To understand the role of the stress reaction in the adaptation of the body to the action of stressors and the occurrence of stress damage, let us consider 5 main, largely associated with each other, effects of the stress reaction, due to which "urgent" adaptation to environmental factors is formed at the level of systems, organs, cells, and which can translate into damaging effects of stress responses.

The first adaptive effect of the stress response consists in mobilizing the function of organs and tissues by activating the most ancient signaling mechanism of cell stimulation, namely, increasing the concentration in the cytoplasm of the universal function mobilizer - calcium, as well as by activating key regulatory enzymes - protein kinases. During a stress reaction, an increase in the concentration of Ca 2 * in the cell and the activation of intracellular processes are carried out due to two factors accompanying the stress reaction.

Firstly, under the influence of a stressful increase in the level of parathyroid hormone (a hormone of the parathyroid glands) in the blood, Ca 2 * is released from the bones and its content in the blood increases, which contributes to an increase in the entry of this cation into the cells of organs responsible for adaptation.

· Secondly, the increased "release" of catecholamines and other hormones ensures their increased interaction with the corresponding receptors of the cells, as a result, the activation of the entry mechanism occurs. Ca 2+ into the cell, increasing its intracellular concentration, potentiating the activation of protein kinases and, as a result, activating intracellular processes.

Let's take a closer look at this. An excitation pulse arriving at the cell causes depolarization of the cell membrane, which leads to the opening of voltage-dependent Ca 2+ channels, the entry of extracellular Ca 2+ into the cell, the release of Ca 2+ from the depot, i.e. from the sarcoplasmic reticulum (SRR) and mitochondria, and an increase in the concentration of this cation in the sarcoplasm. By connecting with its intracellular receptor calmodulin (KM), Ca 2+ activates KM-dependent protein kinase, which "starts" intracellular processes leading to the mobilization of cell function. Simultaneously, Ca 2+ is involved in the activation of the genetic apparatus of the cell. Hormones and mediators, acting on the corresponding receptors in the membrane, potentiate the activation of these processes through the secondary messengers formed in the cell using enzymes coupled to the receptors. The effect on α-adrenergic receptors activates the enzyme phospholipase C conjugated with it, with its help secondary messengers diacylglycerol (DAG) and inositol triphosphate (IFZ) are formed from the phospholipid membrane of phosphatidylinositol. DAG activates protein kinase C (PK-C), IFz stimulates the release of Ca 2+ from the SPR, which potentiates the processes caused by calcium. The impact on β-adrenergic receptors, α-adrenergic receptors and vasopressin receptors (V) leads to the activation of adenylate cyclase and the formation of a secondary messenger cAMP; the latter activates cAMP-dependent protein kinase (cAMP-PK), which potentiates cellular processes, as well as the work of voltage-gated Ca 2+ channels through which Ca 2+ enters the cell. Glucocorticoids, penetrating into the cell, interact with the intracellular receptors of steroid hormones and activate the genetic apparatus.

Protein kinases play a dual role.

First, they activate the processes responsible for the function of the cell: the release of the corresponding "secret" is stimulated in secretory cells, contraction is enhanced in muscle cells, etc. At the same time, they activate the processes of energy formation in mitochondria, as well as in the system of glycolytic ATP formation. Thus, the function of the cell and organs in general is mobilized.

Secondly, protein kinases are involved in the activation of the genetic apparatus of the cell, that is, the processes occurring in the nucleus, causing the expression of genes for regulatory and structural "proteins, which leads to the formation of the corresponding mRNAs, the synthesis of these proteins and the renewal and growth of cellular structures, With repeated actions of the stressor, this provides the formation of a structural basis for stable adaptation to this stressor.

However, with an excessively strong and / or prolonged stress reaction, when the content of Ca 2+ and Na + in the cell is excessively increased, the increasing excess of Ca 2+ can lead to cell damage. With regard to the heart, this situation causes a cardiotoxic effect: the so-called "calcium triad" of damage to cellular structures by excess calcium is realized, which consists of irreversible contractural damage to myofibrils, dysfunction of calcium-overloaded mitochondria and activation of myofibrillar proteases and mitochondrial phospholipases. All this can lead to dysfunction of cardiomyocytes and even to their death and the development of focal myocardial necrosis.

Second adaptive effect of the stress response is that "stress" hormones - catecholamines, vasopressin, etc. - directly or indirectly through the corresponding receptors activate lipases, phospholipases and increase the intensity of free radical oxidation of lipids (FRO). This is realized by increasing the content of calcium in the cell and activating calmodulin-protein kinases dependent on it, as well as by increasing the activity of PK-C and cAMP-PK dependent on DAG and cAMP protein kinases. As a result, the content of free fatty acids, FRO products, phospholipids increases in the cell. This lipotropic effect of the stress reaction changes the structural organization, phospholipid and fatty acid composition of the lipid bilayer of membranes and thereby changes the lipid environment of membrane-bound functional proteins, i.e., enzymes, receptors. As a result of the migration of phospholipids and the formation of lysophospholipids with detergent properties, the viscosity decreases and the "fluidity" of the membrane increases.

The activation of FRO in the heart, liver, skeletal muscles and other organs has been proven during a stress reaction or administration of catecholamines.

The adaptive value of the lipotropic effect of the stress reaction is obviously great, since this effect can quickly optimize the activity of all membrane-bound proteins, and, consequently, the function of cells and the organ as a whole, and thus facilitate the urgent adaptation of the organism to the action of environmental factors. However, with an excessively prolonged and intense stress reaction, an increase in this very effect, i.e. excessive activation of phospholipases, lipases, and FRO can lead to membrane damage and acquires a key role in converting the adaptive effect of a stress response into a damaging one.

In this case, free fatty acids accumulating as a result of excessive hydrolysis of triglycerides by lipases and during hydrolysis of phospholipids by phospholipases, as well as lysophospholipids formed as a result of hydrolysis of phospholipids, become damaging factors. As a result, the structure of the membrane bilayer changes. At high concentrations, these compounds form micelles, which "break the" membrane "and disrupt its integrity. As a result, the permeability of cell membranes for ions and especially for Ca 2+ increases.

The products of FRO activation also become damaging factors of the lipotropic effect during intense or prolonged "stress reactions. With the progression of FRO, an increasing number of unsaturated phospholipids are oxidized and the proportion of saturated phospholipids in the" microenvironment of functional proteins increases in membranes. This leads to a decrease in the fluidity of the membrane and the "mobility of the peptide chains of these proteins. The phenomenon of" freezing "of these proteins into a more" rigid "lipid matrix arises and, as a consequence, the activity of proteins is reduced or completely blocked.

Thus, an excessive increase in the lipotropic effect of the stress response, i.e. its "lipid triad" (activation of lipases and phospholipases, activation of FRO and an increase in the amount of free fatty acids), can lead to "damage to the biomembranes, which plays a key role in the inactivation of ion channels, receptors and ion pumps. As a result, the adaptive lipotropic effect of the stress reaction can turn into a damaging effect.

The third adaptive effect of the stress response is in the mobilization of the body's energy and structural resources, which is expressed in an increase in the concentration of glucose, fatty acids, nucleids, amino acids in the blood; as well as in the mobilization of the blood circulation function of respiration. This effect leads to an increase in the availability of oxidation substrates, initial products of biosynthesis and oxygen for organs whose work is increased. In this case, glucagon is released under stress somewhat later than catecholamines and, as it were, duplicates and reinforces the effect of catecholamines. This becomes especially important in conditions when the effect of catecholamines is not fully realized due to desensitization of β-adrenergic receptors caused by an excess of catecholamines. In this case, the activation of adenylate cyclase is carried out through glucagon receptors (Tkachuk, 1987). Another source of glucose is the activation of protein hydrolysis and an increase in the pool of free amino acids, arising under the influence of glucocorticoids and, to a certain extent, parathyroid hormone, as well as the activation of gluconeogenesis in the liver and skeletal muscles. In this case, glucocortioids, acting on their receptors at the level of the cell nucleus, stimulate the synthesis of key enzymes of gluconeogenesis glucose-6-phosphatase, phosphoethanolpyruvate carboxykinase "and" others "(G6likbvG1988"). The result of gluconeogenesis activation is the transamination of amino acids and the formation of It is important that both hormonal mechanisms of glucose mobilization during a stress reaction ensure the timely supply of glucose to such vital organs as the brain and heart.In a stress reaction associated with acute physical exertion, the arising under the influence of glucocorticoids in skeletal muscle activation of the glucose-adenine cycle, which ensures the formation of glucose from amino acids directly in muscle tissue.

