26. PSYCHOSOMATIC PROBLEMS

Question 1

1. What is one of the oldest applications of Psychological approaches?

Answer 1

• the treatment of somatic problems

(Galen in 2nd Century Rome was very influential in this)

Question 2

2. What were Galen’s views?

Answer 2

• passions were an important cause of illness
• this theory was influential until the 8th century
• these passions included:
  - anger
  - fear
  - lust

Question 3

3. After the 8th Century, which two approaches arose?

Answer 3

1. Psychosomatic Medicine
2. Psychophysiological Approach

Question 4

4. What did Psychosomatic Medicine attempt to establish?

Answer 4

• the psychological causes for physical disorders
  (such as asthma, eczema, ulcers)

Question 5

5. What was the Psychosomatic Medicine strongly influenced by?

Answer 5

• Psychoanalysis
• this influence has now declined
• this leaves behind very little practical application

Question 6

6. What does the Psychophysiological Approach emphasise?

Answer 6

• the importance of considering psychological processes
• rather than just looking at diagnostic categories

Question 7

7. What are the foundations of the Psychophysiological Approach?

Answer 7

• experimental work
• physiological responses are measured during experimental tasks
• this probes particular physiological processes

EG: listening to stimuli
: reacting by pressing a button when the stimuli
happen

Question 8

8. What is the aim of the Psychophysiological Approach’s experimental work?

Answer 8

• to examine whether particular types of stimuli (or
  psychological reactions) consistently produce:
  - characteristic physiological reactions

Question 9

9. What does a stimulus result in in experimental work?

Answer 9

• specific responses

Question 10

10. What is responsible for the development of specific disorders in vulnerable individuals?

Answer 10

• particular stressors

Question 11

11. What was much of the early work on Somatic Disorders based on?

Answer 11

• patients who were seen after several previous medical
  referrals
• this means that they were exposed to ineffective
  attempts at treatment
• this brings about a variety of potentially conflicting
  explanations for the patient’s problem

Question 12

12. What has the understanding of psychological approaches to somatic problems been influenced by?

What does this result in?

Answer 12

• the tendency to refer to psychological treatment as a
  last resort
• this results in high rates of complicating psychological
  conditions amongst patients

Question 13

13. What happens when the number of cases with complicated psychological conditions in clinic populations increases?

Answer 13

• the perception of the condition between psychologists
  and patients becomes different

Question 14

14. What do patient’s tend to perceive their conditions as in clinic populations?

Answer 14

• they perceive them as physical
• these conditions become chronic to them
• they become distressed with the failure of medical
  treatment
• they perceive themselves as having a psychological
  problem
• this is a result of their chronic medical condition
• this perception leads to the patient experiencing
  psychiatric referral
  (this referral is often for problems that the patient
  finds not as important)

Question 15

15. Which phenomena are a result of this referral pattern?

Answer 15

• hypochondriases
• headaches
• sleep disturbance
• these are secondary to other clinical syndromes

Question 16

16. What are two other Clinical Syndromes that are a result of the referral pattern?

Answer 16

1. Depression
2. Anxiety

Question 17

17. Where is there a greater emphasis on Liaison work?

LIAISON= cooperation work

Answer 17

• it is involved in psychological treatment
• especially treatment that is involved in primary or secondary medical settings

Question 18

18. What does Liaison work result in?

Answer 18

• it results in changes in:
  - the characteristics of the patients themselves
  - the way in which psychological treatment is viewed

Question 19

19. What are the three broad categories that the somatic presentation of psychological problems falls into?

Answer 19

1. Problems where there are observable and identifiable disturbances of the bodily functions
2. Problems where the disturbances are primarily perceived symptoms
   (there is also a sensitivity to or excessive reaction to normal bodily sensations)
3. A mixed group

Question 20

20. What are the major conditions included in the category: “Problems where there is an observable and identifiable disturbance of bodily functioning”?

Answer 20

• IBS (irritable bowel syndrome)
• hypertension
• tics
• spasms
• asthma
• insomnia
• sleep disorders
• psychogenic vomiting
• skin conditions

Question 21

21. What are the major conditions included in the category: “Problems where the disturbance is primarily one of the perceived symptoms. There is also a sensitivity to or excessive reaction to normal bodily sensations”?

Answer 21

• hypochondriasis
• somatisation disorder
• idiopathic pain disorder
• hysterical conversion
• dysmorphobia

Question 22

22. What are the major conditions included in the category: “Problems in which the basis of symptoms is mixed, uncertain or varies”?

Answer 22

• headaches
• disproportionate breathlessness
• functional chest pain
• cardiac neurosis
• chronic pain

Question 23

23. What are the most common Somatic Problems seen in General Practice and in the Psychiatric Setting?

Answer 23

• Insomnia
• Headaches
• Irritable Bowel Syndrome
• Hypochondriasis

Question 24

24. How would we calculate threat interpretations in terms of illness?

Answer 24

(probability x awfulness) / (coping + rescue)