Download Chapter 14 - Dr. Saadia McLeod

Chapter
Fourteen:
Psychoneuroimmunology and
ImmuneRelated
Disorders
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•Psychoneuroimmunology
•HIV infection and AIDS
•Cancer
•Arthritis
•Type I diabetes
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Education.
•Interactions among different processes of
adaptation
• Behavioral
• Neuroendocrine
• Immunological
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•Functions
• Distinguishes between what is self and what is
foreign
• Attacks and rids the body of foreign invaders
•Natural immunity - Generalized defense
against pathogens
•Specific immunity - Delayed response to a
specific invader
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•Assessing the functioning of immune cells
•Assessing the production of antibodies to
latent viruses
•Assessing levels of immune system products
•Using indirect measures
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•Principles
• Different kinds of stressors require different
kinds of defenses
• Maximally efficient immune response to any
situation entails costs
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•Immediate short-term stressors produce a
pattern of immune responses
•Brief stressors lead to a shift from cellular
immunity and toward humoral immunity
•Chronically stressful events have adverse
effects
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•Increased vulnerability to infectious disease
•Stress predicts more severe illness and higher
production of cytokines among people who
are already sick
•Autoimmune disorders are affected by stress
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•Stress compromises immune functioning
•Depression is associated with:
• Decrease in cellular immunity
• Prolonged inflammatory responses
• Delayed wound healing
• Sleep disturbance
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•Lonely people have poorer health and
immunocompromise
•People with insecure attachments to others
show lower NK cell cytotoxicity
•Chronic interpersonal stress predicts
inflammatory activity
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Marital disruption and conflict
• Separated and divorced women show poorer immune
functioning
• Partner violence has been tied to adverse changes in
immune functioning
• Risks are higher for women than for men
Caregiving
• Stressful for people who provide care for a friend or
family member with a long-term illness
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•Protective effects of psychosocial resources
• Social support can buffer against adverse
immune change in response to stress
• Resources like finances limit deterioration in
immune functioning
•Optimism
• Important influence on stress-related distress
and immune changes
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•Personal control/benefit finding
• People considering stressors as uncontrollable
show adverse immune effects
• Factors responsible for beneficial effects on
immune functioning
• Prioritizing goals
• Emphasizing relationships, personal growth, and
meaning in life
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•Relaxation
• Mutes the effects of stress on the immune
system
• Interventions have significant effects on the
immune system and on health outcomes
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•Acquired immune deficiency syndrome
(AIDS): Spread due to the high rate of
extramarital sex, lack of condom use, and
high rate of gonorrhea
•Human immunodeficiency virus (HIV):
Attacks the helper T cells and macrophages
of the immune system
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•Rapid growth in the first few weeks
• Infection spreads throughout the body
•After 3 to 6 weeks viral growth is gradual
• Compromises the immune system by killing
the helper T cells
• Creates a vulnerability to opportunistic
infections
• Leads to the diagnosis of AIDS
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•Combination of antiretroviral medications
•Reduces sexual transmission if initiated
earlier
•Drugs need to be taken regularly to be
effective
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•Depression, bereavement, and thoughts of
suicide
•Stigma associated with AIDS
• Negative reaction toward people with AIDS
• Interventions that reduce depression are
beneficial
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•Nondisclosure is the major barrier to
controlling spread of HIV
•People with strong social support networks
are more likely to disclose
•Benefits of disclosure
• Receiving social support
• Positive health consequences
• More CD4 cells and helper cells than nondisclosers
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14-19
•Majority of women depend on social services
and Medicaid to survive
• Resulting depression can worsens the disease
•Many women make drastic changes to their
lives to make it better
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•Center around:
• Getting tested
• Refraining from high-risk sex
• Using a condom
• Not sharing needles
•Role of education
• Educating the target population about risky
activity
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• Providing information about HIV infection and
modes of transmission
• Addressing false beliefs
• Effective means of secondary prevention for
HIV+ individuals
• Culturally sensitive interventions fare better
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•Sexual negotiation skills
• Important in interventions with high risk
groups
• Focus interventions on building self-efficacy
for practicing safe sex
• Increase motivation for at-risk groups to
change their risk-related behavior
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•Developed for adolescents to:
• Warn about the risks of unprotected sexual
intercourse
• Help instill safe-sex practices
•Stage model of behavior change - Guides
interventions to increase safe-sex practices
•Interventions that address the norms
surrounding sexual activity are needed
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•Guiding framework for many interventions
•Can be directed to health behaviors
