Chapter 7 - Psychological Factors affecting Medical Conditions

Question 1

Historical Perspective

Answer 1

Psychological processes can affect bodily states
Voodoo death
No identifiable pathophysiological cause = psychological cause

Psychodynamic theory – specific disorders consequences of emotions/personality traits

Biopsychosocial model
Social characteristics
Pain and stress = psychological phenomenon
Certain behaviours increase risk of disease

Question 2

Ways Psychological/Behavioural Factors Ruled

Answer 2

When factors…

Influences course of condition

Interfere with treatment

Poses additional health risks

Influences pathophysiology of disorder

Question 3

Endocrine System

Answer 3

Secretes hormones

HPA axis
Hypothalamus, pituitary-adrenal axis
CRH, ACTH, cortisol
Increase food intake (hunger), fat deposition

SAM axis
Sympathetic. adrenomedullary system
Adrenaline, epinephrine, norepinephrine
Decrease food intake, increase heartrate and blood pressure

Question 4

Immune System

Answer 4

Network of cells and organs defending against antigens

White blood cells

Nonspecific immune response – circulating white blood cells identify/destroy antigens
Phagocytosis

Question 5

Cellular Immunity

Answer 5

Antigen presented to T-lymphocytes by macrophages

T-cells reproduce and circulate body
Helper – control response of other T-cells
Killer – attack foreign cells
Suppressor – inhibit actions of helper and killer cells

Memory T-cells produces – stored for next time threat encountered

Question 6

Humoral Immunity

Answer 6

Invading antigens presented by macrophages to B-lymphocytes

B-cells reproduce
Memory
Plasma – secrete/neutralize antigens

Question 7

Immune Response

Answer 7

Psychoneuroimmunology – study of mind-brain-immune system interactions
Exposure to acute stressors changes # of T-cells
Animals social disruption = suppression of immune system functioning
Reduced lymphocytes in participants shown gruesome film

Pathways psychosocial variables impact immune functioning
          Direct action of CNS
          Hormonal changes due to stress
          Behavioural changes (ex. poor diet)

Question 8

Construct of Stress

Answer 8

Stimulus
Major stressors
Hassles

Response
General adaptation syndrome
Alarm – mobilize defenses
Resistance – coping
Exhaustion – susceptible to disease

Transaction
Primary appraisal – event/trigger
Secondary appraisal – ability to cope/respond
Problem vs emotion focused

Question 9

Psychosocial Factors Influencing Disease

Answer 9

Boscarino
Vietnam War veterans
Higher combat exposure = higher rates of disease

Social status
Lower status = 3-4x more likely to die within 10 years

Social support
More connections = fewer deaths

Personality
Alexithymia
Difficulty with subjective feelings
Difficulty distinguishing feelings from bodily sensations
Constricted imagination
Externally oriented

Question 10

Infectious Disease

Answer 10

Cohen
Exposed healthy individuals to nasal drops (virus or saline)
Increased stress and negative emotions = increased signs of infection

Herpes symptoms recurrence associated with varying stress levels

Question 11

Ulcers

Answer 11

Erosion of lining of stomach/duodenum

Stress diverts blood away from stomach to skeletal muscles
Decreases effectiveness of stomach lining
Stress = hypersecretion of digestive acids

Jay Weis
Rats and predictability of shocks
Predictability decreases ulceration

H. Pylori – type of gut infection generating ulcers
Stress increases rate
30-60% ulcers involved

Question 12

Cardiovascular Disease

Answer 12

Leading cause of death/disability in Western societies

Ischemic heart disease – blood supply to heart compromised
Myocardial infarction – heart attack

Stroke – blood supply to brain interrupted
Death of neural tissue

Question 13

Risk Factors of Cardiovascular Disease

Answer 13

Arrhythmias – disturbance in normal pumping of heart

Atherosclerosis – buildup in blood vessels

Modifiable risks – diet, smoking

Protective factors – physical activities

Hypertension – high level of resting blood pressure

Question 14

Psychosocial Factors of Cardiovascular Diseases

Answer 14

Stress reactivity paradigm
Cardiovascular reactivity

Cardiovascular recovery

Rosenman
          Type A (aggressive) people 2x more likely heart disease than Type B (calm)

Hostility = increased risk of heart disease
Affective – tendency to respond with anger
Cognitive/attitudinal – negative view of others
Behavioural – aggressiveness

Question 15

How Hostility leads to Heart Disease

Answer 15

Exaggerated autonomic and neuroendocrine stress response

More demanding interpersonal life

Negative social perspective
Interpersonal stress
Increased vulnerability

More likely to engage in unhealthy behaviours

Constitutional vulnerability – link between hostility and poor health conditions

Question 16

INTERHEART Study

Answer 16

9 risk factors for 90%+ heart attacks

Smoking
Blood lipids
High blood pressure
Diabetes
Abdominal obesity
Low consumption of fruits/vegetables
Alcohol intake
low physical activity
Psychosocial factors

Question 17

Treatment of Psychosocial Diseases

Answer 17

Generic approach – focus physiological arousal response/behaviours and thought process
Relaxation training
CBT – identify and challenge thoughts promoting stress
Stress management
Biofeedback

Specific interventions
Cognitive behavioural transactional perspective – target specific variables (ex. Type A)
Reduce behaviour
Social support, coping strategies