Quality Stress Management Course

8 Minute Meditation for Stress Relief

When you skillfully learn to handle your stress, not only does your stress level go down, but your quality of life goes up. The skills you will learn in the 8 Minute Meditation Stress Reduction Program have a global impact. Just think about it: If you lower your stress, you feel calmer. Your heart rate is normal, your digestive and other systems are working normally, the way they were designed to. Your entire body and mind are in harmony, functioning to give you the most aware, joyful experience you can have. There's nothing in the way. Then, the world may appear totally different. Colors may seem more vivid. Your shoulders seem lighter, like some great burden has been lifted from them. Life is just good again. Read more here...

8 Minute Meditation for Stress Relief Summary


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Contents: 2 Ebooks, Guided Meditation Audio
Author: Victor Davich
Official Website: www.8minutes.org
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My 8 Minute Meditation for Stress Relief Review

Highly Recommended

I started using this ebook straight away after buying it. This is a guide like no other; it is friendly, direct and full of proven practical tips to develop your skills.

This ebook does what it says, and you can read all the claims at his official website. I highly recommend getting this book.

Coping And Stress Management

Coping is a broad term that encompasses several strategies, including stress management, counseling, psychotherapy, and use of psychotropic medication. Successful coping involves using whatever resources are at your disposal. The need for professional help may be indicated by a number of situations. For example, if your efforts to manage stress are foundering and you are feeling overwhelmed in spite of your best efforts, you probably need to consult a therapist. Likewise, if you are so depressed or anxious that it seriously interferes with your everyday activities, self-help may not be enough. If you find yourself having recurrent thoughts of death or of hurting yourself or having fantasies that you would be better off dead, you need professional help. Managing Stress In learning how to manage stress successfully, the first step is to take stock of yourself and your life. Although many people know that they feel stressed, they have a surprisingly sketchy idea of why. Keeping a stress...

Evidence of the Relationship Between Stressful Life Events and MS Exacerbation

Charcot, who first characterized MS in the 19th century, wrote that grief, vexation, and adverse changes in social circumstance were related to the onset of MS (Charcot, 1877). Since then, numerous clinical studies have been conducted examining the relationship between stressful life events and MS exacerbation. A growing body of empirical work has examined the relationship between stressful life events and MS exacerbation. A recent meta-analysis of 14 studies examining the effects of stressful life events on MS exacerbation found significantly increased risk of exacerbation associated with stressful life events (d 0.53) (Mohr et al., 2004). Although this is only a modest effect size, it is clinically relevant, given that the positive effect of the most commonly used disease-modifying medications on exacerbation, interferon betas, is estimated at d 0.30 to 0.36 (Filippini et al., 2003). All of the studies in the meta-analysis used either neurologist ratings or confirmation of...

Development of strategy

Policy comprises of content whereas strategy consists of content and process. Strategic management does not attempt to provide a prescription for problems but seeks to combine the deliberate and emergent approaches to strategic development and is often seen as both a process and an outcome (5). In addition to developing strategy the clinician may be expected to have personal skills like financial, conflict, time, and stress management.

The Healthillness Continuum

As we previously stated, health, just as life itself, is a process of continual change. And we must continually adapt to these changes in our lives in order to maintain good health and well-being. It is our adaptation or response to that change, rather than the change itself, that affects our health. For example, two students just found out about a big test tomorrow, for which they are completely unprepared. One student responds to this stressful situation (stressor) by going home, getting his books out, and starting to study. The other student breaks out into a sweat, and spends most of the evening fretting over this outrage and imagining what will happen to him if he doesn't pass the test. No doubt, this student is doing more damage to his health than is his friend. And, considering the time and energy he is expending on worrying (and not studying), he may experience even more stress when they receive their grades

Some methodological considerations

These developments have enabled what are often seen as 'soft' variables to be quantified, and this in turn has allowed a reasonably persuasive case to be made that significant bias has not followed the use of the investigator as the primary measuring instrument. For example, Creed, ( 6) in a study of stressful life events and appendectomy, documented a relationship between severely threatening events rated contextually and the onset of non-inflamed but not inflamed conditions. The research was persuasive for two reasons. First, on the basis of a detailed description of the event and surrounding circumstances a consensus rating team reached agreement about the likely degree of threat of each life event, blind to the person's reported response and whether or not he or she was a patient. Second, the interviewer, who provided the team with this edited account was blind to clinical details. (He only consulted the medical records after the ratings had been made.) Such flexibility is...

Chapter References

Finlay-Jones, R. and Brown, G.W. (1981). Types of stressful life event and the onset of anxiety and depressive disorders. Psychological Medicine, 11, 803-15. 84. Craig, T.K.J., Drake, H., Mills, K., and Boardman, A.P. (1994). The South London Somatisation Study. II Influence of stressful life events, and secondary gain. British Journal of Psychiatry, 165, 248-58.

S Evidence statements

Two uncontrolled pre-post studies examining coping skills training and stress management instruction were also included. The first study assessed coping skills training in patients with MS. The results showed an overall beneficial effect on measurements of depression, physical mobility and emotional reaction.24 The second study examined the efficacy of stress management instruction in patients with disease of mixed aetiology. The results showed a positive effect on two of the four outcome measures assessed24,25 (III).

Recent abortion Young boys with recent leg trauma are also at

Stress precipitates chest pain in both boys and girls at equal rates often anxiety and stress are not easily apparent. Not all such children present with hyperventilation or an anxious appearance. However, if child has had a recent major stressful event (eg, separation from friends, divorce in family, or school failure) that correlates temporally with the onset of chest pain, it is reasonable to conclude that symptoms are related to the underlying stress.

Social Functioning In Depression

Depressed individuals are characterized by a wide range of social deficits (see Barnett & Gotlib, 1988 Segrin, 2000, for reviews). It is noteworthy that there is no single cohesive theory to account for the origins of these social difficulties. Instead, relatively isolated bodies of empirical research (for example, studies examining the associations between depression and stressful life events, social networks, marital functioning, etc.) have implicated different aspects of interpersonal functioning as being important in understanding the etiology and maintenance of depression, as well as relapse of this disorder. Given recent reviews of the social functioning of depressed persons (e.g., Hirschfield et al., 2000 Segrin, 2000), we will not attempt to present an exhaustive review of this research in this chapter. Rather, we will organize our discussion of the social functioning of depressed persons by describing two main types of social deficit in MDD those that involve problems with...

Psychological processes and treatment implications

A number of other therapies have also been shown to be effective, particularly in the alcohol field, including self-control training, self-help groups, marital and family therapy, coping and social skills training, anxiety and stress management, aversion therapies, and brief intervention strategies. (2 25)

Do school prevention programmes work

Outcome research of prevention programmes in the United States has been the subject of a comprehensive review.(21) Programmes should be guided by awareness that the average age of trying alcohol, cigarettes, solvents, or cannabis for the first time is between 11 and 13 years, and that exposure to drugs is now the norm for older teenagers.(22) The two distinct aims are to delay experimentation in younger children and to minimize harm in those over 13, many of whom can be assumed to be dabbling already or to have friends who are doing so. Only those programmes that actively involve students in discussion and debate, and provide relevant skills training such as assertiveness, ways of resisting social pressure, problem solving, stress management, and confidence boosting, have any measurable benefit. Improvement in knowledge without this practical dimension has no effect on behaviour, and scaremongering or moralizing can be actively counterproductive.

