Health Psychology

1. Health Psychology Psychology 46.339 (01) Summer 2007 Instructor: Dr. Fuschia Sirois Wednesday August 8: LAST CLASS! Lecture 9, Prep. Guides 9, 10 Chapter 13: Heart Disease, Hypertension, Stroke, and Diabetes Chapter 14: Psychoneuroimmunology, AIDS, Cancer, and Arthritis

2. Coronary Heart Disease: What Is CHD? • A general term referring to illnesses caused by atherosclerosis • Narrowing of coronary arteries, the vessels that supply the heart with blood • Angina pectoris • Pain that radiates across the chest and arms • Caused by temporary shortage of oxygen • Myocardial infarction – heart attack

3. Coronary Heart Disease (CHD): Role of Stress • Development of CHD is associated with • Hostility • Depression • Cardiovascular reactivity to stress • Acute stress can precipitate sudden clinical events • Balance of control and demand in daily life is associated with CHD • Heart disease is more common in low SES individuals –WHY?

4. Coronary Heart Disease: Women and CHD • Cardiovascular disease • Leading killer of women in Canada • Women have 50% chance of dying from 1st heart attack (30% for men) • Recall that symptoms of a female heart attack are different from those for men • Women seem to be protected at younger ages relative to men • Higher levels of HDL premenopausal • Estrogen diminishes sympathetic nervous system arousal

5. Coronary Heart Disease: Cardiovascular Reactivity and Hostility • Type A Behavior Pattern • Behavioral and emotional style marked by an aggressive, unceasing struggle to achieve more and more in less time • Often in hostile competition with other individuals or forces • Risk factor for coronary artery disease Anger and Hostility appear to be especially implicated as risk factors

6. Coronary Heart Disease: Cardiovascular Reactivity and Hostility Cynical Hostility • Particularly lethal type of hostility • Characterized by suspiciousness, resentment, frequent anger, antagonism, distrust of others • Have difficulty extracting social support from others • Fail to make effective use of available social support • Hostility combined with defensiveness is particular problematic

7. Coronary Heart Disease: Recovery Research suggests that social support decreases recovery time after heart surgery, heart attacks • depressed cardiac patients have higher mortality rate than non-depressed patients (7.5% vs 2.5%, in 1 study) Quality of Social Support is important • by-pass surgery patients feel highly supported if partners express low fatigue, low displeasure, & low sadness - i.e. if partners are well adjusted to the situation (Schroeder & Swartzer, 1998)

8. CHD: Negative Emotions and Risk Factors • Strong Associations between • Depression and heart attack • Hopelessness and heart attack • Anxiety and sudden cardiac death • Recent research • Social dominance may be related to all-cause mortality • Vital exhaustion predicts the likelihood of a heart attack

9. Management of Heart Disease – Cardiac Rehabilitation Cardiac invalidism • psychological state that can result after a myocardial infarction or diagnosis of coronary heart disease • the perception that a patient’s abilities and capacities are lower than they actually are • both patients and their spouses are vulnerable to these misperceptions.

10. Coronary Heart Disease: Interventions - Interventions Behavioral Interventions can help reduce the risk of CD and also aid in the treatment of CD • relaxation techniques can significantly reduce BP &  the need for medications • Diet changes can help reduce serum cholesterol levels • Exercise can also help to reduce BP • weight loss is the most frequently prescribed behavioral change - reduces BP Anger management training, stress coping strategies can help to reduce reactivity of Type A behavior

11. Stroke: Overview • Condition that results from a disturbance in blood flow to the brain • Often marked by resulting physical or cognitive impairments and, in the extreme, death. • Deaths • Stroke is the fourth leading cause of death in Canada. • Each year, about 16,000 Canadians die from stroke. • Each year, more women than men die from stroke. • A chief risk of stroke • That more strokes will follow in its wake • Aspirin reduces the risk of recurrent strokes

12. Stroke: Overview • Prevalence • There are between 40,000 to 50,000 strokes in Canada each year. • After age 55, the risk of stroke doubles every 10 years. • A stroke survivor has a 20% chance of having another stroke within 2 years. • Effects • Of every 100 people who are hospitalized for stroke: • 20 die before leaving the hospital • 50 return home • 10 go to an inpatient rehabilitation program • 15 require long-term care

13. Stroke: Warning Signs Learn to recognize the warning signs of a stroke. • Weakness - Sudden weakness, numbness or tingling in the face, arm or leg. • Trouble Speaking - Sudden temporary loss of speech or trouble understanding speech. • Vision Problems - Sudden loss of vision, particularly in one eye, or double vision. • Headache - Sudden severe and unusual headache. • Dizziness - Sudden loss of balance, especially with any of the above signs.

