Pathophys CH 9

Chapter 9
Stress and Adaptation
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Homeostasis
• The purposeful maintenance of a stable
internal environment
• Homeostasis does not occur by chance
but is the result of organized self-
government.
• The regulating system determining
homeostatic state consists of a number
of operating mechanisms acting
simultaneously.
Constancy of the Internal
Environment
• Constancy in an open system requires
mechanisms that act to maintain this
constancy.
• Steady-state conditions require that any
tendency toward change automatically
meet with factors resisting change.

Stress and Homeostasis
• A state manifested by symptoms that arise

from the coordinated activation of the
neuroendocrine and immune systems
(general adaptation syndrome)
• A state manifested by a specific syndrome of
the body developed in response to any
stimuli that made an intense systemic
demand on it
• Meaning?

Stress
• Any intrinsic or extrinsic stimulus that

evokes a biological response
• The compensatory responses to these
stresses are known as stress responses.
• Based on the type, timing and severity of the
applied stimulus, stress can exert various
actions on the body ranging from alterations
in homeostasis to life-threatening effects and
death.

Stress and Diseases
• Stress can be either a triggering or

aggravating factor for many diseases and
pathological conditions.

The Relationship
Between Stress and Disease
• Contagious diseases
vs. chronic diseases
– Biopsychosocial
model
– Health promotion &
maintenance
• Discovery of causation,
prevention, and treatment

Overview of the Stress
Process

Responding to Stress
Emotionally
• Emotional Responses
– Annoyance, anger, rage
– Apprehension, anxiety, fear
– Dejection, sadness, grief
– Positive emotions
• Emotional response and

performance

Behaviorally
• Behavioral Responses
– Frustration-aggression
hypothesis
– catharsis
– defense mechanisms
• Coping
– Reappraisal
– Confronting problems
– Using humor
– Expressing emotions
– Managing hostility
Effects of Stress:
Behavioral and
Psychological
• Impaired task
performance
• Burnout
• Psychological
problems and
disorders
• Positive effects

Physiologically
• Video

Physiologically
• Physiological Responses
– Fight-or-flight response
– Selye’s General Adaptation Syndrome
•Alarm
•Resistance
•Exhaustion

Figure 4.5
General adaptation syndrome.

Copyright © 2019 Pearson Education, Inc. All Rights Reserved
Term Description
Stress • Psychologic & physiologic response to an event
• Often applies to perceived threat or challenge
Coping • Psychologic & behavioral measures
• Aimed at handling stress demands
• Stress demands include internal or external factors
Adaptation • Physiologic & psychologic processes
• Used in response to stress

Adaptation
• The ability to respond to challenges of

physical or psychological homeostasis and to
return to a balanced state
• We will discuss this during the next class

Effects of Stressors
• What happens physiologically?

Figure 4.2
Bodily effects of stress.

HPA Axis
• Affects hormone secretion
– Pituitary and adrenal glands
– Involved in cortisol release
•Negative feedback loop

Effects of Stressors
• Activation of CNS pathways
– HPA axis
– SNS
•Sympathetic adrenal medullary
system
•Locus coeruleus-norepinephrine
(LC/NE)
– Endogenous opioid pathway
LE and NE Systems
• Group of neurons located in the pons
– Multiple connections
•E.g., limbic system, hypothalamus,
thalamus, portions of the SC
• Regulates norepinephrine release
• Controls alertness, arousal, vigilance
• May affect CNS coordination during
stress response
Figure 4.8

Figure 4.3
Psychosocial stress affects wound healing through the release of cortisol and by activation of the SNS.

Hormones Responding to
Stress
• Growth hormones
• Thyroid hormone
• Reproductive hormones
• Antidiuretic hormone (ADH)

Reactions to Acute Stress
• Facilitation of neural pathways
mediating arousal
• Alertness
• Vigilance
• Cognition
• Focused attention
• Appropriate aggression

Effects of Chronic Stress
• Pathophysiologic changes occur.
• Altered physiological function
– Cardiovascular, gastrointestinal,
immune, neurologic systems
• Altered psychological factors
– Depression, accidents, suicide,
chronic alcoholism, drug abuse,
eating disorders
Allostasis
• Constancy through change
• Presumes continual state of flux
– Body responds to multiple
environmental demands
– Physiologic mechanisms may be
active or at rest