The social and family environment Social class

Since the 1930s, numerous studies in North America and Europe have consistently found that the economically disadvantaged social groups contribute disproportionately to the first admission rate for schizophrenia. Two explanatory hypotheses, of social causation ('breeder') and of social selection ('drift'), were originally proposed.(l00) According to the social causation theory, the greater socio-economic adversity characteristic of lower-class living conditions could precipitate psychosis in genetically vulnerable individuals who have a constricted capacity to cope with complex or stressful situations. In the 1960s this theory was considered to be refuted by a single study(101 which found that the social class distribution of the fathers of schizophrenic patients did not deviate from that of the general population, and that the excess of low socio-economic status among schizophrenic patients was mainly attributable to individuals who had drifted down the occupational and social scale...

Risk factors age of onset and outcome

If a factor operates to increase the risk of schizophrenia and to bring on its onset, then it is logical to think that if it is still present then it will be associated with a poor outcome. Thus, a family history of schizophrenia, a history of obstetric complication, childhood low IQ, and continued drug abuse are all associated with a poor outcome. On the other hand, those patients who develop psychosis following stressful life-events tend to have a better outcome than those with no such precipitant. (9)

Other aspects of study design

Variation in the sources of recruitment of cases (e.g. any admission to a treatment facility or catchment area sampling), and of information regarding course and outcome variables (e.g. face-to-face interviews or collateral data from case notes or informants), can obviously influence the results of any follow-up study. In addition, subtle variations in study design, such as whether investigators assessing patients' symptoms and functioning at any point in time are 'blind' to data from previous assessments, can influence the final results. Inclusion of a comparison group (e.g. patients with other psychotic disorders) would help evaluate the extent to which any observed patterns of course and outcome are specific to schizophrenia, whereas appropriate controls drawn from the general population can provide reference points for assessing social variables, such as occupational functioning, stressful life events, or habit-related behaviour such as substance use.

Prevention Of Coronary Heart Disease As The Goal

Terol, saturated fatty acids, and trans fatty acids and increased exercise and stress management. In fact, a recent study employing intensive lifestyle changes in patients with coronary heart disease achieved a 37 lowering of LDL (low-density lipoprotein) cholesterol, a 91 decline in anginal episodes, and a decline in coronary artery stenosis within a year all without drugs. A prescription for lifestyle changes should accompany the one for a hypocholesterolemic drug.

Differential diagnoses

Stressor criterion (exceptionally stressful life event vs. exceptionally threatening or catastrophic event), the time course (symptoms start to diminish within 48 h versus no time limit), and symptom pattern (PTSD, but not acute stress reaction, includes involuntary re-experiencing the traumatic event).

Other Therapies for Stress Urinary Incontinence

Whereas simple and definitive sling, retropubic, or injectable therapy will suffice for the overwhelming majority of incontinent patients, it is often extremely difficult to manage stress urinary incontinence that is of a refractory nature. Accordingly, less often used modalities may be required to cure the condition, including the use of obstructing or circumferential slings, artificial urinary sphincters (AUS), or even transvaginal closure of the bladder neck.1 These methods are certainly retained for a last resort of therapy, yet still maintain a prominent position in care, because all patients will not be successfully managed with standard therapies.

Involuntary subordination

However, for humans, low rank is not always a position of anxiety or threat sensitivity, especially if one sees the higher ranks as benevolent and helpful. Moreover, submissiveness is made up of a complex set of behaviours, not all of which may be associated with stress or depression (Gilbert, 2000a). Hence, we can make a distinction between voluntary and involuntary submission (Gilbert, 1992, 2000a). Voluntary submissiveness would be behaviours such as willingly following the requests and demands of a leader or significant other (and from which one benefits), whereas involuntary submission is having to do things one does not wish to, when not to do so will result in conflicts and losses (for example, having to comply to a bullying other, or someone one is dependent on). As Sloman (2000a) makes clear, in the involuntary submissive situation there is submissiveness but with continual arousal of fight and flight. In this context, although submissive behaviour may reduce the chances of...

Course and prognosis

Many patients with OCD have a sudden onset of symptoms, usually after a stressful event such as pregnancy, a loss, or a sexual problem. Owing to the secretive nature of the disorder, there is often a delay of 5 to 10 years delay before patients come to psychiatric attention, although the delay may shorten due to increased public awareness to the disorder through articles, books, and movies. The course is usually long, but variable some patients experience a fluctuating course, while others experience a chronic course.

Epidemiology and course

The duration of episodes of depersonalization varies considerably between individual patients. Some are brief and transient while others last hours, weeks, or months, usually resolving gradually in contrast to their sudden onset. The course is usually chronic and marked by remissions and exacerbations. Recurrent episodes may occur in response to real or perceived stressful events, while others pursue an unremitting course with continuous depersonalization lasting for years.

Tensiontype headache

Physiotherapy is the treatment of choice for musculoskeletal symptoms accompanying frequent episodic or chronic tension-type headache. In stress-related illness, lifestyle changes to reduce stress, and relaxation and or cognitive therapy to develop stress-coping strategies, are the treatment mainstays. Prophylactic medication has a limited role. Amitriptyline is first-line in most cases, withdrawn after improvement has been maintained for 4-6 months. Long-term remission is not always achievable, especially in long-standing chronic tension-type headache. A pain management clinic may be the final option.

Umanganese For Pimples

It is important to keep the skin clean and free from oil. Facial steaming opens blocked skin pores and clears out sebum. Do not squeeze acne spots as they may become infected and leave scars. Reduce stress and avoid refined sugar and foods. For mild cases of acne, topical exfoliants and face washes are usually sufficient for medium cases, beneficial preparations should contain benzoyl peroxide or salicylic acid for severe acne, topical or oral antibiotics may be necessary or vitamin A derived drugs which include topical Retin A and Accutane taken internally. Long-term antibiotic use should be avoided and vitamin B complex and acidophilus supplemented as antibiotics destroy intestinal flora. Sunlight and ultraviolet light are beneficial if not undertaken excessively. A Chinese medical journal has reported success with administration of intravenous garlic against a fungal infection of the brain, cryptococ-cal meningitis,11 found in some AIDS patients. A nutrient-dense diet, rest, and...

Self Administration of Psychostimulants

A larger number of studies examined the consequences of administering stress levels of corticosterone. These studies show that repeated administration of high (stress-level) doses of glucocorticoids increases drug self-administration, and reproduces the increase in drug responding seen during stressful situations. For example, rats receiving repeated injections of corticosterone intraperitoneally acquire cocaine self-administration at a lower dose compared with vehicle-treated controls (75). An intravenous injection of corticosterone before a self-administration session can also increase drug responding in animals that would not readily acquire cocaine self-administration (76).

Why Do Glucocorticoid Hormones and Drugs of Abuse Interact

In conclusion, glucocorticoid hormones are an essential component of our capacity to endure stressful situations, probably by attenuating their aversive impact. The role of these hormones in drug abuse is likely related to the long-lasting sensitization they induce in the reward system when repeatedly activated during stress. Consequently, understanding the molecular mechanisms that mediate such long-lasting effects of glucocorticoids could help us to better understand addiction and to develop new treatments of this condition.

Other Types Of Familial Parkinsonism With Parkinsonplus Syndrome Phenotype

Tonic spasms, bradykinesia, or postural instability.177 The onset of symptoms usually occurs in late childhood or early adulthood and may be triggered by stressful events. Treatment with levodopa carbidopa is usually unsatisfactory. Linkage has been established to chromosome 19q13, and the locus has been named DYT12, but the mutation

Irritable Bowel Syndrome

Irritable bowel syndrome is a chronic condition that appears early in life and is characterized by periods of exacerbation and remission. Exacerbations are frequently associated with stressful situations or life events. The most common symptoms are those of abdominal pain, altered bowel habits, bloating, and sensation of incomplete evacuation. The characteristics and severity of the abdominal pain vary from patient to patient but keep a particular pattern over time. The pain is often described as crampy, rarely severe, and temporarily relieved by bowel movements. Nocturnal pain, weight loss, fever, and other constitutional symptoms are typically absent.

