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H 30/05/2015

( )

: . MD, PhD, MRCGP, MEPMA




/- .
E-mail: geobellos1010@yahoo.gr

, 2014


26/01 03/02 3.2
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. 10

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Stress can be defined as any perceived


physical or psychological change that
disrupts
an
organisms
metabolic
balance.

Surveys and research reports conducted over


the past 2 decades reveal that 43% of all
adults suffer adverse effects due to stress.

In fact, 75% to 90% of all visits to primary


care physicians are in some way related to
the adverse impact of psychosocial stress.


STRESS
STRESS

Eustress

Distress

Positiv
e
Reaction to
Stress

Negative
Very
Low

Stress
Level

Very
High

BURN
OUT

()

(Distress)

EUSTRESS
( )

H
STRESS
Appraisal
Stressor

Stress

Coping
Outcome

EKKIN

Miller, A., Maletic, V. & Raison, C.L. (2009). Inflammation and its discontents: the role of cytokines in the pathophysiology of major depression. Biological Psychiatry, 65, 732-741.

STRESS

STRESS

HPA=Hypothalamic-Pituitary Adrenal Axis


SNS=Sympathetic Nervous System




GRAY
BLUE .

KAI -

Shrink Hippocampus / Increase


proinflammatory cytokines
Lower antioxidant levels
Reduce Natural Killer cells
Shrink telomeres
Negatively affect insulin sensitivity
Increase platelet aggregation
Adversely affect endothelium
Reduce Nitric Oxide levels
Degrades bone
Adversely impact genetic expression

Chronic distress raises the risk for


many health disorders, including:
Coronary heart disease
Hypertension
Eating disorders
Ulcers
Diabetes
Asthma

STRESS: work

related stress,
including role
conflict &
burnout

John Wiley & Sons, Inc. 2010

Summary:
Scientists have shown that anger, anxiety, and depression not only affect the functioning of the heart,
but also increase the risk for heart disease. Stroke and heart attacks are the end products of
progressive damage to blood vessels supplying the heart and brain, a process called atherosclerosis.
Atherosclerosis progresses when there are high levels of chemicals in the body called proinflammatory cytokines. It is thought that persisting stress increases the risk for atherosclerosis and
cardiovascular disease by evoking negative emotions that, in turn, raise the levels of proinflammatory chemicals in the body.

Atherosclerosis progresses when there are high levels of chemicals in the body called proinflammatory cytokines.
It is thought that persisting stress increases the risk for atherosclerosis and cardiovascular disease by
evoking negative emotions that, in turn, raise the levels of pro-inflammatory chemicals in the body.
Researchers have now investigated the underlying neural circuitry of this process, and report their
findings in the current issue ofBiological Psychiatry.
"Drawing upon the observation that many of the same brain areas involved in emotion are also
involved in sensing and regulating levels of inflammation in the body, we hypothesized that brain
activity linked to negative emotions -- specifically efforts to regulate negative emotions -- would
relate to physical signs of risk for heart disease," explained Dr. Peter Gianaros, Associate Professor at
the University of Pittsburgh and first author on the study.

Summary
In preclinical studies, the combination of chronic stress and a high sugar/fat diet is a
more potent driver of visceral adiposity than diet alone, a process mediated by
peripheral neuropeptide Y (NPY).
Methods
In a human model of chronic stress, we investigated whether thesynergistic
combinationof highly palatable foods (HPF; high sugar/fat) and stress was associated
with elevated metabolic risk. Using a case-control design, we compared 33 postmenopausal caregivers (the chronic stress group) to 28 age-matched low-stress
control women on reported HPF consumption (modified Block Food Frequency
Questionnaire), waistline circumference, truncal fat ultrasound, and insulin sensitivity
using a 3-h oral glucose tolerance test. A fasting blood draw was assayed for plasma
NPY and oxidative stress markers (8-hydroxyguanosine and F2-Isoprostanes).
Results
Among chronically stressed women only, greater HPF consumption was associated
with greater abdominal adiposity, oxidative stress, and insulin resistance at baseline
(allp's.01). Furthermore, plasma NPY was significantly elevated in chronically
stressed women (p<.01), and the association of HPF with abdominal adiposity was
stronger among women with high versus low NPY. There were no significant
predictions of change over 1-year, likely due to high stability (little change) in the
primary outcomes over this period.
Discussion
Chronic stress is associated with enhanced vulnerability to diet-related metabolic risk
(abdominal adiposity, insulin resistance, and oxidative stress). Stress-induced
peripheral NPY may play a mechanistic role.

