Stress or General Adaptation Syndrome

Ketevan Gambashidze M.D., Ph.D., D.Sc. Associate

Professor
Stress is a term used frequently to describe the way, people
feel about Physical, Psychological and even
Spiritual disturbances.
However, stress is actually a biologic response.

Stress is the acute response of the

organism against stressors.

The Stress response is a ubiquitous phenomenon, an adaptive

mechanism that allows a person to be ready against
stressors.
It is designed as an acute defense reaction in the face of a
stressor.
The Stress response is an "Old world" response that increases
survival in an environment.
 Stress is an Inborn Biologic Mechanism which exists in all living

creatures. Its purpose is to protect the organism and to ensure its survival

and the survival of our species.

The Stress Mechanism, also thought of as the Survival Instinct, operates

through a concept which is often referred to as FIGHT or FLIGHT.

When threatened the individual may have little or no time to think or plan.

Nature understood this and gave us the ability to either turn and fight the

threat, or to run from it.

In our MODERN society threats are everywhere, however, we are rarely

able to attack or run.

Hence, we most often respond by creating what we think of as stress and

The events and environmental agents,
responsible for initiating the stress
response are called

stressors

According to Selye, stressors may be

Endogenous arising from within the body
or Exogenous, arising from outside
the body.
 Stressors can be Physical, Psychologic or Sociologic.

Modern stressors are:

1. Daily hustles:
- Traffic 4. Self and family
- Quarrels maintenance issues:
- Parking - Salaries
- Cost of living
2. Unrealistic performance
expectations, interpersonal
Conflicts:
- Marital separations
Old" stressors:
- Divorces
Temperature extremes
3. Chemicals: Physical dangers
- Alcohol Uncertain food
- Drags Microorganisms
- Toxins
- Smoke
 The Stress response is initiated when a
stressor is PRESENT in the body or PERCEIVED
by the mind.

There are three ways to appraise a situation:

Harm/Loss - sustaining damage or injury.

Threat - anticipating damage or injury in the near future.
Challenge - mobilizing energy for personal growth or gain in
challenging situation.
1. Eustress stress reaction providing adaptation
and supporting well-being (adaptation)

2. Distress stress reaction leading to disease

development (dysadaptation)
 Types of stress

Eustress is good stress and only arises in motivating and inspiring situations.

Neustress is neutral stress, neither good nor bad. This kind of stress arises when
a tornado hit an unoccupied island.

Distress is "bad" stress. Every individual is familiar with this kind of stress.
Distress can be divided into two kinds of stress: acute stress, or superficial
intense stress that disappears quickly, and chronic stress, or prolonged stress
that can linger for no specific period.

Hyperstress is an excessive amount of stress.

Hypostress is an insufficient amount of stress

 S t r e s s Response G r a v i t y depends on :

Stressors power
and Conditioning of the individual
properties being stressed

Personality and
Level of Duration of exposure Behavior pattern
perceiving of to stressors
the individual*

Autonomic nervous system Social support system

reactivity or lability

Development factors*
Prior stress experiences

Predictability and Control Negative thoughts

 PRIOR STRESS EXPERIENCES
The effects of stress are less severe if an individual has had prior experience with the stressful
situation. Example: A surgeon performing nine surgeries a day will experience less stress than
an internist seeing his first patient. Prior exposures to stress help prepare for the "stressful"
situation.

DEVELOPMENT FACTORS
The effects of stress depends on the development level of the individual who is experiencing
stress. Different factors effect the cognitive development of an individual. Therefore, two
individuals with different background may not perceive an event to be stressful (different level
of perceiving).

PREDICTABILITY and CONTROL

The effect of stress depends on whether the events can be predicted. The severity of the stress
is less stressful if the individual can perceive some degree of control of the stress.
 SOCIAL SUPPORT
The effect of stress depends on whether there is a good social support of family and friends. An
individual with someone to confide in will experience less stress than an individual without social
supports. Social support from others helps an individual cope with stress because it raised his/her self-
esteem and confidence.

NEGATIVE THOUGHTS
The effect of stress depends on whether an individual is optimistic or pessimistic. An individual with
daily negative thoughts will experience more stressful events than an individual with positive thoughts.

