Talk:Chronic stress/Archive 1

No sources
This article has no sources at all.

- 75.16.72.187 (talk) 03:02, 14 December 2007 (UTC)

Could we put magnesium into the article somewhere? Baiter (talk) 04:07, 16 April 2008 (UTC)

I'm removing the random list of non-relevant, non-comprehensive causes for chronic stress. —Preceding unsigned comment added by Laocoont (talk • contribs) 00:04, 10 November 2008 (UTC)

I would like to delete the short list of ways to lower stress and add a longer more effective which contains steps provn to work —Preceding unsigned comment added by Kmsunnyd (talk • contribs) 16:00, 25 March 2010 (UTC)

Treatments/ Causes of stress
I think there are other effective treatments besides what has been listed. I will also work on making the list a little longer. Also included should be common causes of stress. We could work on changing that as well. - Kmsunnyd (3/31/2010) —Preceding unsigned comment added by 75.73.207.121 (talk) 03:11, 1 April 2010 (UTC)  Also (J.ramsdill) as well as Kmsunnyd

One simple treatment of stress that we can all do is to laugh. "Laughter is a healing activity" according to Mike Adams, the editor of the medical journal NaturalNews. (see the site www.naturalnews.com/chronic_stress.html —Preceding unsigned comment added by Ahouansivi1 (talk • contribs) 16:08, 1 April 2010 (UTC)

In the first sentence under Relaxing, revise the text to say: “There are a variety of ways to increase a sense(s) of calm and well-being, which are commonly grouped together as “relaxation techniques” or strategies. From guided imagery to yoga to square-breathing to biofeedback, these techniques and strategies are relatively easy to learn and apply in our everyday lives. We can engage in these techniques and strategies on a regular basis as part of our healthy everyday routines, and we can purposefully use these techniques and strategies in response to a stressful event or situation as it occurs.” It could also be good to introduce sleep hygiene strategies here, for the reason that insomnia (or not getting enough sleep) makes stress worse. From some of the things that I have read so far, we could say something like: “There are a variety of strategies that people can use to help themselves to sleep better, which in turn enables us to handle stress better. For example, having a set bedtime and wake-up time, not drinking alcohol or caffeine for several hours before bed, and getting up and doing something during the night if you cannot sleep (versus tossing-and-turning in bed) are all easy-to-implement behaviors that research has shown to work.” —Preceding unsigned comment added by Ahouansivi1 (talk • contribs) 22:20, 7 April 2010 (UTC)

Symptoms
I would like to change the structure to the "Symptoms" section according the the layout guidelines. They prefer to minimize bullet points, so I will be changing it into a paragraph form.--Gdudycha (talk) 15:41, 8 April 2010 (UTC)

Editing Lead
This lead is very lacking and could use alot of help. It is not comprehensive and does not meet the Wikipedia Featured Article standards. I will be working to edit this. J.ramsdill (talk) 03:02, 1 April 2010 (UTC)J.Ramsdill

As we (myself, Kaja, and Ahouansivi) begin working to improve this page, we are going to begin our focus on the lead, structure, and writing-style/quality of this work.

- - - - —Preceding unsigned comment added by IsabelD (talk • contribs) 14:33, 1 April 2010 (UTC)

At present this lead section is poorly written, as it does not let the reader know what is coming in terms of the article's broader content. IsabelD (talk) 14:37, 1 April 2010 (UTC)

I am working as a group along with Isabel, who posted a min ago, and another student to revise this article beginning with the lead. With the intent to further this article's credible status and in hope to reach "Good" or "Featured" standing. I agree with Isabel that this lead section is lacking. We have begun to draft our revisions and will be implementing those ideas soon. Kajasimpson (talk) 15:34, 1 April 2010 (UTC) Kajasimpson

- - - -

This is our group's (Isabel, Kaja, and Ahouansivi) suggestion for new/revised text for the lead:

Chronic stress is an unfortunate reality for many people who struggle to manage the multiple and oftentimes conflicting demands of work, school, relationships, family, finances, and other pressures that are commonplace in modern-day industrialized societies. Recognized by experts across a range of physical- and mental health- disciplines as a complex phenomenon that simultaneously affects our biology/physiology, psychological/cognitive functioning, and relationship stability/well-being, chronic stress is something that calls for equally complex and diverse solutions/treatments in its effective reduction and management.

This article begins by reviewing what we know about chronic stress in terms of how it affects us, focusing attention across this bio-psycho-social continuum of experience(s). It then offers what we can do to combat chronic stress across the same continuum – from exercise and medications (bio-) to behavioral management strategies and stress and psychotherapies (psycho-) to relational and support systems/strategies (social-) known to mediate and/or ameliorate this common – but serious – problem. It concludes with a list of scientific and practical resources for further review and application. 71.34.60.188 (talk) 00:04, 8 April 2010 (UTC)

- - - -

This is our group's (Isabel, Kaja, and Ahouansivi) revised suggestion for new/revised text for the lead:

Chronic stress is an unfortunate reality for many people who struggle to manage the multiple and oftentimes conflicting demands of work, school, relationships, family, finances, and other pressures that are commonplace in modern-day industrialized societies. Recognized by experts across a range of physical- and mental health- disciplines as a complex phenomenon that simultaneously affects our biology/physiology, psychological/cognitive functioning, and relationship stability/well-being, chronic stress is something that calls for equally complex and diverse solutions/treatments in its effective reduction and management (Sutton). This article begins by reviewing what we know about chronic stress in terms of how it affects us, focusing attention across this bio-psycho-social continuum of experience(s). It then offers what we can do to combat chronic stress across the same continuum – from exercise and medications (bio-) to behavioral management strategies and stress and psychotherapies (psycho-) to relational and support systems/strategies (social-) known to mediate and/or ameliorate this common – but serious – problem. It concludes with a list of scientific and practical resources for further review and application.

[submitted by IsabelD] IsabelD (talk) 23:21, 11 April 2010 (UTC)

Biology Section
I believe that the entire Biology section should be re-written in a more understandable manner. I'm not sure if it's just me, but it gets all scrambled in my head as I am reading it.--Gdudycha (talk) 04:09, 2 April 2010 (UTC)gdudycha

In the first paragraph under Biology, revise the first sentence to read: “Animals exposed to stressful events and/or sequences of events (i.e. strains), especially those that they cannot control, manifest several physiological responses in their neurological and endocrine systems.” Then, after outlining/highlighting some of the things that we know about animal research, we should add in a bridge to what we know about humans. For example: “Research regarding the biological and physiological effects of stress informs and overlaps with what we know about the impact(s) of stress on human beings. Anybody who has ever gotten butterflies in his/her stomach when s/he was nervous, experienced insomnia because they were worried about something and could not “turn off” their brains/thoughts, and/or gotten a headache during finals week knows that our minds and our bodies are in constant dialogue.” From there, then, highlight (and of course, cite/reference) some of the human researchAhouansivi1 (talk) 23:28, 7 April 2010 (UTC)

- - - -

This is our group's (Isabel, Kaja, and Ahouansivi) revised suggestion for new/revised text for this section:

In the first paragraph under Biology, revise the first sentence to read:

Animals exposed to stressful events and/or sequences of events (i.e. strains), especially those that they cannot control, manifest several physiological responses in their neurological and endocrine systems (Sapolsky).