STRESS,
:

50

30-50% of patients with CAD


exhibit mental-stress induced
ischemia in lab testing
Often ischemia is not
accompanied by angina and
not explained by physical
exertion
Mental stress hemodynamics
are physiologically different
from other cardiovascular
stressors

November 20, 2013


Emory Health Sciences
Summary:
Researchers have found that women younger
than 50 with a recent heart attack are more likely
to experience restricted blood flow to the heart
(myocardial ischemia) in response to
psychological stress. Emory researchers working
with Vaccarino have identified two areas where
there are specific differences in younger women
who had a recent heart attack: inflammation and
heart rate variability, a measure of the
responsiveness of the autonomic nervous
system. Low heart rate variability has been
previously linked to greater heart disease risk.
Interleukin-6 is a marker of inflammation that
goes up and down quickly depending on
someone's environmental exposures including
mental stress, even in healthy individuals. In the
MIMS study, women age 50 and below had much
higher levels of IL-6 in their blood, compared to
age-matched men, both before the mental stress
test and afterwards. Women and men older than
50 had similar levels of IL-6.
This is additional evidence that young women
after a heart attack may be more vulnerable to

Stress results in a significant


decline in natural killer (NK)
cell cytotoxic activity.
NK cells play a key role in
immune system surveillance
against viral-infected cells
and cancer cells.
Stress also reduces the
production of secretory IgAan important part of immune
response in the
gastrointestinal system,
urinary tract and lungs

Thompson, R. A., & Nelson, C. A. (2001). Developmental science and the media: Early
brain development. American Psychologist, 56(1), 5-15.

, S
Indulgent lifestyle
Energy imbalance
Stress
Aging

Epigenetics
CH3
CH3CH3

Previous
generations
experiences
behavior, Genotype
nutrition

Oscillatory,
circadian, seasonal
rhythms perturbation

Metabolic,
neuronal
malprogrammin
g

Mitochondrial
dysfunction

Chromosome/
DNA
damage/telom
eres






STRESS

Stress induced atrophy


of dendrite spine density
in hippocampus and
PFC, hypertophy in
amygdala
Plasticity in the adult
brain especially in the
hippocampus sleep is
essential
Glucocorticoids, CRF,
BDNF, Inflammatory
cytokines, monoamines,
glutamate, CBT

.D

etS

TY A
Stressed, hurried,
angry, hostile,
organized, on time.
Body produces an
extra amount of stress
hormones.
Take the positive
qualities and reduce
anger and hostility.

T B
Procrastinate, weight
gain, creative, laid
back, no worries.
Take the good and
reduce putting off
responsibilities.

2009 McGraw-Hill Higher Education. All rights reserved.

48




(hostility),
(anger) (cynicism)
.


,

.
, Suarez Richards

LDL-
,
.
,

,

I. Sympathetic dominance by continuous stress plus


II. Deficiency in production of endogenous digitalis-like compounds
with alterations of sodium-potassium pump activity results in
III. Lowered pH (acidity) that increases perfusion pressure and
provokes effects on contractility of coronary arteries, leading to
changes in hemodynamic shear stress and atherosclerosis as
consequence.
*Carlos ETB Monteiro, Acidic environment evoked by chronic stress: A novel mechanism to explain
atherogenesis. Available from Infarct Combat Project, January 28, 2008 at
http://www.infarctcombat.org/AcidityTheory.pdf

T D

Distressed
personality with
negative emotions.

Tends to be
depressed, anxious,
and insecure.

Exercise, relaxation
and a healthy diet
can help.


Produce a large amount
of harmful
catecholamines when
stressed that damage
the heart and increase
risk for sudden heart
attack.
Faulty perceptions of
stressor perceive
nearly every stressor as
life and death.
Could be any personality
type.
Reframing, thought
stopping, and relaxation
are important.

2009 McGraw-Hill Higher Education. All rights

51

1 -
.

2
.

All of which must be present for a


duration of more than 1 month and
causes clinically significant distress or
impairment in social, occupational, or
other important areas of functioning.


PTSD

PTSD
-

< 10%
AFFECTIVE DISORDERS
1.02.2015

STRESS

( :
80% IGs..)

ANO ..

STRESS

HRV

STRESS

VitruvianMan
LeonardoDaVinci

Was mich nicht umbringt


macht mich starker.
Friedrich Nietzsche

O,

DNA repair
Immune competence
Neurologic acuity
Neuromuscular activity
Better memory
Resistance/ adaptation
to stress


1. Relax neck and shoulders
2. Take a stretch
3. Get a massage
4. Exercise

5. Count to 10
6. Control your thoughts
7. Fantasize
8. Congratulate yourself
9. Ignore the problem if appropriate, after evaluation
10. Perform self maintenance
11. Talk to a counselor

12. Meditate
13. Pray
14. Remember your purpose
-
15. Take a break
16. Try progressive relaxation
17. Try yoga
18. Try aroma therapy
19. Laugh

20. Prioritize daily tasks
21. Learn something
22. Practice a hobby

.

.
?

Newsweek
March 26, 2007

Donald Miralle / Getty Images for Newsweek


Physical Therapy: Research suggests that
exercise can affect the moods and even relieve
depression

By Michael Craig Miller, M.D.

Abundant fruits and vegetables


Healthy fats: olive oil, nuts, fatty
cold water fish, fish oil
Low glycemic index/load
carbohydrates
Green tea, turmeric, ginger
Reduce stress
Get regular exercise
STRESS

C-reactive protein (CRP)
Interleukin-6 (IL-6)
Tumor necrosis factor-F-


STRESS

STRESS ,
EIA


DISTRESS


.


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