Consequences.docx

Consequences There are multiple consequences with the stress response. The body’s hypermetabolic state from lipolysis gluconeogenesis, glycogenolysis as this provides the body with increased nutrients for healing and energy. Some negative consequences are associated with a prolonged or profound response. These can be decreased muscle mass due to gluconeogenesis and the protein catabolism that occurs in the muscles. There can be an impaired nitrogen balance with the muscle catabolism. There is an increase in the nitrogen excreted in the urine. There can be a decreased immune response related to a decreased number of T-cells and their protection and the thymic atrophy that occurs. This sustained stress response can cause hyperglycemia and the last one is the main one is the cardiovascular wear and tear due to the constant catecholamine release. It is possible to measure the impact of stressors and some of these measurements are part of a normal physical assessment. Some of these biological measurements can include testing the blood for hyperglycemia, so the serum or the capillary level. You can test the adrenal function. This can include measuring levels of aldosterone, cortisol and ACTH. Cortisol levels can be measured looking at the metabolites in twenty-four hour urine collections or serum levels or salivary levels, noting that the cortisol levels have a diurnal rhythm and peak in early morning. There are suppression and stimulation tests that are able to measure the APH feedback system. ACTH can be given to access adrenal cortex response. Dexamethasone, a synthetic glucocorticoid drug can be administered to measure the negative feedback suppression of ACTH. The insulin tolerance test or ITT can be ordered by endocrinologists. This is the gold standard for assessing the HPA-axis. This is hypoglycemic stress test where the closely monitored patients receive insulin purposely to lower the blood glucose level to less than 2.2 millimoles per litre. Then the serum cortisol and growth hormone response is measured. Other biological tests could be looking at the serum catecholamine. However the half-life is a problem with this test. You can measure the cardiovascular reactivity with your blood pressure and pulse. The measurements of urinary nitrogen, as this reflects protein breakdown in the body. Psychosocial measurements could be any instruments to assess anxiety, fear, mood, coping, support. Many of these tests include the self-reporting of physical symptoms recognizing that the individual’s perception is a key factor when assessing stressors. Adaptation There are multiple variables that contribute to the adrenal corticoid response and many experiments have been targeted to describe their impact. One such example was the Trier Social Stress Test or TSST that was to induce large and consistent endocrine and cardiovascular response and moderate to high seductive stress. They looked at public speaking responses to stress over five days in twenty healthy males. The experiment detailed that the participant arrived to the lab, where an IV was inserted and then rested for thirty minutes. At this time they were taken to another room and introduced to the task that they would have to complete. In this room three people were already sitting at a table with a working video camera and tape recorder installed. The participant was asked to stand at the microphone in front of the three people and take the role of a job applicant, who is interviewing in front of company staff managers. The protocol asked that they introduce themselves to the managers in a free speech of five minutes duration, and try to convince the managers that they were perfect for the job. For this job interview the participant was told that each of the managers were specially trained to monitor non-verbal behaviour and the tape recorder would be analyzing their voice frequency for non-verbal inflections and the video would also analyze their performance. After these instructions, the participant returned to the first room, and was given ten minutes to prepare for their talk. Interestingly they were given paper and pens to prepare but were not allowed to bring this in for their speech. After the preparation time they returned to the assumed company managers and after being welcomed, were to proceed with their speech. If they finished early they were told to continue until the five minutes was up. Then they were asked prepared questions. After the fifteen minutes that would be the speech, plus the questions about the job, the participants were asked to subtract the number 13 from 1,022 as fast as accurately as possible and with every failure they had to restart. At the twenty minute mark the task was stopped and the person was taken back to the first room. These individuals rested for 30-70 minutes. After the five days, they were told about the goals of the study and reassured that the voice frequency and video analysis would not be done. They measured heart rate, and they collected blood, saliva samples for cortisol level measurements and they also measured serum ACTH, prolactin and growth hormone. These are the results of the test. The baseline was initially measured and then measured after they were introduced to the task. At the end of the preparation time, cortisol levels were measured. After the conclusion of the job interview and mental arithmetic task, another measurement was done followed by levels drawn at thirty, forty and fifty minutes after the task. The interesting part is, even after the task was completed the cortisol levels. Peaked thirty minutes later with a gradual decline but still well above baseline approximately one hour later. The other key finding was to look at their coping and adaptation strategies, although for each of the days, the type of job they were interviews for and the subtraction tasks were different. They produced less cortisol in their response and each day showed less of a range in results. Stress and Healing We also know that stress affects healing. Chronic stress has been connected to poor response to vaccines. Studies have linked longer serum conversion time after the vaccines, with people experiencing higher levels of measured stress. We know that increased cortisol levels affect healing as the natural killer cells are depressed with higher cortisol levels, and these cells are important first line defences for detecting cancer cells. Increased cortisol is associated with immune dysregulation, and this is connected to increased mortality, because the adaptive immune response is depressed and less like to identify and eradicate pathogens, causing longer would healing times. Other implications with chronic stressors can lead to the down regulation of systemic pro-inflammatory responses and thus the body is not as responsive to inflammatory stimuli. In addition angiogenesis can be impaired because cortisol inhibits vascular endothelial growth factor. Some studies looking at wound healing were with caregivers, students and couples. The first study was conducted to look at the effects of stress caused by caring for a relative with dementia. They showed that for these chronically stress caregivers it took 24% longer to heal a cutaneous wound than the control groups. Another study looked at dental students trying to identify the impact of academic stress on wound healing. Two punch biopsies were placed on the hard pallet. The first during summer holidays and the second one done prior to the first major exam. Each student served as their own control. The results showed that the wounds produced before an exam took 40% longer to heal than identical wounds made during the holiday time period. Last but not least, a study looked at couples with hostile behaviour. They found that couples who demonstrated consistently higher levels of hostile behaviour with all their interactions healed at 60% of the rate than that of the control group with low hostile couples. Researchers continue to look at cytokine activity and linking the complexities and the interrelationships of stress and the impact on the body.

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