Then, after outlining/highlighting some of the things that we know about animal research, we should add in a bridge to what we know about humans. For example:

Research regarding the biological and physiological effects of stress informs and overlaps with what we know about the impact(s) of stress on human beings (McEwen). Anybody who has ever gotten butterflies in his/her stomach when s/he was nervous, experienced insomnia because they were worried about something and could not “turn off” their brains/thoughts, and/or gotten a headache during finals week knows that our minds and our bodies are in constant dialogue (Sutton).

From there, then, highlight (and of course, cite/reference) some of the human research.

[submitted by IsabelD] IsabelD (talk) 23:23, 11 April 2010 (UTC)

Revising the article
It's a great idea to revise this article, it really can use it. However, some of the proposed texts above are not very encyclopedic. I recommend that your read WP:MOS and some of the articles linked from there to get an idea of what is needed. Happy editing! --Crusio (talk) 07:10, 8 April 2010 (UTC)

- - - -

This is our group's (Isabel, Kaja, and Ahouansivi) other suggestions for new/revised text:

In the first paragraph under Treatment, revise the first sentence to a couple of sentences that are more comprehensive:

Consistent with the notion that chronic stress is a bio-psycho-social phenomenon, so too should its effective management and treatment (Sutton). Attention to our biology/physiology (McEwen; Rozanski et al.), psychological health and cognitive functioning (Hammen et al.), and social/relational experiences is better than relying on any one ‘solution’ per se (Korn et al.). Indeed, healthy lifestyles (and healthy stress management) do not rest on the carrying out of any single behavior, supplement or medication; they encompass a broad range of healthy sequences that cumulate into the whole being more than the some of the parts (Sutton). In the first sentence under Relaxing, revise the text to say: There are a variety of ways to increase a sense(s) of calm and well-being, which are commonly grouped together as “relaxation techniques” or strategies. From guided imagery to yoga to square-breathing to biofeedback, these techniques and strategies are relatively easy to learn and apply in our everyday lives. We can engage in these techniques and strategies on a regular basis as part of our healthy everyday routines, and we can purposefully use these techniques and strategies in response to a stressful event or situation as it occurs.

It could also be good to introduce sleep hygiene strategies here, for the reason that insomnia (or not getting enough sleep) makes stress worse. From some of the things that I have read so far, we could say something like:

There are a variety of strategies that people can use to help themselves to sleep better, which in turn enables us to handle stress better. For example, having a set bedtime and wake-up time, not drinking alcohol or caffeine for several hours before bed, and getting up and doing something during the night if you cannot sleep (versus tossing-and-turning in bed) are all easy-to-implement behaviors that research has shown to work. In the first sentence(s) under Support Systems, revise the text to say:

Connecting with others through supportive networks, systems, and relationships is another good way to combat stress. Whether through informal means (e.g., socializing with friends, playing organized sports, participating in hobby-clubs) or formal/professional means (e.g., group therapy), the experience of being with others serves to reduce stress. Being with others offers a good context(s) to talk about, give/receive support for stress, and sometimes just having fun can help us to forget about our everyday worries for awhile (Sutton). At the conclusion of the article, begin a resource list and say:

The following resources represent further scientific readings and current-knowledge regarding chronic stress, and practical resources for use in our everyday lives.

Then, we could divide up the resources section into two parts. One part could have the scientific knowledge (e.g., research papers), and other could have practical resources (e.g., web sites with links to supportive organizations).

Scientific Knowledge/Resources: Chumaeva,Nadja, Mirka Hintsanen, Niklas Ravaja, Markus Juonala, Olli T. Raitakari, and Liisa Keltikangas-Järvinen. “Chronic Stress and the Development of Early Atherosclerosis: Moderating Effect of Endothelial Dysfunction and Impaired Arterial Elasticity.” International Journal on Environmental Research and Public Health 6.12 (2009): 2934–2949.

Hammen, Constance, Patricia Brennan, Danielle Keenan-Miller, Nicholas Hazel, and Jake Najman. “Chronic and Acute Stress, Gender, and Serotonin Transporter Gene–Environment Interactions Predicting Depression Symptoms in Youth.” Journal of Child Psychology and Psychiatry 51.2 (2010): 180–187.

Korn, Leslie, Rebecca Logsdon, Navak Polissar, Alfredo Gomez-Beloz, Tiffany Waters, and Rudolph Rvser. “A Randomized Trial of a CAM Therapy for Stress Reduction in American Indian and Alaskan Native Family Caregivers.” The Gerontologist 49.3 (2009): 368-377.

McEwen, Bruce. “Physiology and neurobiology of stress and adaptation: central role of the brain.” Physiological Reviews 87.3 (2007): 873-904.

Ostiguy, Caroline, Mark A. Ellenbogen, Anne-Marie Linnen, Elaine F. Walker, Constance Hammen, and Sheilagh Hodgins. “Chronic Stress and Stressful Life Events in the Offspring of Parents with Bipolar Disorder.” Journal of Affective Disorders 114.1 (2009): 74–84.

Rozanski, Alan, James Blumenthal, Karina Davidson, Patrice Saab, and Laura Kubsansky. “The Epidemiology, Pathophysiology, and Management of Psychosocial Risk Factors in Cardiac Practice: The Emerging Field of Behavioral Cardiology”. Journal of the American College of Cardiology, 45.5 (2005): 637-651.

Practical Resources: Sutton, Amy L., ed. Stress-related Disorders Sourcebook: Basic Consumer Health Information About Stress And Stress-related Disorders, Including Types of Stress, Sources of Acute And Chronic Stress, the Impact of Stress On the Body's Systems, And Mental And Emotional Health Problems Associated With Stress, Such As Depression, Anxiety Disorders, Substance Abuse, Posttraumatic Stress Disorder, And Suicide; Along With Advice About Getting Help for Stress-related Disorders, Information About Stress Management Techniques, a Glossary of Stress-related Terms, And a Directory of Resources for Additional Help And Information. Array Detroit, MI: Omnigraphics, 2007.