In the mobilization of fat stores under stress, catecholamines and glucagon play the main role, which indirectly through the adenylate cyclase system activate lipases and lipoprotein lipases in adipose tissue, skeletal muscles, and heart. In the hydrolysis of blood triglycerides, parathyroid hormone and vasopressin seem to play a role, the secretion of which under stress, as mentioned above, increases. The fatty acid pool thus formed is used in the heart and skeletal muscles. In general, the mobilization of energy and structural resources is expressed quite strongly during a stress reaction and provides an "urgent" adaptation of the body to a stressful situation, ie. is an adaptive factor. However, under conditions of a prolonged intense stress reaction, when the formation of "structural traces of adaptation" does not occur, in other words, there is no increase in the power of the energy supply system, intensive mobilization of resources ceases to be an adaptive factor and leads to a progressive depletion of the organism.

The fourth adaptive effect of the stress response can be defined as "directed transfer of energy and structural resources into a functional system that implements this adaptation response." One of important factors of this selective redistribution of resources is the well-known, local in its form "working hyperemia" in the organs of the system responsible for adaptation, which is simultaneously accompanied by vasoconstriction of "inactive" organs. Indeed, with a stress reaction caused by acute physical exertion, the proportion of the minute volume of blood flowing through skeletal muscles increases by 4-5 times, and in the digestive organs and kidneys, this indicator, on the contrary, decreases by 5-7 times compared with the state of rest ... It is known that under stress an increase in coronary blood flow develops, which provides an increased function of the heart. The main role in the realization of this effect of the stress reaction belongs to catecholamines, vasolressin and angiotensin, as well as substance R. The key local factor of "working hyperemia" is nitric oxide (NO) produced by the vascular endothelium. "Working hyperemia" provides an increased flow of oxygen and substrates to the working organ through vasodilation in this organ

It is obvious that the redistribution of the body's resources under stress, aimed at the preferential provision of organs and tissues responsible for adaptation, regardless of its mechanism, is an important adaptive phenomenon. At the same time, with an excessively pronounced stress reaction, it can be accompanied by ischemic dysfunctions and even damage to other organs that are not directly involved in this adaptive reaction. For example, ischemic ulcers of the gastrointestinal tract that occur in athletes during severe long-term emotional and physical stress.

The fifth adaptive effect of the stress response consists in the fact that with a single sufficiently strong stress effect following the well-known "catabolic phase" of the stress reaction (the third adaptive effect) considered above, a much longer "anabolic phase" is realized. It is manifested by a generalized activation of the synthesis of nucleic acids and proteins in various organs. This activation ensures the restoration of structures damaged in the catabolic phase, and is the basis for the formation of structural "traces" and the development of stable adaptation to various environmental factors. This adaptive effect is based on the hormonal activation of the formation of secondary messengers IFZ and DAG, an increase in the level of calcium in the cell, as well as the effect of glucocorticoids on the cell. In addition to mobilizing the function of the cell and supplying it with energy, this process has an “outlet” to the genetic apparatus of the cell, which leads to activation of protein synthesis. In addition, it was shown that during the deployment of the stress reaction, the secretion of growth hormone (growth hormone), insulin, thyroxin, which are "inhibited" at the beginning of the reaction, is activated, which potentiate protein synthesis and can play a role in the development of the anabolic phase of the stress reaction and activation of cell structures that had the greatest load during stress mobilization of cell function. However, it should be borne in mind that the excessive activation of this adaptive effect, apparently; can lead to unregulated cell growth.

In general, we can conclude that with a prolonged intense stress reaction, all the main adaptive effects considered are transformed into damaging ones and this is how they can become the basis of stress diseases.

The effectiveness of the adaptive response to stress and the likelihood of stress damage and diseases are largely determined, in addition to the intensity and duration of the stressor, by the state of the stress system: its basal (initial) activity and reactivity, i.e., the degree of activation under stress, which are genetically determined. , but can change in the course of individual life.

Chronically increased basal activity of the stress system and / or its excessive activation under stress are accompanied by high blood pressure, dysfunction of the digestive system, and suppression of immunity. In this case, cardiovascular and other diseases can develop. Decreased basal activity of the stress system and / or its inadequate activation under stress are also unfavorable. They reduce the body's ability to adapt to environment, to solve life problems, to the development of depressive and other pathological conditions.

Federal Agency for Education

State educational institution

"Volgograd State Pedagogical University"

Department of Morphology, Human Physiology and Medical and Pedagogical Disciplines

Test

on the physiology of higher nervous activity

and sensory systems

« Stress. Adaptive reactions of the body "

Volgograd 2009

1. Stress and its functions.

2. Types of stress: physiological and psychological stress (informational and emotional), their characteristics.

3. The basic concepts of G. Selye about stress.

4. Contemporary research stress. Theory of neural and endogenous

regulation of stress.

5. Nonspecific protective and adaptive reactions:

a) changes in metabolism and energy

b) change in the functional state of the body's vegetative systems. The value of nonspecific protective and adaptive reactions of the body.

6. Characteristics of specific adaptive reactions of the body (by the example of any stressful impact).

7. The mechanism of development of nonspecific and specific protective and adaptive reactions.

8. The essence of improving adaptive physiological mechanisms.

9. Influence of stress on performance, cognitive and integrative processes.

1. Stress (Stress reaction) (from the English. Stress - tension, pressure, pressure) - a nonspecific (general) reaction of the body to an effect (physical or psychological) that violates its homeostasis, as well as the corresponding state of the nervous system of the body (or the body in overall). In medicine, physiology, psychology, there are positive (eustress) and negative (distress) forms of stress. Allocate neuropsychic, heat or cold, light, anthropogenic and other stresses.

In modern literature, the term "stress" denotes a wide range of phenomena from adverse effects on the body to favorable and unfavorable reactions of the body, both under strong, extreme, and normal effects for it.

The author of the concept of stress, Hans Selye himself, defines: "Stress is an organic, physiological, neuropsychic disorder, namely a metabolic disorder caused by irritating factors." His concept of stress is identical to a change in the functional state corresponding to the task solved by the body. According to G. Selye, “complete freedom from stress means death”, even in a state of complete relaxation, a sleeping person experiences some stress, while distress is the stress that is unpleasant and damages the body.

Initially, Selye considered stress exclusively as a destructive, negative phenomenon, but later Selye writes: “Stress is a non-specific response of the body to any presentation of demands on it. .... From the point of view of the stress response, it does not matter whether the situation we are faced with is pleasant or unpleasant. It is only the intensity of the need for restructuring or for adaptation that matters "(Selye G.," The Stress of Life ".)

This understanding is shared by researchers who distinguish stress in the narrow sense of the word as a manifestation of the adaptive activity of the body under strong, extreme effects for it from stress in the broad sense of the word, when adaptive activity occurs under the action of any factors significant for the body.

The biological function of stress - adaptation. It is designed to protect the body from threatening, destructive influences of various kinds: physical, mental. Therefore, the appearance of stress means that a person is involved in a certain type of activity aimed at resisting the dangerous influences to which he is exposed. This type of activity corresponds to a special FS and a complex of various physiological and psychological reactions. As stress develops, PS and body responses change. Thus, stress is normal in a healthy body. It helps to mobilize individual resources to overcome the difficulties encountered. This is the defense mechanism of the biological system. The effects that cause stress are called stressors... Distinguish physiological and psychological stressors.

Physiological stressors have a direct effect on body tissues. These include pain, cold, high temperature, excessive physical activity, etc.

Psychological stressors are stimuli that signal the biological or social significance of events. These are signals of threat, danger, anxiety, resentment, the need to solve a complex problem.

2. In accordance with two types of stressors are distinguished physiological stress and psychological... The latter is subdivided into informational and emotional.

Information stress arises in a situation of information overload, when a person cannot cope with a task, does not have time to make the right decisions at the required pace, with a high responsibility for the consequences of decisions made. By analyzing texts, solving certain problems, a person processes information. This process ends with a decision. The volume of processed information, its complexity, the need to make frequent decisions - all this constitutes the information load. If it exceeds the capabilities of a person with his high interest in the performance of this work, then they speak of information overload.

