psychosocial stress
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Etiology
- family & marital difficulty
- financial problems
- job stress
- physical or mental illness
- shiftwork or night work
- school stress, especially when combined with work & family obligations
- substance abuse, including tobacco & alcohol
- care of aging parents, often combined with raising one's own children
- loneliness
Pathology
- activation the hypothalamic-pituitary-adrenal axis
- secretion of cortisol & aldosterone by the adrenal cortex
- increased sympathetic tone
- activation of sympathetic nervous system
- release of catecholamines by the adrenal medulla
- serotonin system may modulate sympathetic activity
- oxytocin facilitates the sensation of social stress[8]
- the inflammatory response may be activated
- may increase cellular oxidative stress[2]
- the immune system may be suppressed
- blood pressure may increase
- heart rate may increase
- oxygen demand may increase
- arrhythmias may occur
- the duration of psychosocial stress as well as the response of the individual to the stress have a major influence
- may accelerate telomere shortening in mitotic cells[2]
Complications
- even low levels of psychosocial stress linked to increased mortality[3]
- stress-related disorders are associated with increased risk for life-threatening infections
- job stress contributes modestly to cardiovascular risk (HR=1.23)[4]
- psychosocial stress is the third most important modifiable risk factor for myocardial infarction (after dyslipidemia & smoking), more important than diabetes mellitus, hypertension, or obesity[9]
- emotional stress stimulates sympathetic activity & increases risk of MI[11] (RR=2.44)
- childhood psychosocial stress increases risk for early coronary artery disease[10]
- stress-related psychiatric disorder (including posttraumatic stress disorder, acute stress reaction, & adjustment disorder) associated with increased risk of cardiovascular disease (RR=1.7)[14]
- increased risk of peptic ulcer independent of NSAID use or H pylori infection[7]
- psychosocial stress may impair decision-making[12]
- may result in increased tendency to remain in unfavorable situations[12]
- perceived psychosocial stress is associated with both prevalent & incident cognitive impairment in the elderly (RR=1.4-1.6)[17]
- psychosocial stress may increase subsequent risk for neurodegenerative disease[16]
Differential diagnosis
Management
- strategies
- removal or alteration of the stressor
- change in perception of the stressful event
- reduction in the physiological sequellae of stress
- use of alternative coping strategies
- techniques
- relaxation techniques
- muscle relaxation
- quiet environment
- passive attitude
- deep breathing
- biofeedback
- behavior modification
- healthy behavior can modify the effects of stress[6]
- anger management
- life-style changes
- diet
- exercise
- relaxation techniques
- treatment of concurrent depression
- general recommendations
- daily exercise
- eat a diet rich in fruits & vegetables & whole grains
- do not smoke
- use alcohol in moderation or not at all
- relaxation (see above)
- support from family & friends (biofeedback)
- active social networks
- positive interpersonal relationships[6]
- treat comorbidities
Comparative biology
- chronic restraint* produces generalized dendritic hypertrophy in the basolateral amygdala[13]
- selective maturation of dendrites that project to the ventral hippocampus (& not dorsomedial prefrontal cortex)
- activity in glutaminergic synapses that strengthen connections between the basolateral amygdala & ventral hippocampus[13]
* established stress stimulus in animal studies
More general terms
More specific terms
- adjustment disorder
- bullying
- caregiver stress (caregiver burden, caregiver burnout)
- posttraumatic stress disorder (PTSD); includes acute stress disorder
- sexual harassment
Additional terms
References
- ↑ UpToDate version 11.3, 2003 http://www.uptodate.com
- ↑ 2.0 2.1 2.2 Journal Watch 25(2):18, 2005 Epel ES, Blackburn EH, Lin J, Dhabhar FS, Adler NE, Morrow JD, Cawthon RM. Accelerated telomere shortening in response to life stress. Proc Natl Acad Sci U S A. 2004 Dec 7;101(49):17312-5. Epub 2004 Dec 01. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15574496
- ↑ 3.0 3.1 Russ TC et al Association between psychological distress and mortality: individual participant pooled analysis of 10 prospective cohort studies BMJ 2012;345:e4933 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22849956 <Internet> http://www.bmj.com/content/345/bmj.e4933
- ↑ 4.0 4.1 Kivimaki M et al Job strain as a risk factor for coronary heart disease: a collaborative meta-analysis of individual participant data Lancet, Early Online Publication, 14 September 2012 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22981903 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60994-5/abstract
- ↑ World Health Organization Assessment and Management of Conditions Specifically Related to Stress. http://apps.who.int/iris/bitstream/10665/85623/1/9789241505932_eng.pdf
- ↑ 6.0 6.1 6.2 Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
- ↑ 7.0 7.1 Levenstein S et al. Psychological stress increases risk for peptic ulcer, regardless of Helicobacter pylori infection or use of nonsteroidal anti- inflammatory drugs. Clin Gastroenterol Hepatol 2014 Aug 8 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25111233 <Internet> http://www.cghjournal.org/article/S1542-3565%2814%2901136-7/abstract
- ↑ 8.0 8.1 Eckstein M, Scheele D, Weber K et al Oxytocin facilitates the sensation of social stress. Hum Brain Mapp. 2014 Sep;35(9):4741-50 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24659430
- ↑ 9.0 9.1 Medical Knowledge Self Assessment Program (MKSAP) 17, 18. American College of Physicians, Philadelphia 2015, 2018.
