Review Article
Sandra Sungailaite
Abstract
Introduction: Patricia was a 49-year-old woman who presented with confusion while drinking at a bar. Her friend said that she was behaving normally, but was found on the bathroom floor “not making sense.” On examination, she was lethargic and confused. She gave short answers to questions and did not know the location or date. She was able to name some common objects, but could not sustain attention to participate in a meaningful conversation. She fell asleep when she was not examined and could only be briefly aroused with noxious stimuli. A head CT was normal as was basic blood chemistry. When life gets overwhelming, people often drop their leisure activities first. But cutting yourself off from pleasure can be counterproductive. Even when time is tight, look for opportunities to do something for yourself, whether that means reading a novel, singing along to your favorite tunes or streaming your favorite comedy on Netflix. Humor and laughter can benefit both mental and physical health. The experience of stress can be either acute or chronic. Acute stress usually occurs in response to a short-term stressor, like a car accident or an argument with your spouse. Acute stress can be very distressing, but it passes quickly and typically responds well to coping techniques like calming breathing or brisk physical activity. Objectives: James was a 56-year-old man who arrived to the ER after being thrown from his motorcycle. He was taken to a trauma center and was unable to move his legs. A CT scan showed a significant spinal cord injury. The neurosurgeon started him on high-dose, intravenous methylprednisolone, a steroid commonly used in neurological diseases to decrease inflammation, as this had been the hospital protocol for the past 15 years. James developed a urinary tract infection several days later and never regained movement in his legs. George was a 24-year-old man who presented with confusion and lethargy for three days. An MRI revealed multiple demyelinating lesions consistent with multiple sclerosis (MS). Many of them enhanced with the administration of contrast, indicating active inflammation. One of the most research-supported treatments for stress and anxiety is cognitive behavioral therapy, or CBT. At the root of this therapy approach is the understanding that our thoughts influence our emotions, which in turn influences our behaviors. Reframing your thoughts around a stressor can help manage your emotions, reducing feelings of stress. Some tips: If you feel yourself spiraling into imagining worst-case scenarios, stop and put your mind elsewhere. Set realistic expectations for yourself. Strive for acceptance of situations outside of your control. Chronic stress occurs when stressors don’t let up. The roots of chronic stress can vary widely, from situations people can control or avoid (such as having a toxic friendship) to difficulties that are hard to escape (poverty, racism or other discrimination). Because people respond differently to stressful circumstances, a situation that one person might find tolerable can become a source of chronic stress for another. Results: Studies conducted in multiple countries have found that green space improves mood. Even nature videos can speed the recovery from stress compared with videos of urban scenes. Taking a moment to notice nature — even in the form of a bustling city park — can refocus and calm your mind. Strong social support can improve resilience to stress. Reach out strategically. Some friends or family members may be good at listening and sympathizing. Others might excel at practical help, like bringing over a home-cooked meal or covering an hour of child care. Giving support can also increase positive emotions and decrease negative emotions. Just make sure your relationships stay in balance. A friend who requires support but never gives it may increase your stress level. If you feel overwhelmed and self-help isn’t helping, look for a psychologist or other mental health provider who can help you learn how to manage your stress effectively. He or she can help you identify situations or behaviors that contribute to your stress and then develop an action plan to change the stressors, change your environment and change your responses. Chronic stress can damage both mental and physical health. Being chronically stressed may leave you feeling fatigued, sap your ability to concentrate and cause headaches and digestive difficulties. People prone to irritable bowel syndrome often find that their symptoms spike with psychological stress. Though acute stress can heighten certain immune responses, the wear-and-tear of chronic stress is bad for the immune system. Chronic stress can also affect cardiac health, with multiple studies finding a link between chronic stress and the development of coronary artery disease.