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A comprehensive approach to stress in primary care.

Stress is a precipitant of many physical and emotional problems that patients present to their primary care physicians. Hans Selye's classic General Adaptation Syndrome is described as it relates to the body's response to stress. Techniques for assessing stress are presented. Stress management techniques that primary care physicians can employ in the office include prescribing relaxation and exercise, cognitive restructuring, dealing with negative thoughts, and setting appropriate goals. Severe or prolonged stress warrants consideration of a diagnosis of a mental disorder, use of a psychotropic medications, or referral to a psychiatrist or other mental health provider.

Humans↗

[Combined effect of immobilization stress and gamma-irradiation on the blood-forming system in mice].

Experiments with mice BALB/C were aimed at studying effects of immobilization stress and consecutive total gamma-irradiation at the dose of 2.0 Gy. Disorders in the blood system were shown to be a function of phase of the general adaptation syndrome (GAS). Acute gamma-irradiation on the stage of GAS resistance inhibited adaptive and compensatory potentials of the blood-forming system, whereas chronic stress by itself increased the spontaneous rate of chromosomal aberrations in nucleus-containing bone marrow cells in experimental animals.

Adaptation, Physiological↗

[A model of ecological hazard and social tension for the description of the health deterioration risk in the Russian population].

A model for quantitative evaluation of risks from long-exposure to high-intensity anthropogenic factors and chronic psychoemotional stress is presented. The model has been based on the concept of G. Seliet concerning the development of non-specific physiological reactions (the general adaptation syndrome) to chronic comparatively intensive stresses. It describes the process of time-dependent depletion of the compensatory body reserve and the probability of regulation disorders and disruption of the adaptation to single factors or their combinations. On the population level, health risks predicted with the model are growth of death probability within a year and in a delayed period (transformation of age-specific coefficients of mortality) and a magnitude of reduction of remaining life expectancy.

Adaptation, Psychological↗

New vistas in psychosomatic medicine.

Further understanding in the field of psychosomatic medicine has come to light recently as the result of new approaches and methods of research. Such diseases as hypertension, ulcerative colitis, rheumatoid arthritis, peptic ulcer, diabetes and cardiovascular dysfunction may represent the body's method of adapting to chronic stress, according to Selye's concept of the general adaptation syndrome, with the phases of alarm, resistance and exhaustion. It has been postulated that unconscious dynamics of which patients are unaware are crucial in the understanding and interpretation of physiological research and therapy of patients with psychosomatic disorders. The concept of partial regression was applicable to patients with psychosomatic illness who were highly successful in social, economic and professional spheres. The illness was viewed as a protection against psychological regression by limited somatic regression. Pilot studies suggested that patients seriously ill with such disorders as ulcerative colitis and asthma responded favorably to enforced psychological regression and exploitation of dependency by excessive coddling, babying and mothering by an "all-giving" physician in a hospital setting. Good physician-patient relationship remains the keystone in therapy and is the common denominator to many so-called successful modes of treatment.

Asthma↗

[Risk of delayed effects of chronic ionizing and non-ionizing irradiation in establishing hygienic standards].

The authors analyze the range and incidence of diseases in delayed periods following chronic exposure to different dose rates of ionizing radiation (IR) and high and super-high frequency electromagnetic fields (EMF) with the intensities just above the population exposure limits. The epidemiological data review lays emphasis on delayed non-tumor pathologies impacting human health and performance which have been left out of account in hygienic standards. Risks to health of personnel working in high- and super-high EMFs has been assessed in light of G. Seliet concept concerning the development of non-specific physiological reactions (general adaptation syndrome) to chronic stresses of varying nature, modeling shifts in the adaptive body reserves, and calculated radiation risks from acute and chronic IR exposures.

Adult↗

[Aspects of oxygen regimen and metabolism in patients after operative intervention under neuroleptic analgesia].

Result of microsurgical correction of posttraumatic defect of soft tissues depends a lot on anesthesiological support. During the operation the inhibition of energetic status causes the occurrence of oxygentransporting debt, metabolic acidosis develops. Analgosedation, peculiar to anesthesy, promotes an organism defense toward operative trauma of middle severity, causes temporary hypometabolic effect, changed than by oxidantic stress and general adaptive syndrome development.

Adolescent↗

[Stress in traditional Oriental medicine and clinical chemistry--from the viewpoint of salutogenesis].

The main methodology of modern medicine is pathogenesis, and that of traditional Oriental medicine, complementary and alternative medicine, and mind-body medicine is salutogenesis. Health in pathogenesis is an absolute idea, and health, disease, and death are separate. However from the viewpoint of salutogenesis, the human condition in pathology progresses continuously from health to disease (functional, organic and fatal one) to death, and in each level the subject can create relative health according to the condition. The evaluation of stress consists of evaluating wear-and-tear and the repair and restoration of the body. The general adaptation syndrome, 17-KS-S(S), 17-OHCS (OH), the S/OH ratio, and traditional Oriental medicinal evaluation are clearly related. It may be said that medical care in the new era (comprehensive medicine) consists of pathogenesis by modern medicine, salutogenesis by traditional Oriental medicine, complementary and alternative medicine and mind-body medicine, and the patient's individual autonomy (self-determination by self-responsibility).

