Chapter 7 - Psychological Factors Affecting Medical Conditions Flashcards
dualistic
mind and body is viewed as separate entities, subject to different laws
what perspective emerged in the 1970s
realization that many, perhaps all, disease states are influenced directly/indirectly by social or psychological factors
behavioral medicine
refers to application of the methods of behaviour modification to the treatment or prevention of disease ex. psychological techniques to control pain in patients
health psychology
application of psychological methods and theories to understand the origins of disease, individual responses to disease, and the determination of good health
what is the key criterion to be diagnosed
must have medical condition that is adversely affected by psychological/behavioural factor
what is the exclusion criterion to be diagnosed
factors should not be better explained by another mental disorder
How do we rule in a psychological or behavioural factor?
1) evidence of identified factor influencing course of condition
2) factor interferes with the treatment of the medical condition
3) factor poses additional risk to the health of the individual
4) factor influences the pathophysiology of the disorder
mechanism
activity of a living system that mediates the influence of an antecedent factor on disease
what is illness defined by
defined by symptoms which are subjective reports of internal states
what is disease defined by
defined by signs which are objective indications of an underlying disease process, either directly by a person with appropriate training or indirectly through a specific test
lesion
when a sign involves disturbance in bodily tissue or normal functioning of a bodily system
why is the distinction between illness and disease important?
alerts us about the various mechanisms by which psychological factors may contribute to ill health
how can psychological factors influence ilness
affect our perception of, attention to, or tolerance of bodily signals
what can psychological influences on bodily tissues (via lesions) be?
can be the effects of behaviours (ex. smoking) or psychosocial variables (ex. emotions, interpretation of experience)
what three mechanisms are responsive to psychosocial factors?
endocrine system, autonomic nervous system and immune system
what are several endocrine organs known to be highly responsive to?
psychosocial variables - best known system is HPA axis (releases cortisol in response to a variety of psychosocial influences ex. stress)
endocrine system
organs that manufacture hormones and secrete them into the bloodstream
cortisol
highly active hormone - suppresses inflammation, mobilizes glucose from the liver, increases cardiovascular tone, produces immune system changes and inhibits other endocrine structures
are cortisol features used as a defense mechanism
yes
what are the short term responses in cortisol
promote immediate survival and inhibit unnecessary activity but they are maladaptive when prolonged/exaggerated
what is there evidence for regarding cortisol
suppress immune system function, enhance the development of atherosclerosis and contribute to neuronal damage in brain
does cortisol play a role in increasing the production of fat cells
yes
does cortisol contribute to neuronal damage in the brain that may be associated with dementia
yes
what are two parts of the ANS system
Sympathetic branch and parasympathetic system
sympathetic branch
produces changes that prepare the body for vigorous action; dangerous if prolonged
parasympathetic branch
returns the body to a more balanced state that is within the body’s tolerance
why are effects of the ANS so fast?
because they don’t reply on blood stream, instead rely on speed of nervous conduction
what part of a second endocrine subsystem is the sympathetic system part of
sympathetic-adrenal medullary (SAM) axis
what does the SAM axis do
1) Stimulates release of epinephrine and norepinephrine
2) Associated with “adrenalin rush”, increased energy and body activation
immune system
comprises a network of cells and organs that defends the body against external, disease causing forces or internal pathogens (antigens)
how does the immune system perform its function
through a variety of white blood cells
where are immune cells produced and stored in
several organs including thymus gland, the lymph nodes, bone marrow and small intestine
what are the three categories of immune response
nonspecific, cellular, humoral
nonspecific immune responses
circulating white cells (granulocytes and monocytes) identify invading antigens and destroy them by a process of engulfing and digesting called phagocytosis
antigens
substance that is recognized as foreign to the body
cellular immunity
blood cells called T-lymphocytes create immune episode to foreign body and are altered as a result - responsible for “building up immunity”
helper t-cells
secrete substances called lymphokines that control responses of other types of t-cells
killer t-cells
attack foreign or mutated cells directly
suppressor t-cells
inhibit the actions of both the helper cells and the natural killer cells, thereby providing negative feedback mechanism
memory t-cells
stored in the body in anticipation of the next time it needs to counter the same threat
humoral immunity
invading antigens are targeted by B-lymphocytes
psychoneuroimmunology
study of mind-brain-immunesystem interactions
3 ways psychosocial variables can influence immune acitivity
1) direct action of CNS on organs and structures of the immune system
2) secondary consequence of the hormonal changes
3) changes in behaviour that reflect personal characteristics or adaptations to changing life conditions
What 3 ways is the term stress used
1) to refer to a stimulus or property of external world
2) to refer to a response
3) refer to a transaction that mediates stimulus and response
alarm (first phase)
body mobilizes its defence
resistance (second phase)
actively copes with the challenge through immune and neuroendocrine changes
exhaustion (third phase)
energy is depleted and resistance can no longer be maintained
general adaptation syndrome (GAS)
first formal description and definition of stress - according to this model, stress is inferred from a set of bodily changes that is defined by a response
what are the three phases of GAS
alarm, resistance and exhaustion
what must happen in GAS
some event must occur to set off adaption effectts
transactional model of stress
stress is an ongoing series of transactions between an individual and their environment
appraisals
constantly evaluating what is happening to them
primary appraisal
asks the question “is this a threat to me?”