Anxiety disorders

Insomnia is strongly associated with the symptom of anxiety most acute episodes of insomnia are triggered by stressful events or situations. Patients with anxiety disorders typically complain of difficulty sleeping. Sleep studies have been performed for various categories of anxiety disorders, including generalized anxiety disorder, panic disorder, post-traumatic stress disorder, and obsessive-compulsive disorder. Most groups of patients show evidence of sleep disruption, as evidenced by prolonged latency to sleep onset, increased time awake during the sleep period, early morning awakening, decreased sleep efficiency and reduced total sleep. Changes in REM sleep or SWS are not typically observed. Additional sleep abnormalities have been reported in conjunction with specific anxiety disorders.

Course and prognosis Onset and course

Hypochondriasis appears to follow a fluctuating course that is influenced by stressful circumstances and by a variety of sustaining (e.g. gains of illness) or inhibiting factors. Robbins and Kirmayer(68 observed that some primary care patients had fallen below a threshold for hypochondriasis after 1 year, while others had become newly hypochondriacal. At initial assessment the newly hypochondriacal had higher levels of illness worry, were more likely to see their health as poor, and had more unexplained symptoms than non-hypochondriacal patients. The authors speculated that illness events or ambiguous symptoms may have contributed to hypochondriacal concerns in these vulnerable patients.

Ozone Therapy Intradiscal and Foraminal Injections of O2O3 Mixture

This technique is used mostly in Italy and Germany. The mechanism of action of O2-O3 mixture could be a direct effect on mucopolysaccharides with dehydration and shrinkage of the disc (Fig. 2). Other possible actions include an oxydative stress reduction of the cell-mediated process with inhibition of proteinase release, increase in immunosuppressor cytokines, and inhibition of inflammation and pain mediators (8).

Stress and Multiple Sclerosis

Immune responses after an acute stressor (as measured by NK cell activity, T-cell proliferation, and changes in cell subsets in the peripheral blood) (Ackerman et al., 1996). More recently, acute life stressors have been shown to be correlated with relapses in MS (Ackerman et al., 2000). Mohr and colleagues conducted a meta-analysis of 14 studies concerning stress and MS and concluded that there is a consistent association between stressful life events and subsequent exacerbation in multiple sclerosis (Mohr et al.,2004).

Stressinduced disorders

Counselling has an important role in helping people to adapt to stressful life changes, and may play a part in the treatment of those in whom stress-related psychiatric problems have emerged. In the latter case, counselling may be offered in conjunction with medication. Specific psychological therapies may be required, however, for patients in whom severe psychiatric problems have developed. The place of counselling in the management of a number of stress-induced disorders is considered in this section.

Improving the mental health skills of the primary care team Improving the skills of general practitioners

About half of GP trainees have a 6-month psychiatry hospital attachment, many of which are considered to be unhelpful for a future generalist career. (74) Many GPs have had no higher professional training in mental health and are not required to do so. Historically, continuing medical education for GPs has been based on traditional didactic educational methods which are unsuitable for learning psychiatric interviewing skills. (74,75) GPs are likely to select training by perceived rather than real need. A survey of 190 randomly selected GPs from 95 health authorities in England and Wales (74) found that 35 per cent of respondents had received mental health training in the previous 3 years and that 83 per cent of this group had found the courses useful. Respondents rated their competence in a range of mental health skills as generally average, but felt particularly confident in depression recognition with every respondent rating themselves as average or above 42.5 per cent rated...

Social Stress and Immunity

The nature of a stressful event determines its biobehavioral consequences. For example, social stress, but not restraint stress, can lead to the reactivation of a latent herpes virus infection (Padgett et al., 1998), increased inflammatory responses to a lipolysaccharide (LPS) challenge (Quan et al., 2001), and increased CNS inflammation during acute TMEV infection (Johnson

General Conclusions

A growing body of evidence suggests that two environmental factors, viral infection and stress, may contribute to the development of MS in genetically susceptible humans and animals. Epidemiological studies indicate that MS is triggered by viral infection. Evidence for a relationship between stressful life events and MS exacerbation is also mounting, including longitudinal studies indicating that naturally occurring stressors predict the occurrence of new lesions. However, these human studies are limited because the association between stress and disease exacerbation may be attributable to a spurious third variable that influences both stress and disease. To determine whether there is a causal relationship between chronic stress and viral infection in MS, animal experiments are essential. Using this approach, we have shown that social stress interacts with TMEV infection to determine the severity of behavioral impairment and CNS inflammation. The timing of the stressor in relation to...

Parental physical illness

A recent study(64) found that children who had a parent with cancer reported significantly higher anxiety than a normal population sample and their parents indicated more internalization and somatic symptoms compared to norms. Parental anxiety accounted for the greatest variance in childhood adjustment. However, childhood problems may not always be evident from parent reports. For example, a large study from the United States found that parents underestimate the impact of the illness on their children in the months following the diagnosis of cancer in comparison with children's own reports of problems, particularly those of girls. (60) Increased family responsibilities given to girls and their predominant use of ruminative coping have also been identified as possible mechanisms to explain vulnerability in girls. (65) Children use different coping strategies. Problem-focused or active coping affects the stressors (e.g. seeking information, positive reinterpretation of stressful events)...

Supporting child witnesses in the courtroom

No studies have yet documented the effects of appearing in court on child witnesses. There is no doubt that this is an inevitably stressful event. Some children may be particularly upset by their experience. Feelings of anxiety, fear of retaliation or of not being believed, confusion, humiliation, and embarrassment are common. The stress of appearing in court may be a further trauma for a child who was first traumatized by witnessing or experiencing the crime in question. Anecdotally, some children report that although giving evidence was stressful, they also derived some satisfaction from playing their part in bringing a perpetrator to justice.

Emergency in relation to family problems or abuse

Serious family problems may affect the child to the extent that other people outside the family may seek emergency help for the child. These family problems may include domestic violence, alcohol abuse, and severe overt arguments between the parents. Sometimes the child or adolescent may seek help on their own. These are very stressful situations. The involvement of protective services is usually required.

Biological Effects

TRH has been reported to reduce stress- and deprivation-induced eating, hy-pothetically by induction of satiation. Early work demonstrated thyroid extracts reduced alcohol intake and recent research shows a TRH analog specifically inhibits alcohol preference. It seems likely that TRH is one of several functional elements in the integrative neuropeptide control of alcohol consumption via short-term satiation (Kulkowsky et al. 2000).

Three Hypotheses Regarding the Mechanisms by Which Stress Leads to Exacerbation

Although it is important to understand the effect of MS on acute immune and neuroendocrine responses to stress, it is also clear that the effects of stress on MS exacerbation may well extend over periods much longer than those commonly examined with a TSST. We have recently proposed that hypotheses regarding the relationship between stressful life events and MS exacerbation must take into account the temporal relationship between the stress response and the natural history of the development of MS inflammation and exacerbation (Mohr and Pelletier, 2006). As we have described above, the natural history of an MS exacerbation appears to have a long, if not thoroughly understood, trajectory. For many years, it was assumed that BBB breakdown was a very early event in the development of an MS brain lesion and clinical exacerbation. However, newer neuroimaging techniques such as magnetic transfer ratio (MTR) imaging have shown that changes in the ratio of bound to unbound water begin to...

