Stress and DiseaseStress and Disease

Chapter 10Chapter 10

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StressStress A person experiences stress when a demand A person experiences stress when a demand

exceeds a person’s coping abilities, resulting exceeds a person’s coping abilities, resulting in reactions such as disturbances of in reactions such as disturbances of cognition, emotion, and behavior that can cognition, emotion, and behavior that can adversely affect well-beingadversely affect well-being

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Dr. Hans SelyeDr. Hans Selye Worked to discover a new sex hormoneWorked to discover a new sex hormone Injected ovarian extracts into ratsInjected ovarian extracts into rats Witnessed:Witnessed:

Enlargement of the adrenal cortexEnlargement of the adrenal cortex Thymic atrophyThymic atrophy Development of bleeding ulcers in the stomach Development of bleeding ulcers in the stomach

and duodenal liningand duodenal lining Dr. Selye witnessed these changes with Dr. Selye witnessed these changes with

many agents. He called these stimuli many agents. He called these stimuli “stressors.”“stressors.”

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General Adaptation Syndrome General Adaptation Syndrome (a Nonspecific Response)(a Nonspecific Response)

Selye termed this general response the Selye termed this general response the general adaptation syndrome (GAS)general adaptation syndrome (GAS)

Three stagesThree stages Alarm stageAlarm stage

• Arousal of body defensesArousal of body defenses Stage of resistance or adaptationStage of resistance or adaptation

• Mobilization contributes to fight or flightMobilization contributes to fight or flight Stage of exhaustionStage of exhaustion

• Progressive breakdown of compensatory mechanismsProgressive breakdown of compensatory mechanisms

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GAS ActivationGAS Activation Alarm stageAlarm stage

Stressor triggers the hypothalamic-pituitary-Stressor triggers the hypothalamic-pituitary-adrenal (HPA) axisadrenal (HPA) axis• Activates sympathetic nervous systemActivates sympathetic nervous system

Resistance stageResistance stage Begins with the actions of adrenal hormonesBegins with the actions of adrenal hormones

• Cortisol, epinephrine, norepinephrineCortisol, epinephrine, norepinephrine

Exhaustion stageExhaustion stage Occurs only if stress continues and adaptation is Occurs only if stress continues and adaptation is

not successfulnot successful• Onset of diseaseOnset of disease

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Psychologic MediatorsPsychologic Mediators Reactive responseReactive response

To psychologic stressorsTo psychologic stressors Anticipatory responseAnticipatory response

Anticipating a disruption in homeostasisAnticipating a disruption in homeostasis Conditional responseConditional response

Associating a stimuli with dangerAssociating a stimuli with danger Posttraumatic stress disorder (PTSD)Posttraumatic stress disorder (PTSD)

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StressorsStressors Anything that demands a response in order to Anything that demands a response in order to

maintain homeostasismaintain homeostasis NoxiousNoxious

• Pain, cold, trauma, hunger, electric shock Pain, cold, trauma, hunger, electric shock

Not noxiousNot noxious• Life events (wedding)Life events (wedding)

• Excitement Excitement

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Stress and DiseaseStress and Disease Can precipitate diseaseCan precipitate disease

CardiacCardiac Can worsen existing diseaseCan worsen existing disease

Irritable bowel diseaseIrritable bowel disease AsthmaAsthma Autoimmune diseasesAutoimmune diseases HIV progressionHIV progression

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Psychoneuroimmunologic Psychoneuroimmunologic MediatorsMediators

Interactions of consciousness, the brain and Interactions of consciousness, the brain and spinal cord, and the body’s defense spinal cord, and the body’s defense mechanismsmechanisms

Corticotropin-releasing hormone (CRH) is Corticotropin-releasing hormone (CRH) is released from the hypothalamusreleased from the hypothalamus

CRH also released peripherally at CRH also released peripherally at inflammatory sitesinflammatory sites

Immune modulation by psychosocial Immune modulation by psychosocial stressors leads directly to health outcomesstressors leads directly to health outcomes

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Stress Response Stress Response (Neural Recognition)(Neural Recognition)

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Central Stress ResponseCentral Stress Response CatecholaminesCatecholamines

Released from chromaffin cells of the adrenal Released from chromaffin cells of the adrenal medullamedulla• Large amounts of epinephrine; small amounts of Large amounts of epinephrine; small amounts of

norepinephrinenorepinephrine αα-adrenergic receptors-adrenergic receptors

• αα11 and and αα22

ββ-adrenergic receptors-adrenergic receptors• ββ11 and and ββ22

Mimic direct sympathetic stimulationMimic direct sympathetic stimulation

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Central Stress ResponseCentral Stress Response Cortisol (hydrocortisone)Cortisol (hydrocortisone)