Allostasis
• CNS–neuronal • Mechanisms that
pathways respond
− Cerebral cortex – Immune
− Limbic system – Endocrine
− Thalamus – Musculoskeletal
− Hypothalamus
− Pituitary gland
− Reticular
activating system
Consequences of Persistent Stress &
Allostatic Load
• negative cortisol feedback dwindles (receptor
downregulation?)
• a subpopulation
of CRF secreting
cells begin to
synthesize and
secrete
vasopressin as a
co-existing
releasing factor

Memory of Stress
• Association of a stimulus with memory
– Hippocampus cannot distinguish
threat level of similar cues
– Unconscious misinterpretation of
stimuli may occur
•Pathologic stress response
•Re-experiencing of original
trauma

Posttraumatic Stress
Disorder (PTSD)
• Chronic activation of the stress
response as a result of experiencing a
potentially life-threatening event
• Formerly called battle fatigue or shell
shock
• Caused by major catastrophic events

Characteristics of PTSD
• Intrusion: the occurrence of
“flashbacks” during waking hours or
nightmares in which the event is
relived, often in vivid and frightening
detail
• Avoidance: the emotional numbing
that accompanies this disorder and
disrupts important personal
relationships

Characteristics of PTSD
• Hyperarousal: the presence of
increased irritability, difficulty
concentration, an exaggerated startle
reflex, and increased vigilance and
concern over safety

Stress and Physical Health
• Body systems are susceptible to stress-
related disease
– Examples
•Respiratory
•Neurologic
•Gastrointestinal
•Cardiovascular
•Immune
Neurologic disease
• Multiple sclerosis (MS)
– Anecdotal reports by individuals with
MS
•Psychologic stress precipitates
exacerbations

Neurologic disease
• Theory of MS development
– Inappropriate stress responses
•Exacerbated dysregulation of
cytokine production
•Impaired inflammatory response
•Impaired antibody production
•Individual may demonstrate
altered cytokine profile
Gastrointestinal Disease
• ↑ sympathetic responsiveness to stress
– promotes inflammatory bowel disease
• Stress-related changes in CNS
structures
• Ongoing sympathetic response
• Epinephrine & norepinephrine
release
• ↑ Hypersecretion of gastric acid
Cardiovascular disease
• Mental and psychosocial stress
– Linked to episodes of myocardial
ischemia
– Increase risk for acute myocardial
infarction
• Increased levels of hostility and anxiety
– Linked to development of coronary
artery disease

Cardiovascular disease
• Chronic stress state
– Stimulates sympathetic and HPA
systems
•Causes chronic inflammation
•Inflammation promotes
atherosclerosis
•Increased risk for
cardiovascular disease

Methods for Studying
Physiologic Manifestations of
Stress
• Electrocardiographic recording of heart

rate
• Blood pressure measurement
• Electrodermal measurement of skin
resistance associated with sweating
• Biochemical analyses of hormone levels
Methods for Studying
Physiologic Manifestations of
Stress
• Measurements of urinary & plasma

catecholamines
• Cortisol levels obtained from salivary
samples
• Blood tests to obtain immune cell
(lymphocyte) counts & antibody levels

Treatment Modalities for
Stress
• Helping people avoid coping behaviors
that impose a risk to health
• Providing people with alternative
stress-reducing strategies
– Purposeful priority setting and
problem solving
– Non-pharmacologic methods of
stress reduction

Nonpharmacologic Methods
of Stress Reduction
• Relaxation techniques
• Guided imagery
• Music therapy
• Massage
• Biofeedback

Pathophys CH 9

Uploaded by

Document Information

Original Title

Copyright

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Pathophys CH 9

Uploaded by

Copyright:

Chapter 9

Stress and Adaptation

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

• A state manifested by symptoms that arise

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Any intrinsic or extrinsic stimulus that

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Stress can be either a triggering or

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Emotional response and

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

General adaptation syndrome.

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

• The ability to respond to challenges of

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

• What happens physiologically?

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Bodily effects of stress.

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2019 Pearson Education, Inc. All Rights Reserved

Copyright © 2019 Pearson Education, Inc. All Rights Reserved

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

− Cerebral cortex – Immune

− Limbic system – Endocrine

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Electrocardiographic recording of heart

• Measurements of urinary & plasma

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

You might also like