PSYCHOIMMUNOLOGY

-an emotion to immunity

Dr.M.KANNAN, M.Sc., M.Phil., Ph.D.
Assistant Professor,

Department of Microbiology, V.H.N.S.N.College, Virudhunagar – 626 001

PSYCHOIMMUNOLOGY
• THE CONCEPT of an inter-relationship between immune status and psychologic states can be traced to ancient history. Basic writings of Indian medicine that date back two millennia contain concepts of natural and acquired immunity. • Over the past two decades increasing evidence has supported the hypothesis that psychologic factors play a role in health and the development of illness. Stress, bereavement, affective disorders, and schizophre­nia have all been reported to be associated with immune alterations.

Stress and Illness
• Stress also seems to be linked to physical illness including cardiovascular disorders.

• Stress is linked to: headaches; infectious illness (e.g. ‘flu); cardiovascular disease; diabetes, asthma and rheumatoid arthritis. • High stressed individuals are more than twice as likely to catch a common cold as low stressed individuals.

Overview of Immunology
We all get sick sometimes...but then we get better. What happens when we get sick? Why do we get better?

YOUR ACTIVE IMMUNE DEFENSES

Innate Immunity
- invariant (generalized) - early, limited specificity - the first line of defense

Adaptive Immunity
- variable (custom) - later, highly specific - ‘‘remembers’’ infection

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INNATE IMMUNITY
When you were born, you brought with you several mechanisms to prevent illness. This type of immunity is also called nonspecific immunity. Innate immunity consists of: • Barriers • Cellular response
• phagocytosis • inflammatory reaction • NK (natural killer) and mast cells

• Soluble factors

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INNATE IMMUNITY Barriers
• Physical
• skin • hair • mucous

• Chemical
• • • • • sweat tears saliva stomach acid urine
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INNATE IMMUNITY Cellular response
• nonspecific - the same response works against many pathogens this type of response is the same no matter how often it is triggered the types of cells involved are macrophages, neutrophils, natural killer cells, and mast cells a soluble factor, complement, is also involved
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• •

INNATE IMMUNITY – Soluble factors

• Interferon
• a chemical (cytokine) produced by virus-infected cells that contributes to their death by apoptosis
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• Acute phase proteins
• proteins in the plasma that increase during infection and inflammation • can be used diagnostically to give an indication of acute inflammation

PASSIVE IMMUNITY
While your immune system was developing, you were protected by immune defenses called antibodies. These antibodies traveled across the placenta from the maternal blood to the fetal blood. Antibodies (Y) are also found in breast milk.

The antibodies received through passive immunity last only several weeks.
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Cells of the immune system
Hematopoiesis
• All blood cells arise from a type of cell called the hematopoiesis stem cell(HSC). • Stem cells are cells that can differentiate into other cell types, they are self-renewing- they maintain their population level by cell division. • In humans, hematopoiesis, the formation and development of red blood cells, begins in the embryonic yolk sac during the first weeks of development.
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Hematopoiesis

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Lymphoid cells
• Lymphocytes constitute 20% - 40% of the body’s white blood cells and 99% of the cells in the lymph. • There are approxiamately 1011 (range depending on body size and age: ~1010 – 1012) lymphocytes in the human body. • The lymphocytes can be broadly subdivided into three populations-B-cells, T-cells and null cells-on the basis of function and cell membrane components.
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Lymphocytes
• B-cells mature in bone marrow then concentrate in lymph nodes and spleen • T-cells mature in thymus • B and T cells mature then circulate in the blood and lymph • Circulation ensures they come into contact with pathogens and each other

B -Lymphocytes

Macrophages
• Larger than neutrophils. • Found in the organs, not the blood. • Made in bone marrow as monocytes, called macrophages once they reach organs. • Long lived • Initiate immune responses as they display antigens from the pathogens to the lymphocytes.

NK cells
• In recent years a population of non-B, non-T lymphocytes has been identified. These cells, also known as null or natural killer (NK) cells, attack and destroy tumor cells and virus-infected cells. • In contrast to cytotoxic T cells, which require recognition of specific antigens before activation, NK cell activity does not require prior antigen interaction. • NK cell activity has recently been widely studied as a measure of psychoimmune response.

Organs of the immune system
• A number of morphologically and functionally diverse organs and tissues have various functions in the development of immune responses. • These can be distinguished by function as the primary and secondary lymphoid organs. • The thymus and bone marrow are the primary(or central) lymphoid organs, where maturation of lymphocytes takes place. • The lymph nodes, spleen, and various mucosal-associated lymphoid tissues (MALT) such as gut-associated lymphoid tissue (GALT) are the secondary (or peripheral) lymphoid organs, which trap antigen and provide sites for mature lymphocytes to interact with that antigen.
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ANATOMY OF THE IMMUNE SYSTEM
• Thymus – glandular organ near the heart – where T cells learn their jobs • Bone marrow – blood-producing tissue located inside certain bones
• blood stem cells give rise to all of the different types of blood cells

• Spleen – serves as a filter for the blood
• removes old and damaged red blood cells • removes infectious agents and uses them to activate cells called lymphocytes

• Lymph nodes – small organs that filter out dead cells, antigens, and other “stuff” to present to lymphocytes • Lymphatic vessels – collect fluid (lymph) that has “leaked” out from the blood into the tissues and returns it to circulation

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Organs of the immune system

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How Does Stress Make Us Vulnerable to Disease?
• Stress Diverts energy from the immune system. • It inhibits activities of its B and T lymphocytes and macrophages. • Stress does not cause diseases such as cancer. • It may influence the cancer’s progression.
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LABORATORY STUDIES OF IMMUNE RESPONSE
• In the early literature, peripheral blood smears were examined for abnormalities. • Quantitative studies that have assessed numbers of the various white blood cells or quantitative assessments of immunoglobulin levels were assessed. • Although some attention has been given to measurement of humoral immunity in psychiatric patients, research in recent years has focused predominantly on cell-mediated immunity

• An in vitro lymphocyte stimulation assay was used to measures the proliferative response of either T or B cells to a variety of stimulants. • Lymphocytes are isolated from the blood of subjects and are cultured with these stimulants, or mitogens, to measure levels of activation. • Three mitogens (all plant lectins) are widely used: phytohemagglutinin (PHA) and con- canavalin A (ConA) are predominantly T cell mitogens pokeweed mitogen (PWM) stimu­lates primarily B lymphocytes. • More recently, NK cell activity has been used as a measure of immune response by cytotoxicity assay.

