Body Text
Psychological factors are important patients’ risk factors that affect survival. For example in asthma, stress causes the release of histamine that causes bronchi-constriction. Stress also causes insulin inappropriate release that in turn causes diabetes that is one of the most important factors that affect survival in critically-ill patients [1]. Another important disease that would be affected by stress is the peptic ulcer that is the great cause of mortality in critically ill patients [2].
The appearance of psychological symptoms such as anxiety is dependent on several factors such as genetic factors, coping style, type of personality, and social support. Different studies suggest that several factors affect the response of individuals to disease. For example, females are more vulnerable to events affecting emotional ties [3] and avoidant individuals are more susceptible to express more stress response [4]. Social support and coping strategies are also two well-known issues that affect the ultimate tolerance of the undesired state in different settings [5].
Meanwhile, the endocrine system responds to stress Letter to Editor
and vary among individuals. For example, stimulation of central corticotrophin factor (CRF) secretion by stress will result in the development of depression and anxiety [6]. A recent study suggests neuroendocrine and immune system response in a stress state will ultimately develop depression and in this regard, brain plasticity will be an important determinant factor [7]. Keep these facts in mind, it will be reasonable to think in critically-ill patients one of the most important treatments will be the treatment of psychological disturbances with biological causes. Stress through thyroid hormone greatly influences the immune system [8]. As can be seen, stress through biological factors greatly deteriorates normal body functions. Stress also causes oxidative stress that is traditional described as the production of reactive oxygen intermediates (ROIs) [9].
The tolerance of stress in critically-ill patients will greatly influence survival. As described, considering that stress causes great biological disturbances, medical treatment of such disturbances will be an important treatment for such patients. However psychological treatment should be kept in mind. Encouraging isolation of critically-ill people will help restrict disease but inversely affect dying patients. So in practice, the connection of patients to their families and loved ones will be reasonable to avoid harmful and debilitating emotional conditions [10]. Also, staff may express and expertise a wide range of emotional responses varying from anger and irritability to extreme emotional responses that will greatly influence recourses availability [11]. In this sense, stress management among health care providers also improves the outcome of interventions. Furthermore, induction of artificial sleep in the acute phase of respiratory distress can be helpful. Artificial sleep (artificial coma) can be induced by phenobarbital or propofol and in some cases, patients may benefit from hypnosis [12]. Conversely, also sleep disruption also is not a desirable condition and also should be avoided [13]. The application of various forms of psychological techniques among both patients and health care providers will be helpful. Normally, there are five groups of techniques: (1) progressive muscle relaxation (PMR) (2) distraction imagery (3) focused imagery (4) listening to music (5) sitting quietly [14]. Application of one of these techniques or some of them at the same time based on the situation and appropriately of the patients can be a useful strategy.