Hanipsych, stress

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  • 1. Stress Across Life: Biological Correlates Biological Correlates of Stress among Adults Prof. Hani Hamed Dessoki, M.D.Psychiatry Prof. Psychiatry Chairman of Psychiatry Department Beni Suef University Supervisor of Psychiatry Department El-Fayoum University APA member
  • 2. Biological Psychology Stress
  • 3. HISTORY  Selye (1937) pioneered the field “Stress research”  Nonspecific, stereotypic responses to adverse conditions.  General adaptation syndrome.
  • 4. Christian (1950s)  Relationship between stressors & population density.  Association between increased population density and activation of the pituitary-adrenal axis .  Since then, growing awareness of influence of stress on physiology and behavior.
  • 5. Stress is an enescapable fact of life What is STRESS ?  Stress is a state resulting from events (stimuli) of external or internal origin, real or imagined that tend to affect the homeostatic state.
  • 6. Stress and Health
  • 7. Overview of Terminology Stress: A state of disharmony or a threat to homeostasis Physiological changes increase alertness, focus, and energy Perceived demands may exceed the perceived resources Coping: The ability to maintain control, think rationally, and problem solve Resilience: Resistant quality that permits a person to recovery quickly and thrive in spite of adversity
  • 8. Stress Eustress Manageable Stress can lead to growth and enhanced competence Distress Uncontrollable, prolonged, or overwhelming stress is destructive. Acute Stress Immediate response to a threat or challenge Chronic Stress Ongoing exposure to stress, may seem unrelenting
  • 9. Physical  Events having direct physical threat.  Cold, heat,infection, toxic substance, etc. Psychological  Failure to achive goals.  Dath of loved ones, Job demands, interpersonal problems, financial problems, etc.
  • 10. Stressful situation Psychological Stress
  • 11. Sub-Types Social : Financial problems, dominance , hierarchy insult, loss of self esteem. Occupational : Work place problems, insufficient pay, uneasy relationship with coworkers. Life stressors: Parking place problems, running late, dealing Spouse/children, divorce, isolation. Philosophical/ Spiritual : Meaning and purpose of life, belief in higher power, loss of values. Physical and Psychological stressors are often intertwined.
  • 12. © 2012 John Wiley & Sons, Inc. All rights reserved. Seven Major Sources of Stress
  • 13. STRESS RESPONSE
  • 14. GASTROINTESTINALMETABOLIC CARDIOVASCULAR REPRODUCTIVE GROWTH AND REPAIR IMMUNE Digestion is inhibited (Enzyme action inhibited) STRESS RESPONSE METABOLIC CARDIOVASCULAR GASTRO INTESTINAL GROWTH & REPAIR IMMUNE REPRODUCTIVE Increased heart rate and blood pressure to speed delivery of glucose and oxygen to tissues that need it Digestion is inhibited (Enzyme action inhibited) Inhibition of growth hormone and other anabolic processes Depletion of lymphocytes (suppression of immune response) Inhibition of reproductive functions Triglycerides, glycogen and proteins are degraded and converted in to carbohydrates to provide immediate energy.
  • 15. How these changes are induced ?  CNS : Activation of Sympathetic nervous system, catecholamines excite cells/tissues. (Sympatho-adrenal system)  Endocrine: CRH, ACTH, Glucocorticoids, Adrenalin, vassopressin, endorphins.
  • 16. Stress Brain areas Preganglionic Fibers Adrenal Medulla Adrenalin PVN CRH/AVP Pituitary ACTH Adrenal cortex Glucocorticoids Peripheral sites B-endorphin Behavior
  • 17. What is the role of -endorphin?  A natural pain killer.  Inhibits synaptic transmission to prevent pain perception.  In the absence of -endorphin stress response exaggerated.
  • 18. Stages of the Stress Response General Adaptation Syndrome of Hans Selye (1907-1982) Alarm—when one feels threatened Activation of the fight or flight reaction Resistance—mobilization of resources to solve the problem Continued stress causes adaptation Exhaustion Adaptation fails and level of function decreases
  • 19. Models for Understanding Stress The General Adaptation Model
  • 20. Allostasis Maintaining stress and adaptive responses over the long term implies high levels of activation of the homeostatic processes This causes wear and tear, called 'allostatic load'. See Selye's General Adaptation Syndrome diagram showing the level of endocrine response mounted: Resting response level
  • 21. Stress Paradox Exhaustion Body is at depleted state Must rest in order to recover If stress continues without recovery or exhaustion = illness perpetuation of illness death
  • 22. Stress and the Immune System Psychoneuroimmunology Interdisciplinary field that studies the effects of psychological and other factors on the immune system The biological response to stress changes the activity of the immune system, increasing the risk of: Cancer Periodontal Disease Common Cold Bursitis Colitis Rheumatoid Arthritis Alzheimer’s © 2012 John Wiley & Sons, Inc. All rights reserved.
  • 23. Stress and Cognitive Functioning Cortisol Effects on the Brain SHORT TERM: Cortisol also can prevent the retrieval of existing memories, as well as the laying down of new memories LONG TERM: Prolonged stress can permanently damage the hippocampus, a key part of the brain involved in memory. Once damaged, it cannot provide proper feedback to the hypothalamus, so cortisol continues to be secreted and a vicious cycle can develop © 2012 John Wiley & Sons, Inc. All rights reserved.