[submitted by IsabelD] IsabelD (talk) 23:26, 11 April 2010 (UTC)

Adding Images
I will be adding images, unless anyone disagrees? Gdudycha (talk) 18:49, 22 March 2010 (UTC)Gdudycha

Looks good :-) 75.252.76.97 (talk) 04:58, 12 April 2010 (UTC)

Effects of Stress
I have a paragraph or two, along with an image, I would like to add to the page about the effects of stress on the body.--Gdudycha (talk) 15:07, 8 April 2010 (UTC)

I edited this portion to not address the reader. To address the reader makes it "non-encyclopedic". It should read with facts to inform, not personally directed toward. I adjusted what I thought would work, without taking away from the point of reference. Kajasimpson (talk) 21:24, 12 April 2010 (UTC)

my contribution
started this article! — Preceding unsigned comment added by SteveNash11 (talk • contribs) 22:59, 4 July 2011 (UTC)

Very little information in this article.
I am just watching the teaching company course called "stress and your body" ( http://www.thegreatcourses.com/tgc/courses/course_detail.aspx?cid=1585 ), and this article should have much more information about how chronic stress is damaging the body. --152.94.59.5 (talk) 19:06, 6 September 2011 (UTC)

Adrenal fatigue
Adrenal fatigue is not a real medical condition, so stating that stress is "linked" to it is ridiculous. We should not be giving undue WP:WEIGHT to WP:FRINGE ideas. I should add that just because something has a source, does not mean it necessarily has to be in the article, as is claimed in the edit summaries. Yobol (talk) 14:54, 19 March 2014 (UTC)
 * You don't agree with the belief that their may be a link, so you've engaged in POV edit warring. The entry was cited. Here are some more that discuss the link between stress and the condition.

--evrik (talk) 15:10, 19 March 2014 (UTC)
 * No WP:MEDRS compliant source says it exists, so to say it does violates our guidelines. Yobol (talk) 15:15, 19 March 2014 (UTC)
 * Really?


 * Sure your not just cherry picking your facts? --evrik (talk) 15:18, 19 March 2014 (UTC)
 * Sure your not just cherry picking your facts? --evrik (talk) 15:18, 19 March 2014 (UTC)


 * As per MEDRS, you need a review published in the biomedical literature, or a statement by a major medical or scientific body, for health-related information. None of the sources you bring are great and most of them are not acceptable.  The sciencebasedmedicine source is OK, and it supports the statement that the medical consensus is that this is not a valid condition.  The adrenalfatigue.org site is a WP:SPS and fails Identifying_reliable_sources_(medicine).  WebMD is suboptimal source but often OK; it to stands with the medical consensus on this issue. womentowomen also is WP:SPS and fails Identifying_reliable_sources_(medicine).  About.com is not acceptable for health-related information.  Please respect WP:FRINGE and WP:MEDRS.  Yobol is correct here. Jytdog (talk) 15:19, 19 March 2014 (UTC)
 * That book is by the leading proponent of the theory (same guy who runs the adrenalfatigue.org website); it too fails Identifying_reliable_sources_(medicine). Jytdog (talk) 15:19, 19 March 2014 (UTC)

Sourcing and style
Content in this article that is WP:Biomedical information needs to be sourced per WP:MEDRS. For style, please read and follow WP:MEDMOS. Please cite complete references - the way to do this is described at WP:MEDHOW.

I placed a banner at the very top of this page that has links to Pubmed to find recent reviews. Jytdog (talk) 00:49, 11 November 2016 (UTC)

Physical Symptoms
Chronic stress physically affects our body in numerous negative ways. It causes our organ systems to behave in ways that will result in serious consequences.

Musculoskeletal System

When stressed, muscles tense up. With chronic stress, the body is constantly in a state of guardedness, which often results in musculoskeletal diseases, such as headaches and migraines.

Respiratory System

Stress makes people breath harder, which is detrimental for those who have asthma and other lung diseases, as they cannot obtain the oxygen they need. In addition, hyperventilation, the rapid breathing caused by stress, is prone to trigger panic attacks.

Cardiovascular System

Chronic stress can bring serious consequences to our cardiovascular system, which composes of the heart and blood vessels. Stress increases heart rate and increases stress hormones and blood pressure, which often results in hypertension, stroke, and heart attacks.

Endocrine System

The endocrine system consists of adrenal glands and liver. When stressed, the adrenal glands produce cortisol and epinephrine. In response, the liver produces more glucose, which causes diabetes and obesity.

Gastrointestinal System

The gastrointestinal system includes the esophagus, stomach, and bowels. Stress causes people to eat differently, which can trigger acid reflux and heartburns. Moreover, the brain becomes more sensitive to the stomach, resulting in the person getting butterflies and stomachaches. Furthermore, stress can mess up bowel movements, causing diarrhea and vomit.

Nervous System

The nervous system is split into two categories, sympathetic nervous system (SNS) and parasympathetic nervous system (PNS). When stressed, SNS releases adrenalin and cortisol, which is the element that triggers the fight or flight response. These hormones causes the heart to beat faster, respiration rate to work harder, etc.

Male Reproductive System

In the male reproductive system, SNS increases the production of testosterone, which creates arousal. The increase in testosterone often has effects on sperm production, maturation, erectile dysfunction, and impotence.

Female Reproductive System

Stress affects the female reproductive system in numerous ways. Often, it causes absence or irregular menstruation cycles, as well as painful periods. Moreover, it makes premenstrual system (PMS) worse than usual. Furthermore, it decreases a woman’s sexual desire.

-- — Preceding unsigned comment added by Ninatchang (talk • contribs) 22:56, 10 November 2016 UTC) (UTC)

suggestions instead of saying "our body" say the body no comma between "diseases, such" change "our cardiovascular system" to "the..." and then change to "which is composed" "stress increases heart rate, stress hormones, and blood pressure, ..." "the endocrine system consists of THE adrenal glands and THE liver" "the liver produces more glucose, which CAN cause..." "can DISRUPT bowel movements" "THE sympathetic..." "which is the HORMONE that..." what kind of effects does the increase of testosterone have on sperm production, maturation, erectile dysfunction, and impotence — Preceding unsigned comment added by Sfletch (talk • contribs) 03:20, 11 November 2016 (UTC)

Telomeres
About this series of edits, there are several issues.


