Introduction to Psychoneuroimmunology Definition - History - Health and Disease Concepts

Why do people decide to become doctors ?

• to treat health problems

• to keep people healthy

Because they care!

Is it possible?

Dilemmas in diagnosis have plagued medicine since its inception:

a compromised diagnostic

compromises treatment

diagnose improvement

enhanced treatment

Traditional view(still held my many scientists)

• the illness appears when the immune system(considered to be autonomous!)

has broken down

Most physicians treat the body:

the organ or the function

Traditional view(still held my many scientists)

• most psychotherapists follow the cognitive-behavior paradigm

treat the mind as something separated from the body

These old views are becoming less legitimate

Our moods, emotions, behavior, brainwaves, and over all, our minds

directly affect our health and longevity

we need to accept the integration of body - mind therapies

the body and mind are in a powerful connection!

because it’s becoming very clear that

• Psychoneuroimmunology (PNI)

= scientific discipline - multidisciplinary field - rapidly expanding

Role – to elucidate the complex processes that underlie health

It was time that a new science appeared:

• Google search 349 000 results in 0,37 sec

• Pubmed 1261 articles

• the last decade the no. of scientific papers using the term ‘PSYCHONEUROIMMUNOLOGY’ has more than doubled.

Psychoneuroimmunology

Definitions

= a discipline that studies the relationships between psychologic states and the immune response. (Mosby's Medical Dictionary, 8th edition. © 2009, Elsevier)

= the study of the effects of the mental and neurological status on the immune system. (McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.)

= the study of the interactions between psychological factors, the central nervous system, and immune function as modulated by the neuroendocrine system. (Dorland's Medical Dictionary for Health Consumers. © 2007 by Saunders, an imprint of Elsevier, Inc. All rights reserved.)

= the study of the integrated interactions of the immunologic, neurologic and psychologic systems and their effects on health. (Jonas: Mosby's Dictionary of Complementary and Alternative Medicine. (c) 2005, Elsevier.)

Wikipedia definition

Psychoneuroimmunology (PNI) is the study of the interaction between psychological processes and the nervous and immune systems of the human body. PNI takes an interdisciplinary approach, incorporating psychology, neuroscience, immunology, physiology, pharmacology, molecular biology, psychiatry, behavioral medicine, infectious diseases, endocrinology, and rheumatology.

The main interests of PNI are the interactions between the nervous and immune systems and the relationships between mental processes and health.

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Wikipedia definition - continuation

PNI studies, among other things, the physiological functioning of the neuroimmune system in health and disease; disorders of the neuroimmune system (autoimmune diseases; hypersensitivities; immune deficiency); and the physical, chemical and physiological characteristics of the components of the neuroimmune system in vitro, in situ, and in vivo.

PNI may also be referred to as psychoendoneuroimmunology (PENI).

“

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Psychosomatic medicine – a connect term of PNI

= an interdisciplinary medical field studying the relationships of social psychological behavioral factors on bodily processes and quality of life.

Psychosomatic medicine is considered a subspecialty of

the fields of psychiatry and neurology. Psychosomatic disorders ▶▶▶ medical treatments + psychotherapy

Mind-Body Medicine - History

• always has been controversy over the mind - body connection

• the history induces → the dichotomy eastern - western medical cultures

Chinese medicine:▶ certain organs of the body represent various mental or emotional conditions▶ a lot of connections are made to nature, through energy meridian lines and hands on manipulation (acupressure)

Stress, the immune system and vulnerability to degenerative disorders of the central nervous system in transgenic mice expressing glucocorticoid receptor antisense RNABianca Marchetti et al.Brain Research Rew., 2001

History

Hippocrates Galen

First references to the mind-body connection ▶▶▶ Hippocrates and Galen

The imbalances in emotions and passions, and their translations as physical illnesses.

History

Lord Chesterfield

1694 - 1773

I find, by experience, that the mind and the body are more than married, for they are most intimately united; and when one suffers, the other sympathizes.

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1596 - 1650

History

René Descartes

Descartes’ mind-body dualism

The start of a breakdown of the relationship between mind and body.

1813 - 1878

History

Claude Bernard

mid 1800s - founded the concept millieu intérieur

… there are protective functions of organic elements holding living materials in reserve and maintaining without interruption humidity, heat and other conditions indispensable to vital activity. Sickness and death are only a dislocation or perturbation of that mechanism.