Stress Onset The Mast Cell Hypothesis

Mast cell activity is also triggered by stress. Restraint stress has been shown to increase BBB permeability in rats through mast cell activation (Esposito et al., 2001), and subordination stress has been shown to increase numbers of mast cells across a number of brain regions (Cirulli et al., 1998). A principal mediator of stress-related mast cell activation is CRH (Theoharides et al., 1998). Hypothalamic CRH is a primary hormonal response to stressful life events. However, CRH is also present at sites of inflammation. Stress-related BBB breakdown via mast cell activation has repeatedly been shown to be facilitated by immune CRH (Theoharides et al., 1998 Singh et al., 1999 Esposito et al., 2001). Recent studies further indicate that increases in hypothalamic CRH consistent with stress responses can increase immune CRH and induce mast cell degranulation, thereby increasing BBB permeability (Esposito et al., 2002).This would suggest that stress onset might have a permissive effect on...

Psychosocial Moderators

The patient's ability to manage stressful life events appears to affect the relationship between stressful life events and exacerbation and inflammation. Cross-sectional work has shown that patients in exacerbation tend to report that they have more emotion-focused coping and lower social support compared with patients who are not in exacerbation (Warren et al., 1991). We examined the effect of coping prospectively on the relationship between stressful life events and the development of Gd+ MRI. We did not find main effects for coping style on the incidence of new Gd+ MRI brain lesions. However, greater use of distraction to cope with stressors was predictive of a significantly weaker effect of stressors on the development of new brain lesions (Mohr et al., 2002). Similarly, there was a trend for instrumental coping in the same direction, while there was a trend for greater emotional preoccupation (a ruminative style) to be predictive of increased effects of stressors on the...

Summary and Future Directions

There is growing evidence of a relationship between the occurrence of stressful life events and exacerbation in patients who have MS (Mohr et al., 2004). The HPA axis appears to be hyperreactive to CRH challenge, but there is no consistent evidence that immune or neuroendocrine reactions to laboratory stressors are different in MS patients compared with healthy controls. We have proposed three potential mechanisms by which stress could increase risk of exacerbation among patients with MS, including the stress resolution hypothesis, the glucocorticoid resistance hypothesis, and the mast cell hypothesis. To date, even the best studies of the effects of stressful life events on MS exacerbation and inflammation have been prospective, longitudinal designs, which cannot rule out the potential influences of third variables. One such potential confounding variable is change in normal-appearing white matter that can occur months before the appearance of conventional neuroimag-ing markers of MS...

Counselling in the workplace

Employment and mental health are known to be significantly related, the unemployed reporting higher rates of mental health problems compared to the employed, and satisfaction at work is positively correlated with mental health. Counselling for work-related difficulties is effective in reducing stress-related problems at work and sickness.(6 66 Counselling services at work include employee assistance programmes and specialized staff counselling services.

Psychosocial mechanisms

Barlow Panic Modelk

Stressful life events Several studies have found an association between stressful or traumatic life events and GAD. In a subset of participants in the Epidemiologic Catchment Area Study, men who reported experiencing four or more stressful life events during the preceding year were more than eight times as likely to meet DSM-III criteria for GAD than those reporting three or fewer stressful life events. (43 The experience of even one very important unexpected negative event was associated with a threefold increase in GAD in both men and women. A variety of stressors have been associated with increased risk of GAD, including early parental death, (44 rape or combat 4.5' and chronically dysfunctional marital and family relationships.(46)

Psychoneuroendocrinological research in personality disorders

Recent research has revealed the impact of social conditions on the neuroendocrine regulation of the individual, particularly with respect to the adaptation to stressful situations. In our sample of patients with a borderline personality disorder and impulsive suicidal behaviour we have found high basal concentrations of cortisol (suggesting a high level of stress) and a very blunted response to the stimulus (suggesting a reduced capacity to respond to external stimulus) compared with the control group. We have found the same pattern in heroin-dependent individuals receiving naltrexone maintenance treatment. A clue to the interpretation of these results lies in the work of Sapolsky, (45 who has studied the adaptation to stress of baboons in the Serengeti savannah in Africa. Males of a lower rank have consistently high concentrations of the stress hormone hydrocortisone in their blood, whereas the concentration is lower in the dominant males. However, in the dominant males...

Neurotoxicology and Behavior William K Boyes PhD

A permanent loss of neurons does not necessarily mean that the functions performed by that neural tissue are also lost forever. The remaining neural tissue retains a great deal of plasticity. Even in the mature brain, synaptic contacts are continuously being modified through changes in structure and functional plasticity. Patients who suffer from brain injury often experience gradual recovery as remaining areas of the brain subsume lost functions. The recovery may not restore function to its original state, however, because the loss of the brain tissue can diminish the overall functional capacity of the brain. Reduced overall functional capacity may lower the ability to deal with future challenging or stressful situations and impair recovery from further injury. Conceptually, a loss of reserve capacity could also cause the functional deficits from normal aging to appear earlier (14).

An integrated aetiological model

The ultimate purpose of studying risk factors for depressive disorders is to contribute to the development of an integrated aetiological model. The most promising research in this area has been performed by Kendler and colleagues on women from the Virginia Twin Register. (27,) In this study, 680 female-female twin pairs of known zygosity were assessed on three occasions at longer than 1-year intervals. Nine predictor variables (genetic factors, parental warmth, childhood parental loss, lifetime traumas, neuroticism, social support, past depressive episodes, recent difficulties, and recent stressful life events) were examined to see how they contributed prospectively to the development of an episode of major depression over the next 12 months. In considering the results from this study, it is important to bear in mind the limitations of this landmark study including the facts that the sample was limited to women and that variables such as marital status, the presence of young children...

Animal Models Of Depression

However, in order to understand the molecular changes underlying major depression true animal models are needed. The best animal model of depression simulates the etiology and replicates symptoms, course and treatment of human depression. In the case of depression stressful life events constitute a factor playing an etiological role. Acute and chronic uncontrollable stress has therefore been used to induce depressive-like behavior in rodents. All animal models have to define clear criteria which allow the validity of the model to be ascertained. This is somewhat difficult in psychiatric conditions, which are in part defined through subjective experience and cannot be assessed in animals. The face validity of a depressive model can be examined by looking at those vegetative symptoms that are altered clinically. These include concentration, appetite, sleep, and libido. One can look for physiological changes that are associated with the condition, in depression this involves altered HPA...

Stress Resolution Hypothesis

This hypothesis suggests that it is the resolution of the stress rather than the onset of stress that facilitates the development of active inflammation during this prodromal period. Whereas chronic stress is commonly marked by increased levels of cortisol (McEwen, 1998), trials of stress-management programs have reported that cortisol decreases as a result of successful stress management intervention (Antoni et al., 2000). MS patients with relapsing disease also often show evidence of low levels of ongoing inflammation not noticeable by the patient or by usual neuroimaging but detectible by triple-dose Gd+ MRI (Silver et al., 1997 Tortorella et al., 1999). Thus, as cortisol rises after the onset of a stressful situation, the person with MS would receive some increased control over inflammation. However, as the stressor resolves, the concomitant reduction in cortisol would represent a decrease in control over inflammatory processes and could leave the individual at an increased risk...

