3. STRESS REACTION Factors affecting stress reaction: Factors affecting stress reaction: STRESSOR PERSONALITY SUPPORT OTHERS

4. STRESSORS Usual life stresses Usual life stresses e.g. family conflicts financial stresses financial stresses academic academic job job marriage marriageResponse: normal—e.g. grief normal—e.g. grief abnormal----Adj. disorder abnormal----Adj. disorder Unusual stresses Unusual stresses Life-threatening Life-threatening e.g. fire drowning drowning war war rape rape earthquake earthquake Response: Response: normal normal abnormal :acute /PTSD abnormal :acute /PTSD

5. Normal Reaction Normal physiological responses Normal physiological responses Normal psychological responses Normal psychological responses Response after stress Response after stress E.g. normal grief E.g. normal grief

7. GRIEF Sadness appropriate to a real loss e.g. death of a relative. NORMAL 1-Shock 2-Disorganization 3-Reorganization ABNORMAL 2-Duration - prolonged 1-Onset - delayed 3-Intensity - severe 4-Nature - distorted

8. NORMAL GRIEF Shock Stage: hours ------ days Shock Stage: hours ------ days Numbness Numbness Denial Denial Anger Anger Yearning Yearning Searching Searching numbness numbness denial denial anger anger yearning yearning searching searching

9. NORMAL GRIEF Disorganization stage :a week ---- 6 months. despair sadness guilt weeping despair sadness guilt weeping social withdrawal social withdrawal psychosomatic complaints psychosomatic complaints disturbed sleep & appetite disturbed sleep & appetite pseudo hallucinations …. Lost person pseudo hallucinations …. Lost person hypochodriacal thoughts hypochodriacal thoughts

10. NORMAL GRIEF Reorganization stage : weeks ----- months. symptoms subside symptoms subside acceptance acceptance return to usual mood & functioning return to usual mood & functioning anniversaries ? anniversaries ?

11. Risk For Abnormal Grief Abnormal Abnormal personality. H/O H/O psychiatric disorder. Death: Death: sudden, traumatic,multiple Psychosocial Psychosocial complication. Relationship Relationship problems: dependant / ambivalent.

12. HELPING THE BEREAVED Explain & facilitate normal process. Explain & facilitate normal process. Support. Support. Caring. Caring. If insomniac : short course of sedatives. If insomniac : short course of sedatives. If MDE :antidepressants. If MDE :antidepressants. Postpone major decisions Postpone major decisions

13. Reaction to impending death 1. Shock & Denial 1. Shock & Denial 2. Anger 2. Anger 3. Bargaining 3. Bargaining 4.Depression 4.Depression 5.Acceptance 5.Acceptance

15. STRESSORS Usual life stresses Usual life stresses e.g. family conflicts financial stresses financial stresses academic academic job job marriage marriageResponse: normal—e.g. grief normal—e.g. grief abnormal----Adj. disorder abnormal----Adj. disorder Unusual stresses Unusual stresses Life-threatening Life-threatening e.g. fire drowning drowning war war rape rape earthquake earthquake Response: Response: normal normal abnormal :acute /PTSD abnormal :acute /PTSD

16. ADJUSTMENT DISORDERS Pt. exposed to usual life stresses Pt. developed abnormal adjustment. maladaptive exaggerated responses. Emotions / behavior------- abnormal. beyond expected (intensity/duration) -Functional impairment.

17. Adjustment disorder with Adjustment disorder with depressed mood. depressed mood. anxious mood. anxious mood. mixed anxiety & depressed mood mixed anxiety & depressed mood disturbance of conduct. disturbance of conduct. depressed emotions and conduct. depressed emotions and conduct. unspecified type unspecified type TYPES

18. Medical illness / surgery. Medical illness / surgery. Difficulties at school / university. Difficulties at school / university. Transition from school to university. Transition from school to university. Marriage / Divorce / Marital conflicts. Marriage / Divorce / Marital conflicts. Employment / Promotion / Retirement Employment / Promotion / Retirement Traveling abroad or away from family. Traveling abroad or away from family. Birth of a defected child. Birth of a defected child. Financial problems Financial problems STRESSES → ADJUSTMNT D.

19.  more in females 2 : 1 (adults).  occur at any age (  in adolescents )  ) medical wards ⇨ disease stresses.  community ⇨ psychosocial. EPIDEMIOLOGY

20. Personality Problems Stressors : nature meaning severity ِ ETIOLOGY

21. COURSE Onset: within stressor---*---*----*----*----*---3/12 stressor---*---*----*----*----*---3/12 *:symptoms. *:symptoms. Duration: maximum --*************************6/12 --*************************6/12 Self-limited but can be chronic. Self-limited but can be chronic.Recurrence

23.  Normal adjustment reactions e.g.: normal grief  Major Depressive Episode  G A D  P T S D & acute stress disorder.  Others. D D

24.  Psychological : Support - empathy - exploration- Crisis intervention Problem-solving : educating pt. about adaptive coping  Pharmacological symptomatic. TREATMENT

25.  100 % → Evil eye,Jinni possession, or black magic.  Traditional healers : traditional,cultural customs. MISCONCEPTIONS

27. STRESS DISORDERS Abnormal reaction to life threatening stresses e.g. fire, natural disaster,war, rape,RTA... Experienced or witnessed. Acute stress disorder : 2 days – 4 W Post- traumatic stress disorder (PTSD) : delayed onset / prolonged duration >1/12

28. FEATURES Severe anxiety reaction. Horror or detachment. Running away/distress on exposure Automatic mental Reexperience. Functional impairment.

29. ETIOLOGY Massive emotions beyond the brain capacity------ great distress. Personal vulnerability.

30. D Adjustment disorders : less severe & usual stresses. Grief Panic disorder, GAD Head trauma. Substance abuse.

31. TREATMENT Psychological: · Support- reassurance- relaxation. · Encourage overcoming denial. · Group therapy. Symptomatic drug treatment : sedatives anxiolytics.

32. PROGNOSIS Good if :.Healthy premorbid personality. · Early intervention. · Social Support. · Less severe.