2. Why do people decide to become doctors ?
• to treat health problems
• to keep people healthy
Because they care!
3. Is it possible?
Dilemmas in diagnosis have plagued medicine since its inception:
a compromised diagnostic
compromises treatment
diagnose improvement
enhanced treatment
4. Traditional view
(still held my many scientists)
• the illness appears when the immune system
(considered to be autonomous!)
has broken down
Most physicians treat the body:
the organ
or
the function
5. Traditional view
(still held my many scientists)
• most psychotherapists follow the cognitive-behavior
paradigm
treat the mind as something
separated from the body
6. These old views are becoming less
legitimate
Our moods, emotions, behavior, brainwaves, and over all,
our minds
directly affect our health and longevity
7. we need to accept
the integration of body - mind therapies
because it’s becoming very clear that
the body and mind are in a powerful connection!
8. It was time that a new science appeared:
• Psychoneuroimmunology (PNI)
= scientific discipline - multidisciplinary field - rapidly expanding
Role – to elucidate the complex processes that underlie
health
9. Psychoneuroimmunology
• Google search
349 000 results in 0,37 sec
• Pubmed
1261 articles
• the last decade
the no. of scientific papers using
the term
‘PSYCHONEUROIMMUNOLOGY’
has more than doubled.
11. Wikipedia definition
“ Psychoneuroimmunology (PNI) is the study of the
interaction between psychological processes and the
nervous and immune systems of the human body. PNI
takes an interdisciplinary approach, incorporating
psychology, neuroscience, immunology, physiology,
pharmacology, molecular biology, psychiatry, behavioral
medicine, infectious diseases, endocrinology, and
rheumatology.
The main interests of PNI are the interactions between
the nervous and immune systems and the
relationships between mental processes and
health.
”
12. Wikipedia definition - continuation
“ PNI studies, among other things, the physiological
functioning of the neuroimmune system in health and
disease; disorders of the neuroimmune system
(autoimmune diseases; hypersensitivities; immune
deficiency); and the physical, chemical and
physiological characteristics of the components of the
neuroimmune system in vitro, in situ, and in vivo.
PNI may also be referred to as
psychoendoneuroimmunology (PENI).
”
13. Psychosomatic medicine –
a connect term of PNI
= an interdisciplinary medical field studying the
relationships of social psychological behavioral
factors on bodily processes and quality of life.
Psychosomatic medicine is considered a subspecialty of
the fields of psychiatry and neurology.
Psychosomatic disorders
▶▶▶ medical treatments + psychotherapy
14. Mind-Body Medicine - History
Stress, the immune
system and
vulnerability to • always has been controversy over
degenerative
disorders of the
central nervous
the mind - body connection
system in transgenic
mice expressing
glucocorticoid
• the history induces → the
receptor antisense
RNA
dichotomy eastern - western
Bianca Marchetti et al.
Brain Research Rew.,
2001
medical cultures
Chinese medicine:
▶ certain organs of the body represent various mental or
emotional conditions
▶ a lot of connections are made to nature, through energy
meridian lines and hands on manipulation (acupressure)
15. History
Hippocrates Galen
First references to the mind-body connection
▶▶▶ Hippocrates and Galen
The imbalances in emotions and passions,
and their translations as physical illnesses.
16. History
“
I find, by experience, that the mind and
1694 - 1773
the body are more than married, for they
are most intimately united; and when
Lord Chesterfield
one suffers, the other sympathizes.
”
17. History
Descartes’ mind-body dualism
1596 - 1650
The start of a breakdown of
the relationship between
mind and body.
René Descartes
18. History
“ … there are protective functions of
1813 - 1878 organic elements holding living
materials in reserve and maintaining
Claude Bernard
without interruption humidity, heat
and other conditions indispensable
mid 1800s - to vital activity. Sickness and death
founded the concept are only a dislocation or
millieu intérieur perturbation of that mechanism.
”
(Bernard, 1865)
19. History
XIX th century - physicians believed
that all diseases were the result of
some sort of anatomical abnormality
1856 - 1939
Freud - developed psychoanalysis
Sigmund Freud trying to explain the cause of illness
which could not be traced to
anatomical sources
20. History
Cannon’s observations:
- any change of emotional state in the beast,
1871 - 1945 such as anxiety, distress, or rage was
accompanied by total cessation of movements
of the stomach
Walter Cannon
Bodily Changes in Pain, Hunger, Fear and Rage, 1915
1932 - - these studies into the relationship between the
used the term effects of emotions and perceptions on the
homeostasis autonomic nervous system, namely the
(gr. Homoios = similar sympathetic and parasympathetic responses
Stasis = position ) that initiated the recognition of the freeze, fight,
or flight response
The Mechanical Factors of Digestion, 1911
21. Walter Cannon
Cannon’s homeostatic theory stimulated new interest
in the relationship between affect, physiology and
health, fostering the emergence of two schools:
1 2
“psychosomatic medicine” Focuses on biological processes rather
= approached discrete than on discrete emotions and is
emotions from the represented by Hans Selye, who
psychoanalytic paradigm introduced the concept of stress as a
general adaptation syndrome
Franz Alexander, in the 1920s that organisms develop
and 1930s, was its main in order to survive.
