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”

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tidak stress dan penyakitanSemoga bermanfaat

Stress and DiseaseStress and Disease : : New PerspectivesNew Perspectives

Prof.Dr.dr.H.Harijono Achmad,SpPD- KGEH

What is stress?What is stress?

A natural defense mechanism Often referred to as “Fight or Flight” 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 arousedHormones sharpen the sensesPulse quickensBreathing deepensMuscles tense

Adrenal Gland

Cycle of Stress

Cortex

Amygdala Locus Coeruleus

Brain Stem

Glucocortocoids (Cortisol)

Corticotropin-Releasing Hormone

Norepinephrine

External vs Internal StressorExternal vs Internal Stressor

External stressors: adverse physical External stressors: adverse physical condition (e.g. pain, cold or hot condition (e.g. pain, cold or hot temperature), stressful psychological temperature), stressful psychological environments (e.g. poor working condition, environments (e.g. poor working condition, abusive relationship). abusive relationship).

Internal Stressors: physical (infection, Internal Stressors: physical (infection, inflammation), psychological.inflammation), psychological.

Short-term (Acute Stress) vs Long-Short-term (Acute Stress) vs Long-term Stress (Chronic Stress)term Stress (Chronic Stress)

Acute stress: Acute stress: – Fight or flight response, the reaction to an Fight or flight response, the reaction to an

immediate threat such as noise, isolation, immediate threat such as noise, isolation, hunger, danger infection, imagining a threat or hunger, danger infection, imagining a threat or dangerous eventdangerous event

Chronic stress: Chronic stress: – To fight or to flee, the reaction to on-going To fight or to flee, the reaction to on-going

stressful situation, for example: on going highly stressful situation, for example: on going highly pressured work, persistent financial worriespressured 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 & FunctionStress, Physiology & Function

Physiology / Function

Emotional stress Environmental stress Xenobiotics

Nervous system Immune system

Endocrine system

General Pattern of Stress General Pattern of Stress ResponseResponse

Increased noradrenalin & dopamine Decreased serotonin Sympathetic dominance (adrenergic component). Loss of parasympathetic tone Decrease in hypothalamus-pituitary-adrenal cortex axis

activity Decreased in hypothalamus-pituitary-thymus axis

activity Decrease in secretion of growth hormone, prolactin and

androgens Increase in ACTH, CRH, cortisol, oestrogens &

somatostatin 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 How does Stress Affects the Immune System ?Immune System ?

Immune cells: – possess receptors for hormones and

neurotransmitters

Lymphoid tissue:– innervated by the autonomic nervous system (ANS)

– Noradrenergic nerve tracts in the thymus and spleen

Stressors causing inflammation process, Stressors causing inflammation process, activate immune system to signal the brain activate immune system to signal the brain or activate nerves nearby that signal the or activate nerves nearby that signal the brainbrain

Activate hypothalamus to initiate cascade Activate hypothalamus to initiate cascade hormones released from pituitary and hormones released from pituitary and adrenal gland causing increased of adrenal gland causing increased of glucocorticoid glucocorticoid (cortisol)(cortisol)

ACTHGrowth HormoneOxytocinProlactinBeta-endorphinGonadal Hormones

Immune Cells

hypothalamus

pituitary

Acute stress releases small amounts of Acute stress releases small amounts of glucocorticoids & activates immune system glucocorticoids & activates immune system

Chronic stress releases large amounts of Chronic stress releases large amounts of glucocorticoids & mutes the immune glucocorticoids & mutes the immune system system – Damages/destroys T cellsDamages/destroys T cells– Induces premature migration of T cells from Induces premature migration of T cells from

ThymusThymus– Results in Thymus shrinkageResults in Thymus shrinkage

EmotionalStimulus

PIT

Cortisol CortisolCRF

ACTH

Amygdala Hippocampus

AdrenalCortex

HypothalamusPVN

+ + - -

Stimulation of Pro-inflammatory CytokinesImmune system Hypothalamic-pituitary-adrenal axis

at inflammatory sites: secretion of :1st TNF-2nd IL-1

stimulated bycatecholamines

3rd IL-6 which feedbacks to inhibit TNF- and IL-1

low oestrogenincreases

pro-inflammatorycytokines

Stress – related Diseases

Chronic stress related to several health Chronic stress related to several health problems: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•Angina Angina •Migraine headachesMigraine headaches•Raynaud’s diseaseRaynaud’s disease

GastrointestinalGastrointestinal•Peptic ulcersPeptic ulcers•Ulcerative colitisUlcerative colitis•Irritable bowelIrritable bowel•Esophageal refluxEsophageal reflux

ReproductiveReproductive•AmenorreheaAmenorrehea

•ImpotenceImpotence

Respiratory•Bronchial asthma•Hyperventilation

DermatologicalDermatological•EczemaEczema•AcneAcne•PsoriasisPsoriasis•AlopeciaAlopecia

Immune systemImmune system•Suppression/Suppression/collapsecollapse

•Malignant cell changes; Malignant cell changes; cancercancer

•Organ/tissue Organ/tissue rejectionrejection

MusculoskeletalMusculoskeletal•Tension headachesTension headaches•Low back painLow back pain