1-an aversive stimulus event.
 2-aspecific physiological and
psychological response.
 3-aspecial type of transaction between
the person and the environment.

Are those life events that induce change
in routine .
 Or in situations where no change has
occurred when change might have
been expected.


in1961 Holms found that the predictors of
recovery in pts with Pulmonary TB were:
-Strong family ties
- Steady employment
-Adequate income
-Regular recreation.
-Job satisfaction
He moved from the study of predictors of
recovery to predictors of the onset of illness.
1967Holms and Rahe developed the
schedule of recent life events , SRE, each
one has # of life change units LCU.
 They found linear relationship between LCU
scores and the # of illnesses experienced.
 In a later study they found that illness
developed within 2 years in 30%of subjects
with lowLCU scors,50% with intermediate
scores,80%with high LCU scores.

Most researchers agree that stressinduced illness may be caused by
chronic physiological arousal, the final
response to stress may be mediated by
several factors that can either buffer or
intensify the stressors. These are:
 Person perception.
 Coping style
 Social support systems
 Degree of genetic vulnerability.

Events that are stressful for one person may
not be for another.
 Lazarus(1977)has pointed out that stimulus
can evoke a stress reaction by
psychophysiological means only if it is
interpreted by the person as harmful or
threatening.
 Rose(1980)after stressful life event level of
cortisol,caticholamine and GH rise but only
catecholamine show arise after events of a
pleasurable nature(+ve and –ve life events
have diferent physiological consequences.

Coping is: behavior that involve special
physical and emotional energy and
attention that’s required to deal with some
difficult circumstances.
 It is 2 types:
-direct action: when the person
tries to master the stress.
-palliation: when the person is
unable to manage the environmental
challenge successfully.

Recent research evidence suggests that
those who have social supports are
protected in crisis from a variety of
pathological states(bebbington,1987)
 Studies of marital and health status reveal
that married have lower mortality rates
than those who are single(ortmeyer1974)
 Brown and Harris(1978)women with high
degrees of stress and little support had 4
times the rate of depression than women
with equal degrees of stress but much
support.

Another component in the multifactorial
causation of onset of illness is the pt genetic
susceptibility.
Stress may play a contributing role in
causation, but there is no doubt that once
the disease is present, symptoms of these
disorders can be exacerbated by stress.
 On the other hand ,some pts exhibit a
biological hardiness that appear to protect
them from stress-induced illness.

perception
Coping style
Genetic vulnerability
Social support
Psychophysiological changes
Acute illness
The hypothalamus act as a central
mediator for the regulation of the
autonomic, immune, and endocrine
systems .
 It integrates
cortical(cognitive)limbic(emotional) and
autonomic(visceral)inputs and control
many of the neural and endocrine
systems required for homeostasis.

The hypothalamus act as the locus 
where psychological stress may be
converted into physiological function.
It contain the nuclei of the autonomic.n.s
which are grouped into two divisions )
the sympathatic and para sympathatic)
that innervate the viscera and many
hormone secreting cells


In response to stress CRF IS SECRETED
FROM THE HYPOTHALAMUS it act at the
pituitary to trigger release of ACTH
which control the serum level of
glucocorticoids, their actions can be
summarized in the short term as
promoting energy use, increasing c.v
activity and inhibiting functions such as
growth, reproduction, and immunity.
Stressors activate N.A systems in the brain
and cause release of catecholamine's
from the ANS.
 The hypothalamus contains the nuclei of
the ANS that innervate the viscera and
glands.

sympathetic
Para sympathetic
Blood flow
Brain,muscle
Gut,kidney,skin
Skeletal muscle
Increased tone
decreased
Immune function
decreased
Increased
Reproductive function
decreased
increased
metabolism
catabolic
anabolic
hormones
Cortisol increased
decreased
In acute stress there is a shift from relaxation
to arousal i.e. a shift in a whole pattern of
hormonal secretions accompanied by an
increase in sympathetic discharge,
catabolic process and energy mobilization
 For a person to remain healthy those
periods of arousal must be balanced by
periods of relaxation
 If stress became chronic no repair of
accumulated damage which may lead to
illness.

Part of the stress response consists of the
inhibition of immune functioning by
glucocorticoids.
 CRF stimulate N.A release via CRF
RECEPTORS' located on the locus ceruleus
which activates the CNS. both centrally
and peripherally, and increase epinephrine
release from adrenal medulla.
 In addition direct links of norepinephrine
neurons synapse on immune target cells.


Glaser(1988) examined the
immunological function of 75 MD during
final exanimation,38 recently separated
women and 34 persons giving long term
care to relatives with Alzheimer's disease
she observed changes in immune cells in
all gps,decrease #of T helper cells, and
natural killer cells.
both humoral and cell mediated immunity
seem to be modulated by stress.
 Studies have shown that stressors such as
death of spouse or sleep deprivation can
alter T cells regulatory pattern and response
to mitogens.
 Several studies of immunological function
have shown that as compared with pts
without depression those with M.depression
have both reduced # of natural killer cells
and diminished natural killer cells capacity.


Behavioral strategies that decrease the
influence of stressors continue to show
promise in the repair and strengthening
of the immune system.
thanks.