Psychological Components of Health

1. Psychological Components of Health

2. Important Terms • Psychogenic Illness • Somatogenic Illness • Diagnosis by Exclusion • History of Hysteria/Conversion Disorder • Demographics of Psychogenic Illness • Illness Perceptions

3. “Right now you have a cluster of sick kids, and nobody’s quite sure what’s going on.”

4. Mystery Illness • 15 students report uncontrollable tics, seizures, stuttering • First report in August, 2011 • Neurological Tests find nothing • Environment tests find no toxins, gas, pesticides

5. Is Cause Somatogenic? • Of somatic origin, originating in the cells of the body • Identifiable cause • Independent of culture/environment

6. Search for Somatic Causes • Environmental Toxins from 40 yr old Train Derailment • PANDAS: virus linked with OCD/Tourettes

7. Is Cause Psychogenic? • Originating in psychological or emotional processes • Diagnosis by Exclusion: can’t identify a physical cause • Symptoms can be affected by culture

8. Historical Background

9. Hysteria • Popularized by Aristotle • Caused by disturbances of the uterus ( hystera) • Uterus moves because it becomes light and dry, due to lack of bodily fluids

10. Jean-Marie Charcot Hysteria as neurological condition Heritable features Linked to hypnotic susceptibility

11. Sigmund Freud • Hysteria caused by subconscious mind acting to protect individual from psychological stress

12. DSM-IV-TR • Dissociative Disorders • Amnesias • Somatoform disorders • Conversion Disorder: • Stress converted into physical symptoms

13. Mass Conversion Disorder

14. Modern Examples Oct 4, 2001 AP Report of Florida Man getting Anthrax

15. Mystery Rash Reported in schools across USA First in one class, then spreading to other classes in same school, then other schools, then different states

16. Characteristics of Mass Conversion Disorder • Symptoms spread by “ line of sight” • Some pre-existing psychological stress • Adolescent or pre-adolescents particularly affected • Females significantly more likely to be affected

17. Why Females?

18. More likely to talk to each other about symptoms • Women may be more social, facilitates spread among friends • More likely to seek medical help

19. Which Symptoms?

20. Vague, General • Nausea/Abdominal Pain • Skin Problems • Dizziness • Hyperventilation • Rash • Headaches • Fatigue

21. “mystery disease” solved Kaiser-Permanente Study PLos , 2012

22. First Report: 2001

23. Epidemic • Internet hits exploded after website created by Mary Leitao • CDC flooded with calls • Clustered in CA, TX, FL • Delusion or Disease? • Delusional parasitosis

24. Clinical, Epidemiologic, Histopathologic and MolecularFeatures of an Unexplained Dermopathy • Symptoms: • Skin lesions • Disturbing skin sensations: • Pins and needles • formication • Emergence of fibers from lesions • Generalized Fatigue • Difficulty concentrating • Short term Memory Deficits

25. “Results: We identified 115 case-patients. The prevalence was 3.65 (95% CI = 2.98, 4.40) cases per 100,000 enrollees. There was no clustering of cases within the 13-county KPNC catchment area (p = .113). Case-patients had a median age of 52 years (range: 17–93) and were primarily female (77%) and Caucasian (77%). Multi-system complaints were common; 70% reported chronic fatigue and 54% rated their overall health as fair or poor with mean Physical Component Scores and Mental Component Scores of 36.63 (SD = 12.9) and 35.45 (SD = 12.89), respectively. Cognitive deficits were detected in 59% of casepatients and 63% had evidence of clinically significant somatic complaints; 50% had drugs detected in hair samples and 78% reported exposure to solvents. Solar elastosis was the most common histopathologic abnormality (51% of biopsies); skin lesions were most consistent with arthropod bites or chronic excoriations. No parasites or mycobacteria were detected. Most materials collected from participants’ skin were composed of cellulose, likely of cotton origin.”

