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BBH 432 Exam 5 Study Guide Let this list help focus your study This is not intended to be an exhaustive list See syllabus for the reading assignments to assist you with the material First exam Aug 27Sep 10 The Concept of Stress History of Stress Stress Physiology and Allostatic Load 1 Definitions stress eustress distress stressors homeostasis fear anxiety stress response perception appraisal 9539 Stress an event that is interpreted as threatening and that elicits the physiological and behavioral responses associated with the stress response Stress is a threat to homeostasis Eustress Positive stress Distress negative stress the everyday use of the word stress Stressor the actual event any factor that causes stress Two types of stressors processive stressors and systemic stressors i Processive Stressors elements in the environment ex snake loud noise psychological stress perceived by the organism as potential dangers These do not cause damage directly but are processed in the cerebral cortex This results in the fight or flight response ii Systemic stressors physiological stress Can cause a disturbance in the organism39s homeostasis iii Often both types of processive amp systemic stressors occur simultaneously They are usually accompanied by pain and orintensive emotions Stress response causes physiological psychological and behavioral response Fear physiologic and psychological experience of stressthreatdanger Specific to immediate stress event type 1 stressors i Fear is universal exists in all cultures and species Anxiety futureoriented state in which an individual anticipates the possibility of threat and thereby experiences a sense of uncontrollability associated with the treat type 2 stressor Perception the physical act of perceiving hearing seeing touch taste and smell Appraisal the act of assigning meaning or value to a perception i Appraisal accounts for individual variances of emotion reactions to the same event Homeostasis components of the internal environment of the body that are required for life and must be maintained within a narrow range for proper bodily functioning Systems that must be maintained body temperature blood pressure heart rate What is the utility of the stress response from an evolutionary perspective One of the first readings Asking why do we still have the stress response after all of these years It39s important because it has a positive role in helping us in day to day situations Ex jump out of the way of a car coming at you Adaptive because it39s important a Evolution is the process in which traits stress response are passed down Understanding the evolutionary history of a trait how it gives an advantage and the costs it imposes can help illuminate its design and regulation and can guide research into its mechanisms and control b Focus on utility the advantage has to be substantial We have seen increased c Terms to know Defense a trait that is latent until arounsed by threatening situations in which it is useful Natural selection genes that give fitness advantage are passed on Phylogeny evolutionary history of a trait Trade offs the fitness costs benefits of those who have a selective advantage 3 Lazarus and Baum s model of stress appraisal Coping can be a good or bad thing look at the models more closely a Lazarus Three process cognitive model of stress and coping iI iii Primary appraisal person evaluates present and potential harm or loss from event Secondary appraisal person evaluates coping resources if not enough resources are available threat is experienced Reappraisal person may change meaning of event to minimize stress reactions b Baums Model black arrows successful coping Evenhsoenxmved gg 5cimc i 1 I quotquot Pquot 39 ix if quot39 j 39W I I 39 xi i quot lc iii ll I Im 39rs A 41 4 I gtltgtI e 39 Fnzwnmnenunana T A J 5QC39dl crw2xI i 1 i S Y ix Fwv 1pprc f E739quotltar it pier aiAquotc g1 C1iiiaiI r 18 iiquot393 mi 7 391ir391fe EojvrIi39it393 ltr wiiiiall rigimi l Tr39TTifi quot l 1r39mapulaIn in ffrl T39 ssgt39 539 jgnrexz 57 it r i i7v 39j39ts 39squotmi md war 4 Characteristics of stressor and perception that affect the stress response a Characteristics Frequency intensity duration ii Positivenegative consequences iii Controlpredict iv Relevance to life goals b Perceptual characteristics that affect response i Anticipation perseveration ii Sense of control real or imaginary iii Appraisal harmful threatening challenging 5 What is hormesis and why it is an important concept Moderate stress might be good for you Hormesis comes from the field of toxicology doses matter think about it like a high dose harmful a little a day good Hormesis an adaptive response of cells and organisms to a moderate usually intermittent stress Experiments on hormesis Lorenz mice and guinea pigs exposed to chronic low level ionizing radiation had slightly greater mean lifespan and gained more weight than nonirradiated animals LOW stress daily is beneficial i Calabresez female rates exposed to low doses of DDT were found to have significantly longer reproductive life spans compared to non exposed Optima zone porridge is just right just right amount of stress Nutrition and moderate exercise are important psychologically moderate amounts of challenges are more beneficial than no mental stress at all High amounts of stress have negative health effects EVERYTHING IN MODERATION 6 Know the following about the HPA and SAM cascades Components of the cascade the organs hormones andor glands involved Timing of response Hormones released major cardiovascular andor metabolic effects of the hormones Rely on readings to enhance your general understanding of the two systems Stress response stimuusgtsensory organsgtthaamusgtamygdalagtresponse SIM sympatheticadrenalmedullary fight or flight response rapid response to trauma and emergency epinephrine and norepinephrine both released both attach to adrenergic receptors on cells stressgthypothaamusgtSAM activatedgt SAM neuronsgtadrenal meduagt norepi amp epi released into blood SNS ympathetic ervous ystem catecholamines eg adrenaline heart rate I blood pressure gt Sympathetic nervous system Arousing fight or flight O O Increases heartbeat amp blood pressure Long postganglionic fibers and axons highly branched which influence many organs Hypothalamus center for fightorflight reaction links nervous systems to endocrine system also involved in homeostasis SNS Lead to every part of the body unlike parasymp Easy to remember that when nervous you sweat when afraid hair stands on end when excited blood pressure rises vasoconstriction these sympathetic only Also causes dry mouth pupils to dilate increased heart amp respiratory rates to increase 02 to skeletal muscles and liver to release glucose Acetylcholine released in preganlionice fibers Norepinephrine aka noradrenaline is neurotransmitter released at the end of postganglionic neurons from nerve terminals directly onto target tissues Sympathetic nevers also trigger norepi release from andrenal gland Can measure SNS activity by measuring blood levels of hormones in blood or urine or by directly measuring nerve firing eates Synapse in adrenal glan that can cause body wide release of NEPI AND EPI in extreme emergency andrenaline rush HPA ypothalamic Eituitary Adrenal axis Hans Selys hypothalamus amp pituitary in brain adrenals above kidneys cortisol often activated at same time as SNS but very different system endocrine responsesnot neural like SNS Are primary metabolic don39t feel as much slower longer action stress recovery brain to peripheral glands hypothaamusgtpituitarygtperiphera gland hypothalamus secretes releasing factors and stimulates pituitary pituitary secretes intermediate hormones and stimulates peripheral glands adrenals testes ovaries peripheral gland secretes final hormone cortisol testosterone estrogen etc final hormone travels in blood binds cells wspecific receptor Alters cell metabolismgene transcription protein production negative feedback the off switch receptors for final hormone on hypothalamic amp pituitary cells decrease releasing factor and intermediate hormone release hormones protein ACTH and steroids cortisol 7 Parts of brain involved in perceiving and interpreting threat what do they do Hippocampus seahorse Required to store memories of threatening Stimuli Not the location of memory storage but themechanism an indexing system Amygdala almond Very important for perceiving threat Damage results in failure to learn to recognizeDanger Limbic system is brain system for appraising threats Adds emotional dimensions to stress perception fear anger anxiety 8 Adrenal gand s role in each stress responsive system what key stress hormones does adrenal gland secrete in SAM and HPA axis respectively And where exactly in the adrenal gland are there secreted from a Synapse in gand can cause bodywide release or epinephrine and norepinephrine in an extreme emergency ADRENALINE RUSH Adrenal gland secretes