McEwen Bruce S
Harold and Margaret Milliken Hatch Laboratory of Neuroendocrinology, The Rockefeller University, New York, NY 10021, USA.
Dialogues Clin Neurosci. 2006;8(4):367-81. doi: 10.31887/DCNS.2006.8.4/bmcewen.
The mind involves the whole body and two-way communication between the brain and the cardiovascular, immune, and other systems via neural and endocrine mechanisms. Stress is a condition of the mind-body interaction, and a factor in the expression of disease that differs among individuals. It is notjust the dramatic stressful events that exact their toll, but rather the many events of daily life that elevate and sustain activities of physiological systems and cause sleep deprivation, overeating, and other health-damaging behaviors, producing the feeling of being "stressed out." Over time, this results in wear and tear on the body which is called "allostatic load," and it reflects not only the impact of life experiences but also of genetic load, individual lifestyle habits reflecting items such as diet, exercise, and substance abuse, and developmental experiences that set life-long patterns of behavior and physiological reactivity. Hormones associated with stress and allostatic load protect the body in the short run and promote adaptation by the process known as allostasis, but in the long run allostatic load causes changes in the body that can lead to disease. The brain is the key organ of stress, allostasis, and allostatic load, because it determines what is threatening and therefore stressful, and also determines the physiological and behavioral responses. Brain regions such as the hippocampus, amygdala, and prefrontal cortex respond to acute and chronic stress by undergoing structural remodeling, which alters behavioral and physiological responses. Translational studies in humans with structural and functional imaging reveal smaller hippocampal volume in stress-related conditions, such as mild cognitive impairment in aging and prolonged major depressive illness, as well as in individuals with low self-esteem. Alterations in amygdala and prefrontal cortex are also reported. Besides pharmaceuticals, approaches to alleviate chronic stress and reduce allostatic load and the incidence of diseases of modern life include lifestyle change, and policies of government and business that would improve the ability of individuals to reduce their own chronic stress burden.
心智涉及整个身体，大脑与心血管系统、免疫系统及其他系统之间通过神经和内分泌机制进行双向交流。压力是身心相互作用的一种状态，是疾病表现的一个因素，且因人而异。造成损害的不只是重大的应激事件，还有日常生活中的诸多事件，这些事件会增强并维持生理系统的活动，导致睡眠不足、暴饮暴食及其他损害健康的行为，产生“压力过大”的感觉。随着时间推移，这会导致身体出现损耗，即所谓的“应激负荷”，它不仅反映生活经历的影响，还反映基因负荷、反映饮食、运动和药物滥用等项目的个人生活方式习惯，以及设定终身行为和生理反应模式的发育经历。与压力和应激负荷相关的激素在短期内保护身体，并通过称为应变稳态的过程促进适应，但从长远来看，应激负荷会导致身体发生变化，进而引发疾病。大脑是压力、应变稳态和应激负荷的关键器官，因为它决定什么是威胁，从而产生压力，还决定生理和行为反应。海马体、杏仁核和前额叶皮质等脑区会通过结构重塑来应对急性和慢性压力，这会改变行为和生理反应。对人类进行的结构和功能成像转化研究表明，在与压力相关的情况下，如衰老引起的轻度认知障碍、长期的重度抑郁症以及自卑个体中，海马体体积较小。杏仁核和前额叶皮质也有改变的报道。除了药物治疗，减轻慢性压力、降低应激负荷和现代生活疾病发病率的方法还包括生活方式改变，以及政府和企业制定政策，提高个人减轻自身慢性压力负担的能力。