14. Stroke: Risk Factors • Modifiable risk factors include • High blood pressure • Heart disease • Cigarette smoking • High red blood cell count • Transient ischemic attacks • Psychological distress • Anger expression

15. Stroke: Consequences • Stroke affects all aspects of life • Personal • Social • Vocational • Physical • Motor, Cognitive, Emotional, and Relationship problems • Symptoms and problems differ depending on which side of the brain was damaged

16. Chronic Illness - Diabetes Diabetes is a chronic blood sugar regulation disorder in which the body is not able to manufacture or utilize insulin properly. • insulin is a hormone produced by the pancreas that regulates blood sugar • Diabetics have defective insulin production/use • when blood sugar levels are out of balance hyperglycemia and hypoglycemia can result • Approximately 2 million Canadians have diabetes. • The rate is three to five times higher among Aboriginal people.

17. Prevalence of Diabetes in Canada by age group

18. Diabetes: Overview • Cells of the body need energy to function • Glucose is the primary source of energy • Insulin is a hormone produced by pancreas • Insulin acts as a “key” to permit glucose to enter cells • Without insulin, cells don’t get the glucose they need • Glucose stays in the blood: Hyperglycemia

19. Diabetes: Types Diabetes mellitus can be Type I or Type II • Type I = Insulin dependent (IDDM) • Type II = Non-insulin dependent (NIDDM) Also gestational diabetes Type I Diabetes (10% of all diabetes) • Abrupt onset of symptoms • Immune system falsely identifies cells in the pancreas as invaders and destroys them • Pancreas doesn’t produce insulin • Develops relatively early in life • most prevalent type of diabetes in children and adolescents

20. Types of Diabetes Type II Diabetes • Cells lose ability to respond fully to insulin (known as insulin resistance) • Pancreas temporarily increases insulin production • Insulin-producing cells may give out • Most common in adults • Increasingly common in children Gestational diabetes A temporary condition that occurs during pregnancy. It affects two to four percent of all pregnancies with an increased risk of developing diabetes for both mother and child.

21. Risk factors you cannot change • Increasing age • Family history of disease • Race or ethnicity • Gestational diabetes or having a baby weighing 9+ lbs at birth

22. Risk factors you can change • Inactive lifestyle • Overweight

23. Diabetes: Health Implications Diabetes is associated with • Thickening of the arteries due to buildup of wastes in the blood • High rates of CHD • Diabetes is a risk factor for cardiovascular disease • Cardiovascular disease is the main cause of death in diabetics (55%), particularly in Type 2 diabetics • Diabetics are 2 to 4 times more likely to have, and to die from, cardiovascular disease than non-diabetics

24. Complications of diabetes • Heart and blood vessel disease • Kidney disease • Eye damage • Foot damage • Infections, slow to heal • Gum disease

25. Diabetes Management 24/7 Constant Juggling: Insulin/medication with: Exercise Food intake BG BG & BG

26. Diabetes Management Proactive • keep juggling the balls Reactive • a response is indicated • corrective actions for highs or low • emergency intervention

27. Chronic Illness - Diabetes

28. Psychoneuroimmunology (PNI) • The study of the inter-relationships between psychosocial factors, and the immune, nervous, and endocrine systems The Immune Systemis comprised of tissues, organs, and processes that protect the body from invasion by foreign material Immunocompetence: The extent to which the immune system is able to fight off invading microorganisms

29. Psychoneuroimmunology: The Immune System - Review • The surveillance system of the body:Primary function • Distinguish between what is “self” and what is foreign • Attack and rid the body of foreign invaders • Distinction between • Natural immunity • Specific immunity

30. Figure 14.1: Interaction between Lymphocytes and Phagocytes

31. PNI: Assessing Immunocompetence & Effects of Stress Two general indicators of Immunocompetence • Measuring the amount of various components of the immune system in the blood • Example: counting T, B, NK cells in the blood • Assessing the functioning of immune cells • Example: ability of certain white blood cells to ingest foreign particles Activation of the HPAC Axis affects immune functioning • Corticosteroids have an immunosuppressive effect • Sympathetic activation can enhance or suppress immune functions under different conditions

32. Psychoneuroimmunology: Assessing Immunocompetence • Immunocompromise • Indicators suggest that immune functioning • Has been disrupted or reduced • Wound-healing • Psychological distress impairs inflammatory responses that initiate wound repair • Immunocompromise relates to health outcomes • Those under stress have lower levels of antibody titres after vaccination

33. PNI: Stress and Interpersonal Relationships • Adverse changes in immunity are associated with • Bereavement (especially those who have become depressed) • Loneliness • Martial disruption and conflict (including short-term conflicts) • Providing care for a friend or family member with a long-term illness

34. Mood and the Immune System Kiecolt-Glaser, et al. (1993) looked at effects of marital conflict on immune system functioning • Newlyweds isolated for 24 hours --> 4 immune assays, observation of behaviors during discussion of marital problems, social support & mood questionnaires • Those who were more hostile or negative showed more negative immune system responses over 24 hrs than did those who were low on negativity/hostility; avoidant, positive or problems solving behaviors were not sig. related to these changes • Women showed more negative changes than men, even though both groups were high on marital satisfaction

35. Chronic Illness - Cancer Cancer - uncontrolled growth of abnormal cells • tumors can be benign or malignant, localized or metastasized (spread to other parts) • Most types of cancer cells form a lump or mass called a tumor. • Tumor cells can break away and travel to other parts of the body where they can continue to grow. This process is called metastasis.