cortisol c They39re secreted from the adrenal medulla 9 What is the main role of cortisol what can influence the levels of the hormone and how does it operate at the cellular level Cortisol is a gucocorticoid metabolizes glucose Comes from adrenal cortex Is a steroid Steroids are lipid soluable so they can get through the cell membrane a Cortisol is the primary stress hormone in humans made from cholesterol b Glucocorticoid cortisol in humans c Name means glucose cortex steroids d Function increase blood sugar suppress immune aid metabolism fatproteincarb Net effect increase nutrients glucose available to body within minutes Acts on two receptors MR and GR gt targets hippocampus g Works at cellular level Equot h 10 Feedback loops in HPAhow do they work Hypothalamus gt pituitary gt peripheral glandorgan gt final hormone binds to receptor alters gene transcription protein product gt negative feedback the off switch receptors for final hormone decrease releasing factor and intermediate hormone release Nega ve Feedback Corticotropin Releasing Hormone ACTH Adrenocorticotropic Hormone HPA Axis CORT 11 What is important about McEwen s theory of stress and disease a Mechanisms mediators for stressdisease link Mesaureable physiological factors that could explain the relationship Individual differences we all have stress but some people get sickothers don39t c Focuses on the long term cumulative effects of stress and the role of life experiences in determining magnitude d Chronic stress as the cumulative effect of many small events Environmental stressors Major life events Trauma abuse work home neighborhood Perceived stress threat helplessness Vigilance Behavioral Individual responses differences a fight or night genes development experience D FS0na behavior diet smoking drinking exercise responses Allostasis I gt Adaptation l Allostatic load The stress response and development of allostatis load the perception of stress is influenced by one s experiencesgeneticsbx When the brain perceives an experience as stressful physiologic and bx responses are initiated leading to allostasis and adaptation Over time allostatic load can accumulate and the overexposure to mediators of neural endocrine and immune stress can have adverse effects on various organ systems leading to disease 12 Modelstypes of allostatic load Nornnal 3 Stress O Q Q cu cc 2 cu 2 2 39 D gt 0 Activity Recovery I I Tirne Allostatic load Repeated hits Lack of adaptation cu cu I I Z Z 0 O Q quot Q U D Q G D ac 2 2 3 3 2 2 2 9 3 3 2 Z 0 Norrnal response repeated over tirne D r I I I I I I I I I I I Iquotl l39l I I39l l39l39I39I39l39I39l39l I39l39l39I39l39I39l39l39l Tirne Prolonged response inadequate response lt1 Q CD CD Z C o o Z 3 U3 I G OJ 0 D 2 2 C53 C 2 2 9 2 D D E No recovery E D Q I I l I I I I I I I I I I I I I I Tirne Time Figure 3 Three Types of Allostatic Load The top panel illustrates the normal allostatic response in which a response is initiated by a stressor sustained for an appropriate interval and then turned off The rernaining panels illustrate four conditions that lead to allostatic load repeated hits from mul tiple stressors lack of adaptation prolonged response due to delayed shutdown and inadequate response that leads to compen satory hyperactivity of other rnediators eg inadequate secretion of glucocorticoids resulting in increased concentrations of cy tokines that are norrnally counterregulated by glucocorticoids a Allostatic load happens at a cellular level b Markers must be known risk factors for disease must be modifiable by stress and age over time Ex cholesterol goes up with age and stress c Allostatic oad thought of as cumulative record of your lifetime exposure to stress Each stressor is one hit d Take pulse increased BP wait hip ratio index of obesity LDL and cholesterol levels blood plasma evels urinary cortisol excretion levels urinary epinorepi excretion levels i All indicators for increased allostatic load are increase except HDL and DHEA Second exam Sep 17Oct 3 Research Strategies Tend and Befriend Social Dominance Hierarchies Stress and Cardiovascular Disease Social Inequality and Health 1 Types of stress we could measure 1 Chronic Stressors 2 Acute stressors 3 Perceived stressors 4 Life Events 5 Daily Hassles 2 Different types of measurement physiological psychological and behavioural measures What are the methods and limitations with each type of measurement v g o Electricalmechanical equipment to take measurements of heart rate BP respiration rate or galvanic skin response 0 Polygraph o Dried Blood Spots DBS blood samples are blotted and dried onto filter paper 0 Saliva Sampes contains over 20 different biomarkers including cortisol and alpha amylase 0 Blood or urine samples can be assessed for the level of hormones that the adrenal glands secrete 0 Advantages and Disadvantages I Advantages to using measures of physiological arousal to assess stress measures are reasonably direct and objective quite reliable and easily quantified I Disadvantages are that the techniques are expensive require training stressful for some people and the measures are affected by factors such as gender weight activity prior to measurement and such substances as caffeine Psychological o Sefreport participants written or oral accounts of thoughts actions and feelings I Used by most health psychologists 0 Life events Social Readjustment Rating Scale Holmes and Rahe 0 Daily Hassles Scale 0 Uplifts Scale Behavioral 0 Diet physical activity sleep duration social interaction parental behavior tobacco exposure substance abuse sun safety behaviors and sexual practices 0 Frequency this method refers to the number of times that a target behavior was observed and counted 0 Rate same as frequency but within a specified time limit 0 Duration this measurement refers to the amount of time that someone engaged in a behavior 0 Fuency processing speed this measurement refers to how quickly a learner can give responses within a period of time 0 Response atency latency refers to the amount of time after a specific stimulus has been given before the target behavior occurs 3 Research strategies for examining stress and illness types of research designs Retrospective research design simplest design ask people to recall past illnesses and stressors Prospective research design a longitudinal design examine a person39s stressors and illnesses for a set period of time 0 Quality of data higher with prospective designs 0 Less likely to be effected by memory distortions and biases Correlational Studies describe the magnitude of covariation between stress and illness but do not show causation an observational study 0 Pearson39s product moment correlations r is the most common Experimental Studies a study in which a treatment procedure or program is intentionally introduced and a result or outcome is observed 0 An experimental group receives the manipulation and is compared to the control group 0 True experiments have several elements manipulation control and random assignment 0 A good experimental study can show causation 4 Be able to define and explain the theory of tendandbefriend behavior Know the primary hormones and behaviors involved in this stress responsive pathway What are its effects what behaviors increase its levels The tendandbefriend response refers to the fact that people often manage threats by caring for offspring amp seeking social support in time of stress Stress responses may be different for women Biobehavioral threat response designed to protect self and offspring Use of social groups Calming and soothing behaviors Conclusion High maternal investment biobehavioral stress responses that maximize survival of self offspring and others TendandBefriend Model Tend Blend into environment quiet amp care for others Befriend Create amp maintain social networks Oxytocin The AntiStress hormone Produced by the hypothalamus amp stored and secreted by posterior pituitary gland Stress touch interpersonal interactions pregnancy lactation oxytocin release decreased BP decreased anxiety decreased depression decreased stress increased bonding increased affiliation longer life Biological amp behavioral effects of oxytocin are enhanced in presence of estrogen Oxytocin levels in women gt men Result Men and women differ in vulnerability to stressrelated diseases disease progression and longevity OXYTOCIN women gt men Released during stress posterior lobe of the pituitary Effects of oxytocin are strongly modulated by estrogen Calms SAM and HPA systems decreases cortisol amp epinephrine Counteracts the fightorflight response TESTOSTERONE men gt women Released during stress associated with aggression Suppresses effects of oxytocin Fuels the fightorflight response Understand the idea of social hierarchy and health in nonhuman primates What can understanding animal hierarchies tell us about stressrelated disease in humans Types of hierarchies Egalitarian society all members are equal and relative ranking is not assigned Linear