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.
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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.
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