •Flashbacks •Nightmares • Impaired concentration • Emotional numbing • Depression. • Symptoms can last for years
    37. 37. Measuring stress 1. Daily hassles scale: for minor but frequent stress 2. Social readjustment rating scales: it measures the impact of various life events 3. Face to face interviews. 4. Life experience surveys
    38. 38. Social readjustment rating scale
    39. 39. Life Events Score  Death of spouse 100  Divorce 73  Marital separation from mate 65  Detention in jail, other institution 63  Death of a close family member 63  Major personal injury or illness 53  Marriage 50  Fired from work 47  Marital reconciliation 45  Retirement 45  Major change in the health or behavior of a family member 44  Pregnancy 40  Sexual difficulties 39  Gaining a new family member 39 (e.g., through birth, adoption, oldster moving, etc.)  Major business re-adjustment 39 (e.g., merger, reorganization, bankruptcy)  Major change in financial status 38  Death of close friend 37  Change to different line of work 36  Major change in the number of arguments with spouse 35  Taking out a mortgage or loan for a major purchase 31  Foreclosure on a mortgage or loan30  Major change in responsibilities at work 29
    40. 40. Less than 150 life change units = 30% chance of developing a stress-related illness 150 - 299 life change units = 50% chance of illness Over 300 life change units = 80% chance of illness
    41. 41. Richard Lazarus and his colleagues have suggested that the petty annoyances, frustrations, and unpleasant surprises we experience every day reduce psychological well being.  These may add up to more grief worsening already present illnesses. Daily hassles scale
    42. 42. It is important to recognize early signs of stress.  If these signs are present all the efforts should be directed towards strengthening the coping strategies. Early signs of stress
    43. 43.  Frustration  Nervousness  Boredom  Mood swings  Low self esteem  Loneliness Emotional effects Physical effects Headaches Diarrhea Insomnia Indigestion Back pain Ringing in ears Nervous twitches
    44. 44.  Not eating/ over eating  Verbal / physical outburst  Smoking  Gambling  Driving too fast  Constant worry  Obsessive thoughts  Trouble thinking  Unable to take decisions  Forgetfulness Mental effects Behavioural effects
    45. 45. Individual level Family level Community level Stress management
    46. 46. Learn decision making techniques Developing time management skills Undertaking regular physical exercise Progressive muscular relaxation Yoga and meditation Individual level
    47. 47. Family acts as the first support system for an individual. Children model their parent‟s behaviours, including those related to managing stress. Having regular conversations can help a family work together to better understanding and address any stress. Family level
    48. 48.  Focus has been more on work related stress.  Sakhi/saheli programme under Rajiv Gandhi scheme for empowerment of adolescent girls.  Stress management programme in colleges. Community level
    49. 49. 1. WHO AFMC’s Textbook of Public health and community medicine . 2. T Bhaskar Rao „s Textbook of Community Medicine 3. Dr. B Sridhar Rao Principles of Community Medicine. 4. WHO India work related stress. 6. Rajiv Gandhi Scheme for empowerment of Adolescent (Sabla) Handbook. References
    50. 50. 6. Frans pouwer, nina kupper, marcel C adriaanse. Does emotional stress causes diabetes mellitus type 2?review from the European depression in diabetes research consortium.published on feb 11,2010 Pouwer/2010/02/11/does-emotional-stress-cause- type-2-diabetes-mellitus-a-review-from-the-european- depression-in-diabetes-edid-research-consortium/ 7. Mc Ewen. BSProtection and damage from acute and chronic stress: allostasis and allostatic overload and relevance to the pathophysiology of psychiatric disorders.-
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