STRESS & STRESS DISORDERS .pdf

12/22/2021 Stress and stress disorders Dr. Uday Edited by: Ibrahim Mohammed Stress and stress disorders Aims Review of concept of stress Overview of pathological stress reactions O...

12/22/2021 Stress and stress disorders Dr. Uday Edited by: Ibrahim Mohammed Stress and stress disorders Aims Review of concept of stress Overview of pathological stress reactions Objectives Define stress Recognize pathological stress Classify stress disorders Deal with specific conditions 1  12/22/2021 Stress and stress disorders Stress: is disturbance in equilibrium. Can be normal (inevitable) in our daily life problems that we can deal with it without suffering, if the problem becomes unsolvable or our reaction due to personal factors exaggerated this will lead to pathological stress and stress disorders. Symptoms: 1. Anger 2. Sadness 3. Worries 4. Negative thinking 5. Self harm (beating himself or substance abuse). Stress and stress disorders Classification General adaptation syndrome Shock: emotionally numb, ‫مرحلة الصدمة‬ adaptation, ‫مرحلة التكيف‬, may end with exhaustion or return to normal exhaustion: pathological stress symptoms appear Clinically in which symptoms may be presented: 1- traumatic events ‫احداث صادمة‬ 2- sudden life change ‫)تغيير عمل او سكن او زواج(تغيرات حياتية كبيرة‬ 2  12/22/2021 Stress and stress disorders What determine the reaction? Biopsychosocial aproach 1. Biological factors: genetic vulnerability to stress. 2. Psychological factors: like personality. 3. Social factors: type of stressors, level of social support that is available around the person, the environment. How to reduce stress? healthy coping: talking about the problem with someone, doing exercise, relaxation, doing hobbies, Healthy defense: denial for a while, humor. Unhealthy coping: anger, violence, substance abuse, self harm, this is pathological. Stress and stress disorders Disorders Acute stress disorders Post traumatic stress disorder ( PTSD ) Adjustment disorder Health problems 3  12/22/2021 Acute stress and post-traumatic stress disorders PTSD Definition: stress related to life traumatic events C/F Exposure to extreme threat: 3 important traumatic events: 1.Individual is threatened to death. 2.Witnessed others being killed or threatened to death. 3.Sexual violence. Criteria of this type: Repeated reliving flashbacks , disturbing dreams; (‫ او تﺟيه بالحلم‬،‫)تﺟﻲ صورة الحادثة بباله مثل الفم تخترق ذهنه‬ Avoidance; ‫يتﺟنب اي ﺷﻲ يذكره بالحادثة‬ Others: non-specific symptoms:, like A. Cognitions and mood: negative thinking, sadness, worries, irritability, dcreased interests, emotional numbness, B. Hyperarousal, sleep disturbance, startling reflux ‫ﺟفلة‬, poor concentration. Note/ The flashbacks has a benefit & distressing by itself at the same time, flashbacks work as a reminder that there is something not resolved, a trauma not healed. Duration: more than 1 month, if less than 1 month called; acute more PTSD PTSD DDx GAD (generalized anxiety disorder) Depression (sadness) Management 1. Secure environment for the victim 2. Behavioral: gradual desensitization, exposure to traumatic events, to remember & comprehend what happened. 3. Drugs SSRIs (selective serotonin reuptake inhibitors) 4. EMDR (Eye movement desensitization retreatment): when we do informational processing, our eyes move right & left. This technique provides by therapist in multiple sessions for 15 - 30 min, work as exercises to the eye 👁 which accompanied by feeling of relaxation & less stress symptoms and help neuroprocessing of trauma. 4  12/22/2021 Adjustment disorder Sudden non traumatic life event (but major life changes). Examples: change carrier, marriage, start college, graduated, start working. Mixed anxiety and depressive symptoms Direct help by therapist (talking about the problem, counseling, doing exercises & relaxation, encouragement for avoid unhealthy coping). symptomatic drug treatment Health problems: Stress caused by developing new illness like DM, HT, accompanied by adjustment disorder. Grief and bereavement ‫الفقد‬ Type of adjustment disorder Stages: 1.Denial: ‫معقولة البارحة ﺟنت احچﻲ وياه‬, may be for 2 weeks. 2.Depression: ‫يحب ينعزل و يگعد وحده‬, continuously preoccupied by the deceased (‫ يسمع صوته كﺄنما موﺟود وياه بالبيت)الفقيد‬، 3.Acceptance: ‫يتقبل الﻲ صار‬ This is normal & differ from culture to another, in eastern culture the grief up to 1 year, in western culture up to 2 months. If the symptoms are atypically severe or atypically prolonged this is called Pathological grief, like severe depression prolonged & not proportional to the cause or interfering with daily life, and this will need treatment. Anniversary grief ( ‫ عيد ميﻼد ﺟرحﻲ أنا‬،‫ يﺟﻲ بالحلم ﺟوعان‬،‫)😂بالذكرى السنوية للفقيد تﺟﻲ الذكريات‬ Guided morning (‫)اﻻحتداد بتوﺟيه‬: encouraging the person to face the reality to comprehend what happen. ‫والى ان يستوعب الﻲ حدث‬،‫ يبچﻲ‬،‫ يطلع صور الفقيد‬،‫روح للمقبرة‬ 5 Stress and stress disorders Assist Prof Dr Uday Khalid  Case scenario an 18 years old first year medical student who started study two months ago. He found himself increasingly irritable , finds difficulty focusing on study and lectures. He is continuously preoccupied with the many reading tasks he should do and worried about that only. He feels continuous fatigue , sometimes sleep little , feels frustrated but enjoy time with friends whenever that was possible Stress and stress disorders Objectives Define stress Recognize pathological stress Evaluate role of biopsychosocial paradigm Classify stress disorders Recognize flashbacks and avoidance in PTSD Differentiate adjustment disorder from anxiety and depression Follow stages of grief reaction Plan management of stress disorders  Stress and stress disorders Definition Symptoms Anger Sadness Worries Negative thinking Self harm  Stress and stress disorders Classification 1- traumatic events 2- sudden life change  Stress and stress disorders What determine the reaction Biopsychosocial aproach How to reduce stress healthy coping Healthy defense  Stress and stress disorders Disorders Acute stress disorders Post traumatic stress disorder ( PTSD ) Adjustment disorder Health problems  Stress and stress disorders Acute stress and posttraumatic stress disorders PTSD Definition C/F Exposure to extreme threat Repeated reliving flashbacks , dreams Avoidance Others Cognitions and mood : negative thinking dcreased interests, emotional numbness, Hyperarousal : Sleep disturbance startling poor concentration Duration 1m acute more PTSD  PTSD DDx GAD Depression Management Secure environment Behavioral Drugs SSRIs EMDR  Adjustment disorder Sudden non traumatic life event Mixed anxiety and depressive symptoms Direct help counselling symptomatic drug treatment  Grief and bereavement Stages Denial Depression acceptance Pathological grief Anniversary grief Guided morning Thank you