hierarchy pecking order each member is assigned a rank relative to one another creating a linear distribution of power Despotic hierarchy one member is assigned dominance while all other members are subordinate Maintenance of dominance Highranking despotic individuals frequently and aggressively reassert their domination over the subordinate cohort causing the greatest physiological indices of stress among dominant individuals reflecting the physical demands of fighting In contrast in other despotic species ex Rhesus monkeys highranking individuals maintain dominance through psychological intimidation where for example mere eye contact with the alpha individual might elicit subordination gestures In some cases subordination is associated with the greatest physiological indices of stress reflecting the frequent psychological stressors for subordinates Subordinate avoidance of dominants The inability to physically avoid dominant individuals is associated with stress and the ease of avoidance varies by species As an extreme example subordinate animals in captivity have many fewer means to evade dominant individuals than they would in a natural setting Thus although dominant wolves have elevated stress hormone levels in the wild subordinates demonstrate this trait in captivity Negative physiological effects of stressful social ranking Consistently animals who are more socially stressed by the dominance hierarchy show indices of hyperactivity of the stress system This includes elevated basal levels of glucocorticoids enlarged adrenal glands that accompany such increased secretion and impaired sensitivity of the system to negative feedback regulation Prolonged stress adversely affects cardiovascular function producing Hypertension and elevated heart rate Platelet aggregation and increased circulating levels of lipids and cholesterol collectively promoting plaque formation in injured blood vessels Decreased levels of protective highdensity lipoprotein HDL cholesterol andor elevated levels of endangering lowdensity lipoprotein LDL cholesterol Chronic stress inhibits reproduction in both genders In females this suppression can take the form of delayed puberty decreased levels of estrogen and progesterone increased incidence of anovulatory cycles and greater risk of miscarriage In males prolonged and major stress can suppress circulating testosterone levels among subordinate male baboons At an extreme this includes atrophy of testes and of hypothalamic regions responsible for gonadotropin release Female Macaques stable matrilineal hierarchies based on the rank of the mother No stress dominant vs stress subordinate Stress subordinate higher adrenal weight lower estrogen lower HDL larger plaque size In addition to being infertile having heart disease high cortisol and low HDL subordinate female macaques also have much greater visceral fat the fat surrounding organs which produces inflammation By any health measure subordinate females are doing worse In male macaques dominants are the ones with heart disease but only if housed in recurrently reorganized unstable social groups Dominant males in stable social groups tended to have less heart disease Dominant male macaques must fight to maintain their privilege What determines whether subordinate or dominant is the unhealthy rank High stress Low social support Dominance Hierarchies in Baboons Linear hierarchies generally stable small shifts upward and downward Dominant males get More sex better food safer positions fewer attacks more grooming LOWER CORTISOL Subordinate males get Less good stuff more attacks higher cholesterol HIGHER CORTISOL Major types of cardiovascular disease Stroke blood clot or bleeding in the brain Atheroscerosis arteries are narrowed by cholesterol in the was plaques coronary heart disease Myocardial infarction heart attack small vessels on the surface of the heart are blocked by a clot or by plaque that has burst Hypertensive heart disease other types of damage to the heart from pressure overload Infectious Disease other types of damage to the heart from pressure ove oad Steps in plaque development how do they develop What are the primary components of plaques Immune cells start plaque development 1 High concentrations of LDL accumulate in the artery wall and are modified oxidized 2 OxLDL stimulates endothelial cells to display adhesion molecules which latch onto monocytes and Tcells 3 Endothelial cells release chemokines which lure the ensnared cells into the intima 4 Monocytes mature into macrophages big eaters and they eat the ox LDL forming foam cells 5 Macrophages and Tcells produce inflammatory cytokines 6 Tcells form the fatty streak the earliest form of plaque Plaque Progression and Rupture 1 Inflammation promotes further growth of the plaque 2 Vascular smooth muscle cells migrate to form a fibrous cap over plaque 3 Foam cells can weaken the cap by digesting it and damaging smooth muscle cells Inflammation role in CVD what test would a doctor use to see if you have it promote further growth of plaque powerful predictor of CVD risk a Blood test b CKG c Endocardiogram d Nuclear Scan 9 What are the mechanisms through which stress can influence CVD Increase risk factors for CVD Increase Rate of plaque formation Trigger an acute event Increase cardiac workload Increase in SNS and HPA Activity Changes in health behaviors DNA damage shorter telomeres 10 Why it is important to study inequalities in social conditions Health is not just the outcome of genetic or biological processes but is also influenced by the social and economic conditions in which we live These influences have become known as the social determinants of health Inequalities in social conditions give rise to unequal and unjust health outcomes for different social groups The strong relationship between SES and health has been documented for centuries dating back to ancient Greece Egypt and China A better understanding of the relationship between SES and disease may reveal important new points for intervention and screening The SES structure in the US and elsewhere is rapidly changing career women elderly 11 What are the social determinants of health The social conditions in which people live powerfully influence their chances to be healthy Indeed factors such as poverty food insecurity social exclusion and discrimination poor housing unhealthy early childhood conditions and low occupational status are important determinants of most diseases deaths and health inequalities between and within countries 12 What is the SES gradient What factors can explain the SES gradient In numerous Westernized societies stepwise decent in SE5 predicts increased risks of cardiovascular respiratory rheumatoid arthritis and psychiatric diseases low birth weight infant mortality and mortality from all causes This relation is predominately due to the influence of SES on health rather than the converse and the disease incidences can be several times greater at the lower extreme of the SES spectrum Subjective SES can be at least as predictive of health as is the objective SES In other words feeling poor may be at the core of why being poor predicts poorhea h Lower socioeconomic status has been linked to chronic stress heart disease ulcers type 2 diabetes rheumatoid arthritis certain types of cancer and premature aging Third exam Oct 10 Oct 24 Psychoneuroimmunology PNI Stress and Aging Gene Environment Interaction Stress and Epigenetics Stress Oxvtocin and Vasopressin 1 The birth of PNI research Robert Ader s key experiment What was so surprising about his findings Psychoneuroimmunology deals with the interactions among the mind behavior the nervous system the immune system and the endocrine system the impact of behaviorstress on these interactions and the implications for health interactions In 1975 Robert Ader conducted the first experiments showing that the brain directly influences the immune system by using classic conditioning in rats Taste Aversion A conditioned taste aversion can occur when eating a substance is followed by illness For example if you ate a taco for lunch and then became ill you might avoid eating tacos in the future even if the food you ate had no relationship to your illness To study taste aversion rats were given an injection of a nauseainducing drug paired with saccharin water Rats love saccharin but wouldn39t drink it anymore because it was associated with getting sick As expected the more saccharin flavored drink they consumed the stronger the aversion A surprising finding was that after conditioning just feeding the rat39s saccharin water was associated with the death of some animals In fact death like the strength of the animals taste aversion varied directly with the volume of saccharin consumed during conditioning The nausea drug was actually an immune suppressant Maybe the rat39s immune system learned when saccharin was give the immune system crashed Conditioned rats exposed to the conditioned stimulus were indeed immune