PSYC 203 Psychological Factors Affecting Medical Conditions

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PSYC 203Psychological Factors Affecting Medical
Conditions

• Vudhichai Boonyanaruthee, M.D.

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????????????

• 1.  ????????????????????????????????????? ?????
  ???????????????? ???????????????????
• 2.  ?????????????????????????????????????????????
  ??????????????
• 3. ???????????????????????????????????????????????
  ??????????????????????????????????????????????????
  ????????????

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?????????????????

• American Psychiatric Association. Diagnostic and
  statistical manual of mental disorders. 4th ed.
• Kaplan HI, Sadock BJ, Grebb JA. Kaplan and
  Sadock's synopsis of psychiatry behavioral
  sciences, clinical psychiatry.
• ??????? ???????????? ??? ????? ????????.
  ?????????????????????????? Textbook of
  psychiatry ????????????????? ????????????????????
  ????? 2542

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FORMATIVE EVAUATION

• ??????????????? ??? ???? ???
• Questions
• 1, ??????????????????????? Psychological Factors
  Affecting Medical Conditions
• 2. ????????????????????????? ???????????
  ?????????
• 3. ???????????????????????????????????????????????
  ???????
• 4. ???????????????????????????????????????????????
  ????????????
• 5. Post Traumatic Stress Disorder
  ???????????????????????????

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FORMATIVE EVAUATION

• ??????????????? ??? ???? ???
• Questions
• 1, ??????????????????????? Psychological Factors
  Affecting Medical Conditions
• 2. ????????????????????????? ???????????
  ?????????
• 3. ???????????????????????????????????????????????
  ???????
• 4. ???????????????????????????????????????????????
  ????????????
• 5. Post Traumatic Stress Disorder
  ???????????????????????????
• Answers
• ?????????

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Psychological Factors Affecting Medical Conditions

• Vudhichai Boonyanaruthee, M.D.

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????????????????????????

• 1????????????????????????????????????????????
  Psychological Factors Affecting Medical
  Conditions
• 2??????????????????????????????
• 3???????????????????????? ????????????????????????
  ????

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Psychological Factors Affecting Medical
Conditions ?????????????????????????????????????
???????????????????PsycheMind SomaBody

• ?????????
• Psychosomatic Disorder(PSD),
• Psychophysiologic Disorder,
• Psychological Factors Affecting Physical
  Condition,
• Psychological Factors Affecting Medical Condition
  ?? DSM IV
• ???????????? Psychosomatic Disorder
  ????????????????????????????????????????????? ???
  ???????????

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Psychosomatic Medicine

• ????????
• ????????????????????????????????????????????
  ????????????????????????????????????( unity of
  mind and body and interaction between them)
• ?????????????????(psychological
  factors)??????????????????????????????
• ????????????? ?????????(concept)???
• ?????????????????(Behavioral Medicine)
  ??????????????????????????????????? ????????
  ???????????????????? ??????????????(Behavioral
  Science) ??? ???????????? (Biomedical
  Science)?????????????????????? ???????????????
  ????????????????????????????? ???????????
  ?????????????????

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History

• 1818 Johann Christian Heinroth ???????????????????
  ? Psychosomatic ????????????????????????????(Ins
  omnia)
• Maximilian Jacobi ??????????????????
  ???????????????????????????? ?????????????????????
  ????????????? ???? Ulcerative colitis, Peptic
  ulcer, Migraine headache, Bronchial asthma,
  ???Rheumatoid arthritis

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Etiology

• ???????? ?????????????????????(chronic),
  ??????(severe) ????????????(perceived)
  ??????????????????????
• ????????????????????(controversy) ??????
  ???????????????????, ?????????????????????????????
  ????????????(general underlying
  psychophysiological factor), ????????? ???
  ???????????????????(organ vulnerability),
  ???????????????????????????????(specific/nonspecif
  ic) ??? ?????????????????????????????????????

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I General Stress

• ????????? ???? ??????????????????????????????????(
  stressful life event or situation) ?????????????
• ???????????????(internal or external)
• ????????? ???? ????????(acute or chronic)
• ??????????????????????????????????????????????????
  ???????????????????????(adequately respond)

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Thomas Holmes Richard Rahe ????????????????????
???????????????????????(Social Readjustment
Rating Scale)

• ???????????????????????? 43 ??????????????????????
  ???????????????????
• ??????????? ?????????????????????????????????(1)??
  ???????????? 100 ??? ?????????????????????????????
  ????(43)?????????????? 11 ???????????????????

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Social Readjustment Rating Scale

• Live Event Mean Value
• Dead of spouse 100
• Divorce 73
• Marital separation form mate 65
• Detention in jail or other institution
  63
• Death of a close family member 63
• Major change in number of family get together
  15
• Major change in eating habits 15
• Vacation 15
• Christmas 12
• Minor violation of the law 11

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Social Readjustment Rating Scale

• ????????????????????? 200 ????? ?? 1 ??
  ????????????????????? Psychosomatic Disorder
• ???????????????????????????????( pessimist )
  ???????????????????????????????????????
  Psychosomatic Disorder ???????????????????????????
  ??????????????????????

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Specific versus Nonspecific Stress
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Specific Psychic Stress

•   ?????????(personality) ???
  ???????????????????? ??????????????????????
  psychosomatic disorder ?????????
• Specific Psychic Stress
• (specific personality or unconscious conflict)
•  
• Homeostatic
  Disequilibrium
•  
• Psychosomatic Disorder(PSD)
•  

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Specific Personality (???????????????)??????????
??????????????????????????????????????????????????
?????????

