Stress and the Brain.docx

Stress and the Brain Dr McEwen and Dr Sapolsky, two world renowned neuroendocrinologists, have both published extensively on the stress response and the relationship between high levels of cortisol and hippocampal dsyfunction. The hippocampus, an important structure for verbal and contextual memory,...

Stress and the Brain Dr McEwen and Dr Sapolsky, two world renowned neuroendocrinologists, have both published extensively on the stress response and the relationship between high levels of cortisol and hippocampal dsyfunction. The hippocampus, an important structure for verbal and contextual memory, is very sensitive to the effects of glucocorticoids namely cortisol and research has shown that sustained stress can damage this area. The high levels of cortisol can prevent the brain from laying down pathways for new memory or from accessing already existing memories. Again, we know that the adrenal steroids protect us with short term exposure but with repeated stress can cause pathophysiology or a dysregulation of the HPA axis. With excessive cortisol in the hippocampus there is an atrophy of dendrites of the pyramidal neurons which can cause memory, particularly short term, difficulties. This is usually reversible if the stressor is short term but if continued exposure to chronic stress the hippocampal neurogenesis can be suppressed or promote apoptosis. Stress-Related Diseases Try to identify some possible stress related diseases for each of the identified systems and then click on the circle to check your answers. Please note that this is not an exhaustive list. Nervous System: Neuropsychological manifestations Fatigue Anxiety Loss of motivation Depression Insomnia Overeating Addiction Cardiovascular System: Heart rate Arrhythmias Hypertension Heart failure Stroke Coronary artery disease Gastrointestinal System: Crohn’s disease Heartburn / GERD Gastritis Ulcer Malabsorption Musculosketal System: Tension headache Backache Inflammatory disease of connective tissue Arthritis Muscle wasting Osteoporosis Integumentary System: Eczema Psoriasis Dermatitis Acne Alopecia Poor wound healing Endocrine System: Hyperglycemia Diabetes mellitus Amenorrhea Cushing disease Addison disease Respiratory System: Respiratory rate Hypersensitivity reactions (i.e. asthma) Exacerbations of COPD Immune System: Immunodeficiency Immunosuppression Autoimmune diseases Genitourinary System: Diuresis Irritable bladder Renal failure Impotence Menstrual irregularities Emotional Symptoms of Stress Emotionally people under stress may present with intense anxiety that can lead to debilitating phobias, irritability, or becoming quickly frustrated, trouble thinking, clearly or they lack concentration skills with or without memory problems. They may feel out of control and this can lead to addiction problems. Clinically you might see these emotional symptoms translated into behaviours, such as increased arguments, isolation from social activities, conflict with co-workers, and employees, frequent job changes, road rage, domestic workplace violence, or overreaction, or they simply might just be labelled the difficult patient. This is by no means a comprehensive list, but I am sure you can think of patients you have dealt with that have one or more of these symptoms of stress. It is not uncommon that most patients if not all would have one or more of these symptoms. What do you imagine the implications are? The main implications, recognizing that there are many others, is the impact on health teaching. We already know they have an inability to concentrate, short term memory problems. Is it no wonder that most of the patients have trouble when given a lot of information? Remember nurses do provide great health teaching. It is not the teaching that is wrong and it is not that the patients at the time are incapable of understanding the concepts. Rather as they deal with these stressors they overreact, they are frustrated, and they have trouble thinking clearly. As you can imagine, and probably have examples in your own life, maybe parents, sisters, brothers, going to the doctor, feeling so overwhelmed, whether it was good or bad news that they didn’t actually hear the news at all. They just can’t take it in. That is why we encourage family members who are slightly less detached from the emotional side of the stressors to come with parents or loved one or whomever, so that both can listen to the information and hopefully get a better picture of what is going on. In nursing you will need to keep this in mind for every patient you encounter as the implications are huge.