suppressed In other words 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 2 Know the main functions and components of the immune system Main Purpose 0 Kill Invaders self vs nonself 0 Keep tumors from growing It is spread throughout the body in the form of the lymphatic system Functions of the Immune System 0 Discriminate self from foreign matter 0 Destruction and clearance of foreign substance I Virus bacteria toxins that might enter body altered self tumors 0 Ignore sef don39t destroy normal cells 0 However I Autoimmune Disease system attacks itself Multiple Sclerosis Celiac Disease Diabetes Type 1 Components of Immune System Lymphatic System 0 Works with immune system to remove diseasecausing agents 0 One way system to the heart 0 Network of connecting vessels and organs I Collects fluid lymph between cells and returns it to bloodstream Lymph Nodes 0 Found at specific points along the lymph vessels 0 They clean the lymph 0 Foreign substances leaking into the lymph nodes activate lymphocytes to mount an immune response Tonsils 0 Located in a ring around the pharynx 0 Functions similar to that of the lymph nodes 0 They are the first to encounter pathogens that enter the body by the nose or the mouth Bone Marrow o The site of origin of all types of blood cells 0 Including all white blood cells Thymus 0 Located in the upper thoracic cavity 0 A site of lymphocyte maturation o Secretes thymosin which aids in the maturation of Tcells Spleen 0 Upper left region of the abdomen 0 Cleans blood disposes of wornout blood cells 0 Removes bacteria White blood cells leukocytes different types and function of leukocytes where do they originate from White Blood Cells WBC Leukocytes Mobile units of body39s defense system Seek and Destroy Functions 0 Destroy invading microorganisms o Destroy abnormal cells cancer 0 Clean up cellular debris Phagocytosis Separation of Components in Blood 0 Plasma Less dense 55 o Pateets WBC s lt1 0 Hematocrit RBC s 45 5 Types of WBC s Each WBC has a specific function 0 Agramulocytes O I Lymphocyte I Monocyte Granulocytes I Eosinophil I Basophil I Neutrophil Neutrophils O 0 5070 of all leukocytes most abundant WBC s Important in inflammatory responses One of the first cells to arrive a number of substances produced during an inflammatory response recruit neutrophils to a site of inflammation They can survive 3 to 4 days but after they digest bacteria they die in about 12 hours Eosinophils o 14 of the WBC s 0 Attack parasitic worms 0 Important in allergic and asthma reactions 0 Three week life span includes maturing working and reaching their intended target 0 Following activation I Production of reactive oxygen species and cytokines Basophils o 05 of the WBC s o The Least common 0 Release histamine and heparin 0 Both are involved in the inflammatory response but heparin also prevents blood from clotting too quickly anticoagulant 0 Important in allergic reactions 0 Basophils mature and perform their duties for a period of three days to a week and a half Monocytes 0 26 of the WBC s half of them are stored in the spleen 0 Play multiple roles in immune function 0 Exit blood diapedesis to become macrophages 0 Macrophage large phagocytic Defend against viruses and bacteria Lymphocytes 0 2533 of the WBC s B lymphocytes Produce antibodies Tlymphocytes Directly destroy virus Invade cells and cancer cells Lymphocytes can live for as long as a month 3 Types I T lymphocytes I B lymphocytes I Natural killer cells T lymphocytes further differentiate into Thelper cells and Tcytoxic cells The major function of B cells is the producing of antibodies in response to foreign proteins of bacteria viruses and tumor cells B cells can become memory B cells Natural Killer NK cells are cytotoxic cell killing and can kill a wide range of cells including tumor cells Part of the innate immune system Development of Lymphocytes o Originate in bone marrow from lymphoid stem cells 0 B cells mature in bone marrow hence B cells 0 T cells mature in thymus hence T cells 0 O O O The immune response Inflammation first and second line immune defence Nonspecific lmmunity defends against any antigen even if it has never been encountered previously mucus skin saliva sweat Antigensspecific receptors are encoded in genes Specific immunity when an antigen has been encountered before innate immunity or a vaccination creates a memory for specific antigens acquired immunity the antibody response Innate Immunity o The dominant system of host defense in most organisms 0 Inflammation is one of the first Reponses I Redness swelling heat and pain I Chemical and cellular responses I During the acute phase of inflammation particularly as a result of bacterial infection neutrophils migrate toward the site of inflammation in a process called chemotaxis and are usually the first cells to arrive at the scene of infection The Nonspecific Macrophage o Engulfs and digest foreign organisms 0 Displays part of organism on its surface as an antigen 0 This signals other cells of invasion I Activates Tcells to duplicate I Produce interleukin 1 that promotes other cell activity Natural Killer Cells are NonSpecific o Kills virally infected cells and tumor cells by release of toxic substances into the cell 0 Produces interferon to enhance killing and inhibits viral production In vitro NK kills tumor cells in 3 hours 0 NK cells taken from stressed animals are less effective than the non stressed animals Second line of defense Specific o Require specifity or fit between immune cell receptor and antigen pre programmed o Cytotoxic T Cells inject toxins to kill foreigners o T Helper th ces enhance function of other cells by release of cytokines interluken2 I Activates Cytotoxic T cells and B cells I HIV attacks and kills Helper T Cells What is the main function of B cells Why they are important Specific Targets Humoral immunity antibodymediated immune system secrete antibodies that coat and neutralize infected cells 0 Help other cells identify and kill infected cells 0 Facilitates NK and Tcell killing 0 How does the brain communicate with the immune system a 1 Immune cells lymphocytes respond to neurotransmitters b 2 Lymphocytes respond to stress hormones SNS nerves to immune storage areas c 3 Cytokines chemicals from immune cells affect brain function What are the effects of stress on the immune system acute and chronic stress HPA axis and cortisol antiinflammation Stress causes dysregulated cortisol response 0 Produces too much or too little 0 Short term stressor raises it Long term and long past stresses might result in too low of cortisol no inflammation suppression Cortisol impairs immune function by 0 Decreasing or increasing cytokines levels 0 Kills WBC 0 High Leves decrease inflammation response Acute Stress and lnflammations 0 Brief lab stressors increase proinflammatory cytokines that can maintain a long term inflammation response I Some cytokines act to make disease worse over time pro inflammatory whereas others serve to reduce inflammation and promote healing antiinflammatory o Stressors can lead to long term systemic inflammatory response 0 BUT does not mean that all systematic inflammations are due to psychological or environmental stressors Chronic Stressors o Immune dysregulationz overreacting immune system can result in allergies arthritis etc while an underreacting immune system can cause cancer and coldflu outbreaks I Both types of reactions can occur simultaneously I Chronic stress is associated with both high and low cortisol levels What is the end replication problem and why is it relevant to telomeres Problem with replicating linear DNA causes Telomeres shorten with each cell division S phase Know the main function of telomeres and telomerase How can telomerase influence telomeres Why is it so important in relation to aging Teomeres ends of linear chromosomes Telomerase 0 Enzyme with RNA and protein components 0 Adds telomeric repeat directly to the DNA sequence 0 Expressed by germ cells early embryonic cells and stem cells Not expressed or has very low activity in most somatic cells human 0 Expressed by 8090 of cancer cells What happens to our telomeres as we age What is the effect of stress on our telomeres Short telomeres correlate with increased age HeLa Cell was derived from use in cancer research These cells proliferate abnormally and rapidly even compared to other cancer cels HeLa cells have an active version of telomerase In this way HeLa cells circumvent the Haylfick Limit Telomere length is a marker for biological aging wear and tear rather than a clock for chronological aging Telomere shortening in response to life stress 0 58 healthy women who were mothers of a healthy child control or a chonnically ill child caregiving o Assesed level of perceived stress over the past month in both groups 0 Measured mean telomere length and telomerase activity o Telomere length was much longer in less stressed mothers than high stress mothers Telomerase activity was much higher in less