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PSIKONEUROIMUNOLOGI Oleh : Joni Haryanto, S.Kp., MS Departemen Keperawatan Dasar Program Studi Ilmu Keperawatan Fakultas Ilmu Kesehatan Universitas Indonusa.

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Presentasi berjudul: "PSIKONEUROIMUNOLOGI Oleh : Joni Haryanto, S.Kp., MS Departemen Keperawatan Dasar Program Studi Ilmu Keperawatan Fakultas Ilmu Kesehatan Universitas Indonusa."— Transcript presentasi:

1 PSIKONEUROIMUNOLOGI Oleh : Joni Haryanto, S.Kp., MS Departemen Keperawatan Dasar Program Studi Ilmu Keperawatan Fakultas Ilmu Kesehatan Universitas Indonusa Esa Unggul Psychosocial factors that weaken & strengthen the immune system

2 Pendahuluan Pengertian Psikoneuroimunologi Pengertian Psikoneuroimunologi Kepentingan Psikoneuroimunologi Kepentingan Psikoneuroimunologi Faktor Psiko-sosial yg memperkuat dan melemahkan imunitas tubuh Faktor Psiko-sosial yg memperkuat dan melemahkan imunitas tubuh Tipe orang yang rentan terhadap stresor psiko-sosial Tipe orang yang rentan terhadap stresor psiko-sosial Sistem imun dapat di modulasi melalui sumber psiko-sosial Sistem imun dapat di modulasi melalui sumber psiko-sosial

3 Psychoneuroimmunology Robert Ader (2000) mrpk discipline-hybrid Robert Ader (2000) mrpk discipline-hybrid Psiko psikologi Psiko psikologi Neuroneurologi Neuroneurologi Imunologi Imunologi Merupakan istilah baru yang digunakan untuk menamakan kajian interaksi antara behavior, fungsi neuroendokrin dan sistem imun Merupakan istilah baru yang digunakan untuk menamakan kajian interaksi antara behavior, fungsi neuroendokrin dan sistem imun

4 What is PNI ? Study of the interrelations between the endocrine, central nervous system and the immune system (Cohen & Herbert 1996) Study of the interrelations between the endocrine, central nervous system and the immune system (Cohen & Herbert 1996) More specifically: Drawing on psychology & medicine, study of how emotional & mental states & social conditions (psychosocial factors) reciprocally link, through nervous & endocrine systems, to immune system & ultimately to immunological health & disease More specifically: Drawing on psychology & medicine, study of how emotional & mental states & social conditions (psychosocial factors) reciprocally link, through nervous & endocrine systems, to immune system & ultimately to immunological health & disease

5 Dasar PNI Percobaan Pavlov ( susu + lonceng + anjing ) Percobaan Pavlov ( susu + lonceng + anjing ) Kasus kanker payudara lebih sering pada orang melankolis dibandingkan sanguin (Galen, 200 AD) Kasus kanker payudara lebih sering pada orang melankolis dibandingkan sanguin (Galen, 200 AD) Proses PikirKopingKesehatan Proses PikirKopingKesehatan

6 PNI dan Sel Stres Melaui HPA-axis dan ANS (autonomic nerve system) Melaui HPA-axis dan ANS (autonomic nerve system) Komunikasi CNS dg sistem imun scr bidireksional Komunikasi CNS dg sistem imun scr bidireksional Paradigma psikoneuroimunologi berkonsep stres-sel: Paradigma psikoneuroimunologi berkonsep stres-sel: Ini menjelaskan bahwa pola pikir dan sistem imun merupakan satu sama lain yg keterkaitan yg lebih dapat diterangkan melalui komunikasi sel yg mengalami stres dan faktor neurotransmiter Ini menjelaskan bahwa pola pikir dan sistem imun merupakan satu sama lain yg keterkaitan yg lebih dapat diterangkan melalui komunikasi sel yg mengalami stres dan faktor neurotransmiter

7 What has PNI taught us? 1. Commonplace personal experiences of > immune-related illness following stress/emotional trauma, now explicable at biomolecular level. (neural-immune links: Felten et al., 1987; endocrine–immune links: Blalock, 1984)

