stress reaction factors affecting stress reaction: factors affecting stress reaction: stressor...

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STRESS REACTIONSTRESS REACTION

Factors affecting stress reaction:Factors affecting stress reaction:

STRESSOR

PERSONALITY

SUPPORT

OTHERS

STRESSORSSTRESSORS Usual life stressesUsual life stressese.g. family conflictse.g. family conflicts financial stressesfinancial stresses academicacademic jobjob marriagemarriage

Response:Response:

normal—e.g. griefnormal—e.g. grief abnormal----Adj. disorderabnormal----Adj. disorder

Unusual stressesUnusual stresses Life-threateningLife-threatening

e.g. firee.g. fire

drowningdrowning

warwar

raperape

earthquakeearthquake

Response:Response:

normalnormal

abnormal :acute /PTSDabnormal :acute /PTSD

Normal ReactionNormal Reaction

Normal Normal physiphysiological responsesological responses Normal Normal psychopsychological responseslogical responses

Response after stressResponse after stress

E.g. E.g. normalnormal griefgrief

GRIEFSadness appropriate to a real loss e.g. death of a relative.

NORMAL 1-Shock

2-Disorganization

3-Reorganization

ABNORMAL

2-Duration - prolonged

1-Onset - delayed

3-Intensity - severe

4-Nature - distorted

NORMAL GRIEFNORMAL GRIEF

Shock StageShock Stage:: hours ------ dayshours ------ days

NumbnessNumbness

DenialDenial

AngerAnger

YearningYearning

SearchingSearching

numbnessnumbness

denialdenial

angeranger

yearningyearning

searchingsearching

NORMAL GRIEFNORMAL GRIEF

Disorganization stageDisorganization stage :a week ---- 6 months :a week ---- 6 months..

despair sadness guilt weepingdespair sadness guilt weeping

social withdrawalsocial withdrawal

psychosomatic complaintspsychosomatic complaints

disturbed sleep & appetitedisturbed sleep & appetite

pseudo hallucinations …. Lost personpseudo hallucinations …. Lost person

hypochodriacal thoughtshypochodriacal thoughts

NORMAL GRIEFNORMAL GRIEF

Reorganization stageReorganization stage : weeks ----- months : weeks ----- months . .

symptoms subsidesymptoms subside

acceptanceacceptance

return to usual mood & functioningreturn to usual mood & functioning

anniversariesanniversaries? ?

Risk For Abnormal GriefRisk For Abnormal Grief

Abnormal personality .Abnormal personality .

H/O psychiatric disorder .H/O psychiatric disorder .

Death: sudden , traumatic ,multipleDeath: sudden , traumatic ,multiple

Psychosocial complication.Psychosocial complication.

Relationship problems:Relationship problems:

dependant dependant / / ambivalent .ambivalent .

HELPING THE BEREAVEDHELPING THE BEREAVED

Explain & facilitate normal process.Explain & facilitate normal process.Support .Support .Caring .Caring . If insomniacIf insomniac : short course of sedatives : short course of sedatives

.. If MDEIf MDE :antidepressants . :antidepressants .Postpone major decisionsPostpone major decisions

Reaction to impending deathReaction to impending death

11 . .Shock & DenialShock & Denial

22 . .AngerAnger

33 . .BargainingBargaining

44..DepressionDepression

55..AcceptanceAcceptance

STRESSORSSTRESSORS Usual life stressesUsual life stressese.g. family conflictse.g. family conflicts financial stressesfinancial stresses academicacademic jobjob marriagemarriage

Response:Response:

normal—e.g. griefnormal—e.g. grief abnormal----Adj. disorderabnormal----Adj. disorder

Unusual stressesUnusual stresses Life-threateningLife-threatening

e.g. firee.g. fire

drowningdrowning

warwar

raperape

earthquakeearthquake

Response:Response:

normalnormal

abnormal :acute /PTSDabnormal :acute /PTSD

ADJUSTMENT DISORDERSADJUSTMENT DISORDERS

Pt. exposed to Pt. exposed to usualusual life life stressesstressesPt. developed abnormal adjustmentPt. developed abnormal adjustment

. . maladaptivemaladaptive exaggerated exaggerated responsesresponses

. Emotions / behavior------- abnormal. Emotions / behavior------- abnormal

. beyond expected (intensity/duration). beyond expected (intensity/duration)

--Functional impairment.Functional impairment.