PERSONALITY - PERSON VARIABLE IN REACTION TO STRESS

The effect of stress depends on the individual's personality.
Different personalities react to stress differently. An individual cognitive character will help determine
how and why he/she reacts to stress differently.
An acute time-limiting stressor is any event that occurs within a short period and
does not usually recur. The best way to envision the effect of acute stressor is to
imagine oneself in a primitive situation, such as being chased by a bear or imagine
walking home late at night and a masked person is approaching quickly.

Common acute stressors include: noise, crowding, isolation, hunger, danger, infection
and imagining a threat or remembering a dangerous event.

Acute stressor results in acute stress. Acute stress is the reaction to an immediate
threat, commonly known as the Flight or Flight response.

Under most circumstances, once the acute threat has passed, the response becomes
inactivated and level of stress hormones return to normal, a condition called the
Relaxation response.
The following are some physiological responses to fight or flight

Muscle tense to the point of pain

Release stored sugar for energy

Increased bowel activity

Dilate cerebral vessels

Increase blood pressure

Changes size in pupil

Increase heart rate

Fluctuate in salivation glands

Hormonal responses to fight or flight

Beta-endorphin tends to diminish pain

Adrencorticotrophic releases corticosteroid
Adrenaline gland medulla stimulates more
adrenaline
 Event-sequencing stressors are situations in which a stressor initiates a series of
stress-producing events (e.g. being fired from a
job and).

Chronic intermittent stress occurs in response to discrete, intermittent stimuli to which

a person is habitually exposed.

Chronic sustained stressors are those to which a person is continuously

exposed. Frequently, however, modern life poses on-going stressful situations that are
not short-lived and the urge to act (to flight or flee) must be suppressed. Stress, then,
becomes chronic. Common chronic stressors include: on-going highly pressured work,
long-term relationship problems, loneliness and persistent financial worries.
 In the presence of danger, the alternatives were clear run away or stand
up and fight.

At this instance the most rapid of the stress responses termed

FIGHT or FLIGHT" response based on autonomic nervous system activation,
basic survival reaction reveals itself.

During "fight-or-flight" responses the heart and respiratory rates increase,

the hands and feet become moist, the pupils dilate, the mouth becomes dry
and the activity of gastrointestinal tract decreases.
 The physiologic response to modern stressors is still essentially the same response that
would occur if affected by a snarling, angered, wild beast.

Perhaps, there is not the extreme fight or flight reactions, but sympathetic nervous
system arousal is provoked, producing real physical changes and symptoms in the stressed
person.

Unlike a wild beast, that will eventually leave, a stressor such as poverty, or interpersonal
conflict persists and is often accompanied by feelings of hopelessness and helplessness.

In these modern situations the physical changes produced by the stress response are not
adaptive but pathologic.
 Autonomic nervous system reactivity or lability.

There are important differences in receptor sensitivity to the catecholamines

increased or decreased sensitivity of receptors to catecholamines, or some
people produce excessive or inappropriate burst of catecholamines when faced
with stressors.
 Repeated or chronic stress events can diminish an individual's ability to
fight/flight capabilities, resulting in repeated infections and illnesses. Chronic stress is
measured in five major body systems.

Immune system - reduces the number of white blood cells and their ability to ward
off illnesses, therefor leaving the body vulnerable for sickness.

Skeletal muscular system - resulting in lower back pain and tension headache.

Parasympathetic nervous system - resulting in constipation, ulcers, diarrhea,

irritable bowels and ulcerative colitis.

Hormone or Endocrine system - affecting the reproduction, menstrual and

growth systems.

Sympathetic Nervous System - results in arrhythmia, hypertension and the

retention of salt and water
 General adaptation syndrome

The general response of the body to stressors was first described by Hans
Selye, who as a medical student observed that

"whether man suffers from a loss of blood, an infectious disease or

advanced cancer, he loses his appetite, muscular strength and ambition to
accomplish anything, usually the patient loses weight and even his facial
expression betrays that he is ill".

So, despite stressors nature, organism's reaction is stereotyped and early

symptoms are nonspecific such as lowering of appetite, weakness,
disability, headache, nausea etc.
 The most prominent result of a stressor is release of adrenocorticosteroids

and hypertrophy or enlargement of adrenal cortex (develops within hours after

the application to stressor), involution or atrophy of thymus, spleen and lymph

nodes, a decrease in the circulating eosinophils and lymphocytes, gastrointestinal

ulcerations and a general anti-inflammatory reaction through the body.

