1 / 20

PSYCHOSOMATIC MEDICINE

PSYCHOSOMATIC MEDICINE. Dr. YASER ALHUTHAIL Ass. Professor & Consultant Consultation Liaison Psychiatry.

mjesse
Download Presentation

PSYCHOSOMATIC MEDICINE

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. PSYCHOSOMATIC MEDICINE Dr. YASER ALHUTHAIL Ass. Professor & Consultant Consultation Liaison Psychiatry

  2. Psychosomatic medicine is an area of scientific investigation concerned with therelationbetween psychological factors and physiological phenomena in general and disease pathogenesis in particular. Integrates mind and body into a psychobiological unit; to study psychological and biological processes as dynamic interacting systems. It emphasizes the unity of mind and body and the interaction between them. A holistic approach to medicine.

  3. Two basic assumptions: There is a unity of mind and body (reflected in the term mind-body medicine) Psychological factors must be taken into account when considering all disease states Emphasis on examining and treating the whole patient, not just his or her disease or disorder.

  4. The concepts of psychosomatic medicine also influenced the field of behavioral medicine which integrates the behavioral sciences and the biomedical approach to the prevention, diagnosis, and treatment of diseases. Psychosomatic concepts have contributed greatly to those approaches of medical care.

  5. Biomedical Model: The application of biological science to maintain health and treating disease. Engel (1977) proposed a major change in our fundamental model of health care. The new model continues the emphasis on biological knowledge, but also encompasses the utilization of psychosocial knowledge. “Biopsychosocial Model”

  6. Stress Theory Stress can be described as a circumstance that disturbs, or is likely to disturb, the normal physiological or psychological functioning of a person. The body reacts to stress in this sense defined as anything (real, symbolic, or imagined) that by threatens an individual's survival by putting into motion a set of responses that seeks to diminish the impact of the stressor and restore homeostasis.

  7. THE STRESS MODEL A psychosomatic framework. Two major facets of stress response. “Fight or Flight” response is mediated by hypothalamus, the sympathetic nervous system, and the adrenal medulla. If chronic, this response can have serious health consequences. The hypothalamus, pituitary gland, the adrenal cortex mediate the second facet.

  8. Neurotransmitter Responses to Stress Stressors activate noradrenergic systems in the brain and cause release of catecholamines from the autonomic nervous system. Stressors also activate serotonergic systems in the brain, as evidenced by increased serotonin turnover. Stress also increases dopaminergic neurotransmission in mesoprefrontal pathways.

  9. Endocrine Responses to Stress CRF is secreted from the hypothalamus. CRF acts at the anterior pituitary to trigger release of ACTH. ACTH acts at the adrenal cortex to stimulate the synthesis and release of glucocorticoids. Promote energy use, increase cardiovascular activity, and inhibit functions such as growth, reproduction, and immunity.

  10. Immune Response to Stress Inhibition of immune functioning by glucocorticoids. Stress can also cause immune activation through a variety of pathways including the release of humoral immune factors (cytokines) such as interleukin-1 (IL-1) and IL-6. These cytokines can themselves cause further release of CRF, which in theory serves to increase glucocorticoid effects and thereby self-limit the immune activation.

  11. High level of Cortisol results in suppression of immunity which can cause susceptibility to infections and possibly also in many types of cancer. Changes in the immune system in response to stress are now very well established.

  12. Immune suppression in response to stress occurs even after removal of the adrenal gland !!. There appears to be an alternative path, other than through the adrenals, for the brain to influence the immune response. Psychoneuroimmunology

  13. DSM-IV Diagnostic Criteria for Psychological Factors Affecting Medical Condition A. A general medical condition (coded on Axis III) is present. B. Psychological factors adversely affect the general medical condition in one of the following ways: (1) the factors have influenced the course of the general medical condition as shown by a close temporal association between the psychological factors and the development or exacerbation of, or delayed recovery from, the general medical condition. (2) the factors interfere with the treatment of the general medical condition. (3) the factors constitute additional health risks for the individual. (4) stress-related physiological responses precipitate or exacerbate symptoms of a general medical condition.

  14. Mental disorder affecting medical condition (e.g., an Axis I disorder such as major depressive disorder delaying recovery from a myocardial infarction) Psychological symptoms affecting medical condition (e.g., depressive symptoms delaying recovery from surgery; anxiety exacerbating asthma) Personality traits or coping style affecting medical condition (e.g., pathological denial of the need for surgery in a patient with cancer, hostile, pressured behavior contributing to cardiovascular disease) Maladaptive health behaviors affecting medical condition (e.g., lack of exercise, unsafe sex, overeating) Stress-related physiological response affecting general medical condition (e.g., stress-related exacerbations of ulcer, hypertension, arrhythmia, or tension headache) Other unspecified psychological factors affecting medical condition (e.g., interpersonal, cultural, or religious factors)

  15. The essential challenge in psychosomatic-psychobiological research is to delineate the mechanisms by which experiences cause certain types of physiological reactions that result in disease states.

  16. Cardiovascular System Psychological factors have been closely studied as part of the pathogenesis of the cardiovascular diseases. Depression is an independent risk factor for the development of coronary artery disease. Depression increases mortality rates following myocardial infarction (MI). Hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis, immune activation with release of proinflammatory cytokines, and activation of the sympathetic nervous system and of corticotropin-releasing factor (CRF) pathways in the central nervous system (CNS).

  17. Gastrointestinal Conditions Functional disorders represent 50% of complaints in GI clinics There is a strong & consistent association between functionalgastrointestinal disorders and psychological factors. Irritable Bowel Syndrome is the most common. Brain-Gut axis Hypersensitivity of GI tract Role of stress

  18. Somatoform Disorders Three enduring clinical features: - Somatic complaints that suggest major medical problems. - Psychological factors and conflicts that seem important. - Symptoms or magnified health concerns that are NOT under the patient’s conscious control.

  19. Somatoform Disorders Somatization disorder Conversion disorder Pain disorder Hypochondriasis Body Dysmorphic Disorder

  20. www.dralhuthail.com

More Related