1 William P. Wattles, Ph.D. Francis Marion University Psychology 314Stress and Disease William P. Wattles, Ph.D. Francis Marion University Psychology 314

2 Health Belief Model Beliefs contribute to behavior Perceived: severitysusceptibility benefits barriers

3 Social Readjustment Rating Scale Measure of Stress25 Change in living conditions 24 Revision of personal habits 23 Trouble with boss 20 Change in work hours 20 Change in residence 19 Change in recreation 19 Change in church activities 18 Change in social activities 17 Personal loan 16 Change in sleeping habits 13 Vacation 12 Christmas or Chanukah 100 Death of spouse 73 Divorce 65 Marital separation 63 Jail Term 63 Death of family member 53 Personal injury or illness 50 Marriage 47 Fired at Work 45 Marital Reconciliation 45 Retirement 40 Pregnancy

4 More stress=more illnessPercent of people with illness

5 More stress=more illnessStress does not influence disease in some mystic fashion. The physiological status of the host is altered in some way.

6 Immunosuppression Stress may cause a suppression in the immune system which may make it easier for foreign organisms to invade the body.

7 Germs always present in our environmentGerm: A microorganism, especially a pathogen. Pathogen: An agent that causes disease, especially a living microorganism such as a bacterium or fungus. Vorticella

8 Road kill

9 Microorganisms on Chicken gut

10 Immune system protects the body from attackForeign organisms include: bacteria viruses parasites fungi cancerous and other diseased cells Intact skin and mucous membranes block most foreign substances. antigen often used to refer to foreign non-self materials. 2

11 Immune system identifies and eliminates (non-self) material.Identifies foreign organisms by detecting antigens (antibody generator molecules). bacteria viruses parasites fungi cancerous and other diseased cells Antigens are microorganism surface proteins that differ from those of host. antigen often used to refer to foreign non-self materials. 2

12 PsychoneuroimmunologyThe study of interactions among: Behavior (psychological) Neural and endocrine function Immune processes New field has exploded in recent years. new articles weekly collaborative model, many disciplines 1

13 Immune System FunctioningIntact skin and mucous membranes block most foreign substances. Two types of responses to invaders Non-specific responses Phagocytosis inflammation Specific Immune system responses T-cells B-cells

14 Nonspecific ResponsesPhagocytosis- the attack of foreign particles by leukocytes Granulocytes release chemicals Macrophages Inflammation- Basically increased blood flow aids in restoration of cells and destruction of invaders

15 Immune system made up of LeukocytesWhite blood cells Produced in the bone marrow but travel to other areas such as spleen, thymus, and lymph nodes. Different ways to measure the immune system function Can learn from experience hence immunity Measurement techniques include lymphocyte blastogensis (proliferation) in response to mitogens such as pokeweed. NK cell function Levels of antibodies levels of interleukins, lymphokines, interferon. communication chemicals When the body has attacked a certain antigen it develops antibodies which can in the future identify the intruder and speed the response. 3

16 Immunity A specific, rapid response to foreign microorganisms based on previous exposure.

17 Vaccination Induced immunityA weakened form of the virus or bacterium introduced into the body to stimulate the production of antibodies.

18 Types of Leukocytes Macrophages (big eaters) engulf and attack microorganisms. B cells (mature in bone marrow) attaches to foreign body and produces an antibody to weaken it. T cells (mature in thymus) directly attack intruder cells. Natural killer cells destroy certain kinds of tumors and virus-infected cells. 4

19 Effects of stress on natural killer cell activitySieber et. al. (1992) Brain, Behavior and Immunity 105 males age 18-26 Diet controlled Stress caused by unpredictable 90 decibel 3000 Hz tone NK levels measured five times 5

20 Natural Killer Cell Activity In stressed and non-stressed adults6

21 Psychological Stress and susceptibility to the common cold.Cohen et al (1991). New England Journal of Medicine 154 men and 266 women All in good health 22% no high school, 51 % h.s. grad, 27% some college 7

22 Procedure Subjects given nasal drops containing a low infectious dose of one of five respiratory viruses. rhinovirus type 2 rhinovirus type 9 rhinovirus type 14 respiratory syncytial virus corona virus type 229 E 8

23 Independent variable: StressThree measures of psychological stress were used Major stressful life events, similar to Holmes and Rahe 10-item Perceived Stress Scale 15-item negative affect scale 9

24 Dependent variables: cold symptoms & infectionsSubject infected if virus detected or significant increase in anti-bodies Subject and physician rating of symptoms Both required for classification as having a clinical cold 10

25 Rates of infection following exposure to cold viruses11

26 Lung metastases in stressed versus non-stressed ratsStress-weight tied to tail, rat placed in tank of warm water. 1 hour after stress rats were injected with tumor cells. 12 days later metastases assessed 12

27 Number of lung metastases as a function of timing of stressTime of stress in relationship to tumor injection. 13

28 Cortisol Hormone released by the sympathetic nervous system.Shifts energy toward increasing blood sugar thus maximizing muscle endurance. Shifts energy away from synthesis of proteins including those essential to the immune system. Suppresses T cell numbers 14

29 Acute stressors and immune functioningGlaser et al. (1985) found decreased mitogen response during exams. Stone et al. (1993) showed reduced response to mitogens in students exposed to 20 minutes of mental tasks. Zakowski (1995) caused decreased mitogen response in subjects by exposing stress involving immersion in cold water. 15