Adjustment disorder withAdjustment disorder with

depressed mooddepressed mood..

anxious moodanxious mood . .

mixed mixed anxietyanxiety & & depresseddepressed moodmood

disturbance of conductdisturbance of conduct..

depresseddepressed emotions and emotions and conductconduct..

unspecified typeunspecified type

TYPES

Medical illness / surgery.Medical illness / surgery.

Difficulties at school / university.Difficulties at school / university.

Transition from school to university.Transition from school to university.

Marriage / Divorce / Marital conflicts.Marriage / Divorce / Marital conflicts.

Employment / Promotion / RetirementEmployment / Promotion / Retirement

Traveling abroad or away from Traveling abroad or away from

family.family.

Birth of a defected childBirth of a defected child..

Financial problemsFinancial problems

STRESSES → ADJUSTMNT D.

more in females 2 : 1 (adults).more in females 2 : 1 (adults).

occur at any age (occur at any age ( in in

adolescentsadolescents ) )

)) medical wards medical wards ⇨⇨ disease stresses. disease stresses.

community community ⇨⇨ psychosocial psychosocial..

EPIDEMIOLOGY

Personality ProblemsPersonality Problems

Stressors :Stressors : nature nature meaningmeaning severityseverity

�ETIOLOGY

COURSECOURSE

Onset: withinOnset: within

stressor---*---*----*----*----*---stressor---*---*----*----*----*---33/12/12

*:symptoms.*:symptoms.

Duration: maximumDuration: maximum

--*************************--*************************66/12/12

Self-limited but can be chronic.Self-limited but can be chronic.

Recurrence Recurrence

Normal adjustment reactions Normal adjustment reactions

e .g.: e .g.:

normal griefnormal grief

Major Depressive EpisodeMajor Depressive Episode

G A DG A D

P T S D & acute stress disorder.P T S D & acute stress disorder.

Others.Others.

D D

PsychologicalPsychological ::

Support - empathy - exploration-Support - empathy - exploration-

Crisis interventionCrisis intervention

Problem-solving : educating pt. about adaptive Problem-solving : educating pt. about adaptive

copingcoping

PharmacologicalPharmacological symptomatic symptomatic..

TREATMENT

100 % 100 % → Evil eye ,Jinni → Evil eye ,Jinni

possession, or black magicpossession, or black magic..

Traditional healers : traditional Traditional healers : traditional

,cultural customs.,cultural customs.

MISCONCEPTIONS

STRESS DISORDERS

Abnormal reaction to life threatening

stresses e.g. fire, natural

disaster ,war, rape ,RTA. . .

Experienced or witnessed.

Acute stress disorder : 2 days – 4 W

Post- traumatic stress disorder (PTSD) :

delayed onset / prolonged duration >1/12

FEATURES

Severe anxiety reaction.

Horror or detachment.

Running away/distress on exposure

Automatic mental Reexperience.

Functional impairment.

ETIOLOGY

Massive emotions beyond the brain

capacity------ great distress.

Personal vulnerability.

ãÍãÏ ÇáÏÑÉ.wmv

D D

Adjustment disorders : less severe & usual stresses.

Grief Panic disorder , GAD

Head trauma.

Substance abuse.

TREATMENT

Psychological:

·Support- reassurance- relaxation.

·Encourage overcoming denial.

·Group therapy.

Symptomatic drug treatment : sedatives anxiolytics.

PROGNOSIS

Good if:

. Healthy premorbid personality.

·Early intervention.

·Social Support.

·Less severe.