Responses to stress
What is the difference between eustress and distress
Eustress is a good type of stress that is mild but useful, usually short-term. Distress is a bad type of stress that is unpleasant or disease producing, usually long-term.
Give an example of a physiological stress symptom that can be misinterpreted for physical illness
Increased heart rate, increased breathing rate, muscle tension, weight loss
Give 3 factors that put someone at risk of experiencing MUS
Increasing age, lower social class, history of trauma, ASD, personal or family history of physical illness, membership in cultures that discourage emotional expression, fear of psychiatric stigmatisation
What is the overall aim of MUS treatment
To help the patient to cope, which minimises the impact
Name 3 life events that can cause stress
Work problems, changes, debts, relationship difficulties, family problems, moving house, exams, diagnosis of physical illness, bereavement
Describe the 'alarm phase' of stress
Initial 'fight or flight' response
What is 1 impact of stress on existing physical illness
Relapse, poor control of chronic disease, increased morbidity
Give one factor that can cause MUS to have poor prognosis
Symptoms last 2 or more years, history of child abuse, long duration of untreated psychiatric disorder, ongoing unresolvable psychosocial stressors
What is the explanation model for FND
Communication error between brain and body
What is an advantage of promoting self-efficacy in patients
Prevents dependency on doctors
Prevents attachment
State 2 of the 4 domains of the stress response, and give examples of one of them
Emotional response- feeling on edge, sad, irritable, overreacting
Cognitive response- difficulty concentrating, switching off, sensitive to criticism, self-critical
Behavioural response- loss of appetite, drinking, smoking, hyperactivity, disturbed sleep
Physiological response- physical symptoms
Which part of the autonomic nervous system is activated during bereavement
Sympathetic
In which disorder of psychogenic somatic symptoms is the patient conscious of faking and conscious of motivation:
a. somatoform disorder
b. factitious disorder
c. malingering
c. malingering
What treatments can be given to someone with MUS (name 2)
Analgesics, antispasmodics, exercise, acupuncture, physiotherapy
Describe the 'exhaustion phase' of stress
Resources are depleted, so the body is unable to maintain homeostasis.
Describe primary and secondary appraisal during the stress response
Primary is appraisal of the actual event
Secondary is appraisal of personal coping abilities, personal resources, and support network.
Which disease accounts for the increased risk of death after loss of a spouse
Cardiovascular disease
State 3 types of functional neurological disorder, and give symptoms of one
Motor- tremor, paralysis
Sensory- vertigo, functional blindness, altered sensation
Axial- abnormal gait, posture, knee-buckling
Speech- Dysarthria, stutter, whisper
Paroxysmal- non epileptic attacks
Describe characteristics of the 'sick role'
Exemptions from usual responsibilities
Honourable discharge from difficult situations
Reinforces further abnormal illness behaviour
Symptoms are not feigned
What are 2 causes of MUS
Genetic, personality traits, familial transmission, pathological care seeking behaviours
What axis is activated in the long-term stress response
Hypothalamic-pituitary-adrenal
What structural change to the heart occurs in 'broken heart syndrome', and what is the effect
Enlarged left ventricle pumps blood less efficiently
How to test for functional limb weakness in the examination for FND
Hoover's sign: Hip extension weakness that improves with contralateral hip flexion against resistance
Hip abductor sign: Abduction weakness that improves with contralateral hip abduction against resistance
Define 'iatrogenic harm'
Harm done by the doctor by carrying out referrals and testing when not needed
What is a diagnostic criteria for bodily distress disorder
At least 2 years of multiple and variable physical symptoms with no explanation found
Persistent refusal to accept advice of several doctors that there is no explanation for symptoms
Some degree of impairment of social and family functioning attributable to the nature of the symptoms and resulting behaviour