By Dr Javed Latoo, Psychiatrist
As humans, we have all experienced stress at some point in our lives. Most of us know how it feels when we are stressed. Stress is a normal response to a stressful trigger or event. It can have detrimental impact on our mental, physical and social well-being if it is prolonged in nature. Stress causes a surge of various hormones in our body including cortisol and adrenaline that can have both physical and psychological consequences.
My motivation to write this article was triggered by a recent study published in a leading medical journal the Lancet as well as the response of my medical colleagues to such research. Their attitude to mental sufferings of their patients due to stress was disappointing. They seem to think stress either does not exist or can't be defined or measured or even treated.
Stress is commonly defined as a response to a perceived threat or challenge that includes biological, behavioural, cognitive, and emotional elements. The stressor can be a real or imagined thing that sets the whole process off. As we all know we can stress ourselves out with things that never happen or might never happen.
We, humans, can get stressed for various reasons including work problems, family problems, legal problems, physical health problems, financial problems and even exams. Displacement due to political conflicts can also be a major source of stress for those involved in such ordeal.
Research has shown that chronic stress has a significant impact on our health as well as social and economic conditions. In the U.K. 10.8 million working days are lost due to stress i.e. 11% of all sickness absence. Work-related stress costs the UK economy > £4 billion every year. People working in the health, social and education sectors are more likely to experience work-related stress.
How stress presents
Individuals who experience chronic stress can present with various problems including mood swings, anxiety, depression, fatigue, headaches, sleep problems, loss of libido, dry mouth, aches and pains, chest pains, poor concentration, increased use of smoking, alcohol, and caffeine. It can even worsen other medical conditions including asthma, psoriasis, and migraine. Various studies have reported that stress can even increase the risk of heart attacks and strokes.
New research shows stress increases cardiovascular events
A recent Harvard Medical School study published in a leading medical journal the Lancet reported an increased risk of cardiovascular accidents including heart attacks and stroke in patients with stress. For the first time, researchers also proposed a model to explain the mechanism behind this increased risk.
The researchers suggested increased stress causes increased amygdalar activity in the brain, leading to increased bone-marrow activity, leading to increased arterial inflammation, leading to cardiovascular disease events involving what they call a neural-hemopoietic-arterial axis. In the past studies had shown that stress increases metabolic activity in a particular area of the brain but now this new study reports that "amygdalar activity independently and robustly predicts cardiovascular events,"
The authors of this study while highlighting the clinical implications suggest that chronic stress could be routinely assessed and managed like the other risk factors for the cardiovascular disease, e.g., smoking, obesity, hypercholesterolemia and high blood pressure.They emphasize that stress is as strong a risk factor as any other and there is need to screen and treat it routinely by health care professionals. The study even suggests that there is a straightforward and useful scale called Perceived Stress Scale PSS10 that can be used to screen stress in our patients. An editorial in the same issue of the Lancet supports this approach of routine screening of chronic stress along with other risk factors for cardiovascular disease.
What needs to change
We know people are reluctant to seek help regarding stress and doctors are not always robust in screening it routinely. Both patients, as well as physicians, need to change their attitude, about stress, given recent research. People working in cardiology, internal medicine, and primary care, particularly, need to get training in assessment and management of chronic stress as a recent study in 151 patients showed that adding stress management to cardiac rehabilitation lowered the risk of 5-year Cardiovascular events by 50%.
There is an urgent need to develop training for doctors so that they can routinely ask patients about stress and offer advice to reduce it. Doctors need to explore the reasons for the stress in their patients and offer management strategies. They may have to treatment medical condition arising due to stress like depression when necessary. Stress can often be managed by ensuring that patients have enough sleep and rest, avoid using caffeine, alcohol or drugs to relieve stress and do regular physical exercise. Patients can also try relaxation techniques like mindfulness, prevent interpersonal conflicts, learn the art of acceptance, learn to say no, manage time in a better way, spend time with their families and friends and commune with nature.
Cite this article as: Javed Latoo (2017). Why doctors need to screen their patients for stress.The Beautiful Space-A journal of Mind, Art and Poetry. February 2017: TBSB112
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