Behavioral Health: Kovacs

Question 1

% of morbidity/mortality related to behavioral and social factors

Answer 1

50%

Question 2

List the Behaviors that Effect Heart Disease

Answer 2

Stress( ie.50 hr work weeks), Lack of exercise, Poor Eating Habits, Smoking

Question 3

Of the 6 million people who are admitted for chest pain, how many show identifiable cardiac ischemia or major physical disorder related to the symptom ?

Answer 3

50%

Question 4

Broken Heart Syndrome

Answer 4

Temporary, preceded by a significant emotional event

Symptoms: Chest pain and fear of heart attack

Question 5

Takotsubo AKA “The Broken Heart Syndrome” presents similar to MI, angina, systolic heart murmur and cardiac failure. Who is most likely to experience this syndrome ?

Answer 5

Post Menopausal women

Question 6

Significant criteria for Takotsubo include…

Answer 6

EKG Changes*
Elevation of Cardiac enzymes
Left Ventricular segmental akiniesia *
Dyspnea or Syncope

Question 7

What is absent during Takotsubo which may allow you to rule out other more serious pathologies…

Answer 7

Absence of coronary narrowing

Absence of obstructive coronary disease or angiographic evidence of acute plaque rupture

Absence of pheochromocytoma or myocarditis

Question 8

Why is Takotsubo Syndrome considered dangerous ?

Answer 8

It can lead to sever (but limited) cardiogenic shock

Question 9

What is often associated with Takotsubo from a behavioral aspect ?

Answer 9

Physical or emotional stress

Question 10

With proper treatment, 95% will have complete recovery from Takotsubo. Will the changes such as LV segmenal akinesia or cardiac enzyme elevation persist ?

Answer 10

No ! Typically these will both return to normal state.

Question 11

What is the best treatment for Takotsubo ?

Answer 11

Cardiac rehabilitation and stress reduction therapy

Question 12

Until proven otherwise, all Takotsubo patients should be treated as …

Answer 12

MI patients to avoid tissue damages

Question 13

Define Stress

Answer 13

A physical and emotional response to real or perceived threats associated with a rush or neurochemicals and hormones.

Question 14

What are a few disorders of mental health that can be caused by or lead to stress ?

Answer 14

anxiety

Depression spectrum

Question 15

What are a few disorders of medical health that can be caused by or lead to stress ?

Answer 15

Heart disease, infection etc.

Question 16

What does stress engage ?

Answer 16

Autonomic Nervous system (FIght or flight response)…..(in the notes it says SNS but that doesn’t make sense to me. Fight or flight is ANS).

Question 17

The HPA axis is activated during stress and involves which ‘releasing hormone’ ? What does this cause to be secreted and from where ?

Answer 17

Corticotropin Releasing Hormone

ACTH from the pituitary gland

Question 18

What is ACTH involved in regulating ?

Answer 18

The release of Cortisol (among other things)

Question 19

Cortisol is important in regulationg Blood pressure and cardiovascular function, mainly by it’s control of what important hormone ?

Answer 19

Aldosterone :Na+ re-uptake and volume expansion –> increased BP

Question 20

How do negative emotions such as aggression, competitiveness, anger, impatience, anxiety and depression affect the cardiovascular sysytem ?

Answer 20

Lead to increased activation of the HPA axis and ANS activation (in the notes it says SNS but that doesn’t make sense to me. Fight or flight is ANS). This will lead elevated cortisol levels –> increased BP

Question 21

In the evolution of Coronary Artery Disease (CAD) due to the Biological Pathway, what is occurring in the ANS ?

Answer 21

Sympathetic up-regulation

Parasympathetic down regulation

Question 22

In CAD due to the Biological Pathway, are vascular inflammation and endothelial dysfunction part of the central stress response system ?

Answer 22

Not
These are secondary effects due to physical effects which may be linked to the Central Stress Response System

Basically the CSRS leads to dysregulation of the ANS and HPA axis.

Question 23

What are the three main variables at work in the Behavioral Pathway to CAD ?

Answer 23

Anxiety, Depression and Stree

Question 24

Anxiety, Depression and Stress can be associated with ….

Answer 24

Chronic Negative outlook (response) to life
Poor Self Care (diet,inactivity, grooming)
Substance abuse

Question 25

Depression markers in CV disease include

Answer 25

increased platelet reactivity
decreased heart viability –> risk of MI
C-Reactive Protein–> Pro-inflammatory
Poor QoL

Question 26

Anxiety and Depression are linked with

Answer 26

Sleep impairment 
Rise in TG's (metabolic syndrome and obesity)
Increased/Repeadted ER visits
Doctor shopping
Increased use of caffeine
Weight changes 
Mood swings 
CVD

Question 27

What do happy thoughts do the the PNS ?SNS ?

Answer 27

Enhances the shit out of it. (Ps. this is dumb)…Causes the SNS to retreat

Question 28

Do negative thoughts have genetic expression ? How ?

Answer 28

Messenger genetics are believed to cross the placenta and influence neural development. Affect penetrance or expressitivity. So all y’all ladies better be having good vibes when you have a bun in the oven.

Question 29

Which dymnamic risk factors help to optimistically impact people when addressed correctly ?

Answer 29

Encouragement on smoking cessation
Finding stress reduction techniques
Weight loss intervention
Counselling and medication
Address depression !

Question 30

what can be done psychologically to treat CAD ?

Answer 30

Relaxation training
Stress management
Group therapies
Building coping and resiliency

Question 31

At this time, is there a reasonable degree of medical certainty towards the ability of psychological stress reductions ability to reduced CHD Mortality ?

Answer 31

Sure isn’t. You just have to believe

Question 32

What are some mal-adaptive strategies for coping with stress ?

Answer 32

Denial
escape
minimize
blame

Question 33

What are adaptive strategies to dealing with stress ?

Answer 33

accept responsibility or blame

exercise a proactive response