Emotional stress as a special case of psychological stress is caused by signaling stimuli. It appears in a situation of threat, resentment, etc., as well as in the conditions of so-called conflict situations in which an animal and a person cannot satisfy their biological or social needs for a long time. Verbal stimuli are universal psychological stressors that cause emotional stress in humans. They are capable of having a particularly strong and lasting effect (long-term stressors).

3. In the main provisions of Selye's concept, it is said that in response to the action of different in quality, but strong stimuli, the body develops the same complex of changes characterizing this reaction, called the general adaptation syndrome (OSA), or reaction stress - stress reaction. At the same time, it should be emphasized that stress is a reaction to a stressor, an extreme stimulus, and not to any stimulus in general, that Selye came to the idea of \u200b\u200bstress in part because he noticed common symptoms in a wide variety of diseases, that is, in extreme circumstances for the body. Selye in most of his works says that stress is a reaction to a strong stimulus, but at the same time, he does not clearly distinguish between stimuli by strength. This leads to confusion, to the idea that stress is a general non-specific adaptive response to any stimulus. An interesting question is, what property of stimuli can create something in common in response to stimuli of different quality, form the basis for a standard adaptive response? Quality cannot be such a basis, since each stimulus has its own quality. The common thing that characterizes the action of a wide variety of stimuli is the amount determined in relation to a living thing as the degree of biological activity. Stimuli that are different in quality may have the same degree of biological activity (the same amount), while irritants that are the same in quality may have a different degree of biological activity (different amounts). Of course, the idea of \u200b\u200ba purely quantitative path of adaptation without taking into account the qualitative characteristics of stimuli also contradicts the facts. However, the quantity, the measure can be the basis for the generality of the reaction of the organism to the action of stimuli of different quality, the basis for the development in the process of evolution of biologically expedient complex, standard responses of the organism. Most likely, this is based on the quantitative and qualitative principle: in response to the action of stimuli that are different in quantity, i.e. according to the degree of its biological activity, standard adaptive reactions of the organism of different quality develop. In other words, the general adaptive reactions of the organism that have developed in the process of evolution are nonspecific, and the specificity, quality of each stimulus is superimposed on the general nonspecific background. General adaptive reactions are reactions of the whole organism, including all its systems and levels. These reactions of the body are characterized, first of all, by automatism. How is this automatic self-regulation carried out? These are complex defensive reactions created in the long process of evolution. The most important role in adaptation belongs to the central nervous system - the main regulatory system of the body. The cerebral cortex with a system of analyzers receives information from the outside world, the subcortical formations of the brain - from the internal environment. Automatic regulation of the constancy of the internal environment is carried out mainly by the hypothalamic region of the brain, which is the center of integration of the autonomic division of the nervous system and the endocrine system - the main executive links that implement the influence of the central nervous system on the internal environment of the body. The hypothalamus combines the nervous and humoral pathways of automatic regulation. The hypothalamus can be figuratively compared with a radar installation included in the system of self-regulation and automation of neurohumoral-hormonal processes that oppose dynamically changing factors not only of the internal, but also of the external environment. The presence of the closest anatomical and physiological connection between the hypothalamus and the reticular formation playing important role in the implementation of generalized nonspecific reactions, also speaks of the importance of these parts of the brain in the formation of nonspecific reactions of the body.

Standard non-specific, adaptive responses accompanying behavior.

Standard -reactions of any individual proceeding according to a previously known scheme.

Non-specific- arise in response to the action of any stimuli.

Responsive -provide adaptation to the action of stimuli. Therefore, the nature of the reaction, its severity and duration depend on the nature of the stimulus.

Types of adaptive responses.

1) Training.

2) Activations.

3) Stress.

The nature of the response to the stimulus is determined.

1) Tensionsympathoadrenal and hypothalamic-pituitary systems, mobilizing the body's resources for adaptation.

2) Resistance, that is, the stability of behavior, the control apparatus, maintaining homeostasis, to the action of factors.

3) Reactivity - the ability to respond to a stimulus. Depends on the functional state of the reacting structures.

Scheme of the course of non-specific standard reactions.

Characteristic of the training reaction.

1) Orientation stage - occurs 6 hours after exposure, lasts 24 hours.

It is accompanied by a moderate increase in the secretion of glucocorticoids, excitement arises in the central nervous system, followed by inhibition. The excitability of the hypothalamus decreases. The body stops responding to mild stimuli. For the next stage to appear, a higher stimulus is needed.

2) The stage of restructuring.

a) There is a decrease in the secretion of glucocorticoids and an increase in mineralocorticoids.

b) The body's defenses increase.

c) In the central nervous system, the threshold of irritation increases, metabolism is reduced, there is a minimum consumption of plastic materials, they accumulate. This stage lasts for a month or more.

d) Stage of fitness.

It occurs if the strength of the stimulus reaches new levels of the excitation threshold.

Resistance to the action of stimuli increases due to an increase in the activity of protective forces. In the brain, the processes of anabolism, in the central nervous system - protective inhibition.

Termination of the action of weak stimuli leads to detraining.

Characterization of the activation reaction.

It occurs under the action of stimuli of medium strength. Has 2 stages:

1) Stage of primary activation. In the central nervous system, moderate agitation, moderate motor activity. Increased secretion of growth hormone, thyroid-stimulating and gonadotropic hormones. Anabolic processes are increased. There is an increase in albumin in the brain, liver, spleen, testes, and blood serum.

Protective forces are activated, resistance is increased.

2) Stage of persistent activation occurs with repeated actions of stimuli of medium strength. It is characterized by the activation of neurons in the reticular formation. Excitation predominates in the central nervous system, there is a persistent increase in protective forces, resistance is increased and persists for some time after the cessation of the action of stimuli.

Stress.

Stress is a stereotypical psychophysiological reaction to significant and strong influences, leading to the mobilization of the body's defenses.

Stress - the reaction develops due to:

1) the action of factors.

An irritant becomes stressful:

a) by virtue of the interpretation or

b) if it has sympathomimetic action;

2) individual propertiesVND and CNS;

3) the value of the functional reservephysiological systems.

Characterization of stressors.

With mental labor stress can arise when it is necessary to achieve very important goalwhen failure to achieve it threatens with serious consequences. This is complemented by the lack of time.

With physical labor a very high physical activity can be a stressor.

Life situations are also referred to as stressors.

By stress events are arranged as follows: death of a spouse, divorce, death of a family member, separation of spouses, dismissal, retirement, marriage. The stress level of each factor is assessed in points. If the amount per year exceeds 300 points - stress disease (coronary artery disease, hypertension, lung disease, suicide).

The type of activity can also become a stressor.

By stress, the professions are located in next order: air traffic controllers, miners, builders, journalists, dentists, drivers.

Interpersonal relationships, evaluative situations are strong stressors.

The role of individual properties of GNI in the development of stress.

Resistance to acting factors depends on the type of GNI: on the severity of arousal and inhibition, on the characteristics of excitability and impressionability.

The development of stress depends on the state of the central nervous system at the moment.

A change in the state of the central nervous system can be associated with phase phenomena in the cortex, when the law of power relations is violated. The response to the acting factor will be different depending on the phase state.

Phases: normal, equalizing, paradoxical, inhibitory. Phase phenomena in the cortex are associated with a change in excitability.

The role of the functional reserve in the development of stress.

Reactions to various stimuli are manifested by an increase in the activity of physiological systems. This is possible only if there are sufficient functional reserves of physiological systems. A decrease in functional reserve due to changes in homeostasis or organic changes does not allow responding adequately to stimuli.

Stages of development of stress - reactions:

stressor → stress phases → stress outcome

a) internal a) alarms a) adaptation

b) external b) increased reactivity b) depletion

Characteristics of stress phases.

Anxiety phase.

In response to a stressor, the mental state, emotional status, motor acts, and autonomic reactions change. Such changes are triggered:

1) nervously through direct innervation of organs that respond to a stimulus;

2) neuroendocrine by the sympathoadrenal system.

3) endocrine pathway - the main role in the anxiety phase is played by hormones of the adrenal cortex.

The role of the sympathoadrenal system(combining 1 and 2 mechanisms of influence).

It exerts its influence through the activation of the endings of the adrenergic nerves and the adrenal medulla.

Adrenalin.

1) Provides improving the transport of substances to working organs by:

a) an increase in heart rate and systolic output through β - adrenergic receptors (AR);

b) expansion of the bronchi.

2) Improves metabolic support:

a) increases blood glucose levels from glycogen;

b) increases the content of fatty acids in the blood;

c) provides gluconeogenesis.