36. What is Cancer? • All cancers have neoplastic growth, altered cells with nearly unlimited growth. • Benign localized • Malignant spread much more threatening • Metastatic cancer cells move to other parts of the body

37. Cancer:Canadian Cancer Society • A set of >100 diseases • All cancers result from DNA dysfunction • Rapid cell growth and proliferation • Cancerous cells provide no benefits to body • Cancerous cells sap the body’s resources An estimated 149,000  new cases of cancer and 69,500  deaths occured in Canada in 2005. • On average, 2,865 Canadians will be diagnosed with cancer every week. • On average, 1,337 Canadians will die of cancer every week.

38. Chronic Illness - Cancer Often called a lifestyle disease • ~ 2/3 of Cancer deaths associated with lifestyle factors Psychosocial factors implicated in the onset of Cancer include personality, stress, coping style, smoking habits (~30% of cancer deaths), diet, occupation (~4% of cancer), & UV exposure (~90% of skin cancers) • Smoking and diet are the 2 leading behavioral risk factors for cancer

40. Adjusting to Cancer More than one-third of cancer victims live at least 5 years after their diagnosis • Coping with physical limitations • Pain and discomfort • Downregulation of immune system, vulnerability to other disorders • Fatigue • Treatment-related problems • Cosmetic problems:Surgical removal of organs • Body image concerns • Use of prosthesis • Conditioned nausea and immune suppression

41. Social Support & Cancer Research suggests that cancer patients who are married survive longer than unmarried patients (Goodwin et al., 1987) WHY? Support groups also give SS • opportunity for downward comparisons (w/worse off patients) & upward comparisons (w/patients successfully coping) Speigel et al. (1993) randomly assigned breast cancer patients to reg. Tx or Tx + support group

42. Arthritis: Overview • Autoimmunity: A condition in which the body produces an immune response against its own tissue constituents • Most prevalent autoimmune disorder: ARTHRITIS • Arthritis means “inflammation of a joint” • Over 200 forms of arthritis. • About 30% of adults have arthritis. • Three major forms of arthritis • Rheumatoid, osteoarthritis, gout

43. Arthritis

44. GENDER AGE OBESITY WORK FACTORS Arthritis occurs more frequently in women than in men. Anybody can be at risk of developing arthritis, but in children is called Juvenile Rheumatoid arthritis Obesity increases the chances of getting arthritis particularly in women If you have a strenuous job that requires repetitive bending, kneeing, or squatting,you are at higher risk of getting arthritis. Risk Factors - Arthritis

45. Serious types of arthritis • Lupus (systemic lupus erythematosus) • Rheumatoid arthritis • Scleroderma • Sjogren’s syndome • Lyme disease • Ankylosing spondylitis • Psoriatic arthritis • Reactive arthritis –aka Reiter’s Syndrome

46. Major symptom of Arthritis is pain - can lead to  activity,  depression, psychosocial costs Chronic Illness - Arthritis Coping & management of arthritis are affected by: • behavioral pain coping • stressful events • social support • culture specific coping strategies • severity of pain • level of functional impairment

47. Rheumatoid Arthritis • Crippling form of arthritis believed to result from an autoimmune process • Usually attacking small joints of hands, feet, wrists, knees, ankles, and neck • Primarily affects • 40-60 age group • Women • Main complications • Pain, limitations in activities, need to be dependent on others

48. Rheumatoid Arthritis • Treatment includes • Anti-inflammatories to reduce inflammation and pain • Rest • Supervised exercise • Cognitive-behavioral interventions • Enhancement of perceived self-efficacy • Optimism • Relearning meaning of pain

49. Osteoarthritis • Form of arthritis that results when the articular cartilage (smooth lining of a joint) begins to crack or wear away because of overuse of a particular joint • May also result from injury or other causes • Usually affects weight-bearing joints • Common among athletes and the elderly • Treatment • Keeping weight down, exercise, aspirin, joint replacement, prescription medications, joint injections

50. Inflammatory Bowel Disease (IBD) • 170,000 Canadian men and women suffer from IBD • 10,000 new cases of IBD diagnosed each year in Canada • Canada has the highest rates of IBD in the world • frequently diagnosed between the ages of 15-25, or 45-55. • Crohn’s disease and ulcerative colitis • Inflammation of the intestines • Difference is which part of the intestines are affected