STRESS AND PHYSICAL HEALTH

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STRESS AND PHYSICAL HEALTH

• Dr. YASER ALHUTHAIL
• Ass.Prof and Consultant
• Psychosomatic Medicine

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• Psychosomatic medicine is an area of
  scientific investigation concerned with the
  relation between psychological factors and
  physiological phenomena in general and disease
  pathogenesis in particular.
• Integrates mind and body into a
  psychobiological unit to study psychological and
  biological processes as dynamic interacting
  systems.
• It emphasizes the unity of mind and body and
  the interaction between them.
• A unitary causative or holistic approach to
  medicine.

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• Biomedical Model
• The application of biological science to
  maintain health and treating disease.
• Engel (1977) proposed a major change in our
  fundamental model of health care.
• The new model continues the emphasis on
  biological knowledge, but also encompasses the
  utilization of psychosocial knowledge.
• Biopsychosocial Model

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• Stress causes a sympathicoadrenal medullary alarm
  reaction characterized by excess catecholamine
  secretion.
• Epinephrine raises blood pressure and heart and
  respiratory rates, enhances neuromuscular
  transmission, elevates the concentration of blood
  sugar by glycogenolysis, mobilizes fat, redirects
  hemodynamic patterns to suit muscular activity,
  and while increasing blood oxygenation, increases
  oxygen consumption.

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• More-specific b-adrenergically mediated
  cardiac effects include increased heart rate,
  contractility, and conduction velocity and a
  short arteriovenous refractory period.
• These catecholamine-mediated cardiac effects
  are thought to be pathogenically related to
  adverse cardiac events.

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• 5 to 10 percent with anxiety disorders
  (predominantly panic attacks and phobias) and 10
  to 15 percent with mood disorders (predominantly
  depressive episodes and minor depression or
  dysthymia).
• Major depressive disorder occurs in 15 to 20
  percent of patients following myocardial
  infarction.

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Depression and CAD

• Prospective community studies domonstrate that
  history of depression or depressive symptoms is
  associated with increased risk for the
  development of IHD and for coronary disease
  death(1.5-2 fold)
• Anda et al. 1993 Barefoot and Schroll 1996
  Barefoot et al. 1996
• Depression increases the risk of death in pts
  with preexisting CAD 3-4 fold compared to
  nondepressed pts
• Carney et al. 2003 Frasure-Smith et al.
  1993,1995a Ladwig et al. 1991

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• Depression predicts recurrent cardiac events post
  CABG at 12 months Connerney et al
  2001.
• Depression clearly adversly affects pts
  perception of their heart disease QOL
  Ruo et al. 2003

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MECHANISMS

• Platelets dysfunction
• Autonomic dysfunction
• Ab inflammatory process Carney et al. 2002
• Platelets dysfunction
• Increased platelets reactivity
• Increased levels of beta-thromboglobulin,
  platelets factor 4
• Increased likelihood of thrombus formation
• Serotonin

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• Autonomic dysfunction
• Heart rate variability
• Elevated sympathetic activation
• Suppression of vagal tone
• Vulnerability to arrhythmias
• Ab inflammatory process
• Elevated markers IL-6, CRP

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Indirect ways

• Adherence to treatment
• Smoking cessation
• Exercise
• Dietary regimen

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Depression and CHF

• Major depression more than doubled the mortality
  risk
  Jiang et al. 2001

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Anxiety and CAD Risk

• 2 Prospective epidemiological studies demonstrate
  an association of anxiety with sudden cardic
  death
• High levels of anxiety symptoms are associated
  with a tripling of risk of sudden cardiac death.

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Anger, Hostility, and Type A Behavior

• Type A anger, impatience, aggravation, and
  irritability
• Mixed results !
• hostility is associated with several
  physiological processes that in turn are
  associated with coronary disease, such as reduced
  parasympathetic modulation of heart rate,
  increased levels of circulating catecholamines,
  and increased lipid concentrations during
  interpersonal conflict

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Acute Mental Stress

• Studies of disasters confirm the relationship of
  acute stress to risk for sudden cardiac death
• HR, BP, cardiac autonomic regulation, elevated
  sympathetic activation and diminished
  parasympathetic effects, and coronary vasospasm
• 20-30 of acute coronary events

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Stress management Health Education

• Stress reduction interventions reduce the
  incidence of recurrent MI by 29 and death by 34
  Dusseldrop et al. 1999
• Health education, stress management, and exercise
• Targets BP, Cholestrol, body weight, smoking
  behavior, physical exercise etc.

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• Behavioral risk factors for coronary heart
  disease, such as smoking, overeating, physical
  inactivity, and poor compliance with management
  of diabetes, hypercholesterolemia, and
  hypertension, are the main targets for primary
  prevention interventions.
• psychiatric disorders, acute mental stress, and
  psychological traits are risk factors for
  development and clinical progression of
  cardiovascular disease.
• Psychiatric disorders frequently occur as
  complications or comorbid conditions in
  individuals with cardiovascular disease.