3) Inhibits activity of most internal organs.

4) Provides emotional stress of the body.

5) Activates the activity of the pituitary gland in relation to the hormonal systems.

Norepinephrine:

1) participates in the activation of mental activity;

2) through α-AR increases the tone of most peripheral arteries and arterioles of non-working organs - as a result, an increase in blood pressure and redistribution of blood to working organs;

3) acts on β - AR, increases heart rate, contraction force, MVB and blood pressure.

The role of the adrenal cortex.

1) Mineralocorticoids provide an increase in blood pressure, increasing the reabsorption of Na and H 2 O.

2) Glucocorticoids:

a) activate glucocorticoid receptors of the vascular walls, ensuring the transition of angiotensin I to angiotensin II and a subsequent increase in blood pressure;

b) provide gluconeogenesis (deamination of amino acids and the conversion of nitrogen-free residues into glucose);

c) have an anti-inflammatory effect: they inhibit T - suppressors and activate T - killers.

Phases of increased resistance.

The task of this phase is to maintain a new (increased) mode of operation of physiological systems and the body.

Options for the outcome of stress.

1) Evstress – good stress.

At the same time, the level of tension of the organism does not go beyond the boundaries of the functional reserve of systems. As a result, adaptation to the acting factor and elimination of stress develops.

2) Distress – bad stress.

The stress necessary to adapt to the stimulus goes beyond the capabilities of the body, exhaustion sets in. It manifests itself in symptoms of stress or even illness.

Some symptoms of distress.

1) Somatic: palpitations, pain or burning in the chest, dysfunction of the gastrointestinal tract, pain in the abdomen, neck area, lower back, muscle tension, especially facial muscles.

2) Emotional: strong emotions and rapid mood swings, vague anxiety, increased irritability, inability to feel sympathy for others.

3) Behavioral: indecision, sleep disturbance, alcohol abuse, smoking.

It is believed that 90% of illnesses can be related to distress.

Some diseases of distress: neurosis, stomach ulcer, hypertension, coronary insufficiency, mental disorders, exacerbation of diseases.

The role of distress in purposeful activity.

1) Provides mobilization of the body's resources: in the stage of anxiety - excessive, in the stage of resistance - adequately to the acting stimulus.

2) Stress - the reaction provides adaptation to the stimulus.

3) Stress can cause illness if the degree of stress in the body exceeds its functional reserves.

Emotional stress.It can be caused by:

1) social factors (for example, conflict situations);

2) lack of goal achievement;

3) the action of very strong factors.

It appears in the form of a complex of mental and psychosomatic disorders. It often starts with mental agitation. This is manifested by a flash of rage or, conversely, euphoria.

As a result of emotional stress - unmotivated actions, depression. Emotional stress can lead to neuroses. Signs of neuroses are neurotic components:

1) mental; 2) psychosomatic; 3) vegetative.

Sustainabilityto emotional stress is different for everyone. It is provided by the production of opioids, the activation of GABA. As a result, synaptic transmission and the state of neurons are modulated, the nervous system returns to its original state.

Psychological stress at work.

It occurs depending on:

1) the nature of the profession; 2) on the type of personality; 3) from relationships in the team;

4) from the state of the central nervous system at the moment; 5) from previous influences.

It appears a change in impressionability in the form of daily ups and downs of mood.

Negative emotions are caused by seemingly secondary factors (for example, starting work at 8 in the morning and the need to get up early and travel by transport during peak hours). Psychological stress at work is complemented by disorganized work, decreased productivity and quality of work, and complaints about work stressors appear.

Psychosomatic complaints appear(decreased well-being, various pains, etc.), psychological symptoms of stress appear: a feeling of tension, anxiety, depression.

Individual sensitivity and tolerance to stress at work depends on whether the individual has traits that are predisposition to stress, from the person's behavior.

Type A behavior characterized by:

The desire for competition; - to achieve success; - aggressiveness;

Haste; - recklessness; - impatience and excitement;

Explosive speech and tension of the facial muscles;

Feeling of lack of time and high responsibility. In the blood, cholesterol is increased, blood clotting is accelerated, high adrenaline in the blood.

This behavior coincides with the onset of coronary insufficiency.

Type B behavior.

Individuals with this behavior are the opposite of Type A.

This is a relaxed type. This behavior is beneficial to health.

An intermediate type of behavior.

Work stressors (time pressure, stress) can convert type B to type A and less pronounced type A to more pronounced.

The current (ICD-10) responses to severe stress are categorized as follows:

Acute stress reactions;

Post-traumatic stress disorder;

Adjustment disorder;

Dissociative Disorders.

Acute stress response

A transient disorder of significant severity that develops in individuals without an apparent mental disorder in response to exceptional physical and psychological stress and which usually resolves within hours or days. Stress can be a severe traumatic experience, including a threat to the safety or physical integrity of an individual or loved one (for example, natural disaster, accident, battle, criminal behavior, rape) or an unusually drastic and threatening change in the social status and / or environment of the patient, for example, loss of many loved ones or fire in the house. The risk of developing the disorder increases with physical exhaustion or the presence of organic factors (for example, in elderly patients).

Individual vulnerability and adaptive abilities play a role in the occurrence and severity of acute stress responses; This is evidenced by the fact that not all people with severe stress develop this disorder.

Symptoms exhibit a typical mixed and changing picture and include an initial state of "stunned" with some narrowing of the field of consciousness and decreased attention, inability to adequately respond to external stimuli, and disorientation. This state may be accompanied by either further withdrawal from the surrounding situation, up to dissociative stupor or agitation and hyperactivity (flight response or fugue).

Autonomic signs of panic anxiety (tachycardia, sweating, redness) are often present. Symptoms usually develop within minutes of exposure to a stressful stimulus or event, and resolve within two to three days (often hours). Partial or complete dissociative amnesia may be present.

Acute stress reactionsoccur in patients immediately after a traumatic effect. They are short-lived, from several hours to 2-3 days. Vegetative disorders, as a rule, are of a mixed nature: there is an increase in heart rate and blood pressure, along with pallor of the skin and profuse sweat. Movement disorders are manifested either by sharp excitement (throwing) or lethargy. Among them, there are affective-shock reactions described at the beginning of the 20th century: hyperkinetic and hypokinetic. In the hyperkinetic variant, patients rush about without stopping, make chaotic, unpredictable movements. They do not respond to questions, especially the persuasions of others, and their orientation in their surroundings is clearly upset. With a hypokinetic variant, patients are sharply inhibited, they do not respond to their surroundings, do not answer questions, and are stunned. It is believed that in the origin of acute reactions to stress play a role not only a powerful negative impact, but also the personal characteristics of the victims - old or adolescence, weakening by any somatic illness, such characterological traits as increased sensitivity and vulnerability.

In ICD-10, the concept post-traumatic stress disordercombines disorders that do not develop immediately after exposure to a traumatic factor (delayed) and last for weeks, and in some cases for several months. This includes: periodic appearance of acute fear (panic attacks), severe sleep disturbances, intrusive memories of a traumatic event that the victim cannot get rid of, stubborn avoidance of the place and people associated with the traumatic factor. This also includes the long-term preservation of a gloomy, melancholy mood (but not to the level of depression) or apathy and emotional insensibility. Often people in this state avoid communication (run wild).

Post-traumatic stress disorder is a non-psychotic, delayed response to traumatic stress that can cause mental health problems in almost anyone.

Historical research on post-traumatic stress has evolved independently of stress research. Despite some attempts to build theoretical bridges between "stress" and post-traumatic stress, "these two areas still have little in common.

Some of the well-known researchers of stress, such as Lazarus, being followers of G. Selye, for the most part ignore PTSD, like other disorders, as possible consequences of stress, limiting the field of attention to studies of the characteristics of emotional stress.

Stress research is experimental in nature using special experimental designs under controlled conditions. In contrast, research on post-traumatic stress stress is naturalistic, retrospective, and largely observational.

Criteria for post-traumatic stress disorder (ICD-10):

1. The patient must be exposed to a stressful event or situation (both short and long) of an extremely threatening or catastrophic nature that can cause distress.

2. Persistent memories or "revival" of the stressor in obsessive reminiscences, vivid memories and recurring dreams, or re-experiencing grief when exposed to situations reminiscent of or associated with the stressor.

3. The patient must exhibit actual avoidance or avoidance of circumstances reminiscent of or associated with the stressor.