 * first, well-sourced content was removed
 * second, the sources are generally poor/old
 * "Long-term stress may chip away at the ends of chromosomes." is a news piece from 2004.  Not MEDRS
 * "Organismal stress and telomeric aging: an unexpected connection" is a comment from 2004 on the PNAS paper that the news piece above was discussing.  This is not MEDRS either
 * "Telomere/telomerase dynamics within the human immune system: effect of chronic infection and stress" - this is a review from 2011 and is OK. (just - per WP:MEDDATE we look for refs from the last five years)
 * "Chronic Sleep Deprivation and its Effect on the Length of Human Telomeres: A Review" (not abstracted in pubmed so no PMID). This is a review from 2014 but it was published in Journal of Cell and Tissue Research which is  published by CTR Publications, which is on Beall's list of predatory publishers (see here)   This is not a MEDRS source.
 * "Telomeres in a Life-Span Perspective: A New "Psychobiomarker"?" (not indexed in pubmed so no PMID, but per this the journal is indexed is scopus so OK).  This has elements of review, and is from 2009.   Marginal source; not great.
 * "Stress and telomere biology: a lifespan perspective." is OK per MEDRS - a review from 2013
 * "Systematic review of the association between chronic social stress and telomere length: A life course perspective" is  - a review from this year.  Great per MEDRS
 * third, the content that was added has some issues
 * The structure of it was: "The following are the hypothesized mechanisms through which chronic stress results in the shortening of telomeres (emphasis added): 1) Oxidative Stress, 2) Decreasing telomerase activity; 3) Making people more susceptible to adopting unhealthy lifestyles.   In 1) the chronic stress >>oxidative stress >> telomere shortening is all based on bad sources.  2) is pretty OK.   1) and 2) make sense - oxidative stress increases degradation, and lower telomerase activity reduces re-lengthening.   3) is kind of a mess though. First the ref provided for the causal link  - that chronic stress causes bad lifestyle choices - doesn't support that claim, and the ref used to support lifestyle choices and shortened telomeres is much messier than the content makes it out to be .  which leads to the other issue with the content, namely....
 * Overall the content is much too certain.  even says "The length of telomeres appears to be an important predictor of health and disease. Nonetheless, not all studies report significant associations between stress exposures, or mental health disorders, and TL, and it is still not known whether stress exposure (as opposed to its disease sequelae, for example) is causing the erosion of telomeres. It may be that those most vulnerable to adult stress exposures are those who also have some predisposition, whether genetic, or acquired, such as prenatal or childhood adversity. Caution should be taken as more research is needed to elucidate mechanisms that govern TL dynamics."   And, (especially section 4.1 and everything in 4.2  - down to the difficulty of arriving at a standarized way to measure telomere length) makes it clear the findings are tentative and there are tons of confounders.

So I reverted it. Jytdog (talk) 02:56, 12 November 2016 (UTC)

Training
Folks from the class please review this training module. Jytdog (talk) 04:39, 12 November 2016 (UTC)

Assessment
Hello all, I am thinking about adding a diagnosis section to this article. Below is my paragraph with sources. Please let me know what you think!

Consistent with psychiatric assessment in general, diagnosis of chronic stress considers the current mental status of the patient as well as their social background and medical history. Two main diagnostic methods are medical interviews and self-report questionnaires; in either case, the patient is asked a series of questions that measure their perceived control, coping, and arousal reduction in response to major events. The clinician or researcher may also quantify the data by asking the patient to rate their responses on some defined scale. Medical interviews are done in person with a clinician, and an example of a self-report questionnaire is the Life Stress Inventory. Currently, testing of biological markers of chronic stress is not a standardized diagnostic method.

This is similar to the procedure of diagnosing post-traumatic stress disorder, which involves questionnaires such as the PTSD Checklist (PCL).

Skouzi (talk) 23:09, 10 November 2016 (UTC)
 * The refs here are OK - recent textbooks... but this is not a condition that has a formal diagnosis. Not sure what you are doing with this section. Jytdog (talk) 04:16, 11 November 2016 (UTC)
 * Hi, thanks for the feedback! Did you have a reference that says it's not a formal diagnosis? This would be a helpful addition to the subsection; for example, the title could be changed to "informal diagnosis." Skouzi (talk) 00:43, 12 November 2016 (UTC)
 * It works the other way. If you want to claim that it is a condition and that it has a diagnosis, you need MEDRS sources for that. Jytdog (talk) 01:13, 12 November 2016 (UTC)
 * Oh okay! I have changed the wording to reflect informal diagnosis instead. Is "informal diagnosis" the correct word?  Below is my revised paragraph:
 * Consistent with psychiatric assessment in general, informal diagnosis of chronic stress considers the current mental status of the subject as well as their social background and medical history. Two main evaluation methods are medical interviews and self-report questionnaires; in either case, the subject is asked a series of questions that measure their perceived control, coping, and arousal reduction in response to major events.  The clinician or researcher may also quantify the data by asking the subject to rate their responses on some defined scale.  Medical interviews are done in person with a clinician, and an example of a self-report questionnaire is the Life Stress Inventory.  Currently, testing of biological markers of chronic stress is not a standardized evaluation method.


 * This is similar to the procedure of diagnosing post-traumatic stress disorder, which involves questionnaires such as the PTSD Checklist (PCL).


 * -- Skouzi (talk) 03:34, 12 November 2016 (UTC)
 * I have no idea which refs are which. In the sources you used above, the section of Current Medical Diagnosis & Treatment 2017 you cite does not discuss chronic stress but is general, about psychiatric evaluation.  And the source you used above about "combat stress" is not about chronic stress.  The chapter of "stress and disease" has a diagnosis section but I don't have access to accessmedicine right now.  what does that "diagnosis" section there actually say?   If what you are trying to discuss is how chronic stress is assessed when people do research that might make sense but you need references that actually discuss that.   Also please actually read WP:MEDMOS - we do not refer to "patients".   Jytdog (talk) 04:13, 12 November 2016 (UTC)
 * Yes, I used Current Medical Diagnosis & Treatment 2017 to talk about psychiatric evaluation in general, and used the "combat stress" source to briefly mention PTSD (I wasn't referring to chronic stress with that source). The diagnosis section of the "stress and disease" chapter talks about the medical interview and self-report questionnaires.  You bring up a good point about assessing chronic stress for research, and I am looking for a source for that now.  Also, I changed "patients" to "subject" in my last revised paragraph; my bad for missing that. Skouzi (talk) 04:35, 12 November 2016 (UTC)
 * Again, what does the behavioral medicine ref actually say under "diagnosis"? This is not a condition defined in DSM-V nor in ICD 10, so I am curious what that chapter actually says under "diagnosis".  (sections in medical textbooks often have a "diagnosis" section by rote, but what is actually there is often more nuanced.)  I won't be in a place to have access to accessmedicine until monday; i will eventually check myself but for now you can just summarize it.  Jytdog (talk) 05:16, 12 November 2016 (UTC)
 * In the behavioral medicine source, the first paragraph talks about the diagnosis of stress, not chronic stress specifically, and the multifaceted nature of the thing. The rest is about specifics and examples of the medical interview and self-report questionnaires.  Would replacing/augmenting the behavioral medicine source with this one be an improvement, for example by talking about how chronic stress was assessed in the studies in this literature review?
 * Skouzi (talk) 05:49, 12 November 2016 (UTC)
 * I've taken all of your suggestions and put them in the following revised paragraph. Please let me know what you think!
 * Consistent with psychiatric assessment in general, assessment of chronic stress considers the current mental status of the subject as well as their social background and medical history. In a particular literature review, a subject was defined to have chronic stress if they were a caregiver to a disabled person, living in extreme poverty, or exposed to violence.  These three were measured objectively as well; caregiving was measured by years, poverty by income or poverty level of neighborhood, and violence by self-report questionnaires.  Questionnaires measure the subject’s perceived control, coping, and/or arousal reduction in response to major events.  Currently, testing of biological markers of chronic stress is not a standardized evaluation method.
 * This is similar to the procedure of diagnosing post-traumatic stress disorder, which involves questionnaires such as the PTSD Checklist (PCL).
 * This is similar to the procedure of diagnosing post-traumatic stress disorder, which involves questionnaires such as the PTSD Checklist (PCL).


