During the past two decades, there have been major efforts to understand the influence of the nervous system on immune and inflammatory responses. As a result, it has become clear that the immune system communicates with the neuroendocrine system and that imbalances in the neuroendocrine-immune circuitry are relevant to host defenses. This knowledge is the basis of the scientific discipline called psychoneuroimmunology.
The first edition of Psychoneuroimmunology was published in 1981 and helped to establish the new discipline. In addition to covering the scant amount of research on the subject that was available at that time, it contained a seminal chapter. This chapter, written by Ader and Cohen, reviewed behaviorally conditioned suppression of the immune system and provided strong support for the integration of the "somatic" and "psychological" aspects of immunity.
The table of contents of the third edition of Psychoneuroimmunology is an indication of the depth and breadth of its subject matter. Molecular biology, genetics, the neurosciences, immunology, cell biology, endocrinology, chronobiology, pharmacology, anatomy, biochemistry, and the behavioral sciences are considered. This list demonstrates that psychoneuroimmunology constitutes a meeting ground for medicine, biochemistry, genetics, psychology, and human ethology. It emphasizes the indivisibility of somatic and psychological processes and the inseparability of immunologic and neuroendocrine processes.
The first three parts of Psychoneuroimmunology deal with the pathways that bridge the brain and the immune system -- namely, the neuroendocrine and autonomic nervous systems. The primary and secondary lymphoid organs are sympathetically and parasympathetically innervated, and these types of nerve fibers form neuroeffector junctions with the lymphocytes, monocytes, macrophages, and granulocytes that possess the appropriate receptors. Several chapters in the book cover the ways in which neural and neuroendocrine signals modify immune processes and the ways in which cytokines affect brain function. One of the most valuable chapters deals with how sleep influences the homeostatic regulation of the immune system. Sleep deprivation, for example, adversely affects resistance to infectious diseases. Most of the mechanisms underlying the relation between sleep and modulation of the immune system are unknown, but it seems clear that these mechanisms are important in host defenses.
Parts IV and V of Psychoneuroimmunology document the effects of behavior and stress on immune function. Important topics, such as pain and the effects of early rearing experiences and social interactions, are covered. Psychoneuroimmunology ends with chapters, in part VI, devoted to the links between psychoneuroimmunology and neurologic and psychiatric diseases, infection, surgical trauma, cardiovascular disease, periodontal disease, alcoholism, and aging. These contributions discuss the influence of emotions on immune responsiveness and the ways in which personal and social support can help in the recovery from an immune-mediated disease.
Reading this book leaves the impression that research in psychoneuroimmunology is growing exponentially. The third edition of Psychoneuroimmunology contributes substantially to this effort.
Daniel P. Cardinali, M.D., Ph.D.
Copyright © 2001 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