4. Either:

4.1. Psychogenic amnesia, either partial or complete, for important periods of exposure to the stressor.

4.2. Persistent symptoms of increased psychological sensitivity or anxiety (not observed prior to the stressor), represented by any two of the following:

4.2.1. Difficulty falling asleep or staying asleep

4.2.2. irritability or outbursts of anger;

4.2.3. difficulty concentrating;

4.2.4. increasing the level of wakefulness;

4.2.5. enhanced quadruple reflex.

Criteria 2,3,4 arise within 6 months after a stressful situation or at the end of a period of stress.

Clinical symptoms in PTSD (according to B. Kolodzin)

1. Unmotivated vigilance.

2. "Explosive" reaction.

3. Dullness of emotions.

4. Aggressiveness.

5. Impaired memory and concentration.

6. Depression.

7. General anxiety.

8. Attacks of rage.

9. Abuse of narcotic and medicinal substances.

10. Unsolicited memories.

11. Hallucinatory experiences.

12. Insomnia.

13. Thoughts about suicide.

14. "The guilt of the survivor."

Speaking, in particular, about adjustment disorders, one cannot but dwell in more detail on concepts such as depression and anxiety... After all, they are always associated with stress.

Previously dissociative disordersdescribed as hysterical psychoses. It is understood that in this case the experience of a traumatic situation is displaced from consciousness, but transformed into other symptoms. The appearance of a very bright psychotic symptomatology and the loss of sound in the experiences of the transferred psychological impact of a negative plan also signify dissociation. This group of experiences includes the states previously described as hysterical paralysis, hysterical blindness, deafness.

The secondary benefit for patients of the manifestations of dissociative disorders is emphasized, that is, they also arise by the mechanism of flight into illness, when psycho-traumatic circumstances are unbearable, overpowering for the fragile nervous system. A common feature of dissociative disorders is their tendency to relapse.

There are the following forms of dissociative disorders:

1. Dissociative amnesia. The patient forgets about the traumatic situation, avoids the places and people associated with it, the reminder of the trauma meets fierce resistance.

2. Dissociative stupor, often accompanied by loss of pain sensitivity.

3. Puerilism. Patients in response to trauma show childish behavior.

4. Pseudodementia. This disorder proceeds against the background of mild stunning. Patients are confused, look around in bewilderment and exhibit the behavior of the retarded and incomprehensible.

5. Ganser's syndrome. This state resembles the previous one, but includes mimicry, that is, patients do not answer the question ("What is your name?" - "Far from here"). It is impossible not to mention the neurotic disorders associated with stress. They are always acquired, and not constantly observed from childhood to old age. In the origin of neuroses, purely psychological reasons (overwork, emotional stress) are important, and not organic influences on the brain. Consciousness and self-awareness are not disturbed in neuroses, the patient is aware that he is sick. Finally, with adequate treatment, neuroses are always reversible.

Adjustment disorderobserved during the period of adaptation to a significant change in social status (loss of loved ones or prolonged separation from them, the situation of a refugee) or to a stressful life event (including a serious physical illness) .At the same time, a temporary connection between stress and the resulting disorder must be proved - not more than 3 months from the onset of the stressor.

When adjustment disordersin the clinical picture are observed:

depressed mood

• anxiety

  a feeling of inability to cope with the situation, to adapt to it

  some decrease in productivity in daily activities

  addiction to dramatic behavior

  outbursts of aggression.

By the predominant feature, the following are distinguished adjustment disorders:

short-term depressive reaction (no more than 1 month)

prolonged depressive reaction (no more than 2 years)

mixed anxiety and depressive reaction, with a predominance of disturbance of other emotions

reaction with a predominance of behavior disorder.

Among other reactions to severe stress, nosogenic reactions are also noted (they develop in connection with a serious somatic illness). There are also acute reactions to stress, which develop as reactions to an extremely strong, but short-lived (within hours, days) traumatic event that threatens the mental or physical integrity of the individual.

Under the affect, it is customary to understand a short-term strong emotional excitement, which is accompanied not only by an emotional reaction, but also by the excitement of all mental activity.

Allocate physiological affect,for example, anger or joy, not accompanied by clouding of consciousness, automatisms and amnesia. Asthenic affect- a rapidly depleting affect, accompanied by a depressed mood, a decrease in mental activity, well-being and vitality.

Stenic affectcharacterized by increased health, mental activity, a sense of their own strength.

Pathological affect- a short-term mental disorder that occurs in response to an intense, sudden mental trauma and is expressed in the concentration of consciousness on traumatic experiences, followed by an affective discharge, followed by general relaxation, indifference and often deep sleep; characterized by partial or complete amnesia.

In a number of cases, the pathological affect is preceded by a long-term traumatic situation, and the pathological affect itself arises as a reaction to some "last straw".

Acute reaction to stress (adaptation disorder), according to ICD-10 code F43.0, is a short-term, but severe mental disorder that occurs under the influence of a strong stressor.

The reason for a change in human behavior and a violation of his mental state can be:

• catastrophe;
• loss of one or more loved ones;
• a sharp change in social status;
• news of a serious illness;
• the social status of the refugee;
• accident;
• natural disasters;
• rape;
• criminal acts.

All life events that cause strong and prolonged experiences, prolonged stressful state, can cause disorder of adaptive reactions.

Crisis conditions are more typical for people located to it: the elderly, sick, exhausted, with mental or somatic diseases.

Life circumstances, accidents, losses - all this contributes to the development of the violation. However, if a person does not have a natural disposition to the disease, external factors are not enough to manifest an acute reaction.

There is a group of people who are more prone to adjustment disorders and other acute reactions to stress than others. These are hypersensitive people who take any event to heart. Physical and mental illnesses also contribute to the development of disorders.

Acute stress reactions are manifested immediately after the onset of a stressor, symptoms of adjustment disorders immediately make themselves felt.

Initially, the patient falls into complete stunning. He moves away from reality. The next stage is the emergence of anxiety. This state does not give rest to the patient. He is unable to adequately assess the situation. Most of the events of reality go unnoticed.

Another symptom of acute reactions to sudden changes is disorientation.

An acute stress reaction is a mentally unhealthy condition of a person. It lasts from several hours to 3 days. The patient is stunned, unable to fully understand the situation, the stressful event is partially recorded in memory, often in the form of fragments. This is due to temporary amnesia caused by stress. Symptoms usually persist for no more than 3 days.

One of the reactions is post-traumatic stress disorder. This syndrome develops solely because of situations that threaten a person's life. Signs of such a state are lethargy, alienation, repetitive horrors, pictures of the incident that pop up in the mind.

Often suicidal ideas are visited by patients. If the disorder is not too severe, it gradually goes away. There is also a chronic form that lasts for years. PTSD is also called combat fatigue. This syndrome was observed in participants in the war. After the Afghan war, many soldiers suffered from this disorder.

Adjustment disorder occurs due to stressful events in a person's life. This can be the loss of a loved one, a sharp change in life situation or a break in fate, separation, resignation, failure.

As a result, the personality is unable to adapt to unexpected change. The person cannot continue to live their normal daily life. There are insurmountable difficulties associated with social activities, there is no desire, no motivation to make simple everyday decisions. A person cannot continue to be in the situation in which he finds himself. However, he does not have the strength to change and make any decisions.

Varieties of flow

Caused by sorrowful, difficult experiences, tragedies or a sudden change in life situations, adjustment disorder can have a different course and character. Depending on the characteristics of the disease, adjustment disorders are distinguished with:

1. Depressed mood... Feelings of fear and hopelessness are characteristic. The patient is constantly depressed.
2. Anxious mood... The main symptoms are heart palpitations, tremors, agitation.
3. Mixed emotional traits... Several symptoms are imperative, including anxiety, depression and others.
4. If an adjustment disorder develops with predominance of behavioral disorders a person susceptible to illness violates all generally accepted moral standards.
5. Disruption to work or study... There is no desire to do work or study. Depression and anxiety are observed, which disappear in their free time from work and study.

Typical clinical picture

Usually, the disorder and its symptoms disappear after 6 months of the stressful event. If the stressor is of a prolonged nature, then the time frame is much longer than six months.