 * Skouzi (talk) 07:14, 12 November 2016 (UTC)
 * Thanks for summarizing the behavioral medicine source. so it is not about chronic stress.  OK.   I still have no idea what your references are: "skouzi source 3" is meaningless.   Outside of that, the content you are proposing: 1) appears to be WP:SYN (what that means, is that it appears that you are the one saying assessing chronic stress is similar to assessing PTSD, not the source you cite);  and 2) is more definite about how chronic stress is assessed than is true in reality; based on the reviews I have read, there is no standard way of assessing chronic stress. You seem to have picked one way (" In a particular literature review") and made that appear to be general.  This is not OK.  3) is unclear if you are talking about what happens when people see doctors (how "chronic stress" might be assessed clinically) vs how people study it (research.. which is not the same as what happens clinically)  Jytdog (talk) 11:58, 12 November 2016 (UTC)
 * I'm working on the paragraph now but I have a question; since one of the studies included in my literature review source was about PTSD and telomere length, can I assume that the literature review defined PTSD as a form of chronic stress? Skouzi (talk) 04:34, 13 November 2016 (UTC)

Mental Symptoms
Chronic stress produces symptoms in both the body and the mind. Along with the aforementioned metal symptoms (anxiety, depression, and difficulty concentrating), there are many other symptoms such as listlessness overreaction, confusion, performance anxiety, poor performance, anger, hostility, guilt, and resentment associated with chronic stress. . These symptoms can often be confused with the symptoms of a cold, depression, or another mental illness. This can lead to misdiagnosis and mistreatment of chronic stress. Although it may seem like these symptoms are caused by a pathogen, they are actually caused by the prolonged proinflammatory cytokine production. While this response is initially helpful in situations of acute, or short term stress, and for the fight or flight response, a long term inflammatory response can cause damage. This is demonstrated in patients with MS, an inflammatory disease, who are much more likely to develop depression from the prolonged inflammation. Chronic stress and this continued proinflammatory response is linked to neurosis, depression, schizophrenia, and even suicide.

Biochemical pathways in the brain, specifically the prefrontal cortex, are responsible for these symptoms. The prefrontal cortex (PFC) is the area of the brain that is the most sensitive to stress and also regulates thoughts, actions, and emotions. When functioning without stress, catecholamine is released to help the PFC function. When chronic stress occurs, catecholamine release increases and it impairs the function of the PFC. Because the PFC regulates attention and working memory, these functions are also impaired. Catecholamine also increases amygdala function, which regulates fear and increases anxiety, and causes the symptom of thoughts becoming much more quick and reflexive. If stress lasts long enough, as is the case for chronic stress, the catecholamine pathways are rerouted to continually increase amygdala function and decrease PFC function. This causes the hypothalamus to continue to release two hormones, noradrenaline and dopamine. Dopamine becomes depleted, which creates the symptoms associated with depression, and the continuous noradrenaline release can cause spine loss. The brain switches from “top down” thinking which is thinking that prioritizes what is most important, to “bottom up” thinking, which is thinking that focuses on anything that is the most attention capturing which creates the symptom of poor focus. Chronic stress also creates a loss in dendritic material and disrupts the relationship between the PFC and the hippocampus. This relationship is necessary to form flexible memory consolidation, which can be severely impaired in people with chronic stress. While dendrites in the PFC deplete, dendrites in the amygdala strengthen which strengthens the stress response and makes it difficult to break out of chronic stress. Sfletch (talk) 06:01, 13 November 2016 (UTC)

-- — Preceding unsigned comment added by Sfletch (talk • contribs) 23:33, 10 November 2016 (UTC)
 * the first source (used twice - see WP:MEDHOW for how to cite a source multiple times without repeating it) is 11 years old.   is incorrectly cited; it was actually published in 2008 and it is too old; also not a great journal.  The 4th source is incorrectly cited; it is  and published in 2010; on the edge of being too old.  The fifth source is from a very strong journal but is too old; this is .  Jytdog (talk) 04:15, 11 November 2016 (UTC)

Check the source citations, they seem off by a little bit. Otherwise, the information is good! — Preceding unsigned comment added by Ninatchang (talk • contribs) 04:05, 12 November 2016 (UTC)

I fixed the double sourcing and incorrect dates for the citations. Thank you for the edits. Sfletch (talk) 06:58, 13 November 2016 (UTC)
 * sourcing is just the first step. It is OK to use a source twice; you just don't cite it separately.  So the header doesn't appear to match the contents, which talk about all kinds of physical things (not just "mental").  And most of the first paragraph appears to be unsourced.  The third paragraph gets into all kinds of mechanism stuff that has nothing to do with symptoms at all.  And none of this makes an effort to integrate with the existing "symptoms" section..... which is itself problematic.   You all picked a very hard topic to work on, unfortunately.  Jytdog (talk) 07:46, 13 November 2016 (UTC)
 * I tried to get rid of all of the physical symptoms I had in there and tie the first paragraph more closely into the general symptoms section. I also cited the first paragraph more often but the large chunk at the end is all from the one source. The third paragraph is mainly there to explain the cause of these symptoms. Should i make it a new subsection?Sfletch (talk) 08:23, 13 November 2016 (UTC)

Merger proposal
Folks in the class, I am sorry about this, but you have chosen to work on a topic that is really difficult in any case, and that Wikipedia currrently handles very badly.