26. Conclusions “This unexplained dermopathy was rare among this population of Northern California residents, but associated with significantly reduced health-related quality of life. No common underlying medical condition or infectious source was identified, similar to more commonly recognized conditions such as delusional infestation”

27. Chronic Fatigue Syndrome Symptoms: impaired concentration/STM swollen lymph nodes/sore throat Muscle aches multi-joint pain w/out redness or swelling malaise after exercise headaches of a new type, pattern or severity

28. Real ? Mikovits' team announced a breakthrough. The scientists said they had found evidence of a retrovirus called XMRV significantly more often in the blood of patients diagnosed with CFS than in blood from healthy peers. The journal Science published their paper online Oct. 8, 2009.

29. Mistake? At the same time, other scientists began reporting that they could not find evidence of the retrovirus in the blood of patients with CFS — or in anyone else's. Researchers wondered publicly whether lab contamination could explain Mikovits' results, and this summer one scientific team published evidence that XMRV was, indeed, a lab contaminant.

30. Fraud? Then, a study published in September showed that the WPI could not reliably find evidenceof XMRV in the blood of patients. On Sept. 29, WPI fired Mikovits, according to court filings, and Science said a few days later that it was investigating allegations of datamanipulation. On Nov. 7, shortly after the WPI sued Mikovits, a Nevada district court judge signed a temporary restraining order prohibiting her from destroying, altering or deleting any "misappropriated property." The WPI also reported the lab notebooks and other materials as stolen to the police force of the University of Nevada at Reno, which issued a warrant for Mikovits' arrest Nov. 17,

31. Difficulty in Diagnosing Psychogenic Illness

32. Seen as stigmatizing: “backward”; “ignorant” • Dangers of environmental toxins are real • Patients ( and parents) insulted by diagnosis • Diagnosis by exclusion is never satisfying- can’t prove a negative

33. Perceptions linked to health outcomes: • Functioning • Use of health care • Adherence to treatment • Overall mortality Importance of Health Belief Model "patients' perceptions of their illness guide their decisions about health."

34. What Happened to Girls in Le Roy? NYTimes Magazine, March 2012

35. “The day after Katie and Thera appeared on “Today,” a neurologist in Buffalo whose practice had seen many of the girls was given the greenlight to speak about the diagnosis: it was conversion disorder, he said, which meant the girls were subconsciously converting stress into physical symptoms. And because so many students were afflicted with similar symptoms, it was also considered to be mass psychogenic illness, which is another way of saying mass hysteria.”

36. “ To many parents, the diagnosis was woefully inadequate, even insulting.“It’s a very hard pill for me to swallow — what are we, living in the 1600s?” the guardian of one of the girls said. Besides, kids are always stressed, and some of these kids may have been less stressed than most. On CNN, James DuPont, the father of an afflicted girl, said, “A lot of these kids were just, you know, having a happy, normal life.”

37. “Right around this time — when Brockovich started appearing in the news and everyone was talking about toxins and trust in local officials was at an all-time low — the neurologists in Buffalo who were treating some of the girls started seeing their patients’ conditions worsen. One of the doctors, Laszlo Mechtler, told The Batavian that patients who had been improving were suddenly in his office, “crying, ‘This chemical is in my head and I’m damaged for the rest of my life.’ ” Doctors also saw an increase in cases, which they attributed to sensational coverage and increased stress. As more girls got sick, the story got bigger, and then more girls got sick. “

38. “Conversion disorder presents something of a paradox in that it engages some voluntary pathways in the brain but is experienced by the patient as wholly involuntary. One study found overlapping, but distinctly different, brain activity in patients diagnosed with conversion disorder and patients asked to “fake” the same illness, in this case a limp ankle, suggesting “more complex mental activity” in patients with conversion disorder.”

39. Girls given antibiotics • “When the subject of the girls’ personal backgrounds came up — the biopsychosocial factors that might be affecting their health — Trifiletti said he had not had the time to ask them about those kinds of things. The abuse, the troubling family circumstances — much of it came as news to him. “Jeez, I didn’t realize the extent,” Trifiletti said. “These aren’t things people want to talk about. I don’t know, maybe I’m wrong. It’s hard to distinguish between the drug and the placebo effect.””

40. “Jennifer McVige, the neurologist at Dent who has been treating many of the girls, told me she was seeing dramatic improvements in many of the girls as well, especially after news outlets took down videos showing them experiencing tics.”