Attachment and physical health Flashcards
What is the Human Systems of Homeostasis?
Act to balance internal and external factors that may affect a system and keep it functioning within certain parameters
What are some regulatory systems that affect mental health?
Function:
Emotional Regulation
Systemic arousal/ energy conservation
Memory
Perception
Sleep /Wake cycle
Anatomical/Physiological Systems:
Limbic system
Autonomic system
Hippocampus/ Median Temporal lobe and Brain stem
Temporal Lobes and visual cortex
Pituitary /Endocrine
wHAT IS THE limbic system concerned with?
Concerned with the modulation of Emotions and Instincts
What does emotional dysregulation look like?
Extreme emotional outbursts
Uncontrolled temper
Self Harm
Difficulty maintaining relationships
Which parts of the nervous are involved in hyperarousal and hypoarousal?
Hyperarousal – Sympathetic Nervous system
Hypoarousal - Parasympathetic Nervous system
What are the causes of dysregulation?
Disrupted Attachment
Psychological Trauma (post Traumatic stress Disorder)
Temporary Effect of Trauma, Life Event or Stress
How was the attachment theory developed?
Bowlby First described concept: Human and animals attached to caregiver who feeds them
Lorenz ‘52– goslings follow parent not for food
Harlow ’58 – monkeys bond to cuddly pole with food rather than wire food pole
What is the theory behind attachment theory?
Attachment functions to protect infant from external dangers eg predators
Probable also emotional connection itself gives meaning/ has importance for our functioning
Social Animals
Essential for development of child
Affects individual through lifecycle
What is the neurophysiology behind attachment theory?
Oxytocin
Area of brain mainly involved limbic system and Right Hemisphere
Autonomic System Regulation - Separation – increase pulse and decreased temperature. If prolonged or frequent can lead to changes in cortisol and so affects bodies response to stress eg increase in infection
What is the window of tolerance
Window between 2 different bodily crises of hyper arousal - between flight/flight and freeze/dissociation
What are the types of attachment styles
Secure
Anxious
Ambivalent
Avoidant
What can affect attachment?
Iry caregiver emotionally unavailable eg depression
Drugs/ alcohol
Abuse/neglect
Anxious
Ambivalent
Avoidant
What is the secure attachment style?
Able to internally self regulate the emotional neural systems and response to environment From about 5 years upwards
Develop reciprocal social bonds
What is the anxious attachment style?
Maintaining attachment with a caregiver who is unpredictable
Clingy
What is the ambivalent attachment style
Alternate clinging with excessive submissiveness to no trust
Role reversal – parent cared for by child
Dysregulation of fear and anger
What is the avoidant attachment style
Child tries to minimise need for attachment to avoid rebuff
Remains in distant contact with the caregiver
When severe can ‘freeze’ when reunited with parent
How can we treat certain attachment styles?
NB Brain remains ‘plastic’ into early 20’s
Treatment (Dialectic Behaviour Therapy) can change pattern
Treat co- morbidities eg depression, self harm, eating disorders
Elana is in frequent trouble at school for aggressive outbursts. She is often in fights with her peers.
Elana’s mother had severe obsessive compulsive disorder Elana was often left crying and hungry.
Support was sought from Elana’s paternal grandparents and treatment accessed by her Mum
Elana presents with a three year history of drug misuse, self harm and suicide attempts.
She also presents with low mood and pseudohallucinations
In addition she presents with food restriction, vomiting and weight loss
Elana has been admitted twice with ongoing low mood after taking overdoses and with severe weight loss and refusal to eat.
Elana has now been discharged from hospital but her eating remains restricted . She has no suicidal ideas and her mood has improved.
She is taking Fluoxetine and engaged in Dialectic Behaviour therapy
What do you think the diagnosis may be? (there may be more than one)
Eating Disorder
Depression
Drug Misuse
Attachment Disorder/Emerging personality disorder/borderline personality disorder
Elana is in frequent trouble at school for aggressive outbursts. She is often in fights with her peers.
Elana’s mother had severe obsessive compulsive disorder Elana was often left crying and hungry.
