1. Psychoneuroimmunology (PNI)
    • Mind, brain, and immune system are connected
    • Mind can somewhat heal virally induced infections (i.e. warts)
  2. Stress physiology
    • Stressor - very individualized
    • Most of time stress is a useful, good response
    • There are negative feedback loops that turn the stress off
    • HPA (hypothalamus-pituitary adrenal cortex) - more likely to be active during chronic stress; incr cortisol levels in stress and depression
    • SNS - fight or flight response; epinephrine
    • PNS - opposes SNS; involved w/ release of oxytocin
  3. Classes of Stress
    • Acute stress - activation of immune system EX: Near car accident
    • Chronic stress - suppression of immune system EX: Chronic sadness
    • Reactivity - react to environment EX: pop quiz
  4. Physical vs. Psychological Stress
    • Top-down stress activation - self talk about what is going on; threats vs. challenges; negative vs. positive
    • Bottom-up stress activation - outside things that cause brain to react w/ stress response

    Classes of stress responses - defense vs. defeat (often leads to learned helplessness)

    Learned helplessness - learn that you can't change anything; hopeless
  5. Social interactions
    • Most positive social interactions seem to buffer stress and even improve immune function when stressed
    • Negative life events produce their strongest effect on health when social support is low
    • Marriage benefit - those who marry even if get divorced, live longer than single people
    • It is the perception not the actual amount or type of social support that makes a difference
  6. Personality Types
    • Type A - time driven, can't wait, hostile, multi-tasker, talk fast
    • Type B - relaxed, easy-going, lack sense of urgency, disengaged
    • Type C - more likely to get autoimmune disease or cancer, won't allow themselves to feel emotion
  7. Humor
    Laughter decreases cortisol and improves immunity
  8. Exercise
    • Can be a stress buffer
    • For those who like to exercise it improves immune function
    • Elite athletes immune system suffers and they appear to be chronically stressed
    • Older people who rate themselves as physically active have better health (fewer infections) and improved immune function
  9. Depression
    • Known relationship with depression and poor health
    • Pt's with CV disease who are depressed have two times the mortality
    • Sleep disturbances in depression may contribute to mortality and may be through immune mechanisms
    • CRH brain levels incr in depression
    • Brain regulation of peripheral immunity through CRH mediated regulatory autonomic nervous system pathways
    • HPA is dysregulated in depression (hypercortisol)
    • Vegetative symptoms of depression are similar to the behaviors assoc with sickness (fatigue, social isolation, decr appetite, lack of interest)
    • Antidepressant drugs decr pro-inflammatory cytokine expression
    • Other influences: smoking, alcohol, lack of exercise, sleep disturbances
  10. Cytokine hypothesis
    • CNS responds to peripheral blood levels of cytokines
    • Cytokines do not appear to be able to cross blood brain barrier
    • Cytokines in blood may produce a corresponding incr in neurological synthesis of cytokines and changes firing in certain parts of brain
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