There are the bones of a decent article at Stress_(biology), and that article already has pretty significant (albeit messy and messed up) discussion of chronic stress. I have opened a merger discussion here: Talk:Stress_(biology). Discussion about the merger will take place there.

I am sorry if this creates problem for your classwork; I suggest you choose another topic as it is going to take a lot of careful work to fix the two articles. Jytdog (talk) 21:56, 13 November 2016 (UTC)

Acute Stress v. Chronic Stress
Acute stress is stress caused by homeostatic changes that trigger adaptive responses, which include various physiological changes that occur to better prepare the natural immune system for any immediate harm. The stress responses that stimulate the affected organism can either result from physical or psychological stressors. Most of the physiological changes that occur during acute stress take place in the cardiovascular system, where blood pressure, arterial pressure, heart rate, and cardiac output levels are all increased. After the stimulus has occurred, several cardiovascular functions including arterial pressure and heart rate decrease and return to regular levels within 30 to 60 minutes of the end of stress. These adaptive responses aimed to maintain homeostasis are beneficial in dealing with acute stress, however, continuous activation of and exposure to these acute stressors can then result in several of the negative effects of chronic stress.

Chronic stress is thus the stress that results from a chronic persistence of stress responses after continuous exposure to these acute stressful events or continued failure to generate adequate responses to these events. Elevated levels of cardiovascular functions become maladaptive if they persist for too long. If prolonged, chronic stress often leads to several psychiatric and cardiovascular diseases along with overall worsened physical health.

-- — Preceding unsigned comment added by Changellen (talk • contribs) 00:28, 11 November 2016 (UTC)
 * Why are you using an 11 year old reference? Jytdog (talk) 03:56, 11 November 2016 (UTC)
 * Sources more than 5 to 10 years old are generally (=not always) discouraged – but that's because we assume that things may have changed (e.g., due to more recent discoveries). It seems unlikely to me that the basic difference between acute and chronic stress has changed much during the last few decades.  If there's no reason to believe that the older source creates bad content, then the old source meets the minimum WP:BURDEN imposed by the sourcing policies.  (Of course, anyone who wants a newer source is free to provide one).  WhatamIdoing (talk) 00:05, 14 November 2016 (UTC)

"Historical Development" and additions to "Chronic Stress-Related Studies"
Hello all! I am intending to add information to the Chronic Stress page. I will be adding a brief history of the early research of stress, and then I will be adding two socially-centered studies to the studies page.

"Historical Development"

Hans Selye (1907-1982), known as the “father of stress,” is credited with first studying and identifying stress. He studied stress effects by subjecting lab mice to various physical, antigenic, and environmental stressors, including excessive exercise, starvation, and extreme temperatures. He determined that regardless of the type of stress, the mice exhibited similar physical effects, including thymus gland deterioration and the development of ulcers. Selye then developed his theory of general adaptive syndrome (GAS) in 1936, known today as “stress response". He concluded that humans exposed to prolonged stress could also experience hormonal system breakdown and subsequently develop conditions such as heart disease and elevated blood pressure.  Selye considered these conditions to be  “‘diseases of adaptation,’” or the effects of chronic stress caused by heightened hormonal and chemical levels  His research on acute and chronic stress responses introduced stress to the medical field.

"Chronic Stress-Related Studies"

The Commonwealth minority health survey (1997) revealed that minority groups, especially Chinese American and Puerto Rico participants, feel more stressed than whites. Minorities also reported higher instances of domestic, sexual, and physical assault. Interpretation of this study is difficult because the effects of chronic, societal stressors such as discrimination (a standard that is not consistently defined in the medical field) must be separated from those caused by interpersonal and acute stressors. This research also lacked breadth and variety in its responder groups, but it can be concluded that discrimination did have some impact on how Black and White focus groups reported their health. Ethnic stressors offer an explanation for biological differences between population groups, but this field requires more research.

A more recent study in 2010, “Race and Unhealthy Behaviors: Chronic Stress, the HPA Axis, and Physical and Mental Health Disparities Over the Life Course,” furthered the topics explored in the Commonwealth minority health survey. It found that populations, specifically Black Americans, that live in chronically stressful environments tend to develop unhealthy habits such as smoking, consuming alcohol, and abusing over-the-counter or using illicit drugs. These behaviors can lead to overall diminished health and decreased life expectancy. The article notes that understanding racial health differences depends on a variety of factors, including socioeconomic status, sex, access to healthcare, and genetic disparities as well. It also hypothesizes that White populations placed in comparably stressful environments would react by developing similarly unhealthy habits and subsequently reduced overall health.

-- — Preceding unsigned comment added by Cakrumm  (talk • contribs) 00:13, 11 November 2016 (UTC)
 * The historical development section is OK. refs come after punctuation, not before.  The 3rd reference, to the Commonwealth Fund, is not MEDRS.  The 4th citation is not correctly written; that paper  published in 2003.  It is a review but is 13 years old.  The 5th reference is also incorrectly written; that is   and is a primary source published in 2010.  None of these - 3, 4, or 5, is the kind of source we look for.  Please see WP:MEDHOW for how to cite journal articles. Jytdog (talk) 04:01, 11 November 2016 (UTC)


 * Fixed the refs and punctuation issues. Commonwealth Fund backed up by a peer-reviewed analysis of the data.  Will fix citations; thank you for the corrections.  Will look into 5th reference, or replace with information from a peer-reviewed source.  Cakrumm (talk) 06:08, 12 November 2016 (UTC)cakrumm
 * If the Commonwealth report is historically important, then it can be both cited and also have an entire article created about it. (Whether it's that important in the field is unknown to me.)  But what would be perfect is not Wikipedia editors writing this kind of studies-comparsion content, but finding a source that already did that, and documenting whatever they said about the studies in the field.  WhatamIdoing (talk) 00:12, 14 November 2016 (UTC)
 * Hi Claire! Your historical development section is very solid.  I agree with your decision to leave off the related studies section from the main page though, as it seems to be debatable. Skouzi (talk) 00:19, 14 November 2016 (UTC)

Proposed social implications section
As I noted above, this is a very hard topic that is made yet more difficult by popular culture notions of "stress" mixed into discussion of the physiological state and its extension in time... and what causes that and what the effects are. The content below mixes the pop culture notions with the scientific/medical ones. Occupational medicine is not society and culture, either. hmm.. some stuff that could be maybe be used here.