Support was sought from Elana’s paternal grandparents and treatment accessed by her Mum
Elana presents with a three year history of drug misuse, self harm and suicide attempts.
She also presents with low mood and pseudohallucinations
In addition she presents with food restriction, vomiting and weight loss
Elana has been admitted twice with ongoing low mood after taking overdoses and with severe weight loss and refusal to eat.
Elana has now been discharged from hospital but her eating remains restricted . She has no suicidal ideas and her mood has improved.
She is taking Fluoxetine and engaged in Dialectic Behaviour therapy
What subspecialty would you refer to in AMH?
) Eating Disorder Service, Access Team, Drug Misuse service, Personality Disorder service…
Co-Ordinator is essential
Elana is in frequent trouble at school for aggressive outbursts. She is often in fights with her peers.
Elana’s mother had severe obsessive compulsive disorder Elana was often left crying and hungry.
Support was sought from Elana’s paternal grandparents and treatment accessed by her Mum
Elana presents with a three year history of drug misuse, self harm and suicide attempts.
She also presents with low mood and pseudohallucinations
In addition she presents with food restriction, vomiting and weight loss
Elana has been admitted twice with ongoing low mood after taking overdoses and with severe weight loss and refusal to eat.
Elana has now been discharged from hospital but her eating remains restricted . She has no suicidal ideas and her mood has improved.
She is taking Fluoxetine and engaged in Dialectic Behaviour therapy
What are your main areas of concern/risk for Elana?
Risk of relapse of eating disorder, drug misuse or mood disorder and self harm.
Care in labelling of Personality disorder when young
Elana is in frequent trouble at school for aggressive outbursts. She is often in fights with her peers.
Elana’s mother had severe obsessive compulsive disorder Elana was often left crying and hungry.
Support was sought from Elana’s paternal grandparents and treatment accessed by her Mum
Elana presents with a three year history of drug misuse, self harm and suicide attempts.
She also presents with low mood and pseudohallucinations
In addition she presents with food restriction, vomiting and weight loss
Elana has been admitted twice with ongoing low mood after taking overdoses and with severe weight loss and refusal to eat.
Elana has now been discharged from hospital but her eating remains restricted . She has no suicidal ideas and her mood has improved.
She is taking Fluoxetine and engaged in Dialectic Behaviour therapy
How would you go about transitioning her?
Early referral important
Care co-ordinater
Transition meetings with Elana present
What are some forms of SMI (Severe mental illness?)
Primary focus on Severe/Serious Mental Illness (SMI)
“Psychological problems that are often so debilitating that their ability to engage in functional and occupational activities is severely impaired”
Commonest disorders - schizophrenia and bipolar disorder, major depressive disorder
Cross-age prevalence ~0.7-0.9%
Drug and alcohol abuse
Dementia/Delirium (not focussed on during this talk, but delirium is a major contributor to morbidity/mortality)
What are some physical co-morbidities in SMI?
Poor physical health is common
SMI patients are more likely (1.3x for females, 1.2x for males) to have one or more physical health conditions than all patients
Differences more pronounced in younger age groups
Highest health inequality in ages 15-34 for asthma, diabetes, HTN, obesity
SMI patients aged 15-34 are 5x more likely to have 3 or more health conditions
Inequalities persist for obesity, asthma, diabetes, COPD, CHD and stroke after controlling for deprivation, age and sex
What is the impact of SMI on mortality?
Patients with SMI have a higher premature mortality than the general population
Average reduction in life is 15-20 years in SMI
Schizophrenia – 10-20 years
Bipolar Disorder – 9-20 years
Drug and alcohol use – 9-24 years
Recurrent depression – 7-11 years
Heavy smoking – 8-10 years
Death rate for those under 75years old is 3.7x higher than the general population
Estimated that 2/3 deaths are from preventable physical illnesses
Compared to general population, under 75s with SMI have death rates:
5 times higher for liver disease
4.7 times higher for respiratory disease
3.3 times higher for cardiovascular disease
2 times higher for cancer
Other causes of death include:
Suicide, substance abuse, accidents, dementia, infections