Health↗

[Immune system response in pneumonia in children during the first year of life].

Lung, immune organs, hypophysis and adrenals of 74 children aged from 1 month to 1 year who died from acute pneumonia are studied. It is found that fatal pneumonia in one-year-old children developed as a rule against the grave premorbid background. Late hospitalization resulted in death of 47% of the patients within first 24 hrs after admission to hospital. Invasion of pathogenic agents results in secondary immunodeficiency as a response to stress during the development of general adaptation syndrome. Preventive measures are recommended for the prophylaxis of respiratory infections in subjects with abnormal premorbid background, early hospitalization and immunomodulating treatment under the control of immune system and adrenal cortex.

Acute Disease↗

[Morphofunctional characteristics of the adrenals in patients with cardiovascular pathology].

The adrenals of 65 patients who had died of rheumatism, endocarditis septica lenta, simple chronic bronchitis, atherosclerotic cardiosclerosis and acute trauma were studied histologically, histochemically, morphometrically and using impregnation methods. Processes in the stroma and endocrine tissue were divided into two groups. The first group included changes relating to the manifestation of general adaptation syndrome. The second one deals with changes reflecting the features of the given disease pathogenesis: degenerative and inflammatory processes typical for certain conditions, various states of different adrenal zones.

Adrenal Glands↗

The modulating influence of enkephalins on the bone marrow haemopoiesis in stress.

The influence of enkephalins on haemopoiesis was studied under conditions of stress. Administration of leu-enkephalin and dalargin to mice subjected to immobilization led to inhibition of proliferation and differentiation of haemopoietic precursor cells and to a reduction in the content of cellular elements of erythroid and granulocyte lineages of haemopoiesis. On the contrary, met-enkephalin produced a stimulating influence on the bone marrow haemopoiesis in stress. The regulatory influence of enkephalins is connected with reduction of glucocorticoid production and inhibition of migration to bone marrow of T-lymphocyte regulators of haemopoiesis of the phenotype Lyt-1+, Lyt-2+ and with the direct action on the bone marrow cells. Participation of endogenous leu-enkephalin in the haemopoiesis regulation in stress takes place at an early stage (the first 24 h) of the general adaptation syndrome formation.

Animals↗

[Hormone changes as indicators of stress in the development and course of myocardial infarct].

The effect of hormonal-metabolic risk factors in the development of various forms of the coronary heart disease is included into a concept of stress. After demonstration of the historical development of the stress research on the further developed basis of the general adaptation syndrome of Selye the adrenocortical system is used for the evaluation of stressors. Thereby the hormonal characteristics of the behaviour of type A which is at risk of an infarction after Friedman and Rosenman are described. The hormonal-metabolic adaptation of the organism to psychosomatic stressors is demonstrated for the acute phase and the chronic phase. In the acute phase the corticol level correlates with the clinical course of the infarction as well as with the haemodynamic parameters PAEDP and heart index. Cortisol is regarded as parameter of the postaggression metabolism. The increased cortisol level dependent upon time in its course leads to the low-T3-syndrome and to the decrease of testosterone. From this result secondarily effective modifications of the metabolism which are above all valuated as defence reactions. In the chronic phase of risk the values of cortisol are lowered in the stress response. This low cortisol response is a functional maladaptation, which according to our retrospective study is prognostically favourable. A therapeutic influence on the adrenocortical function by calcium antagonists is effective, but up to now not yet sufficiently proved.

Adrenocorticotropic Hormone↗

[Trace element composition of bone tissue of mice in the normal state and in hypokinesia].

Using neutron activation analysis, the concentration of 13 elements was measured in functionally different bones of mice: weight-bearing and dynamic femurs, essentially stationary temporal bones, and newly formed ectopis bones under the renal capsule developed at the site of implantation of syngenic bone marrow. It was found that the elementary composition of the above bones was different in the norm and that it varied in the course of 3-week hypokinesia produced by small-size cages. It was shown that during hypokinesia the elementary composition changed according to four different patterns. Progressive demineralization due to Ca, P, Mg and Fe losses was accompanied by compensatory incorporation of Sr. In the course of the hypokinetic stress the content of trace elements (Zn, Cr, Ru, Rb, Br, Co, Sb) varied significantly. The mechanisms of action of these elements was related to the mobilization of activating elements at different stages of the general adaptation syndrome.

Adaptation, Physiological↗

[The role of glycosaminoglycans in regulation of medullary hematopoiesis in stress].

The role of the constituents of hematopoiesis inducing bone marrow microenvironment in myelopoiesis regulation was studied. It was found that during the development of the general adaptation syndrome the functional activity of stroma cells and granulomonocytopoiesis precursor cells intensifies and the content of acid glycosaminoglycans in the bone marrow increases. It is shown that acid glycosaminoglycans produce an effect on the myelokaryocytes in intimate interrelationship with the prostaglandin system, changing the level of intracellular calcium and cAMP in the hematopoietic cells.

Animals↗