The syndrome interferes with normal, healthy life. Its symptoms depress a person not only mentally, but affect the entire body, disrupt the performance of many organ systems. Main features:

• sad, depressed mood;
• constant anxiety and worry;
• inability to cope with daily or professional tasks;
• inability and lack of desire to plan further steps and plans for life;
• violation of the perception of events;
• abnormal, unusual behavior;
• chest pain;
• heart palpitations;
• difficulty breathing;
• fear;
• dyspnea;
• suffocation;
• strong muscle tension;
• restlessness;
• increased use of tobacco and alcoholic beverages.

The presence of the listed symptoms indicates a disorder of adaptive reactions.

If the symptoms persist for a long time, more than six months, steps should certainly be taken to eliminate the violation.

Establishing diagnosis

Diagnostics of the disorder of adaptive reactions is carried out only in a clinic; to determine the disease, the nature of the crisis conditions that have led the patient into a dejected state is taken into account.

It is important to determine the strength of the impact of an event on a person. The body is examined for the presence of somatic and mental illnesses. Examination by a psychiatrist is carried out to exclude anxiety disorder, depression, and post-traumatic stress disorder. Only a full examination can help in making a diagnosis, referring a patient to a specialist for treatment.

Concomitant, similar diseases

A lot of diseases are included in one large group. All of them are characterized by the same characteristics. They can only be distinguished by one specific symptom or the strength of its manifestation. The following reactions are similar:

• short-term depressive;
• prolonged depressive;
• mixed anxious and depressive;
• post-traumatic stressful.

Diseases vary in degree of complexity, in the nature of the course and in duration. Often one turns into another. If treatment measures are not taken in time, the disease can take on a complex form and become chronic.

Treatment Approach

Treatment of the disorder of adaptive reactions is carried out in stages. An integrated approach prevails. Depending on the degree of manifestation of a particular symptom, the approach to treatment is individual.

The main method is psychotherapy. It is this method that is most effective, since the psychogenic aspect in the disease is predominant. Therapy is aimed at changing the patient's attitude towards the traumatic event. The patient's ability to regulate negative thoughts is increased. A strategy is created for the patient's behavior in a stressful situation.

Prescribing drugs is due to the duration of the disease and the degree of anxiety. Drug therapy lasts an average of two to four months.

Among the medicines, antidepressants are necessarily prescribed:

1. Amitriptyline one of the popular drugs. Its reception starts from 25 mg per day. Depending on the effectiveness and characteristics of the organism, the dose may be increased.
2. Melipramine Is another antidepressant. The method of its administration and dosage coincide with the previous drug. They start from 25 mg, increasing to 200. Drink before bedtime.
3. Miansan not only an antidepressant, but also a hypnotic and sedative. It is taken without chewing. The dose ranges from 60 to 90 mg.
4. Paxil - antidepressant. Drink it once a day, in the morning. The dose ranges from 10 to 30 mg per day.

Cancellation of drugs occurs gradually, according to the behavior and well-being of the patient.

For treatment, sedative herbal preparations are used. They have a sedative function.

Herbal tea number 2 helps to get rid of the symptoms of the disease. It contains valerian, motherwort, mint, hops and licorice. The infusion is drunk 2 times a day for 1/3 of a glass. The treatment lasts 4 weeks. Often appoint a collection collection number 2 and 3 at the same time.

Full treatment, frequent visits to a psychotherapist will ensure a return to a normal, familiar life.

What are the consequences?

Most people with adjustment disorder are completely cured without any complications. This group is middle age.

Children, adolescents and the elderly are prone to complications. Individual characteristics of a person play an important role in the fight against stressful conditions.

It is often impossible to prevent the cause of stress and get rid of it. The effectiveness of treatment and the absence of complications depend on the nature of the person and his willpower.

3.3. F43. Reaction to severe stress and adjustment disorders

This heading includes disorders that are caused by the impact of "an extremely strong stressful life-threatening event or significant change in life, leading to long-term unpleasant circumstances, resulting in the development of adjustment disorders."

The prevalence of these disorders is in direct proportion to the frequency of stressful situations. 50% –80% of severely stressed individuals develop clinically defined and adjustment disorders. In peacetime, cases of post-traumatic stress disorder occur in 0.5% of cases in women and in 1.2% of cases in men. The most vulnerable group are children, adolescents and the elderly. In addition to specific biological and psychological characteristics, coping mechanisms are not formed (in children) or rigid (in the elderly) in this group of persons.

3.3.1. F43.0 Acute stress response

This includes transient disorders of significant severity that develop in persons without an apparent mental disorder in response to extremely severe stressful life events (natural disasters, accidents, rape, etc.). These disorders usually resolve in a few hours or days. Clinical symptoms are polymorphic (up to impaired consciousness) and transient.

In addition to a clear temporal relationship between stress and clinical manifestations, the following diagnostic criteria are required for the diagnosis of Acute Stress Response:

Clinical - psychopathological picture is polymorphic and kaleidoscopic; in addition to the initial state of stunnedness, depression, anxiety, anger, despair, hyperactivity, and withdrawal may occur, but none of the symptoms persist for a long time.

Rapid reduction of psychopathological symptoms (the largest within a few hours) in cases where it is possible to eliminate the stressful situation. In cases where stress continues or is inherently unable to stop, symptoms usually begin to disappear after 24–48 hours and are minimized within 3 days.

Crisis condition

Acute crisis reaction

Combat fatigue

Mental shock.

As a rule, such patients rarely come to the attention of psychiatrists.

3.3.2. F43.1 Post-traumatic stress disorder (PTSD)

It occurs as a delayed and / or protracted reaction to a stressful event or situation of an extremely threatening or catastrophic nature that can cause distress in almost any person (catastrophe, war, torture, terrorism, etc.).

Throughout life, 1% of the population suffers PTSD, and 15% may develop individual symptoms.

Risk factors for the development of PTSD include the following: personality traits, addictive behavior, a history of psychotrauma, adolescence, the elderly, and the presence of a somatic illness.

Diagnostic criteria:

Traumatic event;

The onset of the disorder after a latency period following the injury (several weeks to 6 months, but sometimes even later);

Flashbacks, repeating traumatic events. They may appear decades later. A case is described when a veteran of the Korean War, 40 years later, had "flashbacks" - the effect that arose at the moment when a flying helicopter was shown on TV, the sound of which reminded him of military events;

Actualization of psychotrauma in ideas, dreams, nightmares;

Social avoidance, distancing and alienation from others, including close relatives;

Behavior change, explosive outbursts, irritability, or a tendency to aggression. Possibly antisocial behavior or illegal actions;

Alcohol and drug abuse, especially to relieve painful experiences, memories or feelings;

Depression, suicidal thoughts or attempts;

Acute attacks of fear, panic;

Vegetative disorders and nonspecific somatic complaints (eg headache).

In a significant proportion of people, PTSD is chronic and is often combined with mood disorders and drug addiction diseases.

The need for long-term, comprehensive treatment of PTSD survivors is beyond doubt. For mild cases of PTSD, psychotherapy works well. Reconciling the person with their past is the essence of most psychotherapy methods for PTSD. For successful treatment, the psychotherapist must skillfully respond to the "strong affects" that patients so often find: emotional lability, explosiveness, vulnerability. Psychotherapy helps the patient to cope with feelings of guilt, regain the lost sense of control over others, cope with the state of helplessness and powerlessness.

Support groups are essential to help the patient understand the meaning of the traumatic event. In America, there are support groups for veterans for victims of hostilities and prisoners of war, in the Netherlands - a shelter for women who are beaten at home, in Kiev, a group for victims of violence began to function.

Family counseling is an important stage in psychocorrectional work. It is necessary to tell relatives about the clinical signs of PTSD, about the feelings and feelings of the patient, about the principles of behavior of relatives in this situation. It is imperative to inform them about the duration of the course of this disease and the possible "flashbacks" - effect. With close relatives, it is also necessary to conduct psychotherapeutic sessions, because very often the patient's behavior can contribute to the development of borderline mental disorders.

It is very important to educate the patient in relaxation techniques, as feelings of anxiety and tension often accompany them for a long time after the injury.

At certain stages of the development of PTSD, it is advisable to use pharmacotherapy. The indications for the appointment of drug treatment are:

Psychomotor agitation, panic attacks, attacks of fear;

Depression, auto-aggressive behavior;

Aggressive and destructive behavior;

Somatovegetative disorders.

In both acute and chronic PTSD, it is advisable to use antidepressants and benzodiazepine tranquilizers; in some cases, the use of neuroleptics is indicated. It is very important to treat symptomatic alcoholism or drug addiction, which are not uncommon in these patients.

