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

5. 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.

6. 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.

7. POTENTIAL STRESSOR
OVERWHELMING INTERESTING
CHALLENGE

8. VULNERABILITY AND RESILIENCE
 Stress versus coping
 Coping behavior
Defensive behaviors,
Information-seeking behaviors,
Affiliative behaviors,
All-round problem-solving behaviors.

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

10. THE GENERAL ADAPTATION SYNDROME

12. PHYSIOLOGIC RESPONSES TO STRESSORS
 Disrupts an organism's equilibrium.
 Initiation of physiologic adjustments .
 Acute stress>>>>>>Chronic stress.

13. NEUROTRANSMITTERS RESPONSES TO
STRESS
 Stress >>ANS Catecholamines.
 Chronic stress>>>NE>>>>tolerance but novel stressor.
 Dopamine in mesoprefrontal pathway.
 Glucocorticoids induced 5-HT2-mediated actions .
 Hypothalamus,also Anterior Cingulate Cortex And
Amygdala Glutamatergic,
Dopaminergic, And Serotonergic Systems .
Locus Coeruleus
CRH

14. ENDOCRINE RESPONSES TO STRESS

16. PSYCHONEUROIMMUNOLOGY
 Immune system is also a key player in stress
physiology.
 Innate and specific immunity .

17. 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

18.  Innate and cellular immune responses.
 Humoral response

19. NEUROENDOCRINE AXIS /HPA SYSTEM.
 Cortisol Cellular immune response.
 Circulating blood Lymphoid /peripheral
tissues.
 Immune cells Neuroendocrine peptides
(e.g., Endorphin, ACTH).
cells

20. CENTRAL MODULATION OF IMMUNITY
 Brain exerts control over innate, cellular, humoral
immunity and peripheral immune measures.

21. BEHAVIORAL AND PSYCHOLOGICAL
INFLUENCES ON IMMUNITY
 Behaviours and emotions are capable of altering
immunity.
 Classical conditioning.

22. 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-κB, Inflammatory signaling
pathway.

23. CHRONIC STRESS, DEPRESSION AND
IMMUNITY
 Bereavement,Caregiving, Depression
 Glucocorticoid receptor signaling >>> Cellular and
Innate immunity , Proinflammatory cytokines,
CRP.

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

25. 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

26. CYTOKINE INFLUENCES ON THE CNS AND
BEHAVIOR
The immune system and developmental programming of brain and
behavior, Staci D. Bilbo et al

27. CLINICAL IMPLICATIONS
 Exacerbate the course of many chronic diseases.

28. 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.

30. INFECTIOUS DISEASE RISK
 Viral diseases(EB, Herpes)

31. HUMAN IMMUNODEFICIENCY VIRUS (HIV)
 Depression, bereavement, and maladaptive coping,
homosexuality, socially inhibited introverts.
 Suppressing production of the antiviral cytokines.

32. STRESS, DEPRESSION, AND RHEUMATOID
ARTHRITIS
 Chronic stress>>>IL6 Fatigue, pain,
progression.
 Psychointervention>>> emotional distress.

33. 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.

34. 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.

35. REFERENCE
 Kaplan & Sadock's Comprehensive Textbook of
Psychiatry, 9th Edition.

36. Thank you