A physiological analysis of stress and chronic illness

Neuroimmunomodulation: The History of Science in Psychoneuroimmunology

BACKGROUND

From the original studies investigating the effects of adrenal gland secretion to modern high-throughput multidimensional analyses, stress research has been a topic of scientific interest spanning just over a century.

SUMMARY

The objective of this review was to provide historical context for influential discoveries, surprising findings, and preclinical models in stress-related neuroimmune research. Furthermore, we summarize this work and present a current understanding of the stress pathways and their effects on the immune system and behavior. We focus on recent work demonstrating stress-induced immune changes within the brain and highlight studies investigating stress effects on microglia. Lastly, we conclude with potential areas for future investigation concerning microglia heterogeneity, bone marrow niches, and sex differences.

KEY MESSAGES

Stress is a phenomenon that ties together not only the central and peripheral nervous system, but the immune system as well. The cumulative effects of stress can enhance or suppress immune function, based on the intensity and duration of the stressor. These stress-induced immune alterations are associated with neurobiological changes, including structural remodeling of neurons and decreased neurogenesis, and these contribute to the development of behavioral and cognitive deficits. As such, research in this field has revealed important insights into neuroimmune communication as well as molecular and cellular mediators of complex behaviors relevant to psychiatric disorders.

Stress: Eight Decades after Its Definition by Hans Selye: "Stress Is the Spice of Life"

July 1936: Hans Selye describes in 74 lines in the prestigious journal Nature a new concept: Stress [...].

An Integrated Review of Psychological Stress in Parkinson's Disease: Biological Mechanisms and Symptom and Health Outcomes

Parkinson's disease (PD) is characterized by complex symptoms and medication-induced motor complications that fluctuate in onset, severity, responsiveness to treatment, and disability. The unpredictable and debilitating nature of PD and the inability to halt or slow disease progression may result in psychological stress. Psychological stress may exacerbate biological mechanisms believed to contribute to neuronal loss in PD and lead to poorer symptom and health outcomes. The purpose of this integrated review is to summarize and appraise animal and human research studies focused on biological mechanisms, symptom, and health outcomes of psychological stress in PD. A search of the electronic databases PubMed/Medline and CINAHL from 1980 to the present using the key words Parkinson's disease and stress, psychological stress, mental stress, and chronic stress resulted in 11 articles that met inclusion criteria. The results revealed significant associations between psychological stress and increased motor symptom severity and loss of dopamine-producing neurons in animal models of PD and between psychological stress and increased symptom severity and poorer health outcomes in human subjects with PD. Further research is needed to fully elucidate the underlying biological mechanisms responsible for these relationships, for the ultimate purpose of designing targeted interventions that may modify the disease trajectory.

Comparison of stress-induced modulation of smooth-muscle activity between ileum and colon in male rats

Stress is a well-known cause of numerous digestive conditions, including gastrointestinal-function disorders. The autonomic nervous system regulates intestinal movements via cholinergic and adrenergic efferent fibers; however it is not clear how stress could affect these control mechanisms and in particular whether in a site-dependent manner. In this study we tested in vitro the effects of topical application of acetylcholine (Ach) and adrenalin (Adr) on smooth-muscle contractions of intestinal segments isolated from stress-conditioned rats. Stress was loaded by hypergravity stimulation (10min/day) for periods of 1, 6 or 30days. As a result, stress-conditioning affected intestinal sensitivity to Ach and Adr differently at sections of the ileum and colon. In the ileum no significant differences were found between control and stress-conditioned rats, whereas in the colon, samples from 6- and 30-day stress-conditioned rats showed larger amplitudes of Ach-induced contraction, as well as greater antagonization by Adr application. These results suggest that stress conditioning can modify autonomic control of intestinal movements by altering smooth-muscle sensitivity to Ach and Adr.

