1. Psychological Factors Affecting Medical Condition Dr. YASER ALHUTHAIL
Associate Professor & Consultant
Consultation Liaison Psychiatry
The concept of stress
Stress is unavoidable component of life
Stressful life events are correlated with increased risk of becoming medically ill
Hetreogenecity of stress and response to it
Development of concepts
Schedule of recent life events:
Linear relationship between score and illnesses experienced, highest in the following 6 months
The more life events, the more illnesses in the next 2 years
Consistent findings across all cultures
What makes an individual vulnerable?
4. Cognitive appraisal Stressful events for a person may not be so for another!!
Interpretation of a harmful or threatening stress
Positive Vs. negative life events !
5. Coping The behavior involving special physical and emotional energy and attention that is required to deal with some difficult circumstances
Different ways of coping
Could have an impact on the individual
6. Social support Protective effect
Facilitates coping and adaptation
Longer life!!, less physical illnesses, and more positive mental health
Lower mortality rates in married people
Long-term influence of childhood stressors
7. Biological Predisposition Peptic ulcer & H pylori
Acute stress & sudden cardiac death
8. Psychophysiological Pathways
Autonomic nervous system, immune system, neuroendocrine system
Extensive dynamic feedback system
Sympathetic and parasympathetic
Major depression & prolonged periods of stress
Associated with increased morbidity & mortality specially cardiac
Effects on platelets
10. 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.
11. 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)