BAPTIST HEALTH SCHOOL OF NURSING NSG 3036A: PSYCHIATRIC-MENTAL HEALTH HEALTH PROMOTION: STRESS ADAPTATION AND CONCEPTS OF PSYCHOBIOLOGY

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1 BAPTIST HEALTH SCHOOL OF NURSING NSG 3036A: PSYCHIATRIC-MENTAL HEALTH HEALTH PROMOTION: STRESS ADAPTATION AND CONCEPTS OF PSYCHOBIOLOGY LECTURE OBJECTIVES: 1. Define adaptation and maladaptation. 2. Describe biological responses to stress. 3. Describe the concept of stress as an environmental event. 4. Explain the concept of stress as a transaction between the individual and the environment. 5. Discuss psychological and behavioral adaptations to stress and anxiety. 6. Identify gross anatomical structures of the brain and describe their functions. 7. Discuss the association of endocrine functioning, genetics, and altered brain functioning with the development of psychiatric disorders. 8. Discuss the implications of psychobiological concepts to the practice of psychiatric/mental nursing. READING ASSIGNMENT: Townsend, Chapter 1 and Chapter 4 LECTURE OUTLINE: I. Introduction A. Stress has no definitive explanation B. Adaptation-response to stress directed at stabilizing internal biological processes and preserving self-esteem. Considered positive. C. Maladaptive-response to stress that disrupts the integrity of the individual. Considered negative or unhealthy. II. Stress as a Biological Response A. Selye defined stress as the state manifested by a specific syndrome which consists f all the nonspecifically-induced changes within a biologic system. This syndrome of symptoms is known as the fight or flight syndrome. B. Selye called the general reaction of the body to stress the general adaptation syndrome. It has three stages. 1. Alarm reaction 2. Stage of Resistance

2 3. Stage of Exhaustion III. Stress as an Environmental Event A. Defines stress as the thing or event that triggers the adaptive physiological and psychological responses in an individual. B. This event creates change in the life pattern from the existing steady state. C. Miller and Rahe (1997) updated the original Social Readjustment Rating Scale devised by Holmes and Rahe in D. The new scale, Recent Life Changes Questionnaire (RLCQ), reflected and increased number of stressors not identified by the original tool. E. It s unknown whether stress overload predisposes a person to illness or actually precipitates it, but there appears to be a casual link. F. These tools have been criticized because they do not consider the individual s perception of the event, their coping strategies, or available support system at the time of the life change. IV. Stress as a Transaction Between the Individual and the Environment A. This definition of stress emphasizes the relationship between the individual and the environment that is appraised by the individual as taxing or exceeding his or her resources and endangering his or her well-being. B. Precipitating event. A stimulus arising from the internal or external environment and is perceived by the individual in a specific manner. Stress determination depends on the individual s cognitive appraisal. C. Individual s perception of the event. When an event occurs, an individual undergoes a primary and secondary appraisal. 1. Primary appraisal. The individual makes a judgment about the situation in one of the following ways a. Irrelevant. The event is judged irrelevant when the outcome holds no significance for the individual b. Benign-positive. The outcome produces pleasure for the individual c. Stress. Appraisals that include harm/loss, threat, or challenge a. Harm/loss appraisals refer to damage or loss already experienced by the individual b. Threat. Appraisals perceived as anticipated harm or losses c. Challenge. The individual focuses on potential for gain or growth, rather than on risks associated with the event 2. Secondary appraisal. An assessment of skills, resources and knowledge that the person possesses to deal with the situation 3. The interaction between the primary appraisal of the vent that has occurred and the secondary appraisal of available coping strategies determine the individual s quality of adaptation response to stress D. Predisposing factors. Elements influencing how an individual perceives and responds to a stressful event

3 V. Stress Management A. Involves the use of coping strategies in response to stressful situations B. Adaptive coping strategies protect the individual from harm (or additional harm) or strengthen the individual s ability to meet challenging situations ( examples: awareness, relaxation, meditation, interpersonal communication with caring others, problem solving, pets, and music) C. Maladaptive coping strategies allow the conflict being experienced to go unresolved or intensify Part II: CONCEPTS OF PSYCHOBIOLOGY I. Introduction A. The 101 st legislature of the US designated the 1990 s as the decade of the brain with the challenge for studying the biological basis for behavior B. In keeping with the neuroscientific revolution, greater emphasis is placed on the study of the organic basis for psychiatric illness II. The Nervous System: An Anatomical Review A. The brain B. Nerve Tissue 1. The forebrain a. The cerebrum: Right and left hemisphere connected by a deep groove of neurons called the corpus callosum. Each hemisphere is divided into four lobes named for the overlying bones in the cranium a. Frontal lobe b. Parietal lobe c. Temporal lobe d. Occipital lobe b. Diencephalon: Connects the cerebrum with lower brain structures. Consists of a. The thalamus b. The hypothalamus c. The limbic system 2. The midbrain a. Mesencephalon: Also called midbrain and is responsible for visual, auditory, and balance ( righting ) reflexes 3. The hindbrain a. Pons b. Medulla c. Cerebellum 1. The nerve cells of the central nervous system (CNS) tissue are called neurons and are composed of the following parts: a. Cell body b. Axon c. Dendrites