Brief Review of MS Pathology and Pathogenesis

Although the process of inflammation and demyelination is the hallmark of the early, inflammatory period of the disease, it is increasingly recognized that other neurodegenerative processes become more prominent as the disease progresses (Trapp et al.,1998 Confavreux et al.,2000).While axonal transection in the earlier stages of the disease appears to be primarily due to inflammatory processes, degeneration of axons in later stages of the disease may be due to a lack of trophic support from myelin or myelin-forming cells (Scherer, 1999). These two stages may correspond with the RR disease course seen earlier, in which there are exacerbations with quiescence between stages, and the SP course in which progression in the absence of exacerbation becomes increasingly prominent. To date, the impact of stressful life events on progression or neurodegenerative processes remains largely unexamined. We will therefore focus this review on exacerbations and inflammatory processes.

Scarring or sensitization

The idea of scarring may also be relevant to depression in young people. Lewinsohn and colleagues (Lewinsohn et al., 1994b) found in cross-sectional comparisons that formerly depressed individuals shared many psychosocial characteristics with depressed individuals. A subsequent prospective study by the same research group identified 45 adolescents who experienced and recovered from a first episode of depression between two assessment points (Rohde et al., 1994). Psychosocial scars (characteristics evident after but not before the episode) included stressful life events, excessive emotional reliance on others, and subsyndromal depressive symptoms. This level of scarring was more severe than that found in previous research by the same team with depressed adults.

F239 Acute and transient psychotic disorder unspecified

Brief psychotic disorder (298.8) is defined in DSM-IV as an episode of acute and transient psychotic disorders (delusions and hallucinations with disorganized speech and behaviour) which lasts at least a day but less than a month with eventual full return to previous level of functioning. If the symptoms occur after stressful events in the person's life, brief psychotic disorder with marked stressor(s) has to be specified. If the symptoms occur within 4 weeks postpartum, brief psychotic disorder with postpartum onset has to be specified.

Endocrine Models Of Depression Hypothalamopituitaryadrenal HPA axis

Thyrotrophin Releasing Hormone

Assessing the HPA axis can be problematic. Cortisol is a pulsatile hormone, has a strong diurnal rhythm, and is released in stressful circumstances, such as blood sampling. For this reason, more detailed methods of endocrinological assessment are needed. A widely used method in depression has been the dexamethasone-suppression test (DST). Dexametha-sone is a synthetic glucocorticoid which suppresses hypothalamic corticotrophin-releasing hormone (CRH) and pituitary adrenocorticotrophic hormone (ACTH) via glucocorticoid receptors (Figure 2.1). In a proportion of depressed individuals, such suppression fails to occur, averaging around 60-70 in melancholic depression and 30-40 in 'neurotic' depression. The test is not specific to depression, as non-suppression can be seen in other The importance of the HPA axis changes in depression go beyond the apparent ability to provide a neat mediator between stressful events and symptoms, and also concerns prognostic indicators. There are...

Transient amnesias Transient global amnesia

Transient global amnesia most commonly occurs in the middle-aged or elderly, more frequently in men, and it results in a period of amnesia lasting several hours. It is characterized by repetitive questioning, and there may be some confusion, but patients do not report any loss of personal identity (they know who they are). It is sometimes preceded by headache or nausea, a stressful life event, a medical procedure, or vigorous exercise. Hodges and Ward (1 ) found that the mean duration of amnesia was 4 h and the maximum was 12 h. In 25 per cent of their sample, there was a past history of migraine, which was considered to have a possible aetiological role. In a further 7 per cent of the sample, the patients subsequently developed unequivocal features of epilepsy (there had been no focal signs or features of epilepsy during the original attack) and the memory loss was therefore attributed, in retrospect, to previously undiagnosed epilepsy. There was no association with either a past...

Behavioural Activation System Dysregulation Model

Development Depression Biological

Depue and colleagues (Depue et al., 1987 Goplerud & Depue, 1985) have suggested that in bipolar-spectrum disorders the BAS is poorly regulated, such that the limits that define the extent of BAS variation are weak in these individuals. They note the correspondence between the features that characterise high levels of BAS activity (for example, high non-specific arousal, positive emotion, and engagement in goal-directed activity), and the symptoms of a hypomanic state, as well as observing that disengagement from reward-seeking activities, anhedonia and psychomotor retardation often characterise bipolar depression. In a study of the effects of naturally occurring stress on BAS level, Goplerud and Depue (1985) found that, after a stressful event, cyclothymic individuals took longer than did normal controls to return to baseline levels of BAS functioning. This suggests that in bipolar spectrum disorders, BAS dysregulation may exist not in terms of the initial appearance of a mood state,...

Hypertension High Blood Pressure

Blood pressure is considered high at a reading of 140 90. There are no symptoms of the illness and it is recommended individuals over 40 be checked. Hypertension can be controlled by permanent diet and lifestyle changes this includes reducing stress, maintaining proper weight (not more than 5 lb overweight), and eating foods containing compounds that reduce blood pressure such as celery, garlic, and fresh fruits and vegetables. Having a home monitor is helpful. Smoking, alcohol, refined sugar, food allergies, and high-sodium foods can contribute to hypertension. Some people may need extra calcium to stabilize blood pressure. Some individuals are salt sensitive which causes a rise in their blood pressure. Daily exercises and various stress reduction techniques lower systolic and diastolic blood pressure.

Antipsychotic Drugs Smoking And Schizophrenia

There are substantial advantages to studying smoking among hospitalized inpa-tients with schizophrenia 1) patients with schizophrenia have high rates of noncom-pliance with clinical or investigational procedures without the close supervision that the inpatient setting can provide 2) the inpatient environment is stable, and patients are largely protected from stressful events or concurrent substance abuse that may alter their response to nicotine and, 3) the protective containment of the inpatient environment permits rapid detection of and attention to any adverse reactions developing in relation to novel interventions under study.

Immune Function in Sleep Disorders

There is evidence of the association of insomnia and elevated HPA axis activity. Primary insomnia patients connect the onset of the disorder to some stressful event. Chronic internalization of feelings may cause a psychological and physiological arousal, leading, ultimately to insomnia. Perlis, Giles, Mendelson, Bootzin, and Wyatt (1997), for instance, propose the existence of a mechanism of cortical hyperarousal in insomniac patients triggered by emotional, cognitive, and physiological components. Therefore, the hyperactivity exacerbates vigilance and impact negatively on sleep, thus forming a vicious circle in which difficulty to sleep becomes the stressful factor itself. This phenomenon had been proposed by Spath-Schwalbe and co-workers, in 1991, who demonstrated that increased HPA axis activity produces sleep fragmentation, which in turn elevates cortisol-circulating levels. One of the first studies on the relationship between the HPA axis activity and sleep showed that poor...

The Case of Toby Dependent Personality Disorder

The therapeutic alliance would need to engage Toby's trust and also allow and tolerate the initial transfer of dependency. It also would need to provide a context that could reduce her anxious dependency without denying her the secondary gains of this personality disorder, including the protection and attention of her husband. This will be a real challenge, and the clinician can expect to be tested for accessibility. The main goal would be to reduce the dependency clinging behaviors, but not to eliminate them. A secondary goal would be to link the secondary gains of the unwanted behaviors to the new (less dependent) behaviors. For example, she could be coached to share with her husband her successes, rather than her ineptitudes and deficiencies, and gain his attention and support in that way. She could join her husband on an errand or an outing and offer to drive him. Toby would also be led to understand how she has come to respond with anxiety to the anticipation or fear of...

