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Psychoneuroimmunology &

Immune-Related Disorders
CHAPTER 14
Psychoneuroimmunology & HIV/AIDS

 The Immune System

 Psychoneuroimmunology

 HIV/AIDS
The Immune System

(def.) body’s defense against infection (i.e., invasion of microbes and their
growth in the body) and illness

Four means of infection


 Direct transmission
 Indirect transmission
 Biological transmission
 Mechanical transmission
The Immune System

Course of Infection

 Incubation period – time between contact and onset of symptoms

 Period of nonspecific symptoms – headaches, general discomfort,


microbes colonizing

 Acute Phase – disease at its height

 Fatality or a period of decline – invading organisms expelled through


mucus, saliva, and digestive track
The Immune System

Immunity

 (def.) body’s resistance to invading organisms

 Natural (nonspecific) or Specific immunity


 Natural – general set of responses to any kind of infection or disorder

 Specific – ability to fight particular microbes that is acquired after birth


The Immune System

Lymphatic System

 Drainage system of the body


 Capillaries, vessels, and nodes throughout the body

 Lymphatic capillaries drain water, proteins, microbes,


and other foreign materials from spaces between the
cells into lymph nodes

 Lymph nodes filter microbes and foreign materials for


ingestion by lymphocytes
Disorders of the Immune System

 Tonsillitis – inflammation of the tonsils interfering with filtering of bacteria

 Mononucleosis – viral disorder with enlargement of spleen/lymph nodes

 Lymphoma – tumor of lymphatic tissue

 Autoimmune disease – immune system attacks body’s own tissues

 HIV/AIDS – progressive impairment of immunity, making people more likely


to get infections
Psychoneuroimmunology & HIV/AIDS

 The Immune System

 Psychoneuroimmunology

 HIV/AIDS
Psychoneuroimmunology

(def.) the study of interactions among behavioral, neuroendocrine, and


immunologic processes of adaptation

Assessing immune functioning


 Measure the functioning of immune cells in blood
 Measure ability to produce antibodies to a latent virus or vaccine
 Measure levels of immune system products, such as pro-inflammatory
cytokines
 Measure wound healing (e.g., small puncture in forearm)
Psychoneuroimmunology

Stress and Immune System Functioning

 Different kinds of stressors require different kinds of defenses


 Short-term stressors (i.e., a few minutes)
 Brief stressors (i.e., several days)
 Chronically stressful events

 Maximally efficient immune response to any situation entails costs


 Some aspects of immunity may be adaptively suppressed as others are
actively engaged
Psychoneuroimmunology

Factors Related to Poor Immune Functioning

 Stress
 Negative affect, such as depression
 Poor sleep
 Loneliness and chronic interpersonal stress (ex., marital disruption and
conflict; caregiving)
Psychoneuroimmunology

Interventions to Improve Immune System Functioning

 Cognitive Behavioral Techniques


 Stress management
 Ex. Relaxation, mindfulness meditation
 Improving social support
 Promote benefit finding
 Addressing depression
 Improving general health behaviors, with a focus on sleep
Psychoneuroimmunology & HIV/AIDS

 The Immune System

 Psychoneuroimmunology

 HIV/AIDS
HIV/AIDS Basics

Basic Terms
 HIV: Human immunodeficiency virus
 AIDS: Acquired immune deficiency syndrome

Basic Facts
 HIV is a retrovirus attacks the helper T cells and macrophages of the immune
system
 Progress to AIDS when T cell count is 200/microliter blood (healthy individuals
have between 600 to 1,200/microliter blood)
 Variable time between contracting HIV to AIDS
HIV/AIDS Progression
HIV/AIDS Progression

 Early symptoms include abnormalities in the neuroendocrine and


cardiovascular responses to stress

 As T cell levels decrease later in stage 2, people with HIV may begin to show
increased symptoms

 After the progression to AIDS, high risk of opportunistic infections and


cancers that take advantage of a very weak immune system
 Kaposi’s sarcoma and non-Hodgkin’s lymphoma
 Women have high risk of frequent gynecologic infections
 Additional symptoms can include diarrhea, wasting, skeletal pain, neurological
impairment, and blindness
HIV/AIDS

Transmitted by exchange of cell-containing bodily fluids, such as semen and blood.


Most common transmission methods:
 Unprotected sex
 Intravenous drug use
 From mother to child during childbirth or breastfeeding

Currently, an estimated 36.9 million people worldwide are living with HIV/AIDS
 Approximately 1.2 million people in the US are living with HIV, about 13% of whom
are unaware of their infection
 First diagnosed case in the US in 1981
HIV/AIDS
HIV/AIDS in the US
HIV/AIDS in the US (CDC, 2017)

 HIV is largely an urban disease, with most


cases occurring in metropolitan areas
(those areas with 500,000 or more people)

 The South has the highest number of people


living with HIV

 But, the Northeast has the highest number


of people living with HIV per 100,000
New HIV Diagnoses in the US for the Most-
Affected Subpopulation, 2016 (CDC)
New HIV
Diagnoses in the
US by Age, 2016
(CDC)

Among people
aged 13-24 who
were living with HIV,
an estimated 44%
didn’t know
HIV/AIDS in the US (CDC, 2016)
HIV/AIDS in the US
HIV/AIDS in the US
HIV/AIDS

Psychosocial Impact of HIV Infection

 Initially after diagnosis, high rates of depression and bereavement


 These symptoms can lead to increased immune system problems

 In the longer term, most people cope fairly well


 Usually result in positive changes in health behavior (e.g., diet, exercise,
and drug use)
 Risk of irregular periods of depression
HIV/AIDS

