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

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

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

What is PNI ? 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 Science which studies effect of mind on immune system

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

PNI dan Sel Stres Melaui HPA-axis dan ANS (autonomic nerve system) Komunikasi CNS dg sistem imun scr bidireksional 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

What has PNI taught us? 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) Part of the popular Press, some of the New Age gurus have made it seem as though we know all the answers and that we can translate what we have seen in the laboratory directly into important health outcomes, that the way you act and think will automatically translate into huge differences in health. We are certainly not at that point. I think the bottom line is that there is no evidence that your mind can cure disease. The evidence suggests that the mind may well alter the progression of the disease or your susceptibility to disease and that in itself can be extremely important and something well worth investigating. it is possible to condition people to increase the numbers and activity of their own natural killer cells. These cells are thought to be able to destroy certain types of cancer cells. This raised the next big question: can your mind help you fight cancer? scientists have shown that the mind can turn down the immune system. But can we control this effect when we need it? Can we harness its power ? One case stands out. Cohen, Tyrrell and Smith (1991). 394 healthy subjects were assessed for degree of stress. All were exposed to a respiratory virus. Not everyone came down with a cold. Controlling for a large number of other explanatory variables that can sometimes moderate the stress-illness relationship, a direct relation between amount of stress and subsequent infection was found. Blalock, J.E. 1984. The immune system as a sensory organ. J. Immunol. 132:1067-1069. Endocrine path. Stress hormones e.g.cortisol (especially in chronic stress) can damage the immune system

What has PNI taught us? 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. Dr. David Isaacs, Sydney suburban GP, 2000

What has PNI taught us? 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) An excellent example of research that has uncovered a direct relation between stress and illness is experimental work on the common cold Cohen, Tyrrell and Smith (1991). 394 healthy subjects were assessed for degree of stress. All were exposed to a respiratory virus. Not everyone came down with a cold. Controlling for a large number of other explanatory variables that can sometimes moderate the stress-illness relationship, a direct relation between amount of stress and subsequent infection was found. Does the influence of stress on the immune system result in disease? Yes Both children and adults show increased vulnerability to infectious diseases including colds, flus and herpes virus infection, chickenpox, mononucleosis, and Epstein-Barr virus (Cohen & Herbert, 1996: Kiecolt-Glaser and & Glaser, 1987)

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

What has PNI taught us? Certainly no experimental evidence, as yet, that mind can cure immune system diseases (Relman & Angell, 2002) Evidence suggests psychosocial variables may alter susceptibility, progress & recurrence of these (Taylor, 1999) as well as how well pts cope/QOL Within-individual variables help explain range of responses to same pathogens & standard biomedical treatments

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

Kepentingan Psikoneuroimunologi Perawat potensi sbg stressor Dimana klien kehilangan fungsi fisiologis Emosi klien / pasien sangat labil 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

Kepentingan Psikoneuroimunologi Perawat mother instink Nurturen Generative Protective to care (perilaku terapiutik) Client / Patient semakin sehat

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

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

Psychosocial factors modulating immunity a. Weakening influences 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)

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)

Psychosocial Factors Modulating Immunity Job stress (Dorian, et al., 1985) & 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)

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

Psychosocial Factors Modulating Immunity 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)

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

Psychosocial Factors Modulating Immunity 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)

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