•Reduce risk-related sexual behavior
•Maintain adherence
•Reduce viral load
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•Factors that hinder
• Stress and use of alcohol
• Practical problems related to poverty
•Factors that contribute
• Psychosocial resources
• Motivational training
• Interventions that enhance social support
• Text messaging
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•Changing sexual activity
•Reducing risky injection practices
• Information about AIDS transmission
• Needle exchange programs
• Instruction on how to sterilize needles
•Methadone maintenance treatments coupled
with HIV-related education reduces the
spread of AIDS
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•Coping skills
• Coping effectiveness training
• Perceiving that one has control over a stressor
• Written disclosure
•Social support
• Tied to greater adherence and lower viral load
• Support from family helps prevent depression
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Factors that increase disease progression
•
•
•
•
•
Negative beliefs about the self and the future
Depression
Stress
Trauma
Psychological inhibition
Factors that decrease disease progression
•
•
•
•
•
Optimism
Active coping
Extraversion
Conscientiousness
Spirituality
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• Result from a dysfunction in DNA
• DNA - Part of the cellular programming that
controls cell growth and reproduction
•Interventions help reduce risk factors and
improve coping
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•Causes, symptoms, and treatment for each
cancer vary
•Many cancers have long or irregular growth
cycles
•It may be difficult to identify precipitating or
co-occurring risk factors
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Genetic
composition
Ethnicity
Culture and
lifestyle
Socioeconomic
status
Marital status
Dietary factors
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•Particular type of stress may affect the onset
and course of cancer
•Absence of close family ties in childhood
predicts some cancers
•Absence of a current social support network
worsens the course of illness
•Women who are socially isolated are at
greater risk of dying
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•Avoidance has been tied to a more rapid
course of the disease
•Depression can progress and exacerbate the
impact of other risk factors
•Progression may be related to use of denial
or repressive coping strategies
•Altered functioning of the HPA and
sympathetic stress systems permit cancer to
flourish
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•Coping with physical limitations
• Stem from the pain and discomfort
• Fatigue and compromised nutrition
•Treatment-related problems
• Removal of organs in surgical treatment
• Side effects of chemotherapy
• Nutrition therapy is recommended
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•Interventions involving stress
• Stress aggravates all illnesses and cancers
•Issues involving social support
• Strong marital relationship is important
• Young children may show fear or distress
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•Some patients report that they experience
growth for satisfaction in personal
relationships
•May mute neuroendocrine stress responses
• Having a beneficial effect on the immune
system
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•Cognitive-behavioral approaches to cancerrelated problems are vital
•Mindfulness-based stress reduction
interventions help
•Major target is improving health behaviors
•Writing interventions result in fewer
symptoms and fewer medical appointments
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Individual therapy
• Focus on the specific issues faced by the patient
Family therapy
• Emotional support from family
Support groups
• Patients share emotional concerns
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•Affects the small joints of the hands and
feet, wrists, knees, ankles, and neck
•Brought on by an autoimmune process
•Main complications are pain, limitations in
activities, and dependency
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•Stress
• Plays a role in development and aggravation
• Role of the spouse is critical to successful
disease management
•Treatment
• Aspirin, rest, and supervised exercise
• Cognitive-behavioral interventions
• Mindfulness interventions
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•Articular cartilage begins to crack or wear
away because of overuse, injury, or other
causes
• Affects the weight-bearing joints
•Causes depression elevating pain and distress
•Treatment - Keeping one’s weight down and
taking aspirin or pain killers
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•Autoimmune disorder characterized by the
abrupt onset of symptoms
•Results from lack of insulin production by the
beta cells of the pancreas
•May appear following viral infection and
probably has a genetic contribution
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•Frequent urination and unusual thirst
•Excessive fluid consumption and fatigue
•Weight loss, weakness, irritability, nausea
•Uncontrollable craving for food
•Fainting
•Result in a coma if untreated
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•Glucose levels should be monitored and
action should be taken if required
•Active involvement of the patient to the
treatment process is essential to success
• Regular insulin injections
• Dietary control
• Weight control and exercise
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•Low
• Severe complications not evident for 15-20
years
• Failing to self-monitor blood glucose level
•Active coping strategies helps managing the
disease
•Improves when patients and their physicians
share treatment goals
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•Restrictions inconsistent with development
are imposed
•May be stigmatized from peers
•Parents might:
• Infantilize adolescents
• Convince the child that he or she is normal
•Psychologists and interventions can help
improve adjustment and adherence
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