Chapter 26 Stress and Associated Problems - Vocabulary Flashcards

Review of the Stress Response

• The stress response is a generalized or systemic response to a change (stressor), whether internal or external. It may be modified in specific situations.
• Stress and disease: The role of stress in disease became firmly established in the 20th century with Hans Selye’s general adaptation syndrome (GAS) or the "fight or flight" concept (1946). The body continuously responds to minor changes to maintain homeostasis via built‑in compensatory mechanisms for fluid balance, blood pressure, etc. Minor fluctuations are normal.
• A stressor is any factor that creates a significant change in the body or environment. It may be physical, psychological, or a combination, and may be real, anticipated, or imagined, short‑term or long‑term. Examples: pain, cold exposure, trauma, anxiety or fear, a new job, infection, or even joyous occasions.
• Stress is considered to occur when an individual’s status is altered by a stressor. The response is generic but can be modified by perception and coping ability. If the stressor is copeable, the body returns to normal; if not, distress results and harmful effects may occur.
• Stressors are a normal part of life and can positively influence the body when proper coping mechanisms function well. Stressors may stimulate growth and development. Without stressors, life could become dull and inert.
• When extremely severe or multiple stressors occur simultaneously, adaptive mechanisms may be insufficient, leading to greater disruption, maladaptive behaviors, and loss of homeostasis. Aging and pathological disorders can impair stress responsiveness.
• A vicious cycle can occur: the original stressor persists, its effects hinder coping with new stressors, causing more damage and reduced coping capability, further decreasing the chance of returning to normal.
• Maladaptive behaviors (e.g., ignoring the stressor, eating poorly) can add problems without addressing the stressor.
• Selye’s GAS: three stages
  • Alarm stage: hypothalamic, sympathetic nervous system, and adrenal mobilization of defenses.
  • Resistance stage: hormonal levels elevated; essential systems at peak performance.
  • Exhaustion stage: body cannot respond further or is damaged by increased demands.
• The stress response involves an integrated series of actions including the hypothalamus–pituitary axis, sympathetic nervous system, adrenal medulla, and adrenal cortex. The locus ceruleus (noradrenergic brainstem center) provides rapid CNS response. Stress initiates a marked increase in ACTH secretion, followed by a large cortisol rise.
• Major physiologic effects of the stress response include:
  • Elevated blood pressure and increased heart rate
  • Bronchodilation and increased ventilation
  • Increased blood glucose via glycogenolysis, gluconeogenesis in the liver, protein catabolism in muscle, and lipolysis
  • Arousal of the central nervous system
  • Decreased inflammatory and immune responses (cortisol dampens early and later immune responses)
• These actions increase function in critical organs (brain, heart, skeletal muscle) by improving oxygen delivery, circulation, and cellular metabolism. Short‑term stress may enhance cognitive function and short‑term memory. Endorphins are released to act as natural analgesics.
• Most stress responses are adaptive and self‑limiting; problems arise with severe or prolonged stress or impaired adaptation. Severe stress plus new treatment needs (e.g., hospitalization) can add additional stressors (fear, pain, separation from family, changes in routine, privacy concerns).
• Memory and intellectual function can be disrupted with major or prolonged stress; large doses of glucocorticoids have been linked to memory impairment.
• THINK ABOUT 26.2 – Key concepts
  • a) Source of increased blood glucose during stress: Stress triggers glycogenolysis and gluconeogenesis in the liver, protein catabolism in muscle, and lipolysis, all contributing to higher circulating glucose and amino acids; insulin action may be reduced during stress.
  • b) Organs where vasoconstriction occurs and areas with increased blood flow during stress: Vasoconstriction occurs in skin and gastrointestinal mucosa; blood flow to viscera decreases; increased blood flow occurs to brain, heart, and skeletal muscles (and to CNS via central arousal).
  • c) Two ways brain oxygen supply increases during stress: (1) Increased ventilation (bronchodilation and higher respiratory rate) to raise arterial O2; (2) Increased cerebral blood flow/ perfusion due to central autonomic adjustments and glucose availability, supporting heightened neural activity.
  • d) Hormones released during the stress response and two key actions for each:
    • Norepinephrine (SNS terminal and circulating): vasoconstriction in skin and GI mucosa; increased alertness; increased heart rate and contractility; mobilizes energy stores (lipolysis).
    • Epinephrine (adrenal medulla): bronchodilation; increased heart rate and contractility; vasodilation in skeletal muscle; increased glycogenolysis and lipolysis; increased attention and energy availability.
    • Cortisol (adrenal cortex): increases blood glucose via gluconeogenesis; promotes protein catabolism and lipolysis; anti‑inflammatory and immunosuppressive effects; delays tissue healing.
    • Aldosterone (mineralocorticoid): promotes Na+ and water retention; increases blood volume and blood pressure.
    • Antidiuretic hormone / vasopressin (posterior pituitary): increases water reabsorption in kidneys; increases blood volume and blood pressure.
    • Adrenocorticotropic hormone (ACTH, from anterior pituitary): stimulates adrenal cortex to release cortisol and aldosterone.
    • Corticotropin‑releasing factor (CRF, hypothalamus): triggers ACTH release from anterior pituitary (upstream regulator).
• Positive vs negative stress
  • Positive stress (eustress): inspiring and encouraging; may promote long‑term health; can be associated with motivation, efficiency, creativity, and improved focus.
  • Negative stress (distress): the adverse stress response described above; will be discussed later in this chapter.
• Technostress (TS)
  • TS is stress from information and communication technologies (ICTs) and the expectations of ICT use in business and society.
  • Negative neurophysiological effects include elevations in stress hormones (adrenaline, noradrenaline, cortisol), increased sympathetic activity, and changes in neuronal processes in the brain. TS is likely to persist with rising digitalization.
  • TS occurs in all ages, but older individuals may have higher TS levels since they did not grow up with ICTs; smartphone use by younger people is linked to increased stress and has led to the concept of smartphone use disorder (apps like WhatsApp, Facebook, etc. can elevate stress and reduce life satisfaction).
  • The age relationship with TS is not fully clarified and remains under investigation.
• Stress and disease
  • >40% of adults experience adverse effects from stress; 75–90% of doctor visits are for stress‑related problems.
  • Stress can cause minor problems (e.g., headaches) or contribute to more serious issues such as stress ulcers or infections, especially when the stress response is prolonged or severe.
  • Prolonged vasoconstriction and reduced blood supply can cause stomach and mouth ulcers (stomatitis/necrotizing periodontal disease) and nausea; severe stress can impair GI or renal function.
  • In patients with preexisting conditions, stress can be additive or exacerbate the disorder (e.g., hypertension, arrhythmias in damaged hearts).
  • Stress precipitates various disorders: chronic infections (herpes simplex), acute asthma attacks, seizures, cancer or infection following a major crisis, and exacerbation of chronic illnesses like ulcerative colitis, Crohn’s disease, eczema, acne, etc.
  • Chronic illness coping is critical to delay exacerbations; immune suppression under stress increases susceptibility to opportunistic infections and can impair healing.
  • Some diseases (e.g., hypertension, coronary artery disease, diabetes mellitus) may have stress as an etiologic or aggravating factor; stress hormones elevate serum lipids and promote vasoconstriction and BP elevations.
  • A brief selection of stress‑related disorders is summarized in Box 26.1 (organ system associations listed below).
• Box 26.1 – A Selection of Stress‑Related Disorders (representative examples)
  • Gastrointestinal System: Peptic ulcer, stress ulcers; ulcerative colitis; regional ileitis; nausea, diarrhea; stomatitis, periodontitis
  • Nervous System: Multiple sclerosis; seizures; depression
  • Cardiovascular System: Hypertension; angina; congestive heart failure
  • Respiratory System: Asthma
  • Musculoskeletal System: Rheumatoid arthritis
  • Skin: Herpes simplex; eczema; acne
  • Urinary System: Acute renal failure; cirrhosis (in some contexts linked to alcohol use)
  • Other: Cancer; infection; autoimmune disorders; obesity
• Potential effects of prolonged or severe stress
  • Severe stress can lead to acute renal failure from prolonged vasoconstriction and reduced renal blood flow; tubular necrosis and possible cessation of glomerular filtration; permanent kidney damage in some cases.
  • Stress ulcers: multiple gastric ulcers often asymptomatic but dangerous due to potential gastric hemorrhage; Curling ulcers may occur with burns.