What makes a stressor traumatic

ICD-10 uses a broader definition and characterizes traumatic stressors by their exceptional severity and the distress they would cause for the average person 'a stressful event or situation of an exceptionally threatening of catastrophic nature, which is likely to cause pervasive distress in almost anyone'. (5) Thus, the ICD-10 diagnosis refers to a common-sense understanding of which situations are likely to be extremely distressing.

How To Minimize And Manage The Different Types Of Fatigue

Your feelings of fatigue may be worsened by underlying depression. Depression is recognized as a symptom of MS and can also occur if life becomes very difficult when you are dealing with the day-to-day challenges of the disease. If so, feelings of overwhelming tiredness or lassitude may be unrelated to your level of activity and more to your mood. In addition, depression can affect sleep, appetite, motivation, and participation in activities. Such feelings can occur in the morning, afternoon, or evening. They do not appear to occur at any particular time of day in fact, when you are depressed, you may wake up feeling tired. If you feel that your fatigue is related to depression, ask your physician to discuss what medications you can take to improve your mood. In addition, psychotherapy, stress management, relaxation training, and support groups can help you deal with the complexities of your disease and the symptoms it can cause.

Summary and Significance of Research Findings

Relating our findings to the development of multiple sclerosis and autoimmune diseases in general, stressful events that occur prior to or during infection with an infective agent may result in immunosuppression and failure to eliminate the pathogen. The establishment of persistent infection may then lead to the development of autoimmune disease such as multiple sclerosis. Stress-induced immunosuppression may also facilitate the generation of pathogens with enhanced and altered pathogenecity.

Psychological factors Personality

An important sector of the scientific community considers alcohol abuse as a behavioural pattern which has been learned through mechanisms of classical (i.e. Pavlovian) and operant conditioning. According to this interpretation, the perpetuation of heavy drinking results from its association with conditioned stimuli (cues), and from the action of positive (pleasant effects) or negative (stress reduction) behavioural reinforcement. (39) Additional components of this equation are the so-called alcohol 'expectancies'. Alcohol abusers tend to overemphasize the pleasant aspects of drinking and to exclude the negative ones the learning theory of alcoholism assumes that such a cognitive set is also acquired through social exposure. (2B)

The stress diathesis model

Based on these observations, the model postulates two independent components in suicidal behaviour that work in concert. The first consists of lifelong stable traits that comprise a diathesis, which predisposes to aggressive impulsive behaviour in response to stressful circumstances or powerful emotions. This tendency might be conceived as a lowered threshold for motor activation, a diminution in natural inhibitory circuits, or as a volatile cognitive decision style.

Dissociative conversion disorder

Usually in relation to a markedly stressful event. The amnesia is selective and predominantly involves the inability to recall emotionally charged memories. The ability to learn new information is relatively preserved, as are cognitive skills such as reading and writing. A characteristic feature is a loss of personal identity the patient is unable to recall his or her name, age, address, occupation, and family details, and may fail to recognise relatives when they visit. Recovery is usually rapid and complete. In some cases, however, dissociative amnesia lasts for several days or weeks and is accompanied by an apparently purposeful wandering away from the home or place of work. During this condition, known as a dissociative fugue, a new name and identity may be assumed. Self-care is maintained and the patient's behaviour may appear completely normal to people who do not know him or her. Recovery occurs abruptly and there is amnesia for the period of the fugue. Organic conditions that...

Assessment and treatment

During the hospital stay, specific psychiatric treatment should be limited to those who manifest deviant behaviour or painful emotional symptoms. The focus should be on putting the patient at ease. As found for stress management in general, better outcomes are achieved when subjects who prefer information are given a problem-focused intervention, and subjects who have a low preference for information are given an emotion-focused intervention.

Psychological Treatments

Dialectical behavior therapy (DBT) has received considerable attention and has been shown to be an effective treatment for personality disorder, specifically for Borderline Personality Disorder (for a thorough review, see Robins & Chapman, 2004 also Scheel, 2000). Its efficacy with older adults is beginning to get research attention. Dialectical behavior therapy is a cognitive-behavioral treatment model based on biosocial theory with the premise that personality disorder symptoms reflect biological irregularities (Shearin & Linehan, 1994). The treatment is multi-focused and uses individual and group modalities. Dialectical behavior therapy incorporates problem-solving strategies, stress reduction techniques, and attention to the relationship between the individual and the environment.

Fitness and Recreation

There is a belief among many experts in fitness and recreation that participating in physical activity is a close second in terms of its importance to eating and breathing. What would your life be like if you weren't able to participate in all sorts of leisure, fitness, and recreational activities In a society filled with many stressful events, the need to release by moving in any way, shape, or form that is comfortable and enjoyable to you is critical for maintaining overall balance in your daily life. For some people, yoga, meditation, and relaxation exercises fit the bill. Others must hop on a stationary bike or go for a jog to feel invigorated. No matter what type of multiple sclerosis (MS) you have or how much you're able to move, exercise, recreation, and physical activity can be adapted to meet your needs. Don't ever underestimate what you're capable of doing. Many experts in engineering, technology, and exercise have found ways to adapt all kinds of physical activity to meet...

Beginning Lifestyle Change

To help individuals make these dietary and physical activity changes, a number of behavior modification strategies have shown good efficacy. These strategies include a tailored problem-solving intervention, involving goalsetting, self-monitoring, stimulus control, cognitive restructuring, stress management, relapse prevention, social support, and contracting 19 . Stress Management Emotional factors frequently interfere with the development of healthy lifestyles. Stressful life events oftentimes lead to unwanted eating and subsequent weight gain. Recognizing stressors and learning strategies to deal with them can help individuals manage their eating patterns more effectively. Physical activity is an especially good strategy for reducing feelings of stress because it raises an individual's sense of well being. The regular practice of meditation or learning techniques like progressive muscle relaxation can be useful for managing everyday stresses 25 .

Family interventions in the schoolaged years

There are several examples of comprehensive school-aged programmes, including the FAST Track programme (Families and Schools Together) (22 and the LIFT intervention programme (Linking the Interests of Families and Teachers). (23 The FAST Track programme targets children in early elementary school who are at risk of developing later conduct disorder and delinquent behavioural problems. Children and families receive a multifocused intervention package, targeting development across multiple domains, including peers, the school environment, academic achievement, and the family context. The family intervention integrates successful approaches to parent training with issues relevant to the development of school-aged children, including parent-school involvement and early reading. l22 Parents meet in groups weekly during the first school year and every other week in the second year. In addition, an hour of parent-child learning activity is also provided, which emphasizes positive...

S Evidence statement

Function as assessed by the MSQOL-54, and tension, fatigue and vigour, assessed by the POMS-SF.452 However, the second RCT that examined an exercise programme using a leg cycle ergometer found no improvement in either the physical fitness indices assessed or grades of fatigue, as assessed by the Fatigue Severity Scale.453 The last RCT examined the utility of lectures on exercise philosophy combined with nutrition, stress management and an individualised exercise programmes.451 The results showed no effect on either graded exercise time or on EDSS scores.

Biochemistry Hormones

Adrenalin or norepinephrine produced in the adrenal medulla is another hormone indicative of states of stress or anxiety arousal. Low urinary levels of epinephrine in boys of 13 predicted criminal activity when they reached 18-26 years of age (Magnusson, 1987, 1996 Olweus, 1987). The low states of NE are even found in prisoners in stressful situations like awaiting a criminal trial (Lidberg, Levander, Schalling, & Lidberg, 1978).