8 What has PNI taught us? Helps to explain clinical experiences like: Helps to explain clinical experiences like: I see a lot of people with so-called problems relating to dysfunctional immune systems. Things like recurrent coldsores, recurrent infections, even hayfever, other allergies. These nearly always occur on a background of stress. I see a lot of people with so-called problems relating to dysfunctional immune systems. Things like recurrent coldsores, recurrent infections, even hayfever, other allergies. These nearly always occur on a background of stress. Dr. David Isaacs, Sydney suburban GP, 2000

9 What has PNI taught us? 2. Neuroendocrinological system research points to chronic stress as important contributor in range of immune-related conditions. Both children & adults show increased vulnerability to infectious diseases: including colds, flus & herpes virus infection, chickenpox, mononucleosis, & Epstein-Barr virus (Cohen & Herbert, 1996: Kiecolt-Glaser and & Glaser, 1987) Both children & adults show increased vulnerability to infectious diseases: including colds, flus & herpes virus infection, chickenpox, mononucleosis, & Epstein-Barr virus (Cohen & Herbert, 1996: Kiecolt-Glaser and & Glaser, 1987)

10 Variable impact of stress on immune system (Adapted from Robert Sapolsky in Merson, 2001) What has PNI taught us?

11 3. Certainly no experimental evidence, as yet, that mind can cure immune system diseases (Relman & Angell, 2002) 4. Evidence suggests psychosocial variables may alter susceptibility, progress & recurrence of these (Taylor, 1999) as well as how well pts cope/QOL

12 Pendekatan Psikoneuroimunologi Pasien tersebut akan tidak lekas sembuh, bahkan akan terjadi penyakit lain. Pasien tersebut akan tidak lekas sembuh, bahkan akan terjadi penyakit lain. Kebingungan akan menstmulasi hipotalamus menskresi CRF Kebingungan akan menstmulasi hipotalamus menskresi CRF CRF akan menginduksi pituitari menghasilkan ACTH dan meningkat CRF akan menginduksi pituitari menghasilkan ACTH dan meningkat Kelenjar adrenal akibat ACTH menghasilkan cortisol dalam jumlah banyak Kelenjar adrenal akibat ACTH menghasilkan cortisol dalam jumlah banyak Ini mampu mensupresi limfosit T Ini mampu mensupresi limfosit T Akibatnya ketahanan tubuh menurun Akibatnya ketahanan tubuh menurun

13 Kepentingan Psikoneuroimunologi Perawat potensi sbg stressor Perawat potensi sbg stressor Dimana klien kehilangan fungsi fisiologis Dimana klien kehilangan fungsi fisiologis Emosi klien / pasien sangat labil Emosi klien / pasien sangat labil Interaksi perawat dg klien akan memicu proses adaptasi dari kemampuan koping yg telah di kelola oleh perawat. Interaksi perawat dg klien akan memicu proses adaptasi dari kemampuan koping yg telah di kelola oleh perawat. Proses adaptasi akan memicu perbaikan sistem ketahanan tubuh Proses adaptasi akan memicu perbaikan sistem ketahanan tubuh

14 Perawatmother instink Nurturen Generative Nurturen Generative Protective Protective to care (perilaku terapiutik) Client / Patientsemakin sehat Kepentingan Psikoneuroimunologi

15 Proses Keperawatan dan Psikoneuroimunolgi Pengkajian dg dasar caring akan menimbulkan kesan diterimanya pasien/klien Pengkajian dg dasar caring akan menimbulkan kesan diterimanya pasien/klien Diagnose keperawatan akan menjembatani aplikasi profesional Diagnose keperawatan akan menjembatani aplikasi profesional Intervensi lebih memantapkan dalam pelaksanaan tindakan kpd klien/pasien Intervensi lebih memantapkan dalam pelaksanaan tindakan kpd klien/pasien Tindakan keperawatan scr langsung memberikan sentuhan dan upaya meminimalkan stressor yg negatif Tindakan keperawatan scr langsung memberikan sentuhan dan upaya meminimalkan stressor yg negatif Evaluasi untuk mengetahui proses HPA-axis terjadi dan timbul kesembuhan Evaluasi untuk mengetahui proses HPA-axis terjadi dan timbul kesembuhan