  • Mechanisms contributing to ulcer formation under stress: intense vasoconstriction in gastric mucosa reducing regeneration and mucus production; decreased GI motility causing chyme stasis; glucocorticoids delay tissue regeneration; all contribute to ulcers.
  • Preventive measures: maintain hydration to support renal flow; vasodilator drugs to protect renal function; protective gastric mucosa and reduced acid secretion to prevent ulcers.
  • Stress and infection: cortisol‑related suppression of inflammatory and immune responses increases susceptibility to opportunistic infections and mask signs of infection; lymphoid tissue atrophy and reduced leukocytes are observed.
  • Healing impairment: high cortisol reduces protein synthesis and tissue regeneration; catecholamines cause vasoconstriction and reduced nutrient delivery to injured tissue, potentially increasing infection risk and scar tissue.
  • PTSD (Posttraumatic Stress Disorder): recognized after major disasters or trauma; symptoms include re‑experiencing, avoidance, and dissociation; usually begins within 3 months but can appear years later; increased risk of substance abuse; treatment often resolves within ~6 months but can persist.
  • THINK ABOUT 26.3 – explanations
  • Explain how reduced blood flow in an area can interfere with healing and increase infection risk.
• Coping with stress
  • Key: recognize stressors and develop coping strategies to solve the problem or improve coping when the stressor cannot be removed.
  • Factors that can interfere with adaptive responses: fatigue, age, poor nutrition, insufficient knowledge, lack of emotional support.
  • A support system is essential to minimize pathologic effects.
  • Coping strategies (examples):
  • Adequate rest and healthy diet
  • Lifestyle changes to adapt to new situations
  • Regular moderate aerobic exercise (cycling, swimming, running) to reduce muscle tension, improve circulation, and stabilize blood sugar; aerobic exercise uses fats for energy during activity, supporting stable glucose levels; helps provide stable brain blood flow and mood
  • Distraction techniques and problem‑solving to reassess problems more objectively
  • Counseling and support services
  • Relaxation techniques (imagery, biofeedback, music/art therapy)
  • Short‑term anti‑anxiety medication under caution (e.g., lorazepam) due to potential adverse effects (drowsiness, memory loss, impaired judgment, confusion, nausea, low energy)
  • Methodical decision making and goal setting; avoid maladaptive behaviors that worsen stress (e.g., poor sleep, junk food, excessive caffeine, smoking)
  • Individualized coping: coping mechanisms must be tailored and periodically adjusted as stressors change.
• CASE STUDY 26.1 – Situational Stress Response (L.D., 13 years old)
  1) Stressors for L.D.: anxiety about wisdom teeth removal; fear of needle for anesthesia; prior light‑headedness with immunizations; busy dental office with delays; fear of loss of control and separation.
  2) Effect of delay and possible coping: delay can heighten anticipatory anxiety and autonomic activation; reduce stress with reassurance, distraction, or scheduling accommodations; strategies include clear explanations, child‑friendly environment, and allowing a chosen coping technique during the wait (e.g., breathing, counting, parental support).
  3) When called and nearly faint: hypotension likely due to a vasovagal response (autonomic nervous system shift toward parasympathetic activity with bradycardia and vasodilation), not the typical stress response; this is a reflex that can occur with pain or fear in some individuals.
  4) Sweating and dilated pupils: sympathetic nervous system activation causing diaphoresis and mydriasis (pupil dilation) due to circulating catecholamines and peripheral sympathetic drive.
  5) Mother’s reassurance effects: brief supportive reassurance can reduce perceived threat and aid coping; however, overly minimizing distress or removing a sense of control can diminish adaptive coping; supportive, nonjudgmental approaches and effective preparation are preferable.
• STUDY QUESTIONS (selected answers) 1) Factors/mechanisms in the stress response that increase oxygen supplies and how each contributes:
  • Bronchodilation and increased ventilation (to raise arterial O2)
  • Increased heart rate and cardiac output (to deliver more O2 to tissues)
  • Vasodilation to essential muscles and brain (central redistribution to active tissues)
  • Enhanced cerebral perfusion and cellular metabolism in critical tissues
    2) Describe a recent stressor and the stress response: Example will vary; identify stressor, perception (cognitive appraisal), activation of SNS and HPA axis, catecholamine surge, cortisol release, metabolic shifts, and potential coping responses.