stressed mothers 10 Research examples on telomere length across the lifespan Pay particular focus on the effects of early life trauma limitations of previous studies and the main findings from Shalev et al 2012 study Effects of early life trauma childhood maltreatment shows shorter telomere length Limitations of previous studies adult populations retrospective assessment of trauma crosssectional designs not knowing whether telomeres began eroding during stress exposure or whether erosion occurred years later Shalev study stressrelated accelerated telomere erosion can already be observed in ch dhood 11 Why geneenvironment interaction is important What new information can we learn from studying this interaction over and above each component on its own New theories suggest that genes and environment interact to determine how large a stress response will be Gene X Environment Interaction 0 Genetic control of sensitivity to the environment 0 Environmental control of gene expression 0 Bottom line nature of genetic effects differs among environments I Example Phenyketonuria a genetic cause of mental retardation is 100 heritable yet affected individuals can avoid its consequences by eliminating phenylalanine from their diet I Mental disorders disorders might be rare but 13 of population might be carriers of the polymorphism 12 What are the main functions of epigenetic regulation How epigenetics regulate cell differentiation Epigenetics are another layer of information laid on top of the DNA code the DNA remains unchanged Main mechanisms DNA methylation and histone chromatin modification 13 What did Michael Meaney and his colleagues found about high licking and grooming rat mothers What were the effects in the offspring How did they reverse the effects High licking and grooming rat mothers has a positive and enduring impact on the reactivity of the HPA axis in offspring offspring are less fearful and show lowered cortisol responses to stree also become high licking and grooming mothers as well I Among offspring of high LG mothers Less methylation of the GR gene in hippocampus more expression of the GR gene More glucocorticoid receptors in hippocampus 9 of the HPA axis better negative feedback of the HPA axis more adaptive stress response Only 1 week is critical after that methylation is stable but not immutable I better negative feedback Effects are reversible 14 15 Can inject the brains of adult offspring of lowLG mothers with an agent known to reduce methylation The injections not only decreased DNA methylation to levels indistinguishable from highLG offspring but also reduced responsivity to stress to match that of high LG offspring What were the main findings in McGowan et al 2009 study How can methylation in the glucocorticoid receptor gene affect the stress response Childhood abuse leads to long term altered expression of glucocorticoid receptor GR expression in the hippocampus Corresponding changes in methylation of the neuron specific GR gene Childhood adversity might alter the development of systems that serve to regulate stress responses such as hippocampal glucocorticoid receptor expression What can we learn from oxytocin and vasopressin in relation to social behavior from animal research Prarie voles exhibit pair bonding exhibit aggressive behaviors to defend a mate or their offspring therefore show the oxytocin and vasopressin receptors Montane voles do not pairbond Oxytocin and vasopressin are part of the molecular and neural mechanisms that allow for the social cues necessary for individual recognition and behavior that we describe as loving Peptides are messages between populations of cells messages that can act across considerable distances linking widely dispersed cell groups but which lack temporal and spatial decision Compared to neurotransmitters which are private messages from one neuron to another 16 How is oxytocin influencing the stress response Human research on oxytocin effect on the brain and in relation to social support and stress When stressors begin to act cortisol is released which elicits stress responses such as rapid heart rate and high blood pressure Oxytocin is a posterior pituatiary hormone that is released to a broad array of stressors by both males and females which counters these effects of cortisol returning everything back to normal In rodents oxytocin found to enhance sedation and relaxation reduce fearfulness decrease sympathetic activity patterns of responses opposite to fightorflight What determines the effect of OXT and AVP in the brain is the distribution of their receptors Psychology x Brain Imaging x Endocrinology x Genetics Psychology trust recognition of emotions gaze into the eye region Brain Imaging reduced activation of the amygdala Endocrinology blood levels bonding trustworthiness Genetics extreme phenotype autism reduction in repetitive movement OXTR deletion and hypermethylation Oxytocin improves mindreading in humans double blind placebocontrolled within subject design of 30 healthy males tested for ability to infer the affective mental state of others using the reading the mind in the eyes test RMET after intranasal administration of oxytocin placebo showed higher scores with oxytocin in humans oxytocin inhibits the release of cortisol suggesting an anxiolytic effect associated with parasympathetic functioning suggesting a counter regulatory role in fear responses to stress rapid heart beat high BP oxytocin modulates neural circuitry for social cognition and fear in humans 13 males were presented with angry or sad faces and fearfulthreatening scenes after intranasal administration of oxytocin or placebo for the control they were presented simple shapes fMRl shows the amygdala activation by fearinducing stimuli to be strongly modulated by oxytocin in comparison to placebo social support and oxytocin interact to suppress cortisol and subjective responses to psychosocial stress Salivary free cortisol levels were suppressed by social support in response to stress Comparisons of pre and poststress anxiety levels revealed an anxiolytic effect of oxytocin More importantly the combination of oxytocin and social support exhibited the lowest cortisol concentrations as Well as increased calmness and decreased anxiety during stress Fourth exam Oct 31Nov 17 Depression Anxiety Disorders PTSD Cognitive Behavioral Therapy for PTSD Lasting Effects of Trauma 1 The etiology of mood disorders child maltreatment life events and social factors psychological and personality factors Influence of child abuse on adult depression Moderation by the CoritcotropinReleasing Hormone Receptor Gene These results suggest the possibility that heritable differences in CRHmediated neurotransmission exacerbate or dampen the effects of child abuse on the stress hormone system potentially modulating HPA axis sensitivity extrahypothalamic CRH ergic circuits and risk for depressive symptoms in adulthood Life events Prospective research 4267 report a stressful life event in the year prior to depression onset romantic breakup loss of job death of loved one Social Factors interpersonal difficulties Lack of an intimate confiding relationship loneliness Behavior of depressed people often leads to rejection by others excessive reassurance seeking few positive facial expressions negative self diclosures slow speech and long s ences Psychological Affect and Rumination Affect pattern of observable behavior associated with subjective feelings such as facial expression tone of voice and gestures Rumination the compulsively focused attention on the symptoms of one s distress and on its possible causes and consequences opposed to its solutions A lot similar to worry anxiety except worry focuses on the future and rumination focuses on bad feelings and experiences from the past Personality it has been suggested that certain personality characteristics predispose one to abnormal affect Neuroticism tendency to react with higher levels of negative affect predicts onset of depression 2 Depression main symptoms and characteristics Who is most at risk to develop depression Depression 2quot leading cause of disability worldwide Main symptoms of depression depressed mood for at least 2 week period including most of the following Diminished interest in activities Change of more than 5 of body weight Insomnia or hypersomnia Psychomotor agitation Fatigue Feelings of worthlessness guilt Diminished ability to think or indecisiveness Recurrent thoughts of death or suicide Characteristics of Depression Episodic symptoms tend to dissipate over time Recurrent once depression occurs future episodes likely to occur average4 Subcinica sadness plus 3 other symptoms for 10 days significant impairments in functioning even though full diagnostic criteria are not met At risk women are more at risk than men 21 3x as common among the poor heritability from twin studies 4050 lifetime prevalence varies widely 3 in Japan to 17 in US 3 Key brain regions involved in depression with particular