Transfer anxiety: preparing to leave intensive care

There is much literature to substantiate the inadvertent emotional and psychological trauma associated with critical care areas. However, alongside this, there is a growing body of knowledge to show that these intense and specialized areas are actually perceived as secure, safe and familiar environments by some patients and family members. Transfer from the intensive care unit is not always perceived in a positive light and often the transition is dreaded by both the patient and his family. The evidence would suggest that discharge from specialized care environments can actually be as traumatic as admission. This phenomenon has become known as transfer anxiety, relocation anxiety, or translocation anxiety. There is the possibility that transfer may induce stress or distress in some patients, especially when routines, environments and/or invasive monitoring procedures are altered or ceased without prior knowledge, preparation or adequate explanation. If healthcare personnel fail to identify and meet the psychological needs of patients and families relocating from these areas, the detrimental effects may extend far beyond discharge from ICU. For relocating patients, transfer from the ICU can be presented as a positive step. However, treatment to minimize transfer anxiety will only be successful when all healthcare personnel recognize and react positively to the psychological factors that affect patients adversely.

Application of social science on cardiorespiratory specialist courses

This paper draws on experience of introducing social and behavioural science in the specialist curriculum in cardiorespiratory nursing. There is a tendency for some to see cardiorespiratory care as 'high-tech' with the focus on acute care in hospital. However, health promotion and education are key issues and with an increasing number of individuals with chronic cardiac/respiratory disorders, the nurse's enabling role in promoting self-management is essential. It is in these areas where social and behavioural science is particularly relevant. Such a perspective should not be relegated to pre-registration programmes and this paper will argue for the application of social and behavioural science on specialist clinical courses.

Expanding the scope of continuity theory. Application to gerontological nursing

Continuity Theory is a psychosocial theory of aging which posits that as middle-aged and elderly adults adapt to changes associated with the normal aging process, their past experiences, decisions, and behaviors will form the foundation for their present and future decisions and behaviors. Regardless of the clinical setting, nurses working with elderly individuals may find Continuity Theory helpful in viewing the experience of elders in a holistic way that incorporates a life course perspective. By applying Continuity Theory to clinical practice, nurses may be better able to provide individualized, clinically appropriate care to elders.

Psychophysiologic factors contributing to functional performance in people with COPD: are there gender differences?

The purpose of this study was to compare the functional performance profiles of men and women with chronic obstructive pulmonary disease, describe the extent to which physiologic impairment, physical symptoms, and psychosocial resources contribute in a cumulative manner to performance, and outline the extent to which these contributions differ across gender. Secondary data analyses were employed. Although women (n = 45) reported more functional difficulty than men (n = 44) in 9 of 12 Sickness Impact Profile categories, the differences were not significant. Using hierarchical regression procedures, physiologic, symptomatic, and interactive variables predicted total (R2 = .64) and physical performance (R2 = .52), while symptomatic and psychosocial variables predicted psychosocial performance (R2 = .53). Results indicate that models of functional performance may be different for men and women.

Operationalizing Maslow's theory: development and testing of the basic need satisfaction inventory

Although Maslow's theory is frequently cited in the nursing literature and is commonly used as an underlying framework for clinical practice, it has been subjected to limited empirical scrutiny. This may be due, in part, to a scarcity of survey measures to operationalize the construct of need satisfaction. The Basic Need Satisfaction Inventory (BNSI) was developed for this purpose. The instrument, created from Andrews and Withey's indicators of life concerns and their "delighted-terrible" scale, was first examined through secondary data analysis, pilot tested (N = 21), and then administered to samples of men and women with chronic pulmonary disease (N = 109) and healthy older adults (N = 100). Emerging evidence of internal consistency reliability and construct validity suggests that the BNSI may be a useful instrument to measure need satisfaction and to test the adequacy of Maslow's theory for nursing science and practice.

Psychophysiological processes of stress in chronic physical illness: a theoretical perspective

This paper proposes a theoretical framework and conceptual model for clinicians and investigators working with people who have a chronic physical illness. The framework is based upon nursing theory and classical propositions from psychology and physiology. The major premise of the model is that individuals with limited psychosocial attributes and a preponderance of unmet basic needs are more likely to perceive events as threatening and experience a maladaptive stress response, such as heightened symptoms and acute exacerbations of their illness. Conversely, those with strong attributes and a perception of need satisfaction are more likely to view events as challenging, thus avoiding symptomatic discomfort and enhancing personal growth. Implications for nursing practice and research are addressed.