4 2. Three classes of neurons exist within the CNS a. Afferent (sensory) b. Efferent (motor) c. Interneurons 3. Synapses C. Autonomic Nervous System 1. Sypathetic 2. Parasympathetic D. Neurotransmitters: Chemicals that convey information, contained in action potentials, across synaptic clefts to neighboring target cells. Four major categories: 1. Cholinergics 2. Monoamines 3. Amino Acids 4. Neuropeptides a. Acetylcholine a. Norepinephrine b. Dopamine c. Serotonin d. Histamine a. Gamma-aminobutyric acid (GABA) b. Glycine c. Glutamate and aspartate a. Opioid Peptide b. Substance P c. Somatostatin III. Neuroendocrinology. Endocrine functioning in the CNS is under the influence of the hypothalamus, which has direct control over the pituitary gland (two major lobes) A. Posterior lobe (AKA neurohypophysis). Under neural control of the hypothalamus. Two hormones are produced in the hypothalamus and stored in the posterior pituitary with their release mediated in the hypothalamus 1. Vasopressin (antidiuretic hormone) 2. Oxytocin B. Anterior lobe (AKA adenohypophysis). Releases a number of hormones under the control of the hypothalamus 1. Growth hormone (GH)

5 2. Thyroid-stimulating hormone (TSH) 3. Adrenocortocotropic hormone (ACTH) 4. Prolactin 5. Gonadotropic hormone 6. Melanocyte-stimulating hormone C. Carcadian Ryhthms 1. Follows a near 24- hour cycle in humans and may influence a variety of regulatory functions, including the sleep-wake cycle, body temperature regulation, patterns of activity such as eating, drinking, and hormone secretion a. Sleep-wake cycle. Sleep is measured by the type of brain wave activity present during various stages of sleep 1. Stage 0- alpha rhythm 2. Stage 1-beta rhythm 3. Stage 2-theta rhythm 4. Stage 3-delta rhythm 5. Stage 4-delta rhythm 6. REM Sleep-beta rhythm 2. Neurochemical influences a. Serotonin b. Norepinephrine c. GABA d. Acetylcholine IV. Genetics A. The goal of behavior genetics is to clarify the role that genetics factors play in the determination of behavior B. Genotype- the total sets of genes present in an individual at the time of conception and coded in the DNA C. Phenotype- physical manifestations of a particular genotype (examples- eye color, height, blood type, language, and hair type). Phenotypes may be genetic or acquired. Most psychiatric disorders are a combination of both D. Various studies are conducted to determine etiological factors associated with psychiatric illnesses 1. Familial compare the percentage of family members with the illness to those in the general population or a specific control group 2. Genetic search for a specific gene that is responsible for the individual having the illness 3. Twin studies examine the frequency of a disorder in monozygotic and dizygotic twins

6 V. Psychoimmunology 4. Adoption studies allows comparisons to be made of the influences of genetics versus environment on the development of a psychiatric disorder A. Normal immune response 1. Neutophils, monocytes, and macrophages are the cells responsible for nonspecific immune reactions. If this fails, then specific immune mechanisms take over (cellular and humoral responses) 2. With the cellular response, the T lymphocyte (T4 in particular) become sensitized to and specific for the foreign antigen when the body id invaded 3. The humoral response is activated when antigen-specific T4 cells communicate with the B lymphocytes in the spleen and lymph nodes. B cells then produce antibodies specific to the foreign antigen B. Implications of the immune system in psychiatric nursing 1. Studies have hypothesized that the immune system becomes depressed and that individuals become more susceptible to physical illness following exposure to a stressful stimulus or life event resulting in suppression of lymphocytes proliferation and function 2. Certain neurochemicals may influence the immune system. Growth hormones may enhance immune functioning: testosterone, epinephrine, and norepinepherine may decrease immunity; serotonin may have enhancing inhibitory effects on immunity 3. Decreased immunity has been associated with periods of grief, bereavement, and depression. Immunological abnormalities have been associated with alcoholism, autism, dementia, and the onset of schizophrenia VI. Implications for Nursing A. Psychiatric nurses must integrate knowledge of the biological science into their practices if they are to ensure safe and effective care to people with mental illnesses B. Psychiatric nurses must have a specialized knowledge about: 1. Neuroanatomy and neurophysiology 2. Neural processes 3. Neuroendocrinology 4. Carcadian rhythms 5. Genetic influences 6. Psychoimmunology 7. Psychopharmocology 8. Diagnostic technology