emphasis on hippocampus Key brain regions involved in depression Orbital prefrontal cortex and ventromedial prefrontal cortex Dorsolateral prefrontal cortex wide connections to a variety of brain regions Primary function involves executive functioning such as planning cognitive flexibility and memory Amygdala Anterior cingulate involved with highlevel cognitive functions including inhibiton of inappropriate responses decision making and motivated behaviors Hippocampus post mortem hippocampus collected from 19 MDD and 21 control subjects In MDD the dentate gyrus and pyramidal neuron soma size is significantly decreased It is suggested that a significant reduction in neuropil in MDD may account for decreased hippocampal volume detected by neuroimaging In addition differential shrinkage of frozen sections of the hippocampus suggests differential water content in hippocampus in MDD 4 What is the monoamine hypothesis of depression What is the evidence for the involvement of norepinephrine serotonin and dopamine What are some of the limitations Monoamine hypothesis of depression depression results from the reduced activity of brain monoamines serotonin norepinephrine epinephrine dopamine antidepressant medications increase either norepinephrine or serotonin via blockade of monoamine reuptake Prozac selective serotonin reuptake inhibitor Evidence for involvement of norepinephrine in depression depressed patients have decreased norepinephrine and its metabolites in their cerebrospinal fluid and urine Genetic studies show that mice with genetically engineered functional enhancement of the norepinephrine system are protected from stressinduced depressionlike behaviors Therapeutic agents that specifically increase norepinephrine activity are effective antidepressants Evidence for involvement of serotonin in depression patients with major depression show deficient serotonin neurotransmission Serotonin uptakeinhibiting drugs prozac are most often used as antidepressants example of selective serotonin reuptake inhibitor SSRI serotonin is deacticiate in the synapse by reuptake into the presynaptic neuron but Prozac blocks this reuptake of serotonin thus increasing the activation of serotonin receptors Monoamine oxidase inhibitors MAOls long history of use for the treatment of depression bind to and inhibit MAOA preventing monoamine degradation This results in greater stores of monoamines available for release MAOA inhibitors are used in the treatment of depression People with depression have lower than normal levels of the monoamines and MAOA inhibitors restore the levels to within the normal range Evidence for the involvement of dopamine in depression hypofunction of the brain39s dopaminergic system functions as rewarding pathway might result in loss of interest and lack of motivation core symptoms of major depression Limitations of monoamine hypothesis although antidepressants usually bring serotonin levels up to normal very quickly it takes 24 weeks before mood improves significantly therefore serotonin system dysfunction cannot be the sole cause of depression Intensive investigation has failed to find convincing evidence of a primary dysfunction of a specific monoamine system in depression Some antidepressants that have been known for a long time do not act through the monoamine system Experiments that cause depletion of monoamines do not cause depression in healthy people nor worsen the symptoms in depressed patients The hypothesis has been further oversimplified when presented to general public 5 What is the evidence for HPA axis dysregulation in depression How can you study it What is the difference in cortisol levels between depressed patients and controls I The stress system H PA axis is dysregulated in depression as evident by high levels of cortisol Evidence for HPA hypothalamic pituitary axis dysregulation increased circulation of CRH and cortisol in blood urine and CSF in depression high cortisol levels linked to depression cushing s syndrome oversecretion of cortisol includes depressive symptoms and injecting cortisol in animals produces depressive symptoms hypercortisolism changes over time it is a processoriented perspective In acute depression there is an increased state of all hormones in the HPA axis but in chronic depression there is increased CRH and cortisol but low ACTH Postmortem enlarged adrenal glands Reduction in of CRH receptor binding sites Diminished hippocampal volume Functional tests blunted ACTH response to CRH administration due to downregulation of CRH receptors caused bt chronic CRH hypersecretion and impaired suppression of cortisol secretion after DEX administration DST test How do you study the HPA dysregulation evidence in depression DST dexamethasone suppression test blood test that assesses adrenal gland function by measuring how cortisol levels change in response to an injection of a steroid drug dexamethasone dex IS 25 times more potent than cortisol in its glucocorticoid effect and provides negative feedback to the pituitary to suppress ACTH secretion a patient takes a nighttime dose of 1 mg of DEX and the blood cortisol levels are measured in the morning if blood cortisol levels are relatively high test is positive and patient has an autonomous independent source of either cortisol or ACTH impaired suppression of cortisol secretion after DEX administration HPA axis related finding in depression DST in normal controls able to suppress cortisol after DEX administration DST in depressed patients unable to suppress cortisol after DEX administration In depression unable to suppress cortisol causes episodic hypersecretion of cortisol which affects somatic immune and cognitive function In contrast in PTSD the high level of cortisol suppression results in hyposecretion of cortisol 6 What is the relationship between stress and anxiety disorders Anxiety disorders are extremes of normal anxiety they occur when normal anxiety system becomes dysregulated excessive or inappropriate An anxiety disorder encompasses feelings of stress or anxiety and the behavioral efforts to cope with such feelings Relationship between stress and anxiety disorders dysregulation of the stress response contributes to the development of an anxiety disorder stress response excessive or prolonged unable to turn it off 7 Know some of the main symptoms and characteristics of anxiety disorders Symptoms of anxiety disorders Alterations in cognition worrying apprehension planning in response to anxiety focus on potential for harm Physical symptoms consistent with autonomic arousal sweating dry mouth rapid breathing increased blood pressure headache muscle tension Emotional Symptoms uneasiness edginess tension panic Behavioral symptoms avoidance behaviors compulsions Pathological anxiety causes significant distress in one s life and impairs ones ability to function normally Characteristics Of Anxiety Disorders Anxiety disorders are the SECOND most common mental disorder worldwide and FIRST in the US affectiong 40 million adults age 18 and older 18 of us population Lifetime prevalence of anxiety disorders 15 Anxiety disorders often present in early life If anxiety disorders are left untreated they tend to become chronic Comorbid disorders with anxiety depression and substance abuse Anxiety disorders exert a significant impact on ones quality of life 8 Know the major types of anxiety disorders No need to remember all the epidemiology details prevalence age of onset etc but you should understand the main features and differences between the major types of anxiety disorders GAD social phobia specific phobias including agoraphobia panic disorder and OCD Major Types of Anxiety Disorders 1 Generalized Anxiety Disorder GAD 2 Social Anxiety Disorder Social Phobia 3 Specific Phobia 4 Panic Disorder 5 0CD 6 PTSD Generalized Anxiety Disorder GAD chronic anxiety uncontrolled excessive worry The person finds it difficult to control the worry and the anxiety and worry are associated with 3 of the following restlessness difficulty concentrating irritability muscle tension sleep disturbance fatigue Anxiety reported for at least 50 of the day and it is NOT focused on a particular element like specific phobia is The anxiety symptoms cause clinically significant distress or impairment in important areas of functioning international classification of diseases declares GAD when symptoms are present most days for weeks that include motor tension muscle tension twitching and shaking apprehension feeling on edge unable to cope poor concentration insomnia irritability and autonomic overactivity light headedness sweating tachycardia fast heart rate dry mouth epigastric discomfort Social Anxiety Disorder Social Phobia a persistent fear of social or performance situations in which the individual faces public scrutiny unfamiliar people Social phobia is when exposure to the feared situation almost always elicits anxiety The person with social phobia recognizes the fear as unreasonable or excessive