Activated by adrenocorticotropic hormone (ACTH)Activated by adrenocorticotropic hormone (ACTH) Stimulates gluconeogenesisStimulates gluconeogenesis Elevates the blood glucose levelElevates the blood glucose level Protein anabolic effect in the liver; catabolic effect in Protein anabolic effect in the liver; catabolic effect in

other tissuesother tissues Lipolytic in some areas of the body, lipogenic in othersLipolytic in some areas of the body, lipogenic in others Powerful anti-inflammatory or immunosuppressive Powerful anti-inflammatory or immunosuppressive

agentagent

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Emerging ResearchEmerging Research Glucocorticoids, insulin, inflammationGlucocorticoids, insulin, inflammation Link to obesityLink to obesity Link to Type 2 diabetesLink to Type 2 diabetes

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Stress and ImmunityStress and Immunity T helper 1 to T helper 2 shift (Th1 to Th2)T helper 1 to T helper 2 shift (Th1 to Th2)

Decrease in cellular immunityDecrease in cellular immunity Increase in humoral immunityIncrease in humoral immunity

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Central Stress ResponseCentral Stress Response

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PsychoneuroimmunologyPsychoneuroimmunology Interaction of factorsInteraction of factors

PsychologicPsychologic NeurologicNeurologic ImmunologicImmunologic

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Stress-Induced Hormone Stress-Induced Hormone AlterationsAlterations

Female reproductive systemFemale reproductive system Cortisol exerts inhibiting effects by suppressing Cortisol exerts inhibiting effects by suppressing

the release of luteinizing hormone, estradiol, and the release of luteinizing hormone, estradiol, and progesteroneprogesterone

Stress suppresses hypothalamic gonadotropin-Stress suppresses hypothalamic gonadotropin-releasing hormonereleasing hormone

Estrogen stimulates the HPA axisEstrogen stimulates the HPA axis

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Stress-Induced Hormone Stress-Induced Hormone AlterationsAlterations

Endorphins and enkephalinsEndorphins and enkephalins Proteins found in the brain that have pain-relieving Proteins found in the brain that have pain-relieving

capabilitiescapabilities In a number of conditions, individuals not only In a number of conditions, individuals not only

experience insensitivity to pain but also increased experience insensitivity to pain but also increased feelings of excitement, positive well-being, and feelings of excitement, positive well-being, and euphoria euphoria

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Stress-Induced Hormone Stress-Induced Hormone AlterationsAlterations

Growth hormone (somatotropin)Growth hormone (somatotropin) Produced by anterior pituitary, lymphocytes, and Produced by anterior pituitary, lymphocytes, and

mononuclear phagocytic cellsmononuclear phagocytic cells Affects protein, lipid, and carbohydrate metabolism Affects protein, lipid, and carbohydrate metabolism

and counters the effects of insulin and counters the effects of insulin Enhances immune functionEnhances immune function

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Stress-Induced Hormone Stress-Induced Hormone AlterationsAlterations

ProlactinProlactin Released from the anterior pituitaryReleased from the anterior pituitary Needed for lactation and breast developmentNeeded for lactation and breast development Prolactin levels in the plasma increase as a result Prolactin levels in the plasma increase as a result

of stressful stimuliof stressful stimuli OxytocinOxytocin

Produced by the hypothalamusProduced by the hypothalamus Produced during orgasm in both sexesProduced during orgasm in both sexes May promote reduced anxietyMay promote reduced anxiety

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Stress-Induced Hormone Stress-Induced Hormone AlterationsAlterations

TestosteroneTestosterone Secreted by Leydig cellsSecreted by Leydig cells Regulates male secondary sex characteristics and Regulates male secondary sex characteristics and

libidolibido Testosterone levels decrease due to stressful Testosterone levels decrease due to stressful

stimulistimuli

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Stress, Personality, Stress, Personality, Coping, and IllnessCoping, and Illness

A stressor for one person may not be a stressor A stressor for one person may not be a stressor for anotherfor another

Psychologic distressPsychologic distress General state of unpleasant arousal after life events General state of unpleasant arousal after life events

that manifests as physiologic, emotional, cognitive, that manifests as physiologic, emotional, cognitive, and behavior changesand behavior changes

CopingCoping Managing stressful demands and challenges that are Managing stressful demands and challenges that are

appraised as taxing or exceeding the resources of the appraised as taxing or exceeding the resources of the personperson

Link to coronary heart diseaseLink to coronary heart disease

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Stress, Personality, Coping, and Stress, Personality, Coping, and IllnessIllness

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Aging and StressAging and Stress

Stress-age syndromeStress-age syndrome Excitability changes in the limbic system and Excitability changes in the limbic system and

hypothalamushypothalamus Increased catecholamines, ADH, ACTH, and cortisolIncreased catecholamines, ADH, ACTH, and cortisol Decreased testosterone, thyroxine, and other Decreased testosterone, thyroxine, and other

hormoneshormones Alterations of opioid peptides Alterations of opioid peptides ImmunodepressionImmunodepression Alterations in lipoproteinsAlterations in lipoproteins Hypercoagulation of the bloodHypercoagulation of the blood Free radical damage of cellsFree radical damage of cells