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STRESS, MODELS OF STRESSORS, STRESS AND SUBSTANCE ABUSE, IMMUNE SYSTEM,…

- - - - boost of adrenaline
      - fight-or-flight
    - - marked increase in cortisol
      - reattainment of allostatic balance
    - - prolonged stress
      - fatigue, burnout, anxiety, depression
    - - stores of stress hormones are depleted
        
        you become sick
      - one non-specific stress response for all stimuli
      - distress
        
        negative stress
      - eustress
        
        positive stress
  - - - physiological reaction long before the stressor
      - slow recovery
- - - - physiological reactions to events
    - - feel emotions and physiological reactions at once
  - - - Cold Pressor Test
      - cognitive
        
        Stroop task
        
        TSST
    - - cortisol measures
        
        blood plasma
        
        urine
        
        not useful for acute measurements
        
        saliva
        
        hair and nails
        
        cannot measure acute stress
    - - ECG
        
        heart rate
        
        BPM
        
        SNS > PNS
        
        R-R interval (IBI)
        
        60/R-R = HR
        
        smaller interval is increased SNS activity/decreased PNS activity
        
        heart rate variability
        
        vagally mediated HRV (vmHRV)
        
        variability in HR due to changes in PNS activity
        
        RMSSD
        
        increased PNS activity
        
        RSA
        
        increased PNS activity
        
        variability in synchrony with respiration
        
        R-R interval is shortened during inspiration, and prolonged during expiration
        
        depressive disorder is related to lower RSA
    - - hypotension
        
        < 80 / < 60
      - hypertension stage 2
        
        160 / > 100
      - measures
        
        arterial line
        
        invasive
        
        upper arm NBP
        
        non-invasive
        
        only a measure of one time point
        
        CNAP
        
        non-invasive
        
        blood pressure over time
    - - skin conductance level (SCL)
      - not a lot of information on the recovery phase
      - sympathetic activity
    - - lab measures of CV reactivity
      - EDA
      - cross-sectional questionnaire data
    - - ambulant CV activity
      - cortisol from saliva, or hair
      - longitudinal questionnaire data
- - - - detrimental effect of allostasis
      - overactivated stress-response systems
- - - - high demands
      - low control
      - monotony
    - - decreased HRV
  - - - decreased HRV
  - - - unequal treatment within decision-making processes
      - unequal treatment within relational interactions
- - - - sex
        
        V-TSST induces greater effect size of cortisol reactivity in men
      - age
        
        group with < 25 age had greater cortisol reactivity
      - virtual environments
        
        immersive VE's elicit a greater cortisol response than non-immersive VE's
- - - - preparation for free speech/job interview
    - - no feedback from judges
    - - best marker for the response to acute psychosocial stress
      - demographic factors
        
        larger cortisol response in men
        
        similar cortisol response in women in the luteal phase
      - biological factors
        
        CBG
        
        low blood glucose levels
      - clinical conditions are associated with blunted HPAA responses
      - HPAA markers rapidly habituate
- - - - frontal cortex
        
        decision-making
        
        impulse control
      - cingulate cortex
        
        sense of sadness
      - amygdala
        
        anxiety and fear
- - - - larger context of safety
  - - - dopamine levels drop a little below baseline after stimulation
- - - - drugs become anxiety-generating
        
        continued use
  - - - drugs can blunt the stress-response
- - - - decrease perceived stress and negative mood
- - - - suppression of inflammation
- - - - changed immune functioning and disease resistance
    - - chronic activation of stress-response
      - less of an anti-body response
    - - high glucocorticoid levels
        
        increased likelihood of infection
      - norepinephrine
        
        easier for virus to invade lymphocyte and replicate virus
  - - - no reminder to take medication
      - unhealthy diet
      - less able to maintain social relationships
    - - unlikely to be eating, sleeping, and exercising in a healthy manner
  - - - smoking and alcohol
    - - increased immune functioning
    - - tumour growth
- - - - decreased glucocorticoid sensitivity
        
        it will take more glucocorticoids to bring immune functioning back to 100%
        
        no adequate recovery phase
        
        prone to autoimmune disease
    - - cells become resistant to cortisol
      - symptoms of fatigue, diminished appetite, listlessness
- - - - a stressor is absent
      - the stressor is very rare
      - the warning is untimely
      - vague information
- - - - incessant ideation
      - uncontrollable wallowing in dark thoughts
      - SSRIs
      - insufficient levels
    - - psychomotor retardation
      - insufficient levels
    - - dysfunction of pleasure pathway
      - insufficient levels
  - - - cingulatomy
  - - - shared depressive trait for close relatives
      - shared environment of close relatives
    - - chronic illness with overactive immune system
        
        increased rate of depression
      - cytokines
        
        CRH release
        
        norepinephrine
        
        dopamine
        
        serotonin
    - - too little thyroid hormone
        
        development of major depressions
      - oestrogen and progesterone
        
        linked to risk of unipolar depression
  - - - proneness to depression
        
        higher than expected rate of experienced depression
        
        lack of social support
    - - can disrupt memory
        
        Cushing's syndrome
        
        increased risk of depression
      - workings of neurochemicals that underlie depression
      - immunosuppresion
      - decreased volume in frontal cortex
        