theoretician
22. History
▶▶▶ normal psychological
stressors and biogenic stressors
1907 - 1982
increase the action of the
neuroendocrine hypothalamic-
Hans Selye
pituitary-adrenal axis
increasing the levels of
hormones such are
glucocorticoids (like cortisol)
lowering the proliferation
of immune cells
23. Brain-body pathways in stress
Stress
Pituitary gland Hypothalamus
Adrenocorticotropic Autonomic
hormone (ACTH) nervous system (sympathetic division)
Adrenal cortex Adrenal medulla
Secretion of corticosteroids Secretion of catecholamines
Increased protein and fat mobilization Increased cardiovascular response
Increased access to energy storage Increased respiration
Decreased inflammation Increased perspiration
Increased blood flow to active
muscles
Increased muscle strength
Increased mental activity
24. General Adaptation Syndrome
▶ initial brief alarm reaction
▶ prolonged period of resistance
▶ terminal stage of exhaustion and death
25. History
Freeman et al., Phillips et al.,
Vaughan et al. - mid XXth century
1931 - 2001
studies of psychiatric patients:
→ immune alterations in psychotic
George Freeman Solomon patients, including numbers of
lymphocytes and poorer antibody
1964 -
coined the term response to pertussis vaccination,
"psychoimmunology" compared with non-psychiatric
control subjects
published a landmark paper: Freeman H, Elmadjian F. The relationship between blood sugar and lymphocyte levels in
"Emotions, immunity, and normal and psychotic subjects. Psychosom Med 1947; 9: 226–33.
Phillips L, Elmadjian F. A Rorschach tension score and the diurnal lymphocyte
disease: a speculative curve in psychotic subjects. Psychosom Med 1947; 9: 364–71
Vaughan WTJ, Sullivan JC, Elmadjian F. Immunity and schizophrenia.
theoretical integration." Psychosom Med 1949; 11: 327–33.
26. History
▶▶▶ term of PNI - 1975
1932 - 2011
There is a link between what we think
(our state of mind) and our health and
Robert Ader
our ability to heal ourselves.
director of the division of
behavioral and It is possible that a state of mind or
psychosocial medicine at emotional state to affect the immune
New York’s University of
Rochester response that the system is
responsible to keep the human body
healthy.
27. Ader (psychologist) and Cohen (immunologist)
deliberately immunizing conditioned and
unconditioned animals
→ exposing these and other control groups
to the conditioned taste stimulus
↓
measuring the amount of antibody produced
Results - conditioned rats exposed to the conditioned
stimulus were indeed immuno-suppressed
- a signal via the nervous system (taste) was
affecting immune function
This was one of the first scientific experiments that demonstrated that
the nervous system can affect the immune system.
28. History
Indications of neuro-immune interaction
1981 - discovered a network of nerves
David Felten leading to blood vessels as well as cells of
the immune system
- found nerves in the thymus and spleen
terminating near clusters of lymphocytes,
macrophages and mast cells (immune
cells)
29. Ader - Cohen - Felten
authors of book
Psychoneuroimmunology
1981
underlying premise that
the brain and immune system
represent
a single, integrated system of defense.
30. History
▶▶▶ neuropeptide-specific receptors are
present on the cell walls of both the brain
and the immune system
Candace Pert - neuropeptides and neurotransmitters act directly upon
the immune system = their close association with
Pert CB, Ruff MR, Weber RJ,
Herkenham M. Neuropeptides emotions suggests mechanisms through which
and their receptors: a
psychosomatic network. J emotions and immunology are deeply
Immunol. 1985 Aug;135(2
Suppl):820s-826s interdependent
Ruff M, Schiffmann E, Terranova
V, Pert CB.Neuropeptides are - the immune and endocrine systems are modulated not
chemoattractants for human
tumor cells and monocytes: a
possible mechanism for
only by the brain but also by the central nervous
metastasis. Clin Immunol
Immunopathol. 1985 Dec;37(3):
system itself
387-96
→ impact on the understanding of
emotions, as well as of disease
31. Contemporary advances in psychiatry, immunology,
neurology and other integrated disciplines of medicine has
fostered enormous growth for PNI
The mechanisms underlying behaviorally
▶▶ alterations of immune function
▶▶ behavioral changes
are likely to have clinical and therapeutic implications that
will not be fully appreciated until more is known about the
extent of these interrelationships in normal and
pathophysiological states.