- ↑ 10.0 10.1 Juonala M, Pulkki-Raback L, Elovainio M, et al. Childhood psychosocial factors and coronary artery calcification in adulthood: The Cardiovascular Risk in Young Finns Study. JAMA Pediatr 2016 Mar 14 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26974359 <Internet> http://archpedi.jamanetwork.com/article.aspx?articleid=2502623
- ↑ 11.0 11.1 11.2 Smyth A, O'Donnell M, Lamelas P et al Physical Activity and Anger or Emotional Upset as Triggers of Acute Myocardial Infarction. The INTERHEART Study. Circulation. 2016;134:1059-1067 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27753614 <Internet> http://circ.ahajournals.org/content/134/15/1059
- ↑ 12.0 12.1 12.2 Lenow JK et al. Chronic and acute stress promote overexploitation in serial decision making. J Neurosci 2017 Jun 7; 37:5681 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28483979 <Internet> http://www.jneurosci.org/content/37/23/5681
- ↑ 13.0 13.1 13.2 Zhang JY, Liu TH, He Y et al Chronic stress remodels synapses in an amygdala circuit- specific manner. Biol Psychiatry 2018 Jul 4; PMID: https://www.ncbi.nlm.nih.gov/pubmed/30060908 https://www.biologicalpsychiatryjournal.com/article/S0006-3223(18)31633-0/fulltext
- ↑ 14.0 14.1 Song H, Fang F, Arnberg FK et al Stress related disorders and risk of cardiovascular disease: population based, sibling controlled cohort study. BMJ 2019;365:l1255 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30971390 Free full text https://www.bmj.com/content/365/bmj.l1255
Bacon SL Stress, psychiatric disorders, and cardiovascular disease. BMJ 2019;365:l1577 Not indexed in PubMed https://www.bmj.com/content/365/bmj.l1577 - ↑ Song H, Fall K, Fang F et al Stress related disorders and subsequent risk of life threatening infections: population based sibling controlled cohort study. BMJ 2019;367:l5784 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31645334 https://www.bmj.com/content/367/bmj.l5784
- ↑ 16.0 16.1 Song H, Sieurin J, Wirdefeldt K et al Association of Stress-Related Disorders With Subsequent Neurodegenerative Diseases. JAMA Neurol. Published online March 9, 2020. PMID: https://www.ncbi.nlm.nih.gov/pubmed/32150226 https://jamanetwork.com/journals/jamaneurology/fullarticle/2762514
- ↑ 17.0 17.1 George J Incident Cognitive Impairment Tied to Stress. More than one in five older adults report high levels of perceived stress. MedPage Today March 7, 2023 https://www.medpagetoday.com/neurology/dementia/103420
Kulshreshtha A, Alonso A, McClure LA et al Association of Stress With Cognitive Function Among Older Black and White US Adults. JAMA Netw Open. 2023;6(3):e231860. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36881411 PMCID: PMC9993177 Free PMC article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2802090