        loss of thoughtful reasoning and action
        
        increase in emotional responses
        
        memory impairment
        
        impaired decision-making
      - adrenal steroidogenesis inhibitors
      - DHEA
  - - - mourning
      - melancholia
        
        major depression results from internal conflict
        
        take on traits of loved ones
    - - similar to depression
      - cognitive distortion of how the world works
- - - - cortisol is necessary to restore homeostasis
      - you won't enter recovery stage
- - - - suppressed appetite
  - - - stress about over-consuming
- - - - effective for short-term problems
      - more effective if a problem cannot be solved
    - - effective when problems can be fixed
  - - - constructive
    - - emotions associated with the stressor
  - - - when the stressor occurs
    - - anticipatory
- - - - positive or negative perceptions of god
    - - provides coping strategies
- - - - impeded goals
      - no goals
      - unattainable goals
- - - - social stressor
        
        anxiety and vigilance
        
        SNS
      - subordination to social stressor
        
        glucocorticoids
        
        depression
- - - - logical response
      - coping
    - - emotional and physiological response
  - - - perception of threat
    - - perceived ability to cope or not
- - - - SNS
        
        adrenal medulla
        
        (nor-)adrenaline
        
        increase in:
        
        heart rate
        
        blood pressure
        
        breathing
        
        sweat production
        
        decrease in:
        
        digestion
        
        saliva production
        
        size of blood vessels
  - - - CRH
        
        pituitary gland
        
        ACTH
        
        adrenal gland
        
        glucocorticoids
        
        suppressed immune functioning
        
        hypertension
        
        2 more items...
        
        sympathetic activity
- - - - large amounts of glucocorticoids
      - large amounts of CRH
      - appetite suppressed if CRH > glucocorticoids
      - recovery period
        
        substantial amounts of glucocorticoids
        
        little CRH
        
        appetite is stimulated
  - - - increased appetite
  - - - sensitive to glucocorticoids
- - - - sustained suppression of appetite
- - - - peptic ulcers (stomach)
      - helicobacter pylori
        
        causes gastritis
      - duodenal ulceration
        
        people who are anxious, depressed, or are undergoing severe life stressors
      - stress and ulcers
        
        acid rebound
        
        several periods of transient stress
        
        related to the recovery period
        
        decreased blood flow
        
        blood and oxygen is diverted from the gut
        
        acid is flushed away less
        
        oxygen radicals
        
        immune suppression
        
        insufficient amounts of prostaglandins
- - - - body gives up
      - over-activity of the vagus nerve
- - - - lower inflammation
  - - - no increase in happiness and no decrease in depressive symptoms
    - - early memories
    - - no additional increase in happiness
    - - similar effect as original
- - - - ability level is not taken into account
    - - bad communication
      - unclear roles
  - - - observation of stress depends on individual differences
      - objective demands
        
        subjective perception
        
        personality
        
        social support
        
        stress-response
      - person-environment fit
    - - healthy work
        
        both low or high demands
        
        high control
        
        strong support
      - dangerous work
        
        high demands
        
        low control
        
        weak support
        
        increased risk of cardiovascular morbidity and mortality
  - - - more support
      - clear roles
      - clarity of job's future
    - - physical actviity
      - empathy
      - listening to music
      - sleeping more
- - - - sleep problems
      - lower immunity
      - more stress hormones
  - - - Myocardial Infarction
      - stroke
      - Acute Coronary Syndrome
      - Pulmonary Embolism
    - - greater risk of adverse CV events
    - - bereavement is non-repeated event
      - higher risk is relatively short-term
- - - - underactive stress-response
      - inadequate glucocorticoids
      - fatigue, irritability, low blood pressure, salt-pressure
    - - inadequate epinephrine and norepinephrine
      - inability to mobilise the body during energetic demands
    - - inadequate glucocorticoids
    - - interconnection between metabolic and cardiovascular systems
      - subsets of problems predict each other
- - - - allostatic balance
    - - SNS activity
      - decreased insulin
      - glucagon
        
        glycogen is degraded into glucose
      - glucocorticoids
        
        block energy uptake into muscles and fat tissue
      - (nor-)epinephrine
- - - - SNS activation
      - glucocorticoid secretion
- - - - continued metabolism of energy
      - increased risk of CVD, immune suppression, GI disorders
      - impaired hippocampus activity in the case of prolonged stress
  - - - less restoration of energy
      - shallow sleep stages
- - - - can't effectively store glucose
        
        little energy
        
        risk of atherosclerotic problems
    - - increased mobilisation of glucose and fatty acids
        
        increased likelihood of build-up
      - promotes insulin resistance
        
        increased insulin injections
        
        increased insulin resistance
  - - - fat cells are too full
      - other cells become insulin-resistant as well
      - less glucose is taken up
        
        circulating glucose and fatty acids will damage blood vessels
    - - body becomes insulin-resistant
        
        pancreas secretes even more insulin
        
        pancreatic cells will stop working
    - - constant mobilisation of glucose and fatty acids
      - stress hormones instruct cells to become insulin-resistant