Inflammatory bowel disease

Early psychosomatic theories aside, there is no objective evidence that psychiatric disorders cause inflammatory bowel disease. However, patients with this disease and who have psychiatric disorders are more likely to have unexplainable multiorgan physical complaints, more disability than patients with similar disease severity and no psychiatric disorder, and prior histories of physical and sexual abuse. (46) Patients with inflammatory bowel disease frequently report disturbed occupational function, sexual problems, and the inability to venture far from home. (39 Treatment focuses on the identification and treatment of psychiatric disorders, if found, and on quality-of-life issues. Walker et al.(46) treated inflammatory bowel disease patients who had major depression with an antidepressant and found marked improvement in depression and ability to function. Relaxation and stress management (47 and hypnotherapy(48) were found to reduce abdominal pain and diarrhoea. Referral to support...

Management processes

The process of management of health care includes the development of health strategy, its assessment and evaluation, managing finance and resources, and managing personnel and teams. Some of these processes, such as financial and strategic management, are more general tasks whereas time and stress management are more personal.

Major depression

Few disorders illustrate the interaction between genetics and environment more clearly than major depression. In Kendler's study of twins (21) he followed 2164 members of female-female twin pairs. Recent stressful events were the single most powerful risk factor for an episode of major depression. Genetic factors were substantial, but not overwhelming. He followed this cohort of subjects for 17.3 months. During that time 14 per cent of them had major depressive episodes. He found that the four most powerful predictors of a major depression in the month of the occurrence were death of a close relative, serious marital problems, assault, and divorce or separation within a marriage. Genetic factors appeared to alter the sensitivity of individuals to the depression-inducing effect of stressful life events ( Fig 1). Fig. 1 Risk of onset of major depression per person-month as a function of genetic liability and the presence or absence of a severe stressful life event in that month among...


Imagery has helped reduce stress, lower heart rate, stimulate the production of immune cells, and in a study of elderly patients increase killer T-cells. The practice can reduce pain and anxiety, has helped cancer patients tolerate chemotherapy, managed chronic arthritic pain, and aided patients in preparing for surgery and post surgery.

Laboratory Issues

Due to unusual complexity in FMR1, molecular testing should be performed by an experienced molecular pathologist. If the etiology of MR in an individual is unknown, DNA analysis for FXS should be performed as part of a comprehensive genetic evaluation that includes routine cytogenetic analysis. Cytogenetic abnormalities have been identified as frequently as or more frequently than FMR1 mutations in individuals with MR who are referred for FXS testing. In addition, the use of Southern blotting on DNA isolated from amniocytes for prenatal FMR1 analysis, with typical 2- to 3-week turnaround times, may lead to stressful situations on occasion regarding the timing of possible pregnancy termination. Utilization of CVS provides additional time for possible pregnancy termination, but equivocal results sometimes occur due to incomplete methylation when a full mutation is present.

Shortterm predictors

There is good agreement between different studies on the factors that help predict a relapse of psychotic symptoms after a period of stabilization or remission. Stressful life events*6.7,) and a high expressed emotion index6) have attracted considerable interest in this regard but are technically difficult to assess. In addition, the expressed emotion measure is only applicable to patients interacting on a daily basis with family members or other persons in the household. In many settings, such patients would be a minority. By and large, the best predictor of relapse in the short term remains the withdrawal of antipsychotic medication, usually due to non-compliance.(68 Cannabis use on a daily basis has been shown to be associated with an increased risk of relapse in a dose-response relationship. (69) Short-term

Risk factors

Early thinking about depression suggested that there would be those depressions that occurred for largely biological reasons and those precipitated by adverse life events however, it is now clear that such a dichotomous view is incorrect. Kendler et al.(26) showed that there is a significant genotype by environment interaction in the prediction of onset of major depression. They proposed that genetic factors influence the risk of onset of depression, in part, by increasing the sensitivity of individuals to the depression-inducing effects of stressful life events.

Length of episodes

Precipitating events play an important role in the onset of the first few affective episodes thereafter recurrrence seems to become more autonomous with stressful events contributing little or nothing to the process.(19) Stressors may not only precipitate episodes but also increase a pre-existent vunerability, sensitizing the individual and thereby making him or her more vulnerable to further episodes (kindling effect(20)). In bipolar illness there is no difference in the quality or quantity of stressors precipitating depressive and manic episodes a legacy or the loss of a relative can induce depression or hypomania.

Stressor criterion

Both ICD-10 and DSM-IV require that acute stress responses must occur in the immediate aftermath of an exceptionally stressful event. ICD-10 uses a broad concept of what qualifies as an 'exceptional mental or physical stressor'. This includes stressors that would be regarded as traumatic (e.g. rape, criminal assault, natural catastrophe) as well as unusually sudden changes in the social position and or network of the individual (e.g. domestic fire or multiple bereavement). In contrast, DSM-IV uses a narrow definition of stressors that lead to acute stress disorder, which is identical to the stressor criterion of PTSD. It requires (1) that the traumatic event must have involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others, and (2) that the person's response to the traumatic event must have involved intense fear, helplessness, or horror (or disorganized or agitated behaviour in children) (see Chapter .B. for the rationale...

Seeking Wellness

Plex treatments, the patient and family must assume ongoing responsibility for healthcare and self-monitoring. The wellness model is a collaboration between the person with MS and the healthcare team, a positive striving toward self-awareness and self-responsibility. Wellness is a positive striving, unique to the individual, in which a person can have a disease and still be well, with a deep appreciation for the joy of living and with a life purpose. General guidelines include weight control, keeping cholesterol and other blood fats within normal limits, eating a well-balanced diet, managing stress, and getting adequate rest. In addition, balancing work with fun, incorporating hobbies and other life-fulfilling activities, and interacting with a supportive social and family network, are all wellness activities that have been shown to result in better health. It is important to put one's life and life's challenges into perspective and to deal with each day as a new opportunity for...


Meditation techniques have been used in clinical setting to enhance the immune system, reduce stress, manage pain, lower blood pressure, reduce anxiety and depression, and improve blood circulation. Those adept at yoga have learned to control the digestive, respiratory, and circulatory systems.

Adjustment disorder

A varied disorder of distress and emotional disturbance usually interfering with social functioning and performance arising from a significant life change or a stressful life. The causal event does not in any way reach the level of those leading to an acute stress reaction (see above). Symptoms include depressed mood, anxiety, worry (or a mixture of these), a feeling of inability to cope and plan ahead. The individual may be prone to dramatic behaviour or outbursts of violence. The disorder is usually transient and requires no treatment.

Wellness Programs

A focus on self-care in the areas of physical, psychological, or spiritual health. The aims of health promotion wellness programs are to reduce secondary conditions (e.g., obesity, hypertension, pressure sores), maintain functional independence, provide an opportunity for leisure and enjoyment, and enhance the overall quality of life by reducing environmental barriers to good health. This may incorporate, as stated earlier, starting an exercise program, practicing stress management techniques, and or incorporating dietary changes to improve blood lipid profiles.

Behavioural Therapy

Behavioural treatments for obesity originated in the 1960s and were founded on the concept that altering behaviours associated with eating and activity could be central to weight loss. Specific strategies include self-monitoring of both eating habits and physical activity, stress management, stimulus control, problem solving, contingency management, cognitive restructuring and social support. Treatments employing cognitive behavioural therapy (CBT) generally achieve levels of between 5-10 weight loss. A notable fact with regard to studies which have investigated CBT as a treatment strategy is that drop-out rates are very low. Over 80 of subjects who enter behavioural treatments complete the programme and are available for follow-up (80). It is recognised that CBT may produce the best results when combined with other treatments (81).