 * Social Implications

'Chronic Stress in the Workplace In a study comparing regional stress levels, Americans believed work to be the second biggest cause of their problems with stress, surpassed only by money. 'Causes Populations particularly vulnerable to developing chronic stress on the job include those who are especially young or old, recent immigrants, those who are differently abled, and women. The majority of studies detailing chronic stress in the workplace tend to focus on psychosocial hazards. These include poor organizational culture and function, lack of  career development, insufficient  decision latitude/control, poor interpersonal relationships, difficulty balancing  home and work life, inappropriate work environment and equipment, bad  task design, heavy workload/workpace, and long hours.

Workers must also face physical hazards which can cause psychological stress. Awareness of working in an environment with dangerous materials such as carcinogens or hazardous waste can cause fear. Other physical hazards include potential irritants like noise, temperature, and humidity.

There are multiple interactional theories of stress in the workplace, which tend to focus on the interrelationship between employer, employee, and workload. One of the most common and widely cited is the effort-reward imbalance model (Siegrist), which holds that chronic stress can occur when a worker puts in a high level of effort, but receives a low reward.

It is estimated that US businesses can lose upward of $190 billion every year due to problems associated with stress in the workplace. While low levels of stress can motivate workers, as part of the phenomenon known as eustress, chronic stress can lead to impaired work performance in areas such as  coordination,  manual dexterity, and in other cognitive tasks. Roughly 120,000 deaths every year can be attributed to excessive stress in the workplace. Problems employers might face if their workforce is chronically stressed include: high turnover, high levels of  absenteeism, an increased number of customer  complaints, and poor time keeping. The most common health problem discussed in literature related to work stress is cardiovascular disease.
 * Effects

Minorities and those with low education levels are often hit hardest by workplace stressors. Non-Hispanic black men with less than 12 years of education lose an average of 1.7 years of life as a result of workplace stress. In contrast, highly educated non-Hispanic women only lost .3 years of life due to workplace stressors. This can be attributed in part to the fact that those with lower education levels are forced to endure working situations with more occupational hazards.

-- Jytdog (talk) 23:13, 13 November 2016 (UTC)
 * The section is on the social implications, so it does tend to cover social issues. That said, pop culture notions of stress are not always irrelevant or incorrect. The facts below regarding popular beliefs about stress are supported by references (Americans believe work to be second biggest cause of stress problems). Would appreciate more specific feedback on what you consider to be "popular culture notions of "stress" mixed into", with the understanding that the article is not (yet) one and the same with Stress (biology). Lagla (talk) 05:11, 14 November 2016 (UTC)
 * pop culture notions need to identified as such and kept distinct from what we (humanity) know about chronic stress through actual study of it. As I noted above, your class chose a very difficult topic.  "stress" (pop culture)", "stress physiological" and "chronic stress (physiological" are three distinct ideas.  They are mooshed together in the content above.  Also as I mentioned there is occupational medicine content here - the stuff about "your workplace killing you" sourced to the Stanford business school website; that is not a WP:MEDRS source and you cannot use that to derive content about health. Jytdog (talk) 06:50, 14 November 2016 (UTC)
 * I mean, I was asking you to tell me what part of the article you consider to be "pop culture". Also, there actually isn't any content above that I would consider physiology. There is no overlap with occupational medicine, that page just seems to be an overview of the occupation and a list of schools. Lagla (talk) 07:38, 14 November 2016 (UTC)
 * The content talks about people's jobs hurt their health. That is the definition of occupational medicine.  Why is content about that sourced to a business school website?  (the OSHA site is great btw, but why did you pick a 16 year old source?  Here is an OSHA ref that is only 7 years old.  Or see the pdf linked here, from this year, pages 39ff.)  A huge part of working in Wikipedia is the time and care spent in selecting the sources to read and summarize.   Jytdog (talk) 07:48, 14 November 2016 (UTC)
 * You might be thinking of Occupational Safety and Health. Lagla (talk) 10:13, 14 November 2016 (UTC)contribs) 08:05, 14 November 2016 (UTC)

Diet
The following was added in these difs; moving here per WP:PRESERVE - commentary to follow in a bit:


 * Impacts of chronic stress on diet

In both humans and animals, chronic stress has been linked to consumption of obesogenic high-calorie foods and vice versa, creating a cycle of chronic stress and unhealthy eating. Humans specifically have been found to actively pursue energy dense, high-calorie foods in the presence of controlled laboratory stressors, with observed increases in cortisol reactivity. Socioeconomic status has also been linked with chronic stress and obesity. Chronic environmental and social stresses can also contribute to metabolic disease such as obesity and diabetes.

The relation between chronic stress and food may invoke public’s awareness of this “mental to physical disease”. Some current researches reveal that chronic stress may cause metabolic disorders through daily diet, which could lead to various health problems. To test how chronic stress affect human health, a group of researchers from UCSF conduct experiments and conclude that people who are under various chronic stress level have different metabolic response even though they are fed with same food. Their study shows that people who have chronic stress have a higher tendency to gain increased body fat and blood sugar and other metabolic problems, which could cause diseases such as obesity and diabetes. Specifically, how chronic stress contributes to obesity becomes an arousing topic in the society. Karen A. Scott, a professor from department of psychiatry and behavioral neurosciences in University of Cincinnati College of Medicine, points out that chronic stress not only affects normal energy storage inside human body but also alters people’s dietary selection. He illustrates that significant weight gain is observed for people who are under prolonged stressors that include low social status, stressful working environment, social conflict with other people and etc, especially for overweight people. As for change in dietary preference, people under chronic stress is more likely to consume food that are high in sugar and fat, which increases the chance of having obesity.

-- Jytdog (talk) 07:00, 14 November 2016 (UTC)


 * OK, just sources alone. You have two decent sources here  and .  Those were pretty good starting points.  One thing to note for everybody - see how  starts? It says "Obesity and metabolic diseases are linked to chronic stress and low socioeconomic status.".   On the left you have medical diseases and conditions (obesity and metabolic disease) and on the other side are measurement things (chronic stress and low socioeconomic status).   You all keep treating "chronic stress" as though it were something like "obesity and metabolic disease' - like it is a medical condition.  It isn't.  It is something like "low socieconomic status".  You don't talk about "diagnosiing" or "treating" "low economic status".  And this is one of things that makes this topic hard and where you all keep getting tripped up.
 * Also, a bunch of you seem to be taking "link" to mean cause. When people say "link" in a medical paper, they are talking about correlation.   You all need to get grounded on the fact Correlation is not causation.  We have a whole article on that, that I just linked (hah) to.  Please read it.
 * Anyway, instead of just summarizing those two good MEDRS sources, there is all this stuff based on a press release, and hyping the scientist who made one of the reviews, even using a press release from UCSF. If you all had read WP:MEDRS and WP:MEDMOS as the training advises, and as I pointed you to above, you would not be proposing content like this.  Jytdog (talk) 07:43, 14 November 2016 (UTC)


 * content about diet was added in this dif

"Humans specifically have been found to actively pursue energy dense, high-calorie foods in the presence of controlled laboratory stressors, with observed increases in cortisol reactivity."