According to follow-up studies (T.J. McGlinn, G.L. Methcalf, 1989), approximately 50% of patients with PTSD improve within six months after injury. If the patient is able to cope with a stressful situation without emotional lability, anxiety, tension, autonomic dysfunction, the use of psychopharmacotherapy can be discontinued. An indication for stopping treatment can be considered the achievement of a patient's state in which he restored his self-esteem, social and professional status and is able to correct his emotional state without resorting to drugs.

3.3.3. F.43.2 Adjustment disorders.

Adjustment disorders include “states of subjective distress and emotional distress that usually interfere with social functioning and productivity and occur during a period of adaptation to significant life changes or stressful life events. The stress factor can affect the individual or his microsocial environment. "

In general, the clinical picture is characterized by anxiety, anxiety, anorexia, dyssomnia, feelings of inadequacy, decreased intellectual and physical productivity, autonomic disorders, recurring memories, fantasies, ideas about a crisis situation (especially in the daytime). In some cases, dramatic behavior or outbursts of aggressiveness are possible. Clinical manifestations usually occur within a month after a stressful situation, and the duration of symptoms does not exceed 6 months.

The group at increased risk of developing adjustment disorders includes people with mental and behavioral disorders, with somatic diseases, weakened people, adolescents and the elderly, who are simultaneously experiencing several psychosocial stresses that are very significant for the personality.

The ICD-10 identifies the following clinical forms of adjustment disorders:

F43.20 Short-term depressive reaction

Transient mild depressive disorder not exceeding 1 month in duration.

F43.21 Prolonged depressive reaction

Mild depression in response to prolonged exposure to a stressful situation, but lasting more than 2 years.

F43.22 mixed anxiety and depressive reaction

F43.23 with predominant disturbance of other emotions

There are manifestations of anxiety, depression, anxiety, tension and anger.

F43.24 with predominance of disorder of conduct

The clinical picture is dominated by aggressive or dissocial behavior.

F43.25 mixed disorder of emotions and behavior

F43.28 other specific predominant symptoms

Culture shock

Hospitalism in children

Grief reaction.

3.3.3.1. Grief reaction.

An example of the clinical dynamics of an adaptive disorder is the grief response that followed the death of a significant person. According to statistics, after the death of a person, morbidity and mortality among his close relatives increases sharply (from 40% and more). The reaction to this event is possible either in the form of an uncomplicated grief reaction or in the form of a grief reaction within the framework of adjustment disorders.

In the DSM-3-R classification, V-codes are specially highlighted for conditions that do not belong to mental disorders, but can be the subject of attention and treatment of psychiatrists, psychotherapists and psychologists. This group of disorders includes an uncomplicated loss reaction (V-62.82), which is a normal reaction to the death of a loved one. Clinically, it is characterized by depressive experiences that are accompanied by anorexia, insomnia, and weight loss. With an uncomplicated loss reaction, guilt can also occur. Typically, this response to loss is in line with cultural beliefs about grief. Patients rarely seek professional help, and if they come for a consultation, it is mainly about insomnia and anorexia.

An uncomplicated loss reaction can be acute or prolonged (after two to three months). Some authors also describe "the sadness of foresight" - the development of a grief reaction already at the stage of receiving news of a fatal illness of a loved one. The duration of the uncomplicated loss reaction is largely determined by the patient's personal characteristics, his environment and socio-cultural traditions. It is very important to take into account the ethnocultural specificity of responding to stressful situations. Thus, the death of a loved one is accompanied by autistic and depressive reactions in the population of Slavic peoples and Armenians and demonstratively expressive - among Tajiks (A.I. Kuchinov, 1995).

The grief response in adjustment disorders is a clinically defined mental disorder that leads to maladjustment. There are 8 stages of the grief reaction, which were identified and described by A.G. Ambrumova, (1983) and G.V. Starshenbaum (1994). The model was the most typical situation of grief - the death of a loved one.

Stage 1 - with dominant emotional disorganization. As a rule, it lasts from several minutes to several hours and is accompanied by an outburst of negative feelings - panic, anger, despair. Behavior is dominated by affective disorganization with a temporary weakening of volitional control.

Stage 2 - hyperactivity. Duration 2-3 days. During this period, a person is overly active, active, inclined to constant conversations about the personality and affairs of the deceased. His mental status is dominated by emotional lability with mood swings from dysthymic with a predominance of anxious component to euphoric. Emotional dullness without fixation on grief is much less common. At this stage, inappropriate actions may take place (leaving home, negative attitude towards relatives, etc.). P. Janet described an example of non-standard behavior of a girl whose mother died: she continued to look after her and behaved as if her mother was alive.

At this stage, it is advisable for the constant presence of someone close to the deceased who can talk about his virtue and remember his positive deeds and actions. The grieving person should be encouraged to discuss their feelings and thoughts, and allowed to vent their emotions.

Stage 3 - voltage. Its duration is about a week. In the mental status, psychophysical stress and anxiety prevail. Outwardly, patients are constrained, their face is amimic, they are silent. Their condition is periodically interrupted by fidgety activity, throat cramps or convulsive sighs. They often get annoyed when trying to distract them or turn their attention to everyday topics.

Psychodynamically oriented psychotherapists interpret the behavior of these persons at stages 2 and 3 as a rejection of the outside world, identification with the deceased and unwillingness to live.

At this stage, crisis counseling is already needed, the purpose of which is to assist in working through and expressing the affect of grief. The problem of loss is central at this stage. If necessary, the patient is prescribed tranquilizers and sleeping pills.

Stage 4 - the search stage, which usually takes place in the second week after the loss of a loved one. The mental status is dominated by a dysthymic background of mood, loss of perspective and meaning in life. The patient perceives the deceased as living: he talks about him in the present tense, mentally talks to him, sometimes he perceives random passers-by as the deceased. During this period, illusions, hypnogagic and hypnopompic hallucinations are possible. There are two variants of the course of the fourth stage: anxious and oppositional.

An alarming option. These persons in mental status are dominated by anxiety, tension, concern and exaggeration of the problems that have arisen in connection with the death of a loved one. Many patients are fixed on their health and often find manifestations of the disease from which the deceased died.

Oppositional option. In patients, irritability, resentment, a feeling of hostility and tension towards the attending physicians and relatives prevail. As a rule, such a reaction is noted in persons psychologically dependent on the deceased, with a pronounced ambivalent reaction to him during life: from love to a repressed feeling of hostility and aggressiveness.

GV Starshenbaum (1994) explains the personal meaning of an anxious response option by the search for a lost person as a defender; the oppositional variant - the search for an object of identification with a significant other in order to respond to previously suppressed hostile emotions.

As a rule, it is at this stage that it becomes necessary to consult a psychiatrist and, if necessary, hospitalization in a hospital. Depending on the psychopathological syndrome dominant in the clinical picture, it is advisable to prescribe benzodiazepine tranquilizers, tricyclic antidepressants, hypnotics. However, psychopharmacotherapy is only a springboard to further long-term and painstaking psychotherapy. It should not be prescribed for a long time to avoid the development of addiction. Already at the first stages of a patient's stay in a hospital, it is necessary to conduct crisis counseling and to implement the necessary intensive care measures. For this it is advisable to take the following steps (S. Blokh, 1997):

1. Transfer of responsibility. The patient is offered to temporarily shift the solution of all problems and responsibilities to loved ones.

2. Organization of solving urgent problems (caring for children, solving issues of temporary disability of a patient, etc.).

3. Removing the patient from the stressful environment. Hospitalization in itself is already a kind of removal, but it justifies itself only if the patient is placed in a specialized crisis hospital, where professional crisis psychotherapy is carried out.

4. Reducing the level of arousal and distress. Psychotherapeutic intervention and pharmacotherapy are used.

5. Establishing a relationship of trust.

6. Show of concern and warmth, revitalization of hope.

Stage 5 - despair. This is the period of maximum mental anguish, which develops, as a rule, 3-6 weeks after the loss of a significant loved one. The mental status of patients is dominated by complaints of insomnia, anxiety and fear, ideas of self-accusation, self-inferiority and guilt are expressed. Patients experience loneliness, helplessness, note the loss of the meaning of life and further prospects. During this period, they are irritable, refuse to communicate with loved ones, often subjecting them to criticism. At the height of the experience, chest pain often occurs, accompanied by pronounced anxiety and concern. Patients tend to hurt themselves, self-harm. In some cases, they ask to appoint painful injections, they are ready to participate in various psychological experimentsare tuned to psychocorrectional work... At this stage, it is necessary to continue psychopharmacological therapy, adequate to the patient's mental status. Intensive care measures need to be implemented continuously. Psychotherapeutic intervention is paramount at this stage and should be aimed at helping in the experience, expression and processing of the affect of grief and at solving the problem of changes in the patient's life.