30 Stress Management and Immune FunctioningPsychotherapy and Psychosomatics Sept. 2003 43 Alzheimer caregivers, 27 similar age controls. 8-week Stress Management program resulted in an increased immune response to flu vaccine. Background: Previous research has demonstrated that the psychological morbidity experienced by informal caregivers is associated with increased vulnerability to infectious diseases, in particular influenza. A pragmatic trial was conducted to examine whether a stress management intervention (SMI) could reduce psychological morbidity and enhance the antibody response to influenza vaccination in the elderly, and whether changes in immune response of SMI participants were associated with hypothalamic-pituitary-adrenal (HPA) axis activity. Methods: Forty-three elderly spousal carers of dementia patients and 27 non-carer controls were recruited. Sixteen carers were allocated to an 8-week SMI or a non-intervention condition (n = 27). The non-carers formed a no treatment, 'normal' comparison group. At the end of the SMI or its equivalent time period, all participants received an influenza vaccination. IgG antibody titres to the vaccine were measured 0, 2, 4 and 6 weeks post-vaccine. Results: There was evidence of elevated distress in both carer groups compared with non-carer controls throughout the SMI period, but no between-group differences in salivary cortisol. Immune responses to the vaccine revealed that 50% of SMI carers, 7% of non-intervention carers and 29% of non-carer controls produced a four-fold increase in antibody titre. Conclusions: The immune response to influenza vaccination appears amenable to improvement through stress management, although the mechanisms underlying this effect remain unclear.

31 Chronic stress and immune functioningMcKinnon et al (1989) reported fewer B cells. T cells and NK cells in Three Mile Island residents. Arnetz et al. (1987) found reduced mitogen response in unemployed women in Sweden. Kiecolt-Glaser et al. (1987) demonstrated lower levels of T cells in caregivers of Alzheimer’s patients. 16

32 Caveat Mechanisms not fully understoodThe effect, while present, is often small Research not always consistent Stress doesn’t explain many illnesses Stress may increase your risk of illness but not very much. 17

33 AIDS Acquired immune deficiency syndromeHIV virus attacks the immune system AIDS patients suffer from a variety of opportunistic diseases.

34 Autoimmune diseases When the immune system attack the body.

35 Systemic Lupus erythematosusCurrently we cannot cure lupus. However, lupus can be effectively treated with drugs, and most people with the disease can lead active, healthy lives.

36 Common Symptoms of LupusPainful or swollen joints and muscle pain Unexplained fever Red rashes, most commonly on the face Chest pain upon deep breathing Unusual loss of hair Pale or purple fingers or toes from cold or stress (Raynaud's phenomenon) Sensitivity to the sun Swelling (edema) in legs or around eyes Mouth ulcers Swollen glands Extreme fatigue

37 Causes of lupus Scientists believe that genes alone do not determine who gets lupus and that other factors also play a role. Some of the factors scientists are studying include sunlight, stress, certain drugs, and infectious agents such as viruses.

38 Rheumatoid arthritis Rheumatoid arthritis (rue-ma-TOYD arth-write-tis) is a chronic disease, mainly characterized by inflammation of the lining, or synovium, of the joints. It can lead to long-term joint damage, resulting in chronic pain, loss of function and disability

39 Rheumatoid arthritis RA is a systemic disease, which means it can affect other organs in the body. RA is a chronic disease meaning that it continues indefinitely and may not go away. Studies have shown that early aggressive treatment of RA can limit joint damage.

40 Multiple sclerosis MS is thought to be an autoimmune disease that affects the central nervous system (CNS). The CNS consists of the brain, spinal cord, and the optic nerves.

41 Multiple sclerosis Surrounding and protecting the nerve fibers of the CNS is a fatty tissue called myelin, which helps nerve fibers conduct electrical impulses. In MS, myelin is lost in multiple areas, leaving scar tissue called sclerosis.

42 Multiple sclerosis MS is a chronic, unpredictable neurological disease that affects the central nervous system. MS is not contagious and is not directly inherited. Most people with MS have a normal or near-normal life expectancy. The majority of people with MS do not become severely disabled. There is no cure for MS yet, but drugs can help slow the course and/or symptoms in some patients.

43 Illnesses exacerbated by stressCardiovascular disease Diabetes Asthma Rheumatoid arthritis Headaches Infectious disease

44 Diathesis-stress modelTwo factors necessary to produce illness: A predisposition or diathesis is inherited Presence of environmental stressors

45 Ulcers An example of diathesis-stress where the diathesis is infection by bacterium H. pylori. Most people infected with H. pylori do not develop ulcers

46 Stress is mediated by perceptionPeople can manage stress Stress management programs

47 Stress management Change your body Change your beliefsChange your situation Change your reaction

48 Sleep deprivation People who do not get sufficient sleep often feel tired, anxious, drowsy, weary and fatigued. The number of people effected has been estimated between 30% and 50% of the Population.

49 New York Times Sleep A researcher describes sleep-deprived teenagers as existing in a ''kind of gray cloud.'' ''We just ignore these bad feelings from not enough sleep and get used to it,'' she said. ''We forget what it's like to feel good, and how much more efficiently you can do things.''

50 Lack of Sleep and LearningLack of sleep can interfere with learning: tired students have a hard time paying attention They may forget what they were taught because memory formation takes place partly during sleep. “Also kids with less sleep tend to fall asleep in morning classes, which teachers hate.”

51 The End