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Psychoneuroimmunoendocrinology Review and Commentary.

Psychoneuroimmunoendocrinology describes the unity of mental, neurological, hormonal, and immunological functions, addressing the impact of cognitive images of the mind (whatever its elusive definition) on the central nervous, endocrine, and immune systems. It encompasses biofeedback and voluntary controls, impacts on physiology of thought and belief, past/present stress, placebos, social relationships, and "energy medicine." This column highlights clinical applications of cogent studies from these arenas of holistic medicine in the new millennium.

Travel Health and Treating Emergencies in the Woods

Psychoneuroimmunoendocrinological principles seem to relate to this topic only with a long stretch. I submit the following possibilities.

Stress in Challenging Circumstances

In this review, the authors discuss the compromise of immune function secondary to acute and chronic stress that increases vulnerability to viral infections, triggers aggravation of episodes of asthma, accelerates clotting risk for myocardial infarction, and accelerates deterioration of blood sugar control in diabetes.

McEwen BS, Stellar E. Stress and the individual. Mechanisms leading to disease. Arch Intern Med. 1993 Sep 27; 153(18): 2093-2101.

Comment: Travel is stressful. Driving long distances is known to add to our load of stress. Air travel becomes more stressful by the year: cancelled flights, concern about adequate safety inspections, recycled dry air with deficiency of negative air ions, solar radiation exposure, sedentary deep venous thrombosis risk, and dehydration can be listed as acute stressful hazards. As these authors suggest, any acute stress or uptick in chronic stress potentially deteriorates health and may precipitate an acute deterioration in pre-existing disease states such as coronary artery insufficiency, asthma, and diabetes.

Stress and Immunity

In 45 first-time parachutists, the psychological stress increased sympathetic adrenal hormones epinephrine and norepinephrine, cortisol, heart rate, respiratory rate, and fear ratings (p<.001) at the time of jumping. Significant immediate increases in T-cell counts ([CD.sup.2+], [CD.sup.3+], [CD.sup.8+] [p=.001], and [CD.sup.4+] [p = .01]) and a doubling of NK (16) and NK (56) cell counts (p = 001) were found. Twenty minutes after the jump, epinephrine and norepinephrine were at baseline levels, and all immune cellular parameters were significantly below baselines (p = .001). Cortisol returned to baseline one hour following the jump. Experienced jumpers had much smaller and mostly insignificant changes.

Schedlowski M, et al. Psychophysiological, neuroendocrine and cellular immune reactions under psychological stress. Neuropsychobiology. 1993; 28(1-2):87-90. I Clin Immunol. Mar 1993; 13(2): 119-29.

Comment: Experience reduces the impact of stressful experience, and stress effects tend to be short term in the young and fit. This information would particularly relate to alpine hikers, mountain climbers, icefall climbers, rock climbers, and participants in related extreme sports. The autonomic nervous system reacts with sharp increases in the hormonal and biochemical agents, which temporarily erode the responsiveness of the immune system. Marathon runners experience a very high incidence of respiratory infections within days of their competitive runs.

More on Stress and Immunity

Ninety-five randomly selected 18-year-olds from a pool of 583 consenting first-year West Point cadets had blood drawn at registration into the academy program, at the end of the first six weeks of cadet basic training, following winter holidays on return to the academy, and during second year final examinations. A battery of five psychological instruments was completed and repeated one year later. Antibody levels remained essentially unchanged until the fourth blood drawing at final examination time, at which time there was a very significant rise in Epstein Barr virus titers (p<.001), with no significant increases in herpes-virus-1 and human herpesvirus-6 antibody levels. There were also no significant correlations with psychological data from the completed test instruments.

Glaser R, et al. The differential impact of training stress and final examination stress on herpesvirus latency at the United States Military Academy at West Point. Brain Behav Immunity. 1999 Sep; 13(3):240-51.

Comment: In these West Point cadets, the academic stress of final examinations, but not the physical and psychosocial stress of basic training, significantly reactivated latent mononucleosis virus activity, but not that of HSV-1 or HHV-6. These three herpes viruses, causing mononucleosis, gingivostomatitis, and exanthem subitum, respectively, remain in a steady state held at bay by cell- mediated immunity. Reactivation at final examination time, implying compromise of the immune system with consequent secondary rise in antibody titers, gives testimony to the intensity of the mental stress involved in academic competitive testing. The very significant rise in EBV antibodies confirms previous work showing this stress response of the immune system.

The point here is that we experience mental stress that may exceed physical and psychosocial stress when we tend to get out of our comfort zone. Hiking in the mountains can press us into that zone. Three summers ago, while hiking in a downpour on the Cascade Crest trail in the state of Washington, I met a lone hiker walking the opposite direction. He asked if I had encountered his hiking partner walking ahead of him. I said no. He hiked on past, and then a half-hour later, caught up with me after he turned around to go in my direction. His hiking partner had apparently taken a different direction at a fork in the trail; his partner had their tent! He looked ashen and anxious. I think he was stressed much more by his anxiety and mental alarm than he was by being cold and wet.

