Psychological Factors Affecting Medical Conditions

Stress & Medical IllnessStressful life events are correlated with increased risk of becoming medically ill.

Stressors can be perceived positively or negatively, as mediated by cognitive ''coping'' mechanisms.

Maladaptive ways of coping, such as smoking, and substance abuse, may alter susceptibility to illness.

Stress & Medical IllnessA strong network of social support seems to buffer against effects of stress.

The central nervous, endocrine, and immune systems are interconnected.

Response to physical and psychological illness depends both on genetic and acquired factors.

Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) Uses psychological factors affecting medical condition instead of psychosomatic medicine

one or more psychological or behavioral problems that adversely and significantly affect the course or outcome of a general medical condition, or that significantly increase a persons risk of an adverse outcome

A. A general medical condition is present B. Psychological factors adversely affect the general medical condition in one of the following ways: 1. The factors have influenced the course of the general medical condition as shown by close temporal association between psychological factors and development or exacerbation of or delayed recovery from GMC 2. Factors interfere with the treatment of the general medical condition. 3. The factors constitute additional health risks for the individual 4. Stress related physiological responses precipitate or exacerbate symptoms of the general medical condition. Ex. Major depressive disorder delaying recovery from myocardial infarction; depressive symptoms delaying recovery from surgery

EXCLUSION

Classic mental disorders that have physical symptoms - ex. Conversion disorder Somatization disorder - physical symptoms not based on organic pathology Hypochondriasis - exaggerated concern for health Physical complaints associated with mental illness like dysthymia Physical complaints associated with substance related disorders

NEUROTRANSMITTERSStressors activate the noradrenergic system

1. ( in the locus ceruleus ) and cause release of catecholamines from the autonomic nervous system. Stressors also activate the serotonergic systems ( increased turnover of serotonin ) 2. Glucocorticoids may increase serotonin 5Ht2 mediated actions contributing to intensification of of receptors implicated in pathophysiology of major depressive disorder .

ENDOCRINE RESPONSE TO STRESS In response to stress - Corticotropin -releasing factor (CRF ) is secreted from the hypothalamus into the hypophysial-pituitary portal system. CRF ---> release of glucocorticoids promoting energy, increase cardiovascular activity, inhibiting functions such as growth, reproduction, and immunity

STEESSFUL LIFE EVENTS

PERCEPTIONCOGNITIVE COPING AND DEFENSE MECHANISMSGENETIC AND ACQUIRED VULNERABILITYTO PHYSIOLOGICAL AND PSYCHOLOGICALILLNESSSOCIAL SUPPORT

PSYCHOPHYSIOLOGIC CHANEGES ACUTE ILLNESS OR DECOMPENSATOINOF CHORNIC ILLNESS STRESSOR TO FAMILY. VOCATIONAL ECONOMIC LIFE, SELF ESTEEM(i.e. illness is itself a stress)

THE HISTORICAL DEVELOPMENT OF THE MIND-BODY RELATIONSHIPcurrent concepts are products of a long evolutionary process.Followed the socio-cultural, scientific, and philosophical trends of each historical period.Our early ancestors:Same diseases we know of today without aid of todays scientific method or knowledge of anatomy, physiology, and behavior.

THE HISTORICAL DEVELOPMENT OF THE MIND-BODY RELATIONSHIPTheological explanations were frequently invoked, such as:Possession, evil eye, witchcraftRituals were used to rid the body of evil influences. The powerful attraction of these early beliefs as explanatory models is apparent in their continued appeal in our era.

THE HISTORICAL DEVELOPMENT OF THE MIND-BODY RELATIONSHIPHippocrates believed that many diseases and mental states were caused by emotionsMind-body physiology is based on combinations of:Four basic humors (yellow bile, black bile, phlegm, and blood)With the four basic elements (air, earth, fire and water). Various combinations produced different diseases and mental states.

New Thinkingchronic suppression of emotional tension leads to discharge in autonomic nervous system pathways.Causes structural change in specific tissues and organs.The so-called organic neuroses (essential hypertension, bronchial asthma, ulcerative colitis, peptic ulcer, rheumatoid arthritis

ContributionType A behavior pattern-characterized by a sense of urgency, striving for achievement, and hostility-is a risk factor for coronary artery disease.ResearchableRecent critiques found that not all type-A personality characteristics are equally associated with this increased risk.

Life Events Scale (Holmes & Rahe)

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