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”(Bernard, 1865)

1856 - 1939

History

Sigmund Freud

XIX th century - physicians believed that all diseases were the result of some sort of anatomical abnormality

Freud - developed psychoanalysis trying to explain the cause of illness which could not be traced to anatomical sources

1871 - 1945

Walter Cannon

History

1932 - used the term homeostasis (gr. Homoios = similar Stasis = position )

Cannon’s observations: - any change of emotional state in the beast, such as anxiety, distress, or rage was accompanied by total cessation of movements of the stomach Bodily Changes in Pain, Hunger, Fear and Rage, 1915

- these studies into the relationship between the effects of emotions and perceptions on the autonomic nervous system, namely the sympathetic and parasympathetic responses that initiated the recognition of the freeze, fight, or flight response The Mechanical Factors of Digestion, 1911

Walter Cannon

Cannon’s homeostatic theory stimulated new interest in the relationship between affect, physiology and health, fostering the emergence of two schools:

“psychosomatic medicine”= approached discrete

emotions from the psychoanalytic paradigm

Franz Alexander, in the 1920s and 1930s, was its main theoretician

Focuses on biological processes rather than on discrete emotions and is represented by Hans Selye, who introduced the concept of stress as a general adaptation syndrome that organisms develop in order to survive.

1 2

1907 - 1982

History

Hans Selye

▶▶▶ normal psychological stressors and biogenic stressors increase the action of the neuroendocrine hypothalamic-pituitary-adrenal axis

increasing the levels of hormones such are glucocorticoids (like cortisol)

lowering the proliferation of immune cells

Brain-body pathways in stress

Stress

Pituitary gland Hypothalamus

Adrenocorticotropichormone (ACTH)

Adrenal cortex

Secretion of corticosteroids

Increased protein and fat mobilizationIncreased access to energy storageDecreased inflammation

Autonomic nervous system (sympathetic division)

Adrenal medulla

Secretion of catecholamines

Increased cardiovascular responseIncreased respirationIncreased perspirationIncreased blood flow to active musclesIncreased muscle strengthIncreased mental activity

General Adaptation Syndrome

▶ initial brief alarm reaction ▶ prolonged period of resistance ▶ terminal stage of exhaustion and death

1931 - 2001

History

George Freeman Solomon

1964 - coined the term "psychoimmunology"

published a landmark paper: "Emotions, immunity, and disease: a speculative theoretical integration."

Freeman et al., Phillips et al., Vaughan et al. - mid XXth century studies of psychiatric patients: → immune alterations in psychotic patients, including numbers of lymphocytes and poorer antibody response to pertussis vaccination, compared with non-psychiatric control subjectsFreeman H, Elmadjian F. The relationship between blood sugar and lymphocyte levels in normal and psychotic subjects. Psychosom Med 1947; 9: 226–33. Phillips L, Elmadjian F. A Rorschach tension score and the diurnal lymphocyte curve in psychotic subjects. Psychosom Med 1947; 9: 364–71Vaughan WTJ, Sullivan JC, Elmadjian F. Immunity and schizophrenia. Psychosom Med 1949; 11: 327–33.

1932 - 2011

History

Robert Ader

director of the division of behavioral and

psychosocial medicine at New York’s University of

Rochester

▶▶▶ term of PNI - 1975

There is a link between what we think (our state of mind) and our health and our ability to heal ourselves. It is possible that a state of mind or emotional state to affect the immune response that the system is responsible to keep the human body healthy.

Ader (psychologist) and Cohen (immunologist)

deliberately immunizing conditioned and unconditioned animals→ exposing these and other control groups to the conditioned taste stimulus ↓ measuring the amount of antibody produced

Results - conditioned rats exposed to the conditioned stimulus were indeed immuno-suppressed

- a signal via the nervous system (taste) was affecting immune function

This was one of the first scientific experiments that demonstrated that the nervous system can affect the immune system.

Indications of neuro-immune interaction

1981 - discovered a network of nerves leading to blood vessels as well as cells of the immune system

- found nerves in the thymus and spleen terminating near clusters of lymphocytes, macrophages and mast cells (immune cells)

David Felten

History

Ader - Cohen - Felten

authors of bookPsychoneuroimmunology

1981

underlying premise that

the brain and immune system represent a single, integrated system of defense.

History

Candace Pert

▶▶▶ neuropeptide-specific receptors are present on the cell walls of both the brain and the immune system

- neuropeptides and neurotransmitters act directly upon the immune system = their close association with emotions suggests mechanisms through which emotions and immunology are deeply interdependent

- the immune and endocrine systems are modulated not only by the brain but also by the central nervous system itself

→ impact on the understanding of emotions, as well as of disease

Pert CB, Ruff MR, Weber RJ, Herkenham M. Neuropeptides and their receptors: a psychosomatic network. J Immunol. 1985 Aug;135(2 Suppl):820s-826s

Ruff M, Schiffmann E, Terranova V, Pert CB.Neuropeptides are chemoattractants for human tumor cells and monocytes: a possible mechanism for metastasis. Clin Immunol Immunopathol. 1985 Dec;37(3):387-96

Contemporary advances in psychiatry, immunology, neurology and other integrated disciplines of medicine has

fostered enormous growth for PNI

The mechanisms underlying behaviorally

▶▶ alterations of immune function▶▶ behavioral changes

are likely to have clinical and therapeutic implications that will not be fully appreciated until more is known about the extent of these interrelationships in normal and pathophysiological states.