Immunity, Stress, and the Adrenal Cortex

In this review, the authors highlight the important role played by corticosteroids in trafficking immune cells. Glucocorticoid-induced shifts include changes in absolute numbers of white blood cells, with a marked increase in neutrophils; marked decrease in eosinophils, basophils, monocytes, lymphocytes, T-lymphocytes; and a moderate decrease in B-lymphocytes. Decreases are seen in T-suppressor cells (B-cell effect), serum immunoglobulin G, pokeweed mitogen-stimulated cell responses, and anti-SRBC (sheep cell) suppressor activity. No effects are seen for concanavalin-A-, sarcoid-, and Epstein Barr virus-generated suppressor cells.

Cupps TR, Fauci TS. Corticosteroid-mediated immunoregulation in man. Immunol Rev. 1982; 65: 133-40.

Comment: This commentary emphasizes the participation of the hypothalamic-pituitary-adrenal system producing higher corticosteroid production in stress-related biochemistry. Stress can result from any process that excessively challenges the body's systems, regardless of whether the source of the stress is microbiological, physical, or psychosocial. So, long days of challenging hiking in alpine country, difficult sleeping conditions while mountain climbing, and anxiety-producing risks of climbing an icefall all raise corticosteroid levels that depress many mediators of immune responsiveness.

Immunity, Stress, and the Adrenal Medulla

The author in this review points out that stress increases circulating catecholamines, which in turn inhibit both magnesium-calcium and sodium-potassium adenosine triphosphatase, leading to rises in cellular calcium and sodium and renal loss of potassium and magnesium. And, perhaps more importantly, metabolism of catecholamines increases populations of free radicals. Targets of this free radical activity include potential damage to neuronal receptors, atherosclerosis, oncogenic deterioration, and a variety of other organ tissue damage.

Demopoulos HB, et al. The development of secondary pathology with free radical reactions as a threshold mechanism. I Am Coll Toxicol. 1983; 3(2): 173-84.

Comment: Microbiological, physical, and psychosocial stress all appear to lead to an activation of the autonomic-adrenal-medulla system as well as the hypothalamic-pituitary-adrenal-cortex system. Elevated catecholamine metabolites increase free radical levels, reeking havoc in any number of pathological processes. The immune system is included in the array of targets. Acute exacerbations of chronic stress include travel and coping with emergencies in the wilds of nature. The better we cope with chronic stress, the better we cope with the acute exacerbations.

The Stress of Control Issues While Traveling

In 104 student subjects completing psychological tests separating them into those needing power/control and those needing affiliation/support, the former encountering high "power stress" or inhibition had by far the highest mean severity of illness score compared to all other subgroups (p<.01). Statistical trials against all other subjects were even more significant (p<.001).

McClelland DC, Jemmott JB. Power motivation, stress and physical illness. J Human Stress. 1980 Dec; 6(4): 6-15

Comment: In the discussion of this study, the authors interpret their conclusions to mean that those with significant high power stresses have high sympathetic activity and immunosuppression. I recently observed a glaring example in the experience of a close acquaintance who became ill with a viral respiratory infection a week before a long-scheduled two-week Hawaiian vacation with his wife and daughter. Almost recovered by their day of departure, he and the family were met with a canceled flight and the need to stay overnight in a hotel and catch a crowded and delayed next-day flight with separated airplane seats. My friend's wife, a high power/control person, had no control over these events. In mid-flight, she became symptomatic with respiratory viral symptoms, with which she remained totally ill and confined to their condo facility for the entire vacation. The daughter also became ill but recovered quickly. The daughter clearly has none of the mother's control issues. I know that one case doth not a theory prove. However, this observation only confirmed my decades-long observation that illness tends to stalk persons with high control needs when that control is frustrated by unavoidable circumstances. There is a high degree of association linking illness and vacations (Holmes T, Rahe R. The social readjustment rating scale. J Psychocom Res. 1967 Aug; 11(2):213-18).

Robert Anderson is a retired family physician who has authored several major books: Stress Power!, Wellness Medicine, Clinician's Guide to Holistic Medicine (McGraw Hill, 2001) and The Scientific Basis for Holistic Medicine, (6th edition 2004), available from American Health Press, Anderson founded the American Board of Integrative Holistic Medicine, is a past president of the AHMA and a former Assistant Clinical Professor of Family Medicine at the University of Washington, and he teaches The Art of Primary Care at Bastyr University.

by Robert A. Anderson, MD, FAAFP, FACPM, ABHM
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Author:Anderson, Robert A.
Publication:Townsend Letter
Geographic Code:1USA
Date:Jul 1, 2008
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