E.stress basic 1march13

stress

1. STRESS-BASIC CONCEPTS Dr.Soumitra Das Jr /Psychiatry Chairperson: Prof. Dr.Varghese.P.Punnoose , HOD/Psychiatry

2. What is stress? Stress is our mind and body’s response to a real or imagined threat, event or change . Psychological state associated with physiological and hormonal changes caused by conflict,trauma , or other disruptive influences ( stressors).

3. Stressors Traumatic events outside the usual range of human experience Uncontrollable events Unpredictable events Events that challenge the limits of our capabilities & self-concept Internal conflicts

4. Eustress Eustress or positive stress occurs when our level of stress is high enough to motivate us to move into action to get things accomplished.

5. DISTRESS Distress or negative stress occurs when our level of stress is either too high or too low and our body and/or mind begin to respond negatively to the stressors.

6. POTENTIAL STRESSOR OVERWHELMING INTERESTING CHALLENGE

7. Vulnerability and Resilience Stress versus coping Coping behavior Defensive behaviors, Information-seeking behaviors, Affiliative behaviors, All-round problem-solving behaviors.

8. “All life events, be they positive or negative, impose a demand for adaptation, and that such demands are stressful.”

9. The General Adaptation Syndrome

10. Physiologic Responses to Stressors Disrupts an organism's equilibrium. Initiation of physiologic adjustments . Acute stress>>>>>>Chronic stress.

11. Neurotransmitters Responses to Stress Stress >>ANS Catecholamines. Chronic stress>>>NE>>>>tolerance but novel stressor. Dopamine in mesoprefrontal pathway. Glucocorticoids induced 5-HT 2 -mediated actions . Hypothalamus,also Anterior Cingulate Cortex And Amygdala Glutamatergic, Dopaminergic, And Serotonergic Systems . Locus Coeruleus CRH

12. Endocrine Responses to Stress

13. Psychoneuroimmunology Immune system is also a key player in stress physiology. Innate and specific immunity .

14. Connections between the CNS and immune system Autonomic Nervous System Sympathetic nervous system norepinephrine and neuropeptide Y immune cells. Sympathetic nerves Adrenal gland Epinephrine Immune cells Sympathetic regulatory signals. Immune cells, Antibodies by B cells, Release cytokines. Blood lymphoid organs Blood. NK CELL

15. Innate and cellular immune responses . Humoral response

16. Neuroendocrine Axis / HPA system. Cortisol Cellular immune response. Circulating blood Lymphoid /peripheral tissues. Immune cells Neuroendocrine peptides (e.g., Endorphin, ACTH). cells

17. Central Modulation of Immunity Brain exerts control over innate, cellular, humoral immunity and peripheral immune measures.

18. Behavioral and Psychological Influences on Immunity Behaviours and emotions are capable of altering immunity. Classical conditioning.

19. Acute Stress and Immunity in Humans Redistribution of immunoregulatory cells Acute> Cell mediated immunity, IL6. Elderly , chronic stress>>>> immune responses, Long illness. Depression , Sleep disturbances>>>> Nuclear transcription factor- κ B, Inflammatory signaling pathway.

20. Chronic Stress, Depression and Immunity Bereavement,Caregiving, Depression Glucocorticoid receptor signaling >>> Cellular and Innate immunity , Proinflammatory cytokines, CRP.

21. IMMUNITY RESPONSE DECREASES IMMUNITY RESPONSE INCREASE Stressed, Depressed Traumatic experience Co morbid Alcohol use with Depression CBT Coping Positive personality

22. Sleep, Cytokines, and Immunity Normal sleep>>> NK activity, IL-2, IL-6, transsignaling IL-6R, and a relative shift toward Th1 cytokine expression, which is independent of circadian processes. Sleep loss>> proinflammatory cytokines, AB,IL2,NK cell, production. Impaired sleep or REM >>> Night/Day time IL6. IL-10>>> delta sleep. IL-6 and TNF>>> REM sleep, delta sleep

23. Cytokine Influences on the CNS and Behavior The immune system and developmental programming of brain and behavior, Staci D. Bilbo et al

24. Clinical Implications Exacerbate the course of many chronic diseases.

25. Cardiovascular Disease Depression , Stress are risk factor for Atherosclerosis. Increased IL2,IL6,CRP,Adhesion molecule, Binding of immune cells to Endothelium. Shift to TH2 cytokines.

26. Infectious Disease Risk Viral diseases(EB, Herpes)

27. Human Immunodeficiency Virus (HIV) Depression, bereavement, and maladaptive coping, homosexuality, socially inhibited introverts. Suppressing production of the antiviral cytokines.

28. Stress, Depression, and Rheumatoid Arthritis Chronic stress>>>IL6 Fatigue, pain, progression. Psychointervention>>> emotional distress.

29. Cancer and Psychoneuroimmunology Metastatic spread of NK sensitive tumors and can induce angiogenesis. Intervention>>> Decreased distress, increases in active coping, and increases in NK cytotoxicity.

30. conclusion Stress has definite aspects in neurobiology, neuroimmunology, neuroendocrinology. May be a trigger or response. Both useful and harmful. Not merely cause of all disease but the condition which has temporal neurological connection.

31. Reference Kaplan & Sadock's Comprehensive Textbook of Psychiatry, 9th Edition.

32. Thank you