2013 09 30 evening program gp 2 eric hoencamp. the fallacy of seperating somatic and psychological...
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The fallacy of separating somatic and
psychological symptoms.
September 30 , 2013
St. Maarten
Erik Hoencamp
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Two realities
• Split in classification and treatment of somatic or psychological symptoms.
• Leading to split between professionals, research, training curricula and financing of care.
• While
• They co-occur in many clinical situations.
• With regard to genetic vulnerability , environmental risk and protective factors they have the same etiological underpinning.
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Conceptual background
• Gene * environment Interaction.
• Examples of disease/phenotype Depression<> Cardiovascular Disorders
Bipolar Disorder, Schizophrenia<> metabolic syndrome.
• Childhood Adversity as an environmental
factor
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Current paradigm,
Gene*Environment Interaction
Genetic
vulnerability
environment environment
conception
Gene-
expression
Disease
phenotype
epigenetics
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Gene*Environment Interaction
Genetic
vulnerability
environment environment
conception
Gene-
expression
Disease
phenotype
epigenetics
Childhood adversity Depression
Cardiovacular disorder.
Metabolic Syndrome
Psychosis
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Depression & Cardiovascular disease
• Share genetic vulnerability and
environmental component.
• In clinical practice co-occur often , proper
treatment of depression enhances life
expectancy. (psychotherapy ,
antidepressants, treatment CVA)
• NB depends on definition Major
Depressive Disorder.
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Schizophrenia
Bipolar disorder
Depression ??
Anxiety disorders ??
Diabetes
Hypertension
Cardiovascular
Etc.
Metabolic
syndrome both
cause and
consequence of
the disorder?
Life style
Medication
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Environment
social
Migration,dicrimi
nation,etc
family psychological
physical
economic Childhood Adversity
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Depression
Anxiety
Etc.
Cardiovascular
disease
Inflammatory
disease
etc
Affective
Physical
Sexual
Which has highest impact ???
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Example how ACE
effects health
In this case
cardiovascular
disorders
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So, related are
• Depression <>Cardiovascular Disorder.
(Genetic component)
• Schizophrenia /Bipolar Disorder<>
Metabolic syndrome. (Genetic component)
• Childhood Adversity (environmental
component)<> Depression
&Cardiovascular Disorder
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Is there a common denominator
in the pathogenesis ?
• Epigenetic changes in gene expression
• Stress regulation functioning HPA-axis
• Aberrant Inflammatory processes
• Disruptive Bio-rhythms
• Microbiome ?
• Socio-economic risk and protective
factors.
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Domains or levels of expression of pathology
Social , economic, political situation.
Life events risk and protective factors
Behaviour
Emotional , cognitive and physical well being .
Physical functioning and patho-fysiological processes
Structural and functional integrity of body >> vulnerability and/or acquired
disorders, disease.
Pathology is
perceived
here in the
social
context.
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Pathology “ X “ and attributed causality.
Social , economic, political situation, Life events risk and protective factors
Behavior
Emotional , cognitive and physical well being .
Physical functioning and patho-fysiological processes
Structural and functional integrity of body >> vulnerability and/or acquired
disorders, disease.
Pathology is
perceived
here in the
social
context
Pathology X
Somatic Psychological
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Pitfalls separating psychopathology and somatic
pathology
• Psychopathology implies that the
phenotype/disease is caused by
“psychological” factors.
• Somatic pathology implies that it is caused
by an underlying disease.
• Neither is true and leads to strange
situations what is a “ real “ disease
example whiplash , CFD, ..
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What are practical the consequences
• Image : psychopathology, remains having a negative odium and easily leads to stigmatization and rejection. Religious, ideological and political factors play a role in these processes.
• Research and treatment: A fundamental change is needed and slowly in progress where somatic and psychological symptomatology and their relation are taken into account with regard to etiology and treatment.
• Training curricula should be adapted and give more background about both psychological and biological aspects of disease.
• Our own attitude : well intended we may contribute to stigmatization, by treating patients different with psychopathology leading to dependency and lack of self fulfillment and empowerment.
• Organization of health care services , Challenge to increase cost effectiveness of health care .
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Thanks any questions ?