 * ref here is a primary source; but as mentioned here many times, per WP:MEDRS we build content from secondary sources. Jytdog (talk) 18:58, 14 November 2016 (UTC)

Stress in the workplace
in this dif, the following:


 * Stress In the Workplace

The prevalence of chronic stress varies across people because of the difference in amount of stressful events that individuals experience. In addition to socioeconomic status, a person’s occupation can affect the likelihood an individual will be exposed to stressful events. An example of this is presented by A Iacovides et. al., in their report The Relationship Between Job Stress, Burnout and Clinical Depression, where they discuss how nurses who often have frequent contact with very sick patients suffer from chronic stress. “Generally, professionals may function at high levels if their work provides them with positive feedback. However, those facing a highly stressful work environment, like the nursing staff in Intensive Care Units, may manifest higher levels of anxiety, anger, behaviour disorders and depressive symptomatology” (1) The intimate relationship nurses have with patients whose health progressively declines leaves the nurses feeling helpless. “Half of them may be emotionally exhausted, and 80% may report feelings of low personal accomplishment. Signs of clinical anxiety are present in more than 10% of staff, and overt depression may occur in 0.8% of nurses and 3.8% of doctors” (1) This phenomena of psychological stress is observed in professions similar to nursing, where the job requires interacting with an individual whose health declines significantly. “There are reports on the role of work-related psychological distress as a probable cause of dropout among emotional support volunteers (buddies) who work with people living with AIDS—more than 24% of buddies may suffer from burnout.” (1) “Burnout” is defined by Sturgess and Poulsen in their paper The prevalence of burnout in occupational therapists as: “progressive loss of idealism, energy and purpose, experienced by people in the helping professions as a result of their work” (2)

1. Iacovides, A., K.N. Fountoulakis, St. Kaptrinis, and G. Kaprinis. "The Relationship between Job Stress, Burnout and Clinical Depression." Journal of Affective Disorders 35, no. 3 (August 2003): 209-21. doi:http://dx.doi.org/10.1016/S0165-0327(02)00101-5.

2. Sturgess, J., and A. Poulsen. "The Prevalence of Burnout in Occupational Therapists." Occup. Ther. Ment. Health 3, no. 4 (1983): 47-60. doi:10.1300/J004v03n04_05.

So... no effort to cite refs appropriately. A 33 year old ref, and a 13 year old ref, both primary. Written like a book report, not WP content. Jytdog (talk) 19:02, 14 November 2016 (UTC)

blood brain barrier proposed section
the following added in this dif

Chronic stress can also lead to the disruption of the Blood-Brain Barrier (BBB). The brain is unique among all other organs, for it has a special membrane structure that blocks the majority of chemicals from entering the brain through the blood. However, the brain is particularly susceptible to chronic stress, especially in early childhood and old age. When under conditions of stress for a long period of time, stress may transiently open the Blood-Brain Barrier and therefore let toxins, drugs or other unfavorable chemicals into the brain.

refs 1 and 3 are not MEDRS - they are news pieces and are both very old. The Nature Reviews Neuroscience is an OK MEDRS source (on the edge of being too old, but OK). Bizarrely it doesn't mention BBB. It does provide a pretty good summary of the two main hypotheses of how extended exposure of the brain to glucocorticoids (= "chronic stress") might affect the brain. Note - hypotheses and might. As with almost every edit made to this article by this class, the content is far too certain and makes too strong claims. Nothing here is useable.Jytdog (talk) 19:19, 14 November 2016 (UTC)

addition to physiology section
in this dif the following was added:

In a chronically stressed body, the natural response of the adrenal axis is to release the stress hormone, cortisol. Cortisol's function is to maintain body equilibrium. Cortisol helps to control the body's production of glucose to encourage a healthy metabolism and also acts as an anti-inflammatory agent. While cortisol can aid the body during times of stress, it also can have adverse effects if its production is sustained for long periods of time. Cortisol can weaken the body's immune response by inhibiting T-lymphoctye cells, leaving the body vulnerable to disease and infection. Cortisol is also found within the region of the brain that facilitates memory creation and storage, the hippocampus. When the body has an excess amount of cortisol, memory function has been shown to decrease in quality and become damaged by atrophy.

Another adverse effect of chronic stress is a decrease in the production of brain-derived neurotrophic factor (BDNF), a protein important in cell neurogenesis and memory plasticity. BDNF works in the hippocampus with the production of long-term memory. Several kinds of neurodegenerative diseases, such as dementia, Parkinson's disease, and Huntington's disease, have been shown to coincide with BDNF deficiencies.

Nice job formatting citations. About the refs.
 * 1)  is a primary source.  The date of the ref is not correct, this is from 2014
 * 2) low quality journal, not OK
 * 3)  is a 19 year old primary source, for pete's sake.
 * 4)  is a primary source
 * 5)  is a primary source
 * 6)  is a review, hooray!  from 2004. ack.
 * 7)  is a primary source
 * 8)   is a review, hooray!  from 2012.
 * 9)   is a review, from 2008.  meh.

So mostly the sourcing is not useful.

General formatting, punctuation comes before refs, as I have written here about ten times.

The last paragraph seems to have gone off the rails and isn't about chronic stress but rather BDNF. The really key bad sentence is the last sentence of the first paragraph, which like almost every other proposal here pretends that things are way more certain than they are. Jytdog (talk) 19:35, 14 November 2016 (UTC)

Symptoms
We need to add way more to symptoms of chronic stress, I think this is a serious problem in health? --User:Clara32356 —Preceding undated comment added 04:47, 30 March 2019 (UTC)

Wiki Education Foundation-supported course assignment
This article is or was the subject of a Wiki Education Foundation-supported course assignment. Further details are available on the course page. Student editor(s): Mazt2.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 17:40, 16 January 2022 (UTC)

Wiki Education Foundation-supported course assignment
This article is or was the subject of a Wiki Education Foundation-supported course assignment. Further details are available on the course page. Student editor(s): Cakrumm, Skouzi, Ninatchang, Jessicashi, Alberttjin, Danielolds, Lifusun, Tjsasse, Cmachle, Shreysamdani, SekhonS, Changellen, Rtsao100, Maddiemillaaaa, Laura ib35ac fall16, Wchen0721, Nikhilushinde, Samantha mntoya.

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Givi
Gigi 86.21.210.148 (talk) 20:42, 20 April 2022 (UTC)