secondary appraisal
if yes, primary appraisal is a threat, then engages in problem-focused coping or emotion-focused coping
final step in transaction model
“is my coping effective?” - if yes, stress is minimized. if no - appraisal of threat is confirmed - leads to disease or stress effects
why is the transactional model of stress useful
1) the way we perceive a threat plays a role in the physiological response to it
2) it helps organize how we think about psychosocial factors influencing disease
social status that influence disease
individual’s relative position within a social hierarchy matters
controllability
ability to control potentially stressful events
internal locus control
see themselves as masters of their own destiny
external locus control
see themselves as being buffeted by the random events of the world
what is high strain and external locus of control been shown to be associated with
increased risk of morbidity and mortality due to cardiovascular disease
social support
extent to which an individual feels connected to other people in meaningful ways
what does the absence of social support worsen
existing disease
what are the reasons the effects of social support are unclear
1) may be associated with material support in times of stress
2) may be a mean of discovering or testing coping strategies
3) a way of altering stress appraisals
ischemic heart disease
blood supply to the hear becomes compromised which leads to myocardial infarction and stroke
myocardial infarction and stroke
blood supply to the brain is interrupted, leading to death of neural tissue
potential years of life lost (PYLL)
a measure calculated by subtracting age of death from an individual’s life expectancy - than any other cause except cancer and accidents
what does the cardiovascular system provide to the body
nutrients and oxygen to all the tissues in the body and serves as a highway for the elimination of waste products
vasculature
extensive branching network of arteries, arterioles, capillaries, venues and veins
two numbers that express blood pressure
systolic blood pressure/diastolic blood pressure
cardiac output
amount of blood pumped by the heart
total peripheral resistance
the diameter of the blood vessels
arrhythmias
disturbances in the normal pumping rhythm of the heart or from compromised supply of blood to the heart itself
atherosclerosis
buildup of deposits, known as plaques on the walls of the blood vessels
atherogenesis
atherosclerotic plaques are complex structures built up from matter deposited on arterial linings over a course of a lifetime - primarily lipids
hypertension
high level of resting blood pressure
stress reactivity paradigm
reaction to stress is important to understanding CVD
cardiovascular reactivity
degree of change in cardiovascular function change in response to a psychologically significant stimulus
Type A
people who appear to be aggressively involved in a chronic struggle to achieve more and more in less and less time
3 components of Type A that increase CVD
1) affective features
2) cognitive/attitudinal dimension
3) behavioural dimension
affective features
tendency to respond to situations with anger and contempt
cognitive/attitudinal dimension
tendency to view others with a cynicism and to impute bad intentions to them
behavioural dimension
direct and subtle aggressiveness and antagonism
5 models of CVD
1) psychophysiological reactivity model
2) psychosocial vulnerability model
3) transactional model
4) Health Behaviour model
5) constitutional vulnerability model
Psychophysiological Reactivity model
hostile people at a greater risk due to experiencing greater physiological responses to stress
psychosocial vulnerability model
hostile people experience more demanding interpersonal lives than others
transactional model
hostile people construct an antagonist and unsupportive world, worsened by lack of social support and increased interpersonal stress
health behaviour model
hostile people engage in more unhealthy behaviours and less health behaviors
constitutional vulnerability model
link between hostility and poor health outcomes is the result of this - genetics + personality + disease risk
two classes of intervention
1) generic approaches to management of stress
2) interventions for specific psychosocial variables
what do specific interventions target for Type A
personality traits and associated behaviours