The feared social exposure is associated with intense anxiety and distress blushing tremor butterflies Common anxiety provoking social situations are meeting new people interacting parties meetinfs speaking eating dealing with authority figures being assertive Specific Phobia persistent fear that is excessive unreasonable cued by the existence of of the anticipation of a specific object or situation snakes heights flying Exposure to phobia triggers anxiety immediately Recognition that the anxiety is excessive unreasonable Phobia is avoided or encountered with great distress common ones acrophobia heights algophobia pain astraphobia thunderstorms lightning 5 typed of specific phobias 1 animal 2 natural environment 3 bloodinjectioninjury 4 situational 5 other Agoraphobia fear of open spaces crowds or public places Fear of traveling by public transport fear that it may be difficult to get to a place of safety home People with agoraphobia avoid situations that don39t have an immediately available exit risk factors stressful life events fam history domestic instability childhood fears overprotective mom autonomic symptoms tachycardia shortness of breath faintness sweating panic attacks are the marker of severity psychological fear dread behavioral avoidance to the extent that person becomes house bound cognitive I might have died Panic Disorder recurrent and unexpected panic attacks Panic disorders include anxiety about having a panic attack and consequences of the attack Panic attack a discrete period of fear discomfort in absence of real danger develops suddenly palpatations sensation that your heart is pounding sweating trembling shortness of breath etc OCD Obsessive compulsive disorder obsessions intrusive recurrent unwanted ideas and thoughts impulses that are hard to get rid of in spite of the fact that they produce great distress for the individual and compulsions repetitive behaviors actions or mental intended to decrease anxiety due to the obsessions Obsessions and compulsions significantly interfere with one s functioning and cause distress can have one or the other but rare usually have both together OCD has close links with depression 9 What are the main biological factors involved in anxiety disorders What is the role that each factor play norepinephrine GABA serotonin NPY To understand the biological factors involved in anxiety disorders you need to investigate the neural circuitry of the normal fear response and see where there is dysfunction and dysreguation Specifically NE and HPA axis and broder GABA serotonin neuropeptide Y NE norepinephrine dysfunction MAJOR role in the acute stress response and NE over activity is implicated in anxiety disorders Studies have shown longterm alterations in NE system Continuous autonomic hyperarousal in response to traumatic stimuli HPA axis Dysfunction regulation of the HPA axis is by the amygdala and hippocampus which anxiety disorders cause hippocampal atrophy and amygdala activation A role for the CRH system in specific disorders panic and PTSD HPA axis abnormalities are more heterogeneous in anxiety disorders GABA dysfunction GABA is the main inhibitory neurotransmitter in the brain known to counterbalance the action of the excitatory NT glutamate abundance of GABA receptors found in cortex and limbic areas binding of GABA leads to increased inhibitory action A of drugs achieve their effect by modulating the GABA receptors In anxiety disorders there is a decrease in the inhibitory effects of GABA to counteract the increased activity of NE Serotonin anxiety disorders cause low inhibiton which results in less levels of serotonin SSRls block the reuptake of serotonin that helps treat anxiety disorders stressinduced activation of serotonin may produce anxiolytic inhibit anxiety 5HT1A recptors or anxiogenic causes anxiety 5HT2 Neuropeptide Y NPY inhibits the release of NE from sympathetic neurons that reduce anxiety and stress NPY knockout mice display anxiolyticlike phenotype Functional effects exhibited when injected into central nucleus of amygdaa produced Anxiolytic inhibit anxiety symptoms effects 10 PTSD criteria from the DSM what are the 3 categories What are the primary symptoms of PTSD 1 Reexperiencing intrusions at least 1 of the symptoms under this category to be diagnosed 2 Avoidance Numbing at least 3 of the symptoms under this category to be diagnosed 3 Hyperarousal symptoms at least 2 of the symptoms under this category to be diagnosed Core symptom reliving the event flashbacks nightmares waking dreams Delayed or protracted response to the trauma Onset varies immediate or delayed Emotional numbness and detachment Avoidance of activities or situations that remind person of trauma 11 The prevalence of specific types of trauma and the probability to develop PTSD Victims of trauma related to physical and sexual assault face greatest risk of developing PTSD strength severity of stressor is what puts you at risk probability of PTSD RAPE men65 women 45 COMBAT men 40 Physical abuse women 50 men 20 Prevalence of trauma is very high among men less high among women 15 of those exposed to trauma will develop PTSD 12 What is the role of the HPA axis in PTSD Roll of HPA axis stress response system in PTSD use the DXT test PTSD patients exhibit a high level of cortisol suppression resulting in decreased cortisol levels hyposecretion PTSD patients have high cortisol suppression in the DST test which means they have strong negative feedback inhibition of cortisol due to an increased sensitivity of glucocorticoid receptors which stress intolerance and emotional numbing Sensitization hyperarousal and reexperiencing 13 What is the role of the hippocampus in PTSD Know the seminal study on hippocampal volume and risk to develop PTSD What other evidence exist regarding changes in the brain and risk to develop PTSD after trauma Role of hippocampus in PTSD the hippocampus is necessary for declarative memory info facts and knowledge and involved in regulation of stress hormone responses negative feedback of HPA Exposure to stress can damage the hippocampus PTSD patients have poor memory Smaller hippocampus is a predisposing factor of PTSD Seminal study on Hippocampal volume and risk to develop PTSD Smaller hippocampal volume predicts pathological vulnerability to psychological trauma 40 male twin pairs 1 of each pair served in Vietnam war 1 did not 17 developed PTSD 23 did not Smaller hippocampal volume constitutes a preexisting vulnerability factor for pathological response to stress High PTSD severity is associated w lower hippocampus volume both in combat exposed twin and the noncombat exposed twin Other evidence that exists regarding changes in the brain and risk to develop PTSD after trauma MRI studies show PTSD is associated with a smaller hippocampus and cognitive impairment Neuropsvchological performance and IQ interaction between preinduction cognitive skills memory coding speed vocab and severity of combat exposure for PTSD including re experiencing and arousal symptoms aka if you have poor hippocampal skills you are more likely to experience severe PTSD Prospective study Brain structural changes as vulnerability factors and acquired signs of postearthquake stress 42 nonPTSD subjects had brain imaging before the Great East Japan earthquake PTSD scores were negatively associated with the pre grey matter volume in the ACC processing of fear and anxiety and OFC orbitofrontal cortex ability to extint fear and anxiety of traumatic event Silver et Al psychological responses to 911 2700 people took survey online within 3 weeks after 911 was NOT restricted to people who were in NYC or DC on the day followup at 6 months A bigger trauma does not always more sever PTSD Diasthesisstress model diasthesis underlying vulnerabilitydisposition genetic psychological biological interacting with life events if negative life events then negative outcome if positive events positive outcome must study interaction between person and environment Coping styles at baseline predict longer term risk of PTSD 1 Giving up 68 2 Denial 33 3 Avoidance 31 Use of specific coping strategies shortly after an event is associated with symptoms over time Disengaging from coping efforts can signal the likelihood of psychological difficulties up to 6 months after a trauma What is unique about this study Shows that psychological effects of a major national trauma are not limited to those who experience it directly 14 The p Factor What is the p factor and why is it important The p factor is the general psychopathology dimension Higher p scores more life impairment greater familiality worse developmental histories more compromised early life brain function P factors are important because they explain why it is challenging to find causes consequences biomarkers and treatments with specificity to individual mental disorders 15 Why is CBT helpful to PTSD PTSD clients perceive world as dangerous and symptoms they experience make their bodies feel unsafe they