16 Faktor Psikososial Yang Memperkuat Dan Melemahkan Imunitas Tubuh Problems that can beset immune system Age Age Genetic disorders Genetic disorders Infectious diseases Infectious diseases Nutrition Nutrition Chemotherapy Chemotherapy Irradiation Irradiation Allergies Allergies Stress = focus of PNI Stress = focus of PNI

17 Psychosocial factors modulating immunity a. Weakening influences Changes in immune system found to accompany stressful or conflictual social relationships. These include: Changes in immune system found to accompany stressful or conflictual social relationships. These include: - Loss of an intimate relationship from death or divorce (Bartrop et al., 1977) Worse effects if depressed before and after the loss (Irwin et al., 1987) Worse effects if depressed before and after the loss (Irwin et al., 1987)

18 Psychosocial Factors Modulating Immunity - Loneliness. Lonely people have poorer health. Amongst exam students they had more extreme immuno-compromise (Kiecolt-Glaser et al., 1984) - Poorer marital quality for married couples - associated with latent virus antibody response (Kennedy et al., 1988) - Caring for a terminally-ill patient (Esterling et al., 1996)

19 Psychosocial Factors Modulating Immunity Job stress (Dorian, et al., 1985) & Job stress (Dorian, et al., 1985) & unemployment (Arnetz et al., 1987). Both linked to lowered lymphocyte reactivity to mitogen unemployment (Arnetz et al., 1987). Both linked to lowered lymphocyte reactivity to mitogen Tendency to ruminate during stressful events such as exam periods (Workman & La Via, 1987) Tendency to ruminate during stressful events such as exam periods (Workman & La Via, 1987)

20 Psychosocial Factors Modulating Immunity Academic stress can lead to immunological changes and illness. Glaser et al. (1985) assessed 40 2 nd year medical students 6 wks before and during final exams. Lymphocytes, NK cells and NK cytotoxic activity and interferon levels were lower Academic stress can lead to immunological changes and illness. Glaser et al. (1985) assessed 40 2 nd year medical students 6 wks before and during final exams. Lymphocytes, NK cells and NK cytotoxic activity and interferon levels were lower

21 Psychosocial Factors Modulating Immunity Starting kindergarten can raise cortisol levels and negatively alter immune measures (Boyce et al.,1995) Starting kindergarten can raise cortisol levels and negatively alter immune measures (Boyce et al.,1995) Clinical depression is associated with several alterations in immunity e.g. fewer lymphocytes in response to mitogens (chemical challenges), lowered NK cell activity and changes in WBC numbers (Herbert & Cohen, 1993) Clinical depression is associated with several alterations in immunity e.g. fewer lymphocytes in response to mitogens (chemical challenges), lowered NK cell activity and changes in WBC numbers (Herbert & Cohen, 1993)

22 Pendekatan Psikoneuroimunologi Sikap perawat akan mempengaruhi persepsi klien Sikap perawat akan mempengaruhi persepsi klien Perilaku perawat yang otoriter dan cenderung sadisme merupakan tindakan yang dapat menimbulkan penyakit baru / tidak terjadi kesembuhan Perilaku perawat yang otoriter dan cenderung sadisme merupakan tindakan yang dapat menimbulkan penyakit baru / tidak terjadi kesembuhan Perlu ada perubahan sikap perawat menjadi : Perlu ada perubahan sikap perawat menjadi : Sikap Caring Sikap Caring Altruistik Altruistik Profesional Profesional

23 Psychosocial Factors Modulating Immunity Changes in the immune system have also been found to accompany stressful or conflictual social relationships. These include: Changes in the immune system have also been found to accompany stressful or conflictual social relationships. These include: - Loss of an intimate relationship from death or divorce (Bartrop et al., 1977) Worse effects if depressed before & after the loss (Irwin et al., 1987) Worse effects if depressed before & after the loss (Irwin et al., 1987)

24 Psychosocial Factors Modulating Immunity Perceived severe ‘daily hassles’ predict lower NK cell activity (Levy et al., 1989) Across studies it appears that more severe & long-term were stressors, more vulnerable individuals were to health-related problems


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