Seminar II - Medical Psychology english version

Asist. univ. Ioana Cioca

Psychosomatic conception in medicine

Implies the consideration of the patient both from somatic and psychic point of view. This attitude influence the theoretical, therapeutic and diagnostic approach. A holistic manner including psychological point of view, the patients feelings regarding his pathological suffering and the restrictions by the disease or therapeutically team.

Psychosomatic disease and somatic-psychic recoil

1/3 of the patients disorders are exclusively psychological triggered. Disease itself represent o major source of stress. The psychosomatic factor is responsible also for the aggravation of the symptoms, also for the resistance against therapy * low therapeutically compliance.

Double vulnerability
Organ vulnerability / locus minoris resistantiae genetically structural and biochemical weaknesses. Psychological vulnerability premorbid type personality
High emotional reactivity Exaggerated susceptibility Rigidity of cortical processes Blocked external aggressiveness.

Various models explaining the pathogenesis of psychosomatic diseases

Freud conversion hysteria; specific unconscious conflicts can produce particular physical disturbances that symbolized the repressed psychological conflicts; the patient converts the conflict into a symptom via the voluntary nervous system ( e.g. sudden loss of speech, hearing or sight, tremors, muscular paralysis, eating disorders, glove anesthesia, etc.); The idea that specific illnesses are produced by individuals internal conflicts was perpetuated in the work of Flanders Dunbar in the 1930s and Franz Alexander in 1940s. These researchers linked patterns of personality rather than a single specific conflict to specific illness. For example, Alexander developed a profile of the ulcer prone personality as someone whose disorder is caused primarily by excessive needs for dependency and love.

Psychosomatic medicine
Dunbar and Alexander argued that conflicts produce anxiety, which becomes unconscious and takes a physiological toll on the body via the autonomic nervous system. The continuous physiological changes eventually produce an actual organic disturbance. For example, in the case of the ulcer patient, repