Brain on Stress

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How Trauma and and Chronic Stress Alter Brain Function

How Trauma and and Chronic Stress Alter Brain Function

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  • 1. and Chronic Stress Alter Brain Function Course # 830 Contact Hours: 5 Hours Authors: Meredith Patterson, RN, BSN, CRRN Shelda L. Hudson, RN, BSN, PHN Course Material valid through 05/2016 Copyright © 2013 W.S. Keefer All rights reserved Published by the National Center of Continuing Education, Inc., Lakeway, Texas. Printed in the United States of America. We are proud to be a BBB Accredor exceed the Better Business Bu- E L S © Enhanced Learning & Skills... No Exams, Just Learning! Testing Mandatory For Florida & Electrologists Only Visit www.bbb.org A NATIONAL EPIDEMIC WE ALL KNOW . . . . . . that U.S. Copyright Law grants to the copyright owner the exclusive right to duplicate copyrighted, printed and recorded materials. Piracy involves the illegal duplication of copyrighted materials. YOU MAY NOT KNOW . . . . . . that every time you use or make an illegal copy of cassettes or printed material in any form or by any method you may be subject to litigation. involved in illegal duplication. . . . that the penalty for criminal violation is up to tough new law. (Title 17, U.S. Code, Section 506, and Title 18, U.S. Code Section 2319). . . . that civil or criminal litigation may be costly and embarrassing to any organization or individual. We request you contact us immediately regarding illegal duplication of these copyrighted, printed materials. The National Center of Continuing Education will pay a substantial reward for information leading to the conviction of any individual or institution making any unauthorized duplication of material copyrighted by W.S. Keefer or The National Center of Continuing Education. The Brain on Stress Page 1
  • 2. Table of Contents About The Author ........................................3 ........................................3 ...............................3 Introduction ..................................................3 ....................3 ...............................4 ...............................4 .............................................4 ............................................5 ........6 ...............................6 ......................................6 .....................................6 .......................................6 ..................................6 ...................................6 ..........6 .....................................6 ..............6 ........................................7 ......................................7 ............7 ..........8 .......................8 ...........................................9 ............................9 ......................................................... ...................................................... ....................................................... ............................................. .......................................... ..................................................... ......................................... ............................................... ............................................ .............................................. ........................................... .................................................. ................................. ................................... .............................. .............................. ........................................................ .......................... .............................................. ..................................................... .................................................... ..............................9 E xtraordinary efforts have been made by the authors, the editor and the publisher of the National Center of Continuing Education, Inc. courses to ensure dosage recommendations and treatments are precise and agree with the highest standards of practice. However, as a result of accumulating clinical experience and continuing laboratory studies, dosage schedules and/or treatment recommendations are often altered or discontinued. In all cases the advice of a physician should be sought and followed concerning initiating or discontinuing all medications or treatments. The planner(s), author(s) and/or editor(s) of each course have attested to no conflict of interest nor bias on the subject. The National Center of Continuing Education, Inc. does not accept commercial support on any course nor do they endorse any products that may be mentioned in the course. Any off-label use for medications mentioned in a course is identified as such. No part of this publication may be reproduced stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise without the prior written permission of the publisher. Page 2 The Brain on Stress
  • 3. About the Author Stress Meredith Patterson, RN, BSN, CRRN Concepts Introduction Purpose and Goals the care of the patient Instructional alarm reaction The Brain on Stress Page 3
  • 4. In the resistance stage World exhaustive stage and tear. Historical Stress Acute stress Episodic acute stress (See Figure 1) Page 4 The Brain on Stress
  • 5. Holmes-Rahe Social Readjustment Rating Scale 1. 2. 3. 4. 5. 6. 7. 9. 10. 11. 12. 14. 15. 17. 18. 19. 20. 21. 22. 23. Life Event Life Event Mean Value Mean Value Death of spouse......................................... 100 Divorce ........................................................ 73 Marital separation from mate ................... 65 Detention in jail or other institution ......... 63 Death of a close family member................. 63 Major personal injury or illness................. 53 Marriage ..................................................... 50 ..................................... 47 Marital reconciliation with mate ............... 45 Retirement from work ................................ 45 Major change in health or behavior of a family member ...................................... 44 Pregnancy ................................................... 40 ....................................... 39 Gaining a new family member through birth, adoption, older child moving in ....... 39 Major business readjustment (merger, bankruptcy)................................................. 39 ................ 38 Death of a close friend ................................ 37 Changing to a different line of work.......... 36 Major change in the number of arguments with spouse (regarding child-rearing, personal habits) .......................................... 35 Taking out a mortgage or loan for a major purchase (e.g., home, business, etc.) ......... 31 Foreclosure on a mortgage or a loan ......... 30 Major change in responsibilities at work (promotion, demotion, lateral transfer)..... 29 Son or daughter leaving home (marriage, college) ...................................... 29 around the corner and tend to predict 24. Trouble with in-laws .................................. 29 25. Outstanding personal achievement........... 28 26. Spouse beginning or ceasing work outside the home...................................................... 26 27. Beginning or ceasing formal schooling ...... 26 28. Major change in living conditions ............. 25 29. Revision of personal habits (dress, manners) ......................................... 24 30. Trouble with the boss ................................. 23 31. Major change in working hours or conditions................................................ 20 32. Change in residence ................................... 20 33. Changing to a new school........................... 20 34. Major change in type and/or amount of recreation ................................................ 19 35. Major change in church activities ............ 19 36. Major change in social activities (dancing, movies) ....................................... 18 37. Taking out a mortgage or loan for a lesser purchase (car, TV, freezer) ......................... 17 38. Major change in sleeping habits ................ 16 39. Major change in number of family get togethers .................................................... 15 40. Major change in eating habits .................. 15 41. Vacation ...................................................... 13 42. Christmas ................................................... 12 disturbing the peace) .................................. 11 TOTALS ......................................................... 1466 Adapted From: Holmes, T. H., and Rahe, R. H. (1967). The Social Readjustment Rating Scale. Journal of Psychosomatic Research, 11, 213-218. Figure 1 Post-traumatic stress disorder (PTSD) Chronic stress The Brain on Stress Page 5
  • 6. Decision-Making Stress Triggers: A Work Stressors Other Stress Factors Awfulizing The Feedback Loop How the Brain and the Some ways to avoid “Awfulizing” Social Stressors Disease Stressors Page 6 The Brain on Stress
  • 7. Blood pressure Respiration-- Slowing of digestion Increased Release of Red Blood Cells The conversion of glycogen to glucose The brain releases endogenous opiates-- The Brain on Stress Stress and Disease The Brain on Stress Page 7
  • 8. Learning Page 8 The Brain on Stress
  • 9. The Emotional Life of Your Brain a Relaxation Response Exercise and Stress Can Meditation Help? The Brain on Stress Page 9
  • 10. with Sleep Get Your ZZZZ’s Spark: The Revolutionary New Science of Exercise and the Brain, Page 10 The Brain on Stress
  • 11. Stage 1 Stage 2 L-Theanine regular. Stages 3 and 4 5-HTP ing, caffeine, alcohol, and tobacco. Caf Nutrition and the Brain The Brain on Stress Page 11
  • 12. Ashwagandha Out Thinking the Stress blood urea nitrogen and lactic acid in Melatonin Exercise Venting to Others Incognito, Page 12 The Brain on Stress
  • 13. Nurses in life Helping the Stressed Patient Start with a Thorough or pain Skin General Diarrhea The Brain on Stress Page 13