 Selye believed that the above-mentioned
changes were caused by nonspecific physiologic response.
He called this response the General Adaptation Syndrome (GAS).
So, Stress or GAS is a complex of nonspecific reactions
and symptoms developed in response to stressors,
based on neuro-endocrine and metabolic changes,
directed to adaptation.
 Pathophysiology of Stress reaction

Stage of Resistance

Alarm stage
norepinephrine, glucocorticoids,
duration 24-48 hour.
Activation of the hypothalamic-
pituitary-adrenal gland function
is obvious.
Hypothalamus secrets
corticotropin releasing factor
(CRF), CRF stimulates pituitary
gland, which in turn activates
production of ACTH.
ACTH affects on adrenal gland.
Simultaneously sympathetic
nervous system firing develops.
also increases mental alertness.
Increased production of
catecholamines epinephrine,
Stage of
mineralcorticoids, glucagons, Exhaustion
growth hormone, aldosteron.
Decreased
Epinephrine increases cardiac functioning of
output and blood flow to the adrenal cortex.
heart, brain and skeletal
muscles by dilating vessels Decreased
that supply these organs. protectiveness
Dilates the airways, thereby of organism
increasing delivery of often leads
oxygen to the bloodstream. to lethal
outcome.
Norepinephrine constricts
blood vessels of the viscera
and skin. Norepinephrine
Alarm Stage - the body perceives the threat and changes itself into a defensive

mode preparing for fight/flight response. The heart rate, breathing, muscle

tension increases and the release of sugar and fat for energy.

Resistance Stage - the body attempt to restore its equilibrium. After the initial

threat disappears the body relaxes slightly but remain mobilized so that the

resistance and adaptive capacities are still increased and will sustain (requiring

additional energy).

Exhaustion Stage - this stage occurs if the threat returns repeatedly. Wear and

tear will begin to set in and the bodys ability to resist effectively will result in

diminished immune and organ functions depending on the individuals physical

makeup and the ability to cope.

 The Adrenal Cortical Hormones:
Hormones

The Stress Hormones - Adrenalin (epinephrine) and Cortisol:

They prepare the individual for Fight or Flight
They are responsible for the Primary Stress Response

Adrenalin turns on the Inflammatory System, the Defensive Systems and Immune Systems to prepare
the body for external invasion and possible injury.
Inflammation - the first step of repairing any injury that might occur after from Fight or flight.

Cortisol, on the other hand, stimulates the Anti-Inflammatory mechanism which turns off the
Inflammatory mechanism once healing and repair are in process.

These two hormones also affect:

sugar metabolism
blood clotting mechanisms
blood pressure control mechanisms
renal function
blood flow to the digestive and muscular systems
blood pressure, heart rate and rhythm.
 Anti-inflammatory effects of Cortisol

1. Stabilization of the lissome membranes. Therefore, most of the proteolytic

enzymes that are released by damaged cells to cause inflammation, which are mainly
stored in the lysosomes, are released in greatly decreased quantity.

2. Cortisole decreases the permeability of the capillaries. This prevents loss of

plasma in to the tissues.

3. Cortisole decreases both, migration of white blood cells into the inflamed area
and phagocytosis of damaged cells.

4. Cortisole suppresses the immune system, causing lymphocytes reproduction to

decrease markedly. The T lymphocytes are especially suppressed.
Treatment with high doses of corticosteroids results in:

1.Hypertension

2.Alterations in water metabolism

3.Gastro-duodenal ulcerations

Such kind of Treatment

1.Decreases or suppresses production of ACTH and corticosteroids

2.Results in hypoplasia or atrophy of adrenal cortex

3.Makes patient dependent on corticosteroid therapy

 Abrupt cessation of exogenous corticosteroids
results in:
in

1. Acute insufficiency of adrenal gland

2. Alteration of sodium reabsorption in renal tubules

3. Decrease in blood vessel tonus

4. Hypotensia (even collapse)

5. Low level of potassium in blood

6. Impaired heart functioning

7. Nausea

8. Vomiting

9. Abdominal distension
Inescapable situation and undesirable effect of chronic stress may
be relieved by displacement activity that decreases pathogenic
effect

If animals that are deprived of food and

consequently stressed are able to gnaw and
nibble on objects, their stress hormone
output is (reduced) less.

People faced with a social stressor (such as divorce) may displace

the stress with an activity such as alcohol abuse, cigarette
smoking or overeating.
Unfortunately all of these displacement activities increase risk
of diseases and have separate pathophysiologic effects.
Therefore, exercise is more beneficial activity in comparison with
above-mentioned bad habits.