6 stage - with elements of demobilization. This stage occurs in case of non-resolution of the stage of despair. The clinical picture of these persons is dominated by neurotic syndromes (most often neurasthenic and with a predominance of vegetative-somatic disorders), masked subdepression and depression. During this period, patients, as a rule, are uncommunicative, focused on internal experiences, they are seized by a feeling of hopelessness, uselessness, loneliness. They avoid contact with others, formally talk with medical personnel, and refuse psychotherapeutic help.

At this stage, the need to continue pharmacotherapy is obvious. In addition, already at this stage, it is advisable to include patients in crisis groups, where patients who have already experienced similar situations share their experience of overcoming painful emotions, provide support and attention, which has a positive effect on patients and contributes to a faster resolution of the demobilization stage.

7 stage - permission. As a rule, its duration is limited to a few weeks. The patient comes to terms with what happened, comes to terms with it and begins to return to the pre-crisis state. Thoughts of loss "live in the heart." A.S. Pushkin described this state as "My sadness is bright."

At this stage, it is possible to discontinue therapy with tranquilizers. With chronicity of anxiety disorders and not reduced depressive disorders, antidepressant treatment should be continued.

Psychotherapeutic efforts should be aimed at solving the problems of change (marital status, role changes at work and in the family, interpersonal problems, etc.), interpersonal problems. At this stage, it is advisable to train relaxation and develop tactics of adaptation to the changed conditions of life.

8 stage - relapsing. Within 1 year, bouts of grief and despair are possible, accompanied by depressive disorders. The provoking factors, as a rule, are certain calendar dates that are significant for the individual (the birthday of the deceased, New Year and other holidays celebrated for the first time without a loved one, etc.), non-standard situations (success or failure) when there is a need to share the joy or grief with a loved one. Grief attacks can occur acutely, against the background of an apparent stabilization of the state and can end in suicidal attempts, which are regarded by others as inadequate.

In connection with the described patterns of the grief reaction, it is advisable to carry out supportive psychotherapy throughout the year. The most promising at this stage is the conduct of supportive psychotherapy in post-crisis groups working on the principle of a club for people who have experienced a crisis. It is advisable to conduct family psychotherapy with the participation of family members and close people.

Concluding the chapter, it should be said that the clinically formed reactions and states that have arisen as a result of crisis situations are so multifaceted that sometimes they can hardly be categorized and squeezed into the Procrustean bed of the classification of mental and behavioral disorders. The types of overcoming crisis situations of behavior are also multivariate and range from regressive (most often alcohol-dependent) behavior to heroic ... century, whose students considered themselves to be psychotherapists who created the "school of Ericksonian hypnosis", and the authors of works on neurolinguistic programming.

Milton Erickson suffered from a congenital lack of color perception, dyslexia (violation of the reading process) and could not distinguish sounds in pitch, and therefore could not reproduce even the simplest melody. At 17, he contracted polio. In his Teaching Stories (1995), he wrote about this period:

“You see, I had a huge advantage over others. I had polio, I was completely paralyzed, and the inflammation was such that the sensations were also paralyzed. I could move my eyes and hear. It was very lonely for me to lie in bed, unable to move, and only look around. I lay in isolation on a farm where, besides me, there were seven of my sisters, a brother, two parents and a nurse. What could I do to somehow entertain myself? I began to observe people and everything that surrounded me. I soon learned that my sisters could say no when they mean yes. And they could say yes while at the same time implying no. They could offer one another apple and take it back. I started to learn non-verbal language and body language. "

The hopelessly ill Milton Erickson recovered thanks to the rehabilitation system he developed, the elements of which were later reflected in his psychotherapeutic approaches.

At the age of 51, he was again overtaken by an illness, as a result of which he was confined to a wheelchair until the end of his days: his right arm was paralyzed, he was in constant pain. Despite all the limitations, and in many respects thanks to them (once again life provided him with “a huge advantage over others” - being seriously ill), Milton Erickson became a recognized authority in the field of group and short-term therapy, hypnosis and altered states of consciousness. He is the author of numerous scientific papers, chairman of many scientific societies, teacher of Aldous Huxley, Richard Bandler, John Grinder, Margaret Mead ... Confined to a wheelchair, he told his teaching stories to patients, helping them find ways to solve problems, often caused by crisis situations.

The day before his death (on Friday), he completed a weekly cycle of classes, signed autographs on twelve books, said goodbye to the audience. On Saturday he felt a little tired. Early Sunday morning, his breathing suddenly stopped. He lived for 78 years. His wife, four sons, four daughters, grandchildren, great-grandchildren and numerous students accompanied him on his last journey.

Next chapter\u003e

Clinical picture

The most common symptoms are anxiety and depression, which cause the following somatic manifestations: 1) Asthenic syndrome: weakness, increased fatigue. 2) Feeling of numbness, tingling in any part of the body. 3) Violation of sensitivity, hyperesthesia. 4) Hot flashes, chills. 5) Sweating, pallor or redness of the skin (most often face, hands). 6) Pain in any part of the body. 7) Feeling of interruption, heart palpitations, rapid or infrequent pulse. 8) Decreased or increased appetite. 9) Dry mouth, taste in the mouth, taste disturbances. 10) Hiccups, belching, feeling of pain, heaviness in the abdomen, nausea, vomiting. 11) Bloating, diarrhea, or constipation. 12) Cough, shortness of breath. 13) Frequent urination, imperative urge to urinate. 14) A feeling of incomplete emptying of the intestines, bladder. 15) "Hysterical lump" (sensation of a lump in the throat, causing dysphagia), as well as other forms of dysphagia. 16) Tremor of hands, twitching. 17) Muscle tension. 18) Psychogenic itching. 19) Psychogenic dysmenorrhea. 20) Decreased sex drive, erection.

• 1) Provides mobilization of the body's resources: in the stage of anxiety - excessive, in the stage of resistance - adequately to the acting stimulus.
• 2) Stress - the reaction provides adaptation to the stimulus.
• 3) Stress can cause illness if the degree of stress in the body exceeds its functional reserves.

Emotional stress.It can be caused by:

• 1) social factors (for example, conflict situations);
• 2) lack of goal achievement;
• 3) the action of very strong factors.

It appears in the form of a complex of mental and psychosomatic disorders. It often starts with mental agitation. This is manifested by a flash of rage or, conversely, euphoria.

As a result of emotional stress - unmotivated actions, depression. Emotional stress can lead to neuroses. Signs of neuroses are neurotic components:

1) mental; 2) psychosomatic; 3) vegetative.

Sustainabilityto emotional stress is different for everyone. It is provided by the production of opioids, the activation of GABA. As a result, synaptic transmission and the state of neurons are modulated, nervous system returned to their original state.

Psychological stress at work.

It occurs depending on:

• 1) the nature of the profession; 2) on the type of personality; 3) from relationships in the team;
• 4) from the state of the central nervous system at the moment; 5) from previous influences.

It appears a change in impressionability in the form of daily ups and downs of mood.

Negative emotions are caused by seemingly secondary factors (for example, starting work at 8 in the morning and the need to get up early and travel by transport during peak hours). Psychological stress at work is complemented by disorganized work, decreased productivity and quality of work, and complaints about work stressors appear.

Psychosomatic complaints appear(decreased well-being, various pains, etc.), psychological symptoms of stress appear: a feeling of tension, anxiety, depression.

Individual sensitivity and tolerance to stress at work depends on whether the individual has traits that are predisposition to stress, from the person's behavior.

Type A behavior characterized by:

• - striving for competition; - to achieve success; - aggressiveness;
• - haste; - recklessness; - impatience and excitement;
• - explosive speech and tension of the facial muscles;
• - feeling of lack of time and high responsibility. In the blood, cholesterol is increased, blood clotting is accelerated, high adrenaline in the blood.

This behavior coincides with the onset of coronary insufficiency.

Type B behavior.

Individuals with this behavior are the opposite of Type A.

This is a relaxed type. This behavior is beneficial to health.

An intermediate type of behavior.

Work stressors (time pressure, stress) can convert type B to type A and less pronounced type A to more pronounced.