Chapter_010.ppt
Download
Report
Transcript Chapter_010.ppt
Chapter 10
Stress and Disease
Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
Stress
A person experiences stress when a demand
exceeds a person’s coping abilities, resulting
in reactions such as disturbances of
cognition, emotion, and behavior that can
adversely affect well-being
Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
2
Dr. Hans Selye
Worked to discover a new sex hormone
Injected ovarian extracts into rats
Witnessed:
Enlargement of the adrenal cortex
Thymic atrophy
Development of bleeding ulcers in the stomach
and duodenal lining
Dr. Selye witnessed these changes with many
agents. He called these stimuli “stressors.”
Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
3
General Adaptation Syndrome
(a Nonspecific Response)
Selye termed this general response the
general adaptation syndrome (GAS)
Three stages
Alarm stage
• Arousal of body defenses
Stage of resistance or adaptation
• Mobilization contributes to fight or flight
Stage of exhaustion
• Progressive breakdown of compensatory mechanisms
Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
4
GAS Activation
Alarm stage
Resistance stage
Stressor triggers the hypothalamic-pituitaryadrenal (HPA) axis
• Activates sympathetic nervous system
Begins with the actions of adrenal hormones
• Cortisol, epinephrine, norepinephrine
Exhaustion stage
Occurs only if stress continues and adaptation is
not successful
• Onset of disease
Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
5
Psychologic Mediators
Reactive response
Anticipatory response
To psychologic stressors
Anticipating a disruption in homeostasis
Conditional response
Associating a stimuli with danger
Posttraumatic stress disorder (PTSD)
Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
6
Stressors
Anything that demands a response in order to
maintain homeostasis
Noxious
• Pain, cold, trauma, hunger, electric shock
Not noxious
• Life events (wedding)
• Excitement
Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
7
Stress and Disease
Can precipitate disease
Cardiac
Can worsen existing disease
Irritable bowel disease
Asthma
Autoimmune diseases
HIV progression
Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
8
Psychoneuroimmunologic
Mediators
Interactions of consciousness, the brain and
spinal cord, and the body’s defense
mechanisms
Corticotropin-releasing hormone (CRH) is
released from the hypothalamus
CRH also released peripherally at
inflammatory sites
Immune modulation by psychosocial
stressors leads directly to health outcomes
Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
9
Stress Response
(Neural Recognition)
Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
10
Central Stress Response
Catecholamines
Released from chromaffin cells of the adrenal
medulla
• Large amounts of epinephrine; small amounts of
norepinephrine
α-adrenergic receptors
• α1 and α2
β-adrenergic receptors
• β1 and β2
Mimic direct sympathetic stimulation
Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
11
Central Stress Response
Cortisol (hydrocortisone)
Activated by adrenocorticotropic hormone (ACTH)
Stimulates gluconeogenesis
Elevates the blood glucose level
Protein anabolic effect in the liver; catabolic effect in
other tissues
Lipolytic in some areas of the body, lipogenic in others
Powerful anti-inflammatory or immunosuppressive
agent
Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
12
Emerging Research
Glucocorticoids, insulin, inflammation
Link to obesity
Link to Type 2 diabetes
Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
13
Stress and Immunity
T helper 1 to T helper 2 shift (Th1 to Th2)
Decrease in cellular immunity
Increase in humoral immunity
Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
14
Central Stress Response
Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
15
Psychoneuroimmunology
Interaction of factors
Psychologic
Neurologic
Immunologic
Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
16
Stress-Induced Hormone
Alterations
Female reproductive system
Cortisol exerts inhibiting effects by suppressing
the release of luteinizing hormone, estradiol, and
progesterone
Stress suppresses hypothalamic gonadotropinreleasing hormone
Estrogen stimulates the HPA axis
Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
17
Stress-Induced Hormone
Alterations
Endorphins and enkephalins
Proteins found in the brain that have pain-relieving
capabilities
In a number of conditions, individuals not only
experience insensitivity to pain but also increased
feelings of excitement, positive well-being, and
euphoria
Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
18
Stress-Induced Hormone
Alterations
Growth hormone (somatotropin)
Produced by anterior pituitary, lymphocytes, and
mononuclear phagocytic cells
Affects protein, lipid, and carbohydrate metabolism
and counters the effects of insulin
Enhances immune function
Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
19
Stress-Induced Hormone
Alterations
Prolactin
Released from the anterior pituitary
Needed for lactation and breast development
Prolactin levels in the plasma increase as a result
of stressful stimuli
Oxytocin
Produced by the hypothalamus
Produced during orgasm in both sexes
May promote reduced anxiety
Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
20
Stress-Induced Hormone
Alterations
Testosterone
Secreted by Leydig cells
Regulates male secondary sex characteristics and
libido
Testosterone levels decrease due to stressful
stimuli
Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
21
Stress, Personality,
Coping, and Illness
A stressor for one person may not be a
stressor for another
Psychologic distress
Coping
General state of unpleasant arousal after life
events that manifests as physiologic, emotional,
cognitive, and behavior changes
Managing stressful demands and challenges that
are appraised as taxing or exceeding the
resources of the person
Link to coronary heart disease
Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
22
Stress, Personality, Coping, and
Illness
Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
23
Aging and Stress
Stress-age syndrome
Excitability changes in the limbic system and
hypothalamus
Increased catecholamines, ADH, ACTH, and cortisol
Decreased testosterone, thyroxine, and other
hormones
Alterations of opioid peptides
Immunodepression
Alterations in lipoproteins
Hypercoagulation of the blood
Free radical damage of cells
Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
24