Psychosocial heart disease

Question 1

How are psychosocial factors related to heart disease?

Answer 1

Socio-demographic factors associated with risk and accessibility of health care services

Lifestyle factors

Triggering cardiac events

Beliefs influencing use of medical care

Question 2

What are the psychological risk factors for heart disease?

Answer 2

• Socio-economic status
• Lifestyle
• Stress and strain
• Hostility/anger
• Social isolation
• Depression and anxiety
• These factors overlap

Question 3

what is Type A Behaviour what is the link to heart disease

Answer 3

• Widely tested for risk factor heart disease
• Measured by self-report questionnaire or structured interview
• negative attitudinal set, antagonistic style and negative expectations”
• • Greater physiological reactivity to stressors (increased BP, adrenaline, noradrenaline and cortisol)
• Anger can trigger MI
• Greater likelihood of encountering stress
• Hostility also reduces social support

Question 4

link between stress and heart disease

the stress respose pathway has 2 components, what are they:

Answer 4

sympathetic axis- acute route

hypothalamic-pituitary axis- chronic route

Question 5

list the sympathetic response to stress

Answer 5

1. Stressor
2. Hypothalamus
3. ANS-SNS
4. Adrenal glands- medulla
5. Adrenaline and noradrenaline
6. Increased heart rate
7. Arrhythmia

Question 6

hypothalamic-pituitary acis- chronic stress pathway

Answer 6

Hypothalamus (CRH)

Pituitary gland (ACTH)

Adrenal glands- cortex (cortisol)

Increased BP, changes in clotting process

Question 7

allostatic load

Answer 7

”- physiological toll of repeatedly adapting to chronic stressors- the effects are cumulative

Chronically high levels of stress may increase CV reactivity

reactivity is related to family history, physical fitness and support

hyper-reactivity is not associated with the development of heart disease in heealthy populations

But … hyper-reactivity is associated with the development of hypertension– big risk factor for further CV events

Question 8

What are the people’s response to having heart disease?

Answer 8

model for experincing any disease: psychological,social factors and underlying pathology affect people’se experience of illness

regulatory model of illness behaviour model

we interperate the health threat (perceiving the sympotms and then interperating our emotions and cognitions) we then engage in coping behaviour with the illness threat and the emotions they cause) we then finish by appraising our situation

Question 9

how do cognitive responses affect how we inetract with illness

Answer 9

controlllabilty and curability of illness directly related to rates of attending rehab and that less serious consequences meant a quicker return to work and better social functioning.

Question 10

what are 2 common emotional responses to being diagnosed w a disease?

Answer 10

anxiety

depression

Question 11

anxiety

Answer 11

“A feeling of apprehension accompanied by negative thoughts (worry) and physical (somatic) symptoms”

Physical symptoms of heart disease overlap with those of anxiety, easily mixed up (75% of people with MI worry about their cardiac state)

16% of MI patients develop PTSD

No way of knowing who will be affected

biphasic response initially, low anxiety at first which rises and then decreases upon discharge

Question 12

HADS

Answer 12

Psychometric scale that measures anxiety and depression

Score of ~8/21 or higher indicates anxiety

Question 13

Sources of anxiety in medicine

Answer 13

Investigations (cardiac catheterization)

Discharge

Concern of mortality

Fear of over-exertion

Family’s fears (over-protective, leads to cardiac “invalidism”

Question 14

depression and heart disease

Answer 14

Question 15

implications of anxiety and depression for behaviour

Answer 15

Delay in returning to work

Low ratings of social satisfaction

Reduction in sexual activity- impact on relationships and self-confidence

Poorer adherence but more likely to attend doctors with general worries

Negative impact on lifestyle and quality of life

Question 16

positive consequences of MI

Answer 16

Many report healthy lifestyle changes

Some have a greater appreciation for life

Improved close relations

these things can however be short term

Question 17

can psychology play a apart in the management of heart disease?

Answer 17

yes- cardiac rehab

Question 18

definition of rehabilitation

Answer 18

“the sum of activities required to influence favourably the underlying cause of the disease, as well as the best possible physical, mental and social conditions, so that they may, by their own efforts, preserve (or resume when lost) as normal a place in society as possible”

Question 19

Psychological objectives of cardiac rehab

Answer 19

Modify behavioural risk factors:

• lifestyle factors, e.g. unhealthy diet, smoking, lack of exercise
• type A behaviour
• stress

(involves assessment, education and provision of opportunities)

• Improve psychological functioning
• Improve QoL

gives you a locus of control

Question 20

comprehensive cardiac rehab should have

Answer 20

Should have multi-components: menu of treatments

Wide access to all patients

Individualised/ targeted; this helps to increase adherence

Can reduce mortality

Question 21

what are the predicted benefits of cardiac rehab

Answer 21

Positive effects on prognosis, e.g. prevention of future complications

Improvements to psychological and social well-being, including economic costs to the individual, their family and society

Financial cost benefit to health service providers, because if rehab is “effective” then patients will need less future health care

Taking up cardiac rehab is patchy and adherence is sometimes poor

Question 22

evidence base for cardiac rehab

Answer 22

Difficult to evaluate

There are different rehab “packages”

Different outcome measures are used (e.g. mortality, rate of return to work)

Confounding variables (e.g. gender, age, socio-economic)

Varying length of follow up

Question 23

long term benefits of cardiac rehab

Answer 23

Differences in psychosocial benefits decline

Physical benefits decline- mainly because people drop out (risk of death seems less)

Some patients prefer home based programmes

Probably cost effective and QoL is improved