body of knowledge that encompasses all factors contributing to health and disease
Consultation Liason Psychiatry
: the work of a psychiatrist in a general medical hospital
Psychological Factors affecting Medical Condition
: pathophysiological or physical disorders with psychologic determinants; certain criteria have to be met for these factors to be considered a psychological part of the illness:
a general medical condition is present and adversely affected by psychological factors
a temporal relationship shows that the psych factors have contributed to the onset or exacerbation of disease
the factors interfere with the treatment of the medical condition
the factors present additional health risks
History of the theory
: it has long been observed that psychogenic factors can lead to the precipitation or exacerbation of physical disease; the mind and body are normally in harmony and communicate via the emotions; when psychological stress is too great for mental regulatory and coping mechanisms, the mind spills over into the body and is manifested in a physical nature Þ what we call the affects or emotions
affects (or emotions) serve two purposes:
(1) notifies the body that a threat is perceived and motivates avoidance action
(2) physical changes prepare the body for this action (fight or flight)
most theories of psychogenic contribution to disease work on the principle that the overuse of these mechanisms can contribute to tissue damage or dysfunction
Specificity Theories
: they have some basis and clinical utility, but have not been totally validated
Dunbar
: asserted that specific personality profiles increase vulnerability to disease
still used today (i.e., type A personalities predispose to ulcers and coronary artery disease)
Alexander
: used psychoanalytic theory to suggest that specific psychologic conflicts could generate specific organic diseases; this is called conflict specificity
Life Event Studies
: generalize the specificity theories to say that stress can be a non-specific trigger of disease
example: bereaved persons are 7x more likely to die in the year following the death of a spouse
current research focuses on psychogenic factors contributing to autonomic arousal, immune supression, and neuroendocrine control (NK cells are decreased in med students the week before an exam)
Psychosomatic Management
: most patients with psychologic components to their disease are treated by conventional means, and are referred to psychiatry when they are doing poorly under conventional management
treatment is not simply resolving psychogenic conflict - patient must be taught better coping mechanisms to deal with their responses to stress
psychotropic meds; behavior modification; biofeedback; hypnosis; and relaxation therapy can also be used
Clinical Correlation: Cardiac Disease as a Psychologically Affected Physical Condition
psychological factors influence start or course of disease:
type A personality, aggressiveness, competitive, hostile, sense of time urgency, etc predispose to disease
psychological factors add to health risk in CAD:
life choices (diet, smoking); high stress with poor coping skills; isolation; low social support; lack of religion
psychological factors interfere with treatment
denial: onset of MI may be brushed off as heartburn (apparently this happens often in hairy-chested men)
denial of disease can also lead to non-compliance
stress-related responses precipitate or exaggerate symptoms:
can lead to arrhythmias or coronary artery spasm
Panic Disorder and CAD Inter-relationship
cardiac patients can develop panic disorder (a little flutter of the heart can set them into a panic attack)
panic disorder patients can manifest as cardiac symptoms
Depression as a Risk Factor
: mortality is 3-5x greater in depressed MI patients