Assessment of Immune-response

Psychological stress and Immunity
Changes in the immune system have been found to accompany
• • • • • • • • • • • pressure to perform at work, at school or in sports threats of physical violence money worries arguments family conflicts divorce bereavement unemployment moving house alcohol or drug abuse. Sometimes, there is no particular reason for developing stress, or it arises out of a series of minor irritations.

Immunological status of medical students during final exams
• Compared to test-free periods, students undergoing exams have showed  Decrements in lymphocyte response to mitogenic stimulation.  Reduced NK cell activity.  Alterations in T-cell populations.  Increased plasma levels of circulating antibodies and  Decreased cytokine production

loss of an intimate relationship from either death or divorce was also been associated with altered immunity
• Including suppression of lymphocyte responses to mitogenic stimulation. • Reduced NK cell activity and changes in T-cell subpopulations. • Early investi­gations found lowered mitogenic lymphocyte proliferation in bereaved subjects following the loss of a spouse, as compared to both non-bereaved controls and the pre- bereavement period • Subsequent findings indicated that the degree of immune change among bereaved per­sons was related to the severity of depressive response before and after the loss.

• Separation and divorce have similarly been associated with immune alterations • Immunological changes accompany other prolonged stressors, like long-term unemployment and occupational stress. • There are now several studies demonstrating immunological alterations following exposure to standardized laboratory stressors, including challenging computer tasks, mental arithmetic, electrical shocks, loud noise, unsolvable puzzles, graphic films depicting combat surgery, marital discussions involving conflict, and inter­views eliciting the recollection of positive and negative experiences and mood states

Stress and Immunity
• The preponderance of the findings appears to suggest that when the individual is confronted with stressful situations, immune cells in the peripheral circulation tend to increase, especially NK cells and CD8 cells. • If the stress is sustained, there may be a decrease in all types of lymphocytes and an associated increase in phagocytes. Generally, the trend is for leukocytes to be functionally less active under stress. • Thus, even though there are more NK cells, they appear to be less cytotoxic, making it possible that the changes (i.e., increased number of cells with decreased activity) simply maintain the prestress competence while mobilizing the leukocyte population.

Research studies have shown that continue exposure to stressors and a chronically activated stress response can have the effect of lowering the immune defense of the human body. This effect is mediated by the response to those stressors of the autonomous nervous system, which causes the endocrine system to secrete hormones such as cortisol and the catecholamines. The individual whose immune system is impaired is more sensitive to the effect of stressful stimuli and is more susceptible to disease.

Health Problems Linked to Stress
• • • • • • • • • • • • • • • • Heart attack Hypertension Stroke Cancer Diabetes Depression Obesity Eating disorders Substance abuse Ulcers Irritable bowel syndrome Memory loss Autoimmune diseases (e.g. lupus) Insomnia Thyroid problems Infertility

Stress - Relax • Exercise and eat regularly • Avoid excess caffeine intake which can increase feelings of anxiety and agitation • Avoid illegal drugs, alcohol and tobacco • Learn relaxation exercises (abdominal breathing and muscle relaxation techniques) • Learn practical coping skills. For example, break a large task into smaller, more attainable tasks • Decrease negative self talk: challenge negative thoughts about yourself with alternative neutral or positive thoughts. "My life will never get better” can be transformed into "I may

• Relax - Each person has her own way to relax. Some ways include deep breathing, yoga, meditation, and massage therapy. If you can’t do these things, take a few minutes to sit, listen to soothing music, or read a book. • Make time for yourself. It’s important to care for yourself. Think of this as an order from your doctor, so you don’t feel guilty! No matter how busy you are, you can try to set aside at least 15 minutes each day in your schedule to do something for yourself, like taking a bubble bath, going for a walk, or calling a friend. • Sleep. Sleeping is a great way to help both your body and mind. Your stress could get worse if you don’t get enough sleep. You also can’t fight off sickness as well when you sleep poorly. With enough sleep, you can tackle your problems better and lower your risk for illness. Try to get seven to nine hours of sleep every night. • Eat right. Try to fuel up with fruits, vegetables, and proteins. Good sources of protein can be peanut butter, chicken, or tuna salad. Eat whole-grains, such as wheat breads and wheat crackers.

What activities or things could help people to relax? • Listening to music • Playing with a pet • Laughing or crying • Going out with a friend (shopping, movie, dining) • Taking a bath or shower • Writing, painting, or other creative activity • Praying or going to church • Exercising or getting outdoors to enjoy nature • Discussing situations with a spouse or close friend • Gardening or making home repairs • Practicing deep breathing, meditation, or muscle relaxation

A Truth for Health

“Peoples’ health should be no worse at the end of a working day than it was at the start”
M.J. Harrington (1997)

A Truth for Health

“People who work sitting down get paid more than people who work standing up”
Ogden Nash (1902 - 1971)

Discussion

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