also have problems regulating their thought emotions behaviors and awareness so CBT Defines Trauma the body39s response to an event CBT acknowledges that there may be experiences that cannot be controlled through rational thought flashbacks and dissociation of PTSD clients CBT focuses on the present moment with current thoughts and feelings being addressed in the hereandnow The therapist structures and guides the session w interventions that aim to alleviate symptoms and client vulnerability CBT helps clients challenge their beliefs and recognize when they start falling into maladaptive patterns Therapists help clients identify errors in thinking and replace them w realistic thoughts 16 What is the effect of maltreatment on cognitive functions and obesity Maltreatment leads to higher rates of obesity and cognitive deficits that may have lasting effects on academic success and achievement 17 Why is it important to study child maltreatment What is the cost for society and the public health burden Children affected by child maltreatment lower overall graduation rates educational attainment occupational viability child maltreatment extremely prevalent in US Cost for public health burden 134 billion combined for lifetime economic burden majorly attributable to lost productivity not best methodology because very little attention paid to health consequences Classes Dec 1Dec 5 Social Support Personality Stress and Health Stress Management 1 Types of social support and its influence on health Emotional Support Includes provision of care love trust and empathy as well as respect and admiration This type of support is the most abundant and far out numbers all other types of support Related to Attachment Theory that people are the happiest and most effective when they have one or more trusted persons they can confide in Instrumental support Tangible support Includes providing tangible good and services such as money groceries completing work that was assigned to someone else use of one s car etc Informational Support Involves providing information or advise to another in a time of need especially problems solving situations The richest source of this form of support is often from professionals Eg Health professionals lawyers accountants etc However informational support can also be provided by friends and family Companionship Support Inclusion in a social group a sense of social belonging This can be seen as the presence of companions to engage in shared social activities Marital relationships have a large influence on health among men and social support at work is protective for women in high stress jobs Having at least 1 person to trust and confide in makes a big difference in health I Related to higher overall immune functioning vaccine response cellular immunity virus infections kept to a minimum I Reduced risk of death due to heart attack or other circulatory diseases I Men who never married or live alone had a higher risk of heart attack Reduced risk of cancers Faster recovery for injury Fewer complications during pregnancy Facilitates coping and adaptation to change Reduced anxiety levels Overall increased life satisfaction 2 Models of social support Direct Effect Model social support exerts beneficial effects at all stress levels high and low stress Best predict we0being outcomes Stress Buffer Model social support moderates the effects of stress so that social support is only beneficial under high stress conditions best predict the effect of perceived social support on health outcomes in conditions where the need is high 3 Know the main types of personality traits the big five Traits predispose a person to act in a certain way 1Neuroticsim sensitive nervous vs secure confident 2Extraversion outgoing energetic vs soitary reserved 30penness inventivecurious vs consistentcautious 4Conscientiousness efficientorganized vs easygoing careless 5 Agreeabeness friendlycompassionate vs analyticaldetached Prefers variety Factor Description of High Scorer Description of Low Scorer Extraversion E Talkative Quiet Passionate Unfeeling Active Passive Dominant Sociable Agreeableness A Goodnatured Irritable Softhearted Ruthless Trusting Suspicious Neuroticism N Worrying Calm Emotional Unemotional Vulnerable Hardy Anxious Selfcontrolled Sense of wellbeing Openness 0 Creative Uncreative Imaginative Downtoearth Prefers routine Conscientiousness C Conscientious Hardworking Ambitious Responsible Negligent Lazy Aimless Irresponsible SoLIRcE Cloningcr 2008 Theories of Personality Understanding Persons PcarsonPrcnticc Hall 4 Type A behavior pattern as a risk factor for heart disease exaggerate sense of time urgency competitiveness and drive hostile interpret neutral situations as stressful Type A itself is not linked to coronary heart disease BUT its toxic score is AKA hostility hostility is linked with inflammation which results in CHD hostility and anger linked more with men how they deal with it is linked to CHD suppressed anger and destructive anger expression are more robust predictors of CHD 5 Which personality traits are linked with good versus bad health GOOD HEALTH Conscientiousness efficientl organized most protective of big 5 linked to health and longevity highly conscientious individuals more likely to engage in healthy behaviors and less likely to engage in harmful ones linked to resilience Extraversion outgoingenergetic associated w good feelings and happiness more responsive to reward less deterred by punishment and experience positive affect for longer periods and subjective wellbeing linked to greater relationship satisfaction and resilience Openness inventivecurious flexible coping style when dealing with stressors Agreeableness friendlycompassionate when in conjunction with other factors may lead to increased relationship satisfaction and longevity Dispositional Optimism has protective effect optimists may be more effective at coping with stress and use engagement coping BAD HEALTH Neuroticism sensitivel nervous anxious low selfesteem tense carries highest risk to health and wellbeing but mixed evidence for link btwn neuroticism and early mortality People w high neuroticism are more likely to develop internalizing disorders Type A exaggerate sense of time urgency competitiveness and drive hostile interpret neutral situations as stressful toxic score hostility is associated w predictors of CHD Pessimism relates to higher inflammation levels and shorter telomeres 6 The importance of childhood selfcontrol Moffitt et al 2011 paper Dunedin Longitudinal study 38 years of followup Ages 357911 years a composite of rating of childhood selfcontrol Children with low selfcontrol had poorer health than those with high selfcontrol more substanceuse problems than those with high selfcontrol lower SES and income in adulthood than those w high selfcontrol more criminal court convictions age 18adulthood than those w high selfcontrol less warmsensitivestimulating parents w own children than those w high selfcontrol more likely to smoke by age 15 drop out of school and have unplanned parenthood than those whigh selfcontrol less satisfied wlife than those with high selfcontrol Important to enhance selfcontrol to reduce costs of crime control health care social welfare healthy and financially secure old age improve the life chances of the next generation early intervention for best cost benefit ratio I AVOID OBESITY in an era of ready food availability I MAINTAIN FITNESS in an era of sedentary jobs I SUSTAIN MARRIAGES in an era of easy divorce I PREVENT ADDICTION in an era of access to substances I RESIST SPENDING in an era of sophisticated marketing I SAVE FOR OLD AGE in an era without guaranteed pensions 7 Stress management why is it so important for health How people manage stress contributes largely to distress and dysfunction some amount of stress is unavoidable but if certain coping styles limit the negative effects of stress we can teach people these strategies 8 Know the main types of stress management Which ones show a positive effect on our brain and body Key word BALANCE need to integrate everything and adjust to yourself Identify and manage triggers I Time management fundamental changes in lifestyle I Anticipating a problem and taking steps to avoid it Stop automatic thoughts Cognitive Behavioral Therapy I Avoid catastrophizing practice positive reappraisal seek social support Stop trying to control it all I Let some things go choose your battles Change your biological response to stress I Exercise diet breathing practices mindfulness Positive effect for brain and body Diet Mindful eating Cognitive thoughts Time Management Invoking the relaxation response Laugh often Try a new thing Cry Get sleep Musicsinging Pets Say no occassionally Physical Activity Exercise Yogabased stretching Meditation Breathing Imagery Progressive relaxation Social support Spirituality Walking Moderate alcohol Acknowledge you can39t control everything
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