  • 24. Stahl S M, Essential Psychopharmacology (2000) BDNF gene Stress Stress Stress BDNF
  • 25. Stahl S M, Essential Psychopharmacology (2000) Apoptosis
  • 26. Coping With Stress Direct coping Intentional efforts to change an uncomfortable situation Confrontation Acknowledging stress directly and initiating a solution Compromise Choosing a more realistic goal when an ideal goal cannot be met Withdrawal Avoiding a situation when other options are not practical
  • 27. Notional model of emotions that arise from the balance between level of challenge and a person’s coping ability Confidence Challenge apathy boredom relaxation control engagement, flow arousal apprehension, anxiety worry high highlow low
  • 28. The Role of Epigenetic Modulation in Major Depression and Schizophrenia Champagne et al. 2005; Copyright Elsevier (2005). External environment Maternal care Social experiences Genetic background EARLY EXPERIENCES Epigenetic modifications 1 AdultFertilization Pre-natal Postpartum Post-weaning REVERSIBILITY Epigenetic modifications 2 Behavioral phenotype
  • 29. Stress and Ageing Psychological stress is linked to oxidative damage of DNA and other cellular components Experimental Evidence Study of Blackburn & her colleagues Selected 58, normal, healthy mothers 19 Controls : Problem free children 39 Stress group: Chronically ill child Blood samples were drawn and 3 parameters of cellular ageing analyzed:
  • 30. 1. Telomere length : Women with perceived stress had shorter telomeres, extent of shortening was equal to 10 years of additional aging 2. Telomerase activity : About 50% less in stressed women 3. Oxidative stress : Higher in stressed women
  • 31. A telomere A telomere is a region of repetitive nucleotide sequences at each end of a chromatid, which protects the end of the chromosome from deterioration or from fusion with neighboring chromosomes. Its name is derived from the Greek nouns telos (τέλος) 'end' and merοs (μέρος, root: μερ-) 'part.' Telomere regions deter the degradation of genes near the ends of chromosomes by allowing chromosome ends to shorten, which necessarily occurs during chromosome replication. Without telomeres, the genomes would progressively lose information and be truncated after cell division because the synthesis of Okazaki fragments requires RNA primers attaching ahead on the lagging strand. Over time, due to each cell division, the telomere ends become shorter.
  • 32. Telomeres
  • 33. . The study showed only an association between depression and shorter telomeres, and didn't prove a cause-and-effect link. The researchers said they aren't entirely sure what the shorter telomeres might mean in depression. On one hand, study author Josine Verhoeven said, it could be that having shorter telomeres somehow sets a person up for mental troubles. But it's more likely that depression causes damage that leaves traces even at the cellular level, she said. Depression is known to disrupt many physical systems. It alters hormones, suppresses the immune function and changes how nerves work. People with a history of depression have greater risks for diseases of aging, such as heart disease, type 2 diabetes, dementia and cancer. "Results like ours suggest that psychological distress, as experienced by depressed persons, has a large, detrimental impact on the wear and tear of a person's body, resulting in accelerated biological aging," said Verhoeven, a doctoral researcher at VU University Medical Center in Amsterdam.
  • 34. study was published online Nov. 12 in the journal Molecular Psychiatry. One expert said the study is significant in the number of people it involved. "The strength of this report is its size," said Etienne Sibille, an associate professor of psychiatry at the University of Pittsburgh. He is studying how depression ages the brain. Sibille said previous research on the same question had mixed results -- probably because the studies were too limited to pick up the effect, which is small and varies from person to person. "It's a small effect, but it's real," he said. The next question science needs to answer, Sibille said, is whether telomere shortening really matters and if reversing it could improve health. Other studies have shown that a healthier diet, exercise and measures to control stress may lengthen telomeres. "It's just not known whether it has an impact on cell function," he said. "If that's the case, it has potential therapeutic importance." More information Head to the U.S. Centers for Disease Control and Prevention for more on healthy aging. SOURCES: Josine Verhoeven, doctoral researcher, VU University Medical Center, Amsterdam, Netherlands; Etienne Sibille, Ph.D., associate professor, department of psychiatry, University of Pittsburgh; Nov. 12, 2013, Molecular Psychiatry, online
  • 35. Measuring YOUR Life Changes! © 2012 John Wiley & Sons, Inc. All rights reserved.
  • 36. Stress Management 1. Proper diet, exercise & relaxation. Avoid hurry, Worry & curry. 2. Yoga: Flexing & bending of body parts along with controlled breathing does not cause fatigue like aerobic exercise. 3. Pranayama: Regulated deep breathing, rich oxygen supply - relieves of stress.
  • 37. 4. Meditation: Relaxation of body & mind : reduces excitation. 5. Accept reality, accept you can not change. 6. Avoid personal confrontation. 7. Humor: Takes sting out of stress.
  • 38. 8.Laughter: Physical & emotional effects : Muscular activity burns calories, reduces stress hormone levels, increases endorphins, boosts immunity. 9. Music : Soothing effect. 10. Sports, Games, Hobby.
  • 39. Summary "Stress reactivity is better understood as the result of intertwined biological and psychological processes that ultimately ensure an organism's survival.“ "There is a cost to frequent physiological adjustments (allostatic load)“ “One of the most interesting findings emerging from the research ... is that in the absence of supportive care, stressors experienced during sensitive periods of development can ... leave permanent imprints in the neural substrate of emotional and cognitive processes. ... the nervous system of mammals carries their singular epigenetic history and expresses it in unique but predictable ways”.