Transcript Document 7208593

Psychological Factors Affecting Medical
Conditions and Stress Responses
Abdullah S AlSubaie F.R.C.P. (C)
Professor of Psychiatry
Introduction
• What is Stress?
– Too little stress
– Too much stress
– Adequate stress?
• Stress & health: Scientific evidnce…
Stress & Medical Illness
• Stressful 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 Illness
• A 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)
• ''Psychological Factors Affecting Medical
Condition'‘ to include psychological processes
influencing the initiation or exacerbation of
physical disease.
• The category is used to describe conditions
that in the past have been deemed to have a
''psychosomatic'' or ''psycho-physiological''
component.
STEESSFUL LIFE EVENTS
PERCEPTION
COGNITIVE COPING AND DEFENSE MECHANISMS
GENETIC AND ACQUIRED VULNERABILITY
TO PHYSIOLOGICAL AND PSYCHOLOGICAL
ILLNESS
SOCIAL SUPPORT
PSYCHOPHYSIOLOGIC CHANEGES
ACUTE ILLNESS OR DECOMPENSATOIN
OF CHORNIC ILLNESS
STRESSOR TO FAMILY. VOCATIONAL
ECONOMIC LIFE, SELF ESTEEM
(i.e. illness is itself a stress)
THE HISTORICAL DEVELOPMENT OF THE MINDBODY RELATIONSHIP
• current 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 today’s scientific method or
knowledge of anatomy, physiology, and behavior.
THE HISTORICAL DEVELOPMENT OF THE MINDBODY RELATIONSHIP
• Theological explanations were frequently
invoked, such as:
– Possession, evil eye, witchcraft…
– Rituals 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 MINDBODY RELATIONSHIP
• Hippocrates believed that many diseases and
mental states were caused by emotions
• Mind-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.
A New Era…
•
•
•
•
In seventeenth century.
Body-mind division
Misunderstanding led to rigid dualism.
Confused thinking of many modern
physicians: ''organic'' from ''psychological''
disease.
Another Step…
• late nineteenth century by Sigmund Freud and
his contemporaries.
• Confusing “Hysterics”.
• The belief that stress and psychological
conflict could not only influence but actually
produce specific physical diseases became a
focus of many of these physicians then.
New Thinking…
• chronic 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…
Contribution…
• Type A behavior pattern-characterized by a
sense of urgency, striving for achievement,
and hostility-is a risk factor for coronary artery
disease.
• Researchable…
• Recent critiques found that not all type-A
personality characteristics are equally
associated with this increased risk.
No more dualism…
• In the Mid-twentieth century, a new model of
causality was developed by Bertilanffy and
Bateson, who saw the universe from a systems
perspective:
– Systems have self-regulating, homeostatic
properties.
– That create a circular cause-effect.
– Life pends on this type of homeostatic equilibrium,
nesting systems within systems to maintain life.
Bio-Psycho-Social Paradigm
George Engel, an internist with training in
psychoanalysis, proposed the bio-psychosocial model as a paradigm for explaining the
multiple ways in which physical health could
be modified not only by physical pathogens
but also by learning, cultural norms, and
mental processes.
The Bio-Psycho-Social Model
‫سبب‬
‫نتيجة‬
Bio
Social
Psycho
STRESS AND ITS INFLUENCE OF DISEASE ?
• ''stress'‘ (Hans Selye) refers to:
1. Stressor: An aversive stimulus event.
2. Response:
• Psychological response: feelings of threat, harm, or
loss...
• Physiological response Stress responses (physiological,
psychological, or social).
3. Transaction between the person and the
environment.
Stressors
• Those life events that induce change in
routine.
• The persistence of positive or negative
environmental conditions, or specific types of
situations of monotony where no change has
occurred when change might have been
expected (i.e., not getting an anticipated
promotion at work).
Life Events Scale (Holmes & Rahe)
Death of a spouse
100
Divorce
Marital separation
Jail term
Death of a close family member
Personal injury or illness
Marriage
73
65
63
63
53
50
Fired at work
47
Marital reconciliation
45
Retirement
45
Death of a spouse
Change in health of family member
Pregnancy
Sex difficulties
Gain of new family member
Business readjustment
Change in financial state
Death of a close friend
Change in number of arguments with
spouse
Foreclosure of mortgage or loan
Change in responsibilities at work
Son or daughter leaving home
Trouble with in-laws
Outstanding personal achievement
Spouse began or stopped work
Begin or end school
Change in living conditions
100
44
40
39
39
39
38
37
36
35
30
29
29
29
28
26
26
Death of a spouse
Revision of personal habits
Trouble with boss
Change in work hours or conditions
Change in residence
Change in schools
Change in recreation
Change in church activities
Change in social activities
Change in sleeping habits
Change in number of family gettogethers
Change in eating habits
Vacation
Christmas
Minor violations of the law
100
25
24
23
20
20
20
19
18
16
15
15
13
12
11
STRESS & PERCEPTION OF THREAT
• Lazarus: “a stimulus can evoke a stress
reaction by psycho-physiological means only if
it is interpreted by the individual as harmful or
threatening”
• Hinkle and Wolff:
– 25% of the people had 50% of the episodes of illness over
a 20-year period.
– Illnesses often appeared in a cluster during life, when
individuals perceived that they were having difficulty
adapting to the environment.
Coping and Defense Mechanisms
• ''struggling'' or ''contending'‘
• It describes behavior involving special physical
and emotional energy and attention that is
required to deal with some difficult
circumstances.
• Lazarus:
– ''direct action'‘ type: Preparation…
– “palliation” type: Keep living (ego defenses; taking
tranquilizes, alcohol, or sleeping pills;
Social Support
• Support buffers the individual from potentially
negative effects of crisis and facilitates coping
and adaptation.
• Patients with social supports and assets live
longer and have a lower incidence of somatic
illness, as well as more positive mental health.
• Those who are married have lower mortality
rates than those who are single, widowed, or
divorced.
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