Human Studies

The pioneering study on the relationship between sleep loss and the immune system in humans was performed by Palmblad et al. three decades ago. In this study, the group of Palmblad kept a group of healthy women awake for 77 h by submitting them to a simulated stressful situation of a battlefield. They did not find differences before, during or after sleep deprivation in the number of polymorphonuclear leukocytes, monocytes, or lymphocytes-B.

Animal Studies

It seems that this effect is not limited by a habituation process. It would be expected that after constant submission to a stressful situation, the organism would trigger adaptation mechanisms tending to reverse the alterations due to the basic impact of the stressor. On the other hand, concerning REM sleep deprivation and the NK cells, there is an increase of the effect after 10 days of REM deprivation.


Anxiety that results from fear caused by an acute illness or a stressful event, such as a divorce or the loss of a loved one, is usually self-limiting and can be of relatively short duration. Other disorders that have anxiety as a component are not necessarily associated with a life event, and may persist for considerable periods, even throughout the individual's life.


Histrionic persons are hyperemotional and impulsive, but their emotional enthusiasm is transient and their mood is labile. They describe their emotions in an inappropriate and exaggerated way. Emotional display is used to obtain attention and desired goals, and to avoid responsibilities and unpleasant affects. However, their emotions are neither constant nor consistent, which often exasperate friends and clinicians. Histrionic individuals are suggestible, demanding, accusative, and guilt inducing. Instead of feeling anxiety or depression in stressful situations, they show inappropriate naivete or la belle indifference.

Life events

Stressful life events are related to increased reporting of physical symptoms and hypochondriasis. For example, Kellner et al.(60) showed that, among employees of a retail firm, life events were associated with hypochondriacal concerns. Events related to illness and death may have a specific role. For instance, symptoms of hypochondriacal patients sometimes resemble those of family members who have been ill or died. In addition, illness events may give rise to hypochondriacal symptoms 'cardiac neurosis' following myocardial infarction is an example. Also, transient hypochondriasis may follow medical illness in predisposed individuals. Barsky et al.(61 observed a group of general medical patients whose increased hypochondriacal symptoms had subsided in 3 weeks. Compared with non-hypochondriacal patients, they had more medical disorders to which they appeared to have reacted with short-lived symptoms. These patients also had more lifetime psychiatric disorders that contributed to their...

Outcome predictors

Follow-up studies of hypochondriacal medical outpatients have found that a greater initial severity is associated with a less favourable outcome. More severe hypochondriacal symptoms and, in one study, shorter duration predicted a failure to remit.(6 7,72) In two of these studies, failure to remit was predicted by psychiatric comorbidity. These results are consistent with earlier studies showing that, while demographic variables are unimportant, longer duration of illness, psychiatric comorbidity, stressful life events, and lack of serious medical comorbidity are unfavourable prognostic indicators.


The depression of mean arterial pressure in the neem-treated rats is consistent with reports that neem affects conduction in the heart and has vasodilatory effects 11 , Pillai and Santhakumari 14 reported that nimbidin, one of the active ingredients of neem, exerts a mild suppressive effect on CNS function in mice and rats after intraperitoneal administration of doses over 250 mg kg. They also reported anti-histaminergic (H2-receptor blocking) effects which may interfere with neurotransmission within the CNS. Neem leaves have been reported to reduce stress when ingested in small quantities 15 . Thus, neem could contribute to the lower blood pressure observed in the neem-fed rats by lowering stress responses.


More apparent in acutely stressful situations such as exercise, mental stress or physical injury. The adrenal medulla works in many ways like an extension of the sympathetic nervous system (which it is), and it is often difficult to distinguish effects of noradrenaline released at sympathetic nerve terminals from those of circulating adrenaline.

Stress and health

The term 'stress' is usually used to describe situations in which individuals are faced with demands that exceed their immediate ability to cope. (9) Stressful situations are typically those that are novel, unpredictable, and uncontrollable as well as those involving change or loss. These situations can give rise to adverse psychological and physiological changes which, in turn, may result in disease. ( ,0) A range of behavioural and emotional responses are shown by individuals as they attempt to cope with stressful situations and these are accompanied by autonomic, neuroendocrine, and immunological changes. During stressful episodes, releasing factors from the brain cause the pituitary to release ACTH which gives rise to the release of corticosteroids from the cortex of the adrenal glands. In addition to producing a number of well-known changes associated with the mobilization of both short- and longer-term physical resources (e.g. release of adrenaline (epinephrine)or noradrenaline...

Coping with stress

If workers are feeling under stress, it is important for them to isolate those stressors that they control themselves from those controlled by senior staff or management. Nurses have used team-building and attempts to control the number of stressors acting at any one time to reduce stress. Self-assessment questionnaires may be


Besides their primary educational role, schools are important settings for mental health promotion in order to teach children important life skills aimed at reducing acute and chronic social stresses and enhancing social supports, all of which have a direct influence on mental health. Schools need to be committed to improving and sustaining the mental and physical health of children. Mental health promotion in schools should include teaching coping skills, citizenship skills, examination skills and techniques, stress management, achieving potential in relationships and working situations, recognizing and combating bullying, learning to say no to risky behaviours, and education about parenting and child rearing, in collaboration with the health education programme and the addiction programme. (38)

MS and Stress

MS patients frequently report elevated levels of stress prior to initial diagnosis and or disease exacerbation (Warren et al., 1982 Grant et al., 1989 Ackerman et al., 2000 Mohr et al., 2000 Mohr et al., 2004). A recent metaanalysis was conducted on 14 studies investigating the impact of stressful life events on MS exacerbation. The results indicated that stressful life events significantly increased the risk of subsequent disease exacerbation (Mohr et al., 2004). Importantly, 13 of the 14 studies measured common stressful life events, mostly interpersonal stressors at family and work. However, one of the 14 studies did not observe a negative effect of stress on MS. This study examined the impact of a traumatic stressor, missile attacks during the Gulf War, finding reduced relapse rates and no change in lesion development (Nisipeanu and Korczyn, 1993). Thus, the characteristics of the stressor may alter the impact of stress on initial susceptibility and disease course in MS. Chronic...

Defining Depression

The question which received the most research attention over the last three decades is what happens to cause an episode of depression. A host of epidemiological evidence has shown that stressful life events such as family or work-related conflicts, loss of close personal relationships, or major health problems play a role in the initiation of an episode3. Concurrently, there is an overwhelming evidence from epidemiologic studies that - apart from stress - early adverse events and genetic factors also play a role in increasing the risk for depression. With respect to early adverse events Heim and colleagues were able to show long-lasting effects of any kind of abuse in childhood on endocrine responses4. These persistent consequences may contribute to the diathesis for adulthood psychopathological conditions such as depression and have implication for therapeutic response and prognosis5,6. In addition, affective disorders share a significant genetic basis Twin studies provide an...

General aims

Anxiolysis, analgesia, sedation, and amnesia are accepted goals of intensive care. Inadequate pain therapy and sedation not only restrict the comfort of critically ill patients but may also cause specific complications. Elevated catecholamine plasma levels may lead to disturbances of the microcirculation, myocardial ischemia and infarction, cerebral disturbances, and renal failure. Patients with cardiovascular diseases are at particular risk. Thus adequate analgesia and sedation should be integral elements in the management of critically ill patients. Sympathetic hyperactivity, due to severe pain as well as analgesic overtreatment, may result in increased morbidity (Table 1). Therefore complete stress reduction should be restricted to the most critical phases of intensive care therapy.

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