Stress mengundang penyakit! Buat teman-teman dan para sohib semuanya yang usianya sudah atau hampir oversuwid, berikut ini ada hand-out dari pak dokter yang bicara tentang “stress” Memang sedikit ilmiah tapi perlu kiranya diketahui agar pada usia sekarang ini kita dapat mengendalikan beban pikiran agar tidak stress dan penyakitan Semoga bermanfaat

Stress and Disease : New Perspectives Prof.Dr.dr.H.Harijono Achmad,SpPD- KGEH

What is stress? l l A natural defense mechanism l l Often referred to as “Fight or Flight” l l A physical and psychological response to perceived demands and pressures from the outside and from within.

What is Stress? Stress sets off an alarm in the brain The brain prepares the body for action: Nervous system is aroused Hormones sharpen the senses Pulse quickens Breathing deepens Muscles tense

Adrenal Gland Cycle of Stress Cortex AmygdalaLocus Coeruleus Brain Stem Glucocortocoids (Cortisol) Corticotropin-Releasing Hormone Norepinephrine

External vs Internal Stressor l External stressors: adverse physical condition (e.g. pain, cold or hot temperature), stressful psychological environments (e.g. poor working condition, abusive relationship). l Internal Stressors: physical (infection, inflammation), psychological.

Short-term (Acute Stress) vs Long-term Stress (Chronic Stress) l Acute stress: –Fight or flight response, the reaction to an immediate threat such as noise, isolation, hunger, danger infection, imagining a threat or dangerous event l Chronic stress: –To fight or to flee, the reaction to on-going stressful situation, for example: on going highly pressured work, persistent financial worries

STRESS EFFECTS Immediate effect Intermediate effect Prolonged effect Sympathetic nervous response Epinephrine and norepinephrine released Time - 2 to 3 seconds Like a phone call Adrenal response Epinephrine and norepinephrine release from adrenal medulla Time- 20 to 30 seconds Like a telegram ACTH, vasopressin and thyroxine affect various metabolic processes Time - minutes, hours, days or weeks Like an “overnight delivery”

Stress Pathway

Stress, Physiology & Function Physiology / Function Emotional stress Environmental stress Xenobiotics Nervous systemImmune system Endocrine system

General Pattern of Stress Response l l Increased noradrenalin & dopamine l l Decreased serotonin l l Sympathetic dominance (adrenergic component). l l Loss of parasympathetic tone l l Decrease in hypothalamus-pituitary-adrenal cortex axis activity l l Decreased in hypothalamus-pituitary-thymus axis activity l l Decrease in secretion of growth hormone, prolactin and androgens l l Increase in ACTH, CRH, cortisol, oestrogens & somatostatin l l Increased Th2 immune activity

Biological- Psychological response to stressors

STRESS RESPONSE NEUROTRANSMITTER ENDOCRINE RESPONSE IMMUNE RESPONSE Noradrenergic systems activation & release catecholamines, Release of serotonin, glutamate, GABA, CRF- corticotropin-releasing factor (neurotransmitter not hormone) Activation hypophysial- pituitary-portal system Increased: Glucocorticoids Catecholamines Vasopressin Oxytocin. Suppressed when glucocorticoids are released. Catecholamines activate IL-1 IL-6. IL-1+IL-6 activate CRF & decrease immunity

How does Stress Affects the Immune System ?

l l Immune cells: – –possess receptors for hormones and neurotransmitters l l Lymphoid tissue: – –innervated by the autonomic nervous system (ANS) – –Noradrenergic nerve tracts in the thymus and spleen

l Stressors causing inflammation process, activate immune system to signal the brain or activate nerves nearby that signal the brain l Activate hypothalamus to initiate cascade hormones released from pituitary and adrenal gland causing increased of glucocorticoid (cortisol)

ACTH Growth Hormone Oxytocin Prolactin Beta-endorphin Gonadal Hormones Immune Cells hypothalamus pituitary

l Acute stress releases small amounts of glucocorticoids & activates immune system l Chronic stress releases large amounts of glucocorticoids & mutes the immune system –Damages/destroys T cells –Induces premature migration of T cells from Thymus –Results in Thymus shrinkage

Emotional Stimulus PIT Cortisol CRF ACTH AmygdalaHippocampus Adrenal Cortex Hypothalamus PVN

Stimulation of Pro-inflammatory Cytokines Immune system Hypothalamic-pituitary-adrenal axis at inflammatory sites: secretion of : 1st TNF-  2nd IL-1 stimulated by catecholamines 3rd IL-6 which feedbacks to inhibit TNF-  and IL-1 low oestrogen increases pro-inflammatory cytokines

Stress – related Diseases

Chronic stress related to several health problems: Heart diseaseHeart disease DiabetesDiabetes UlcersUlcers Growth problemsGrowth problems Immune system suppressionImmune system suppression Lower survival rates with cancerLower survival rates with cancer

STRESS CARDIOVASCULAR HypertensionHypertension AnginaAngina Migraine headachesMigraine headaches Raynaud’s diseaseRaynaud’s disease Gastrointestinal Peptic ulcersPeptic ulcers Ulcerative colitisUlcerative colitis Irritable bowelIrritable bowel Esophageal refluxEsophageal reflux Reproductive AmenorreheaAmenorrehea ImpotenceImpotence Respiratory Bronchial asthma Hyperventilation Dermatological EczemaEczema AcneAcne PsoriasisPsoriasis AlopeciaAlopecia Immune system Suppression/collap seSuppression/collap se Malignant cell changes; cancerMalignant cell changes; cancer Organ/tissue rejectionOrgan/tissue rejection Musculoskeletal Tension headachesTension headaches Low back painLow back pain