    3) Differentiate positive vs negative response: Positive (eustress) enhances performance and resilience; negative (distress) impairs function and can cause harm if prolonged or inadequately managed.
    4) Case conclusion for the dentist scenario:
  • Post‑procedure healing may be affected by continued pain and jaw stiffness due to impaired tissue repair and increased cortisol/catecholamine effects; manage pain, reduce stress, and support healing.
  • To reduce stress before future procedures: use a less threatening anesthesia method (e.g., mask instead of needle), provide clear information, employ distraction and relaxation techniques, and ensure adequate analgesia.
• CHAPTER SUMMARY
  • The basic stress response is the same across situations, with variations by cause. Stressors are normal and can be positive or negative.
  • The stress response involves three stages (alarm, resistance, exhaustion) and key regulators (hypothalamus, pituitary, SNS, adrenal glands).
  • Technostress (TS) is a modern form of stress linked to ICT use; age and smartphone use patterns influence TS; smartphone use disorder is emerging as a concern.
  • Stress can cause minor problems (e.g., headaches) or major problems (e.g., ulcers, renal failure) and can exacerbate chronic illnesses.
  • Severe or prolonged stress has serious consequences, including poor healing and immune suppression; PTSD can follow major disasters or trauma.
  • Coping strategies include rest, nutrition, exercise, social support, counseling, relaxation techniques, and careful use of medications; maladaptive behaviors should be avoided.
  • A case study illustrates how stress responses can manifest in adolescents and how supportive, informed management can improve outcomes.
• A Selection of Stress‑Related Disorders (Box 26.1, summarized)
  • GI: Peptic ulcers, stress ulcers, ulcerative colitis, regional ileitis, nausea, diarrhea, stomatitis, periodontitis
  • Nervous system: MS, seizures, depression
  • Cardiovascular: Hypertension, angina, congestive heart failure
  • Respiratory: Asthma
  • Musculoskeletal: Rheumatoid arthritis
  • Skin: Herpes simplex, eczema, acne
  • Urinary: Acute renal failure
  • Other: Cancer, infection, autoimmune disorders, obesity
• Potential Complications of Severe Stress
  • Acute renal failure from prolonged vasoconstriction and reduced renal blood flow; tubular necrosis and possible cessation of filtration; in some cases permanent kidney damage.
  • Stress ulcers with pain and GI bleeding; protective measures include hydration, mucosal protection, and acid suppression.
  • Infection due to cortisol‑induced suppression of the immune response; lymphoid atrophy and leukocyte reduction; higher risk of opportunistic infections.
  • Impaired healing due to cortisol‑driven protein synthesis suppression and catecholamine‑driven vasoconstriction.
  • PTSD risk after major trauma; symptoms may include re‑experiencing, avoidance, and dissociation; potential for substance dependence; treatment often resolves within months but may persist.
• THINK ABOUT 26.3 – Implications for healing and infection risk: Reduced blood flow can impede nutrient delivery and waste removal, delaying tissue repair and increasing infection risk.
• ETHICAL/PHILOSOPHICAL/PR practical implications
  • Importance of supporting patients’ coping resources (social support, education, autonomy) to minimize distress and enhance healing.
  • Recognize the biopsychosocial model of stress: biological responses interact with psychological appraisal and social context to influence health outcomes.
• KEY TERMS (selected)
  • bronchodilation, endorphins, homeostasis, lipolysis
  • ACTH, ADH, cortisol, aldosterone, CRF, GAS, TS, eustress, distress

ext{GAS} = \{ \text{Alarm}, \text{Resistance}, \text{Exhaustion} \}

• CONNECTIONS TO FOUNDATION AND REAL‑WORLD RELEVANCE

  • Stress physiology underpins how acute injuries, infections, and chronic diseases unfold in clinical practice.
  • Understanding technostress is increasingly relevant for workplace health and mental well‑being.
  • Coping strategies align with broader behavioral health and preventive medicine, emphasizing resilience and adaptive behavior.

• PRACTICAL IMPLICATIONS FOR EXAM PREP

  • Be able to describe GAS stages and the major hormonal players (CRF, ACTH, cortisol, ADH, aldosterone, catecholamines) and their effects.
  • Distinguish between positive (eustress) and negative (distress) stress, with examples.
  • Explain how stress can contribute to specific disorders (peptic ulcers, renal failure, infections, cardiovascular events) and how coping strategies can mitigate risk.
  • Recall typical complications of severe stress (renal failure, ulcers, infection, poor healing, PTSD).
  • Interpret case scenarios involving autonomic responses (diaphoresis, mydriasis, vasovagal reactions) and apply coping strategies.