• Dunbar ?????????????????????????????? Coronary
  Personality ????????????
• ????????????(overwork),
• ?????(compulsion),
• ???????????????(hard driving) ???
• ????????(aggression)
• ???????????????????????????????????? (coronary
  heart disease)??????????????????

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Meyer Friedman Ray Rosenman ?????????????????
Type A Type B Personalities

• Type A Personality ????????????? Coronary
  Personality ??????????????????????????????????????
  ?????(chronically feel pressure of time)
  ??????????????????????????????????????????????????
  ?????????
• Type B Personality ?????????????????? Type A

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Specific Unconscious Conflicts

• Franz Alexander ???????????????
  ?????????????????????????????????
  ???????????????????? PSD ?????????
• ???? ??????????????????????????????
  (unconscious dependence) ?????????????????????????
  ??? ????????????????? (peptic ulcer)

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Chronic Nonspecific Stress

• ?????????????????????????????? (chronic
  nonspecific stress) ????????????????????????????
  ?????????????????????????????????????????????(gene
  tic organ vulnerability or debility)
  ???????????????????????? PSD

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Physiologic Variables

• Hans Selye ????????PSD
• ?????????????????????????????????????????????????
  ?????????????????? (general-adaption syndrome)
• ??????????????????????????? H-P-A
  Axis(Hypothalamus-Pituitary-Adrenal Axis)
  
  
• Hormone
• Stress PSD
• Hydrocortisone

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Physiologic Variables

• Franz Alexander ????????????????????????
  (chronic stress) ????????? PSD ???????
  ??????????????????? (Autonomic Nervous
  System-ANS)
• 
  ANS
• Chronic Stress
  PSD
• Parasympathetic Activity
  Peptic Ulcer
• Sympathetic Activity
  Hypertension

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Physiologic Variables

• Franz Alexander ????????????????????????
  (chronic stress) ????????? PSD ???????
  ??????????????????? (Autonomic Nervous
  System-ANS)
• 
  ANS
• Chronic Stress
  PSD
• Parasympathetic Activity
  Peptic Ulcer
• Sympathetic Activity
  Hypertension

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Herbert Benson ????????????????????????????????
???(Relaxation Technique)

•  
• Relaxation Therapy
•  
• Cerebral Adrenergic Activity
•  
•  Limbic System
• Monocyte (immune system)
  Brain Peptide
•  Psychic State/ Mood
• Improved PSD
•  

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???????????????? Psychological Factors Affecting
Medical Condition

• ????????????????????????(General Medical
  Condition-GMC)
• ????????????????? (Psychological Factors)
  ??????????? GMC ????? 1 ?? 4 ???????????
• 1. ?????????????????????(course)???????????????
  ????????????????????????????????????????????
  ??????? ????????????????? ??? ????????
  ?????????????????? ???? ??????????????????????????
  ???????
• 2. ????????????? GMC
• 3. ????????????????????????(health risk)
• 4. ???????????????????????????????????????????????
  ??????????????? ???? ????????????? GMC
• ??????????????????????????????????????????????????
  ( nature of the psychological factors)
• (???????????? 1 ?????? ????????????????????????)
•  

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 Nature of The Psychological Factors

• Mental Disorder Affecting Medical Condition
  ??????????????????????????????????? ???? Major
  Depressive Disorder ???????? Myocardial
  Infarction ??????
• Psychological Symptoms Affecting Medical
  Condition ?????????????????????????????????????
  ???? ?????????????????????????????????????????????
  , ?????????????????????????????????????
• Personality Traits or Coping Style Affecting
  Medical Condition ???????????? ????
  ?????????????????????????????????????????????
  ???? ?????????????????????????(pathological
  denial)???????????????????????????????????????????
  ???????? ??????????????????????,?????
  ?????????????????????????????(Cardiovascular
  Disease)

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 Nature of The Psychological Factors

• Maladaptive Health Behaviors Affecting Medical
  Condition ??????????????????????????????????????
  ??????????????????? ???? ??????????????(overeating
  ), ?????????????????, ??????????????????????????(u
  nsafe sex),
• Stress-Related Physiological Response Affecting
  Medical Condition ??????????????????????????????
  ????????????????????????? ???????????????????
  ???? ??????????????????????? Peptic Ulcer,
  Hypertension, Arrhythmia ???? Tension Headache
• Other or Unspecified Psychological Factors
  Affecting Medical Condition ????????????????????
  ?????????????????????????????????????? ????
  ?????????? ??????????????????????, ???????? ????
  ?????

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Some Psychosomatic Disorders
Acne

Immune Disease
Allergic Reaction
Irritable Colon
Angina Pectoris
Migraine Headache
Angioneurotic Edema
Mucous Colitis
Arrhythmia
Nausea
Asthmatic Wheezing
Neurodermatitis
Bronchial Asthma
Obesity
Cardiospasm
Painful Menstruation
Chronic Pain Syndrome
Pruritus Ani
Coronary Hearth Disease
Pylorospasm

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Some Psychosomatic Disorders
Diabetes Mellitus
Regional Enteritis
Duodenal Ulcer
Rheumatoid Arthritis
Essential Hypertension
Sacroiliac Pain Gastric
Ulcer
Skin Disease e.g. Psoriasis
Headache
Spastic Colitis Herpes

Tachycardia Hyperinsulinism
Tension
Headache
Hyperthyroidism Ulcerative Colitis
Hypoglycemia