  • 14. Exploring Stress Issues and Dispelling Stress is the same for everyone: Stress is different for everyone Benson, H. 1976. Steps to Elicit the Relaxation Response. From The Relaxation Response. HarperTorch, p162163. or out of control, or experience Birdsall T., 5-Hydroxytroptophan: a clinically-effective serotonin precursor. Altern Med Rev. 1998 Aug.:3(4)271-80. Bremner, J. Douglas, Does Stress Damage the Brain?, WH Norton and Co., 2002, p73-76) Stress is always bad. According to Stress is everywhere so nothing can be done about it Bremner, J. Douglas “Stressing the Hippocampus: Why it Matters”, , January 8. 2008, Carter, S. Why Sleep Should be on the Top of Your To-Do List, Psychology Today, May 27, 2011. The most popular ways of treating stress are the best ones CNN.com/2009-03-20, Economy and Finances Survey, September 6, 2011 If I don’t have symptoms, I don’t have stress. Davidson, Richard J., The Emotional Life of Your Brain, March 2012, p150-152; 204205. Only major symptoms of stress require attention. Devi, G. A Calm Brain: Unlocking Your Natural Relaxation System, Penguin Group, 2012, p45-47. Working with Patients to Help Manage Stress Where to Start? Dimpfel W. Kler A. Krisel E. Lahnfeld R. Keplinger-Dimpfel I. Source density analysis of the human EEG after ingestion of a drink containing decaffeinated extract of green tea enriched with L-theanine and theogallin. Nutr Neurosci . 2007 JunAug.; 10(3-4); 169-80) Doidge, N. “ The Brain that Changes Itself, Penguin Books, 2007, p.241 Eagleman, D. Incognito: the Secret Lives of the Brain, 2011, Pantheon Books, pg. 145. Page 14 The Brain on Stress
  • 15. Gutkenchtl., J, Strobel A, et al. Tryptophan hydroxylase-2 personality traits and disorders related to emotional dysregulation, Int J Neuropsychopharmacol 2007 June: 10(3) 309-20) Heese T. Jensinson, J.Love C, et al. anxiolytic effects of L-theanine when combined with midazolam in the male Sprague-Dawley rat. AANA J., 2009 Dec.;77(6); 445-9. Hippocampus Functions, October 12, 2012, Medical News.Net www.news-medical.net/health/ Hippocampus-Functions.aspx) Holmes, Thomas H and Rahe, Richard H., “The Social Readjustment Rating Scale”, Journal of Psychosomatic Research, Volume 11, Issue 2, August 1967, pages 213-218, 1967, Elsevier Science Inc. Kaplan, J., Manuck, S., Clarkson, T., Lusso, F. & Taub, D.(1982). Social status, environment and atherosclerosis in cynomolgus monkeys. Arteriosclerosis 2, 359-368. Keane & Davidson. Clinician-Administered PTSD Scale (CAPS) - National Center for PTSDwww.ptsd.va.gov/professional/ pages/assessments/caps.asp Kennedy D., Wake G, Savelev S. et al. Modulation of mood and cognitive performance following acute administration of single doses of Melissa human CNS nicotinic and muscarinic receptor binding properties. Neuropsychoparmacology. 2003 Oct; 28(10); 1871-81. Kirby,E., Friedman, A., Covarrubias, D., Ying, C. Sun, W.,Goosens, K., Sapolsky, R. Kaufer, D. Basolateral amygdala regulation of adult hippocampal neurogenesis and fear-related activation of newborn neurons (June 14, 2011 AOP Molecular Psychiatry) Kimura K. Ozeki M. Juneja L., Ohira H. Theanine reduces psychological and physiological stress responses. Biol Psychol. 2007 Jan; 74 (1); 39-45). NIH Publication No.06-3440-c Brain Basics: Understanding Sleep www.ninds.nih.gov/disorMay 21, 2007 Peck, J., etal. Cognitive effects of exogenous melatonin administration in elderly persons: a pilot study. Am J Geriatri Psychiatry, 2004:12: 432-436. Ratey, J.,M.D. Spark: The Revolutionary New Science of Exercise and the Brain, Little, Brown and Company, 2008, pg. 91; 123-124 Medina, J.“Brain Rules” , Pear Press, 2008, pp 178-180. Miu A, Heilman R, Miclea M. Reduced heart rate variability and vagal tone in anxiety; trate versus state , and the effects of autogenic training Autunom Neruosci: Basic Clin. 2009; 145; 99-103) Mohan, A, Sharma, R, Bijlani, M “Effect of Meditation on StressInduced Changes in Cognitive Functions, The Journal of Alternative and Complementary Medicine, Vol 17, No. 3, 200, pp. 207-212. Nader, K., Kriegler, J., Blake, D, Pynoos, R.S., Newman, E., & Weathers, F.W. (1996). Clinician Administered PTSD Scale, Child and Adolescent Version. White River Junction, VT: National Center for PTSD Nader, K. Assessing traumatic experiences in children and adolescents: Self-reports of DSM-PTSD Criteria B-D symptoms. In J. Wilson & T. Keane (Eds.), Assessing psychological trauma and PTSD, 2nd ed. (pp. 513-537). New York: Guilford Press. (2004). Sandler, M., Clow, A., Watkins, P. J. and Fibiol, V. G. Tribulin — an endocoid marker for anxiety in man. (1988), Stress Med., 4: 215–219. doi: 10.1002/ smi.2460040406 Sapolski, Robert Why Don’t Zebras Get Ulcers, Henry Holt and Company, 2004, pg. 16. Science Daily, More Years to Life and Life to Years Through Increased Motivation for an Active Life, Nov 3, 2011. www.sciencedaily.com/releases/2011/11/111101171042.htm) Singh et al, Afr J Tradit Complement Altern Med. (2011) 8 (S): 208-213. An Overview on Ashwagandha, a Rasayana Rejuvenator of Ayurveda). Stankus, Tony, The Amygdala’s Role In Learning, Memory, Social Intelligence, Criminal Behavior, Mood Disorders And Especially The Retention of Traumatic Memories In Adult PTSD, FSLA, Sept. 9, 2009. Stress in America, American Psychological Association, 2011 report www.apa. org/news/press/releases/ stress/2011/impact.asp National Sleep Foundation, 2007, Sleep in America Poll, http:// www.sleepfoundation.org/sites/ ings%20-%20FINAL.pdf The Brain on Stress Page 15