Psychological Factors Affecting Medical Condition

Dr. YASER ALHUTHAILAssociate Professor & ConsultantConsultation Liaison Psychiatry

The concept of stressStress is unavoidable component of lifePsychosomatic framework

Stressful life events are correlated with increased risk of becoming medically ill

Hetreogenecity of stress and response to it

Multifactorial process

Development of conceptsBiopsychosocial model

Schedule of recent life events:Linear relationship between score and illnesses

experienced, highest in the following 6 months

The more life events, the more illnesses in the next 2 years

Consistent findings across all cultures

What makes an individual vulnerable?

Cognitive appraisalStressful events for a person may not be so for

another!!

Interpretation of a harmful or threatening stress

Positive Vs. negative life events !

Coping The behavior involving special physical and

emotional energy and attention that is required to deal with some difficult circumstances

Different ways of coping

Could have an impact on the individual

Social supportProtective effectFacilitates coping and adaptation

Longer life!!, less physical illnesses, and more positive mental health

Lower mortality rates in married people

Long-term influence of childhood stressors

Biological PredispositionPeptic ulcer & H pylori

Acute stress & sudden cardiac death

Psychophysiological PathwaysThe Hypothalamus:Autonomic nervous system, immune system,

neuroendocrine system

Extensive dynamic feedback system

Sympathetic and parasympathetic

Homeostasis

Major depression & prolonged periods of stress

Associated with increased morbidity & mortality specially cardiac

Effects on platelets

DSM-IV Diagnostic Criteria for Psychological Factors Affecting Medical Condition

A. A general medical condition (coded on Axis III) is present.

B. Psychological factors adversely affect the general medical condition in one of the following ways:

(1) the factors have influenced the course of the general medical condition as shown by a close temporal association between the psychological factors and the development or exacerbation of, or delayed recovery from, the general medical condition.

(2) the factors interfere with the treatment of the general medical condition.

(3) the factors constitute additional health risks for the individual.

(4) stress-related physiological responses precipitate or exacerbate symptoms of a general medical condition.

Mental disorder affecting medical condition (e.g., an Axis I disorder such as major depressive disorder delaying recovery from a myocardial infarction)

Psychological symptoms affecting medical condition (e.g., depressive symptoms delaying recovery from surgery; anxiety exacerbating asthma)

Personality traits or coping style affecting medical condition (e.g., pathological denial of the need for surgery in a patient with cancer, hostile, pressured behavior contributing to cardiovascular disease)

Maladaptive health behaviors affecting medical condition (e.g., lack of exercise, unsafe sex, overeating)

Stress-related physiological response affecting general medical condition (e.g., stress-related exacerbations of ulcer, hypertension, arrhythmia, or tension headache)

Other unspecified psychological factors affecting medical condition (e.g., interpersonal, cultural, or religious factors)