Disclosure of HIV status

 Not disclosing HIV status (often related to fears of stigmatization) or lying


about risk factors can lead to poor outcomes
 Personally, can complicate living with HIV by impacting treatment
 A lack of disclosure to sexual partners can lead to public health risk

 Benefits of disclosure
 More social support
 Higher self-esteem and self-efficacy
 Higher T cell count than non-disclosers
HIV/AIDS: Prevention & Management

Prevention

 Goals  Increase testing, reduce high risk sexual behavior, and reduce
sharing of needles

 Social Science Interventions


 Education – need for targeted, culturally sensitive messages and
information
 Social skills training focused on sexual negotiation
 Interventions based on Transtheoretical (i.e., stages of change) model
and the Information-Motivation-Behavioral skills model
HIV/AIDS: Prevention & Management
HIV/AIDS: Prevention & Management

Management Goals

 Treatment adherence to HAART (Highly active antiretroviral therapy)


 Improve quality of life
 Address factors that may accelerate disease progression
 Stress, emotional distress, depression, passive coping skills, psychological
inhibition, low social support, negative beliefs and expectations about
the self and the future
HIV/AIDS: Prevention & Management

Interventions to Improve Management

 Education
 Cognitive Behavioral Techniques focused on:
 Stress management and active coping skills training
 Improving general health behaviors
 Increasing adherence to HAART
 Reducing risky sexual and drug use behaviors
 Addressing depression, psychological distress, psychological inhibition, and
negative beliefs/expectations about the future
 Improving social support
HIV/AIDS:
Prevention &
Management

An Information-
Motivation-
Behavioral Skills
Model of Adherence
to Antiretroviral
Therapy
(Fisher, Fisher, Amico
& Harman, 2006)
Psychoneuroimmunology & HIV/AIDS

 The Immune System

 Psychoneuroimmunology

 HIV/AIDS
Cancer & Arthritis

 Cancer
 The Basics
 Risk Factors
 Prevention & Management

 Arthritis
Cancer

 (def.) group of diseases caused by the uncontrolled growth and spread of


abnormal cells

Kim, Lee, Kim, Seo,


& Lee (2017)
Cancer

Differences between Cancer and Normal Cells

 Are not specialized


 Ignore the chemical signals that tell cells to stop dividing or that initiate
programed cell death (i.e., apoptosis)
 “Take control” of normal cells, molecules, and blood vessels to feed tumor
 “Hide” from the immune system and spread undetected
 As cancer cells grow into tumors, they begin to use the immune system to
stay alive
Cancer

• Cancer is 2nd highest


cause of death in the
US & most developed
countries

• Some cancers related


to race, ethnicity, and
cultural differences

• The causes, symptoms,


and treatment for each
cancer vary
Cancer

• Since 1993, the US cancer


death rates have shown a
steady decline

• Primary reasons for


decline:
• Reductions in smoking
• Improvements in
treatment

• 64% of cancer survivors


live at least 5 years, and
15% live at least 20 years
Cancer: Risk Factors

Cancer results from the interaction of biological, psychological, and


environmental-social factors
 Genetics
 Infections
 Diet
 Poor health behaviors
 Lack of or low social support
 Environmental exposure to cell-altering substances
Cancer: Risk Factors
Cancer: Risk Factors

Cancer results from the interaction of biological, psychological, and


environmental-social factors
 Genetics
 Infections
 Diet
 Poor health behaviors
 Lack of or low social support
 Environmental exposure to cell-altering substances
Cancer: Risk Factors

Psychosocial Factors Linked to Cancer Progression


 Low social support, depression, psychological distress, avoidance or inability
to confront the disease, denial or repressive coping, pessimism or negative
expectations concerning progression

How are psychosocial factors impacting cancer progression?


 Altering functioning of HPA and Sympathetic stress systems with a focus on
natural killer cells
Cancer Prevention & Management

Targets of Cognitive Behavioral Techniques:


 Improving social support, sometimes using family therapy or support groups
 Addressing psychosocial factors linked to cancer progression, with a focus
on social support and depression
 Treatment adherence
 Active coping skills training
 Management of cancer and cancer treatment effects
 Pain, sleep loss, fatigue, depression, nausea, changes in physical
functioning and appearance, job disruption, and interactions with others
 Promote post-traumatic growth
Cancer & Arthritis

 Cancer
 The Basics
 Risk Factors
 Prevention & Management

 Arthritis
Arthritis

 (def.) more than 100 diseases that attack the joints or other connective
tissues

 The most prevalent autoimmune disease, and one of the most common
causes of disability

 53 million people in the US are afflicted with arthritis severe enough to require
medical care (CDC, 2015)

 Two of the most debilitating forms of arthritis are rheumatoid arthritis (RA) &
osteoarthritis
Arthritis

Rheumatoid Arthritis

 (def.) the immune system attacks thin membranes


surrounding joints leading to inflammation, stiffness, and
pain

 Affects small joints of hands, feet, wrists, knees, ankles,


and neck

 Work disability and depression common


Arthritis

Rheumatoid Arthritis: Treatment

 Aspirin, rest, and supervised exercise

 Cognitive behavioral interventions focused on:


 Managing stress & pain
 Addressing depression and negative mood
 Improving management self-efficacy
Arthritis

Osteoarthritis

 (def.) articular cartilage (i.e., smooth lining of a joint)


begins to crack or wear away because of overuse,
injury, and other causes

 Tends to affect weight-bearing joints (e.g., hips, knees,


and spine)
Arthritis

Osteoarthritis

 Aspirin and other pain killers, keeping weight down,


exercise

 Cognitive behavioral interventions focused on:


 Managing pain
 Addressing depression and psychological distress
 Coping skills training
Cancer & Arthritis

 Cancer
 The Basics
 Risk Factors
 Prevention & Management

 Arthritis
 Definitions and Prevalence
 Managment

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