Psychological Factors Affecting Medical Conditions and Stress Responses

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Psychological Factors Affecting Medical
Conditions and Stress Responses

• Abdullah S AlSubaie F.R.C.P. (C)
• Professor of Psychiatry

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Introduction

• What is Stress?
• Too little stress
• Too much stress
• Adequate stress?
• Stress health Scientific evidnce

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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.

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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.

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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.

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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)
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THE HISTORICAL DEVELOPMENT OF THE MIND-BODY
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 todays scientific method or
  knowledge of anatomy, physiology, and behavior.

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THE HISTORICAL DEVELOPMENT OF THE MIND-BODY
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.

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THE HISTORICAL DEVELOPMENT OF THE MIND-BODY
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.

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A New Era

• In seventeenth century.
• Body-mind division
• Misunderstanding led to rigid dualism.
• Confused thinking of many modern physicians
  ''organic'' from ''psychological'' disease.

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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.

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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

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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.

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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.

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Bio-Psycho-Social Paradigm

• George Engel, an internist with training in
  psychoanalysis, proposed the bio-psycho-social
  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.

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The Bio-Psycho-Social Model
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STRESS AND ITS INFLUENCE OF DISEASE ?

• ''stress' (Hans Selye) refers to
• Stressor An aversive stimulus event.
• Response
• Psychological response feelings of threat,
  harm, or loss...
• Physiological response Stress responses
  (physiological, psychological, or social).
• Transaction between the person and the
  environment.

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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).

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Life Events Scale (Holmes Rahe)
100 Death of a spouse
73 Divorce
65 Marital separation
63 Jail term
63 Death of a close family member
53 Personal injury or illness
50 Marriage
47 Fired at work
45 Marital reconciliation
45 Retirement
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100 Death of a spouse
44 Change in health of family member
40 Pregnancy
39 Sex difficulties
39 Gain of new family member
39 Business readjustment
38 Change in financial state
37 Death of a close friend
36 Change in number of arguments with spouse
35 Foreclosure of mortgage or loan
30 Change in responsibilities at work
29 Son or daughter leaving home
29 Trouble with in-laws
29 Outstanding personal achievement
28 Spouse began or stopped work
26 Begin or end school
26 Change in living conditions
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100 Death of a spouse
25 Revision of personal habits
24 Trouble with boss
23 Change in work hours or conditions
20 Change in residence
20 Change in schools
20 Change in recreation
19 Change in church activities
18 Change in social activities
16 Change in sleeping habits
15 Change in number of family get-togethers
15 Change in eating habits
13 Vacation
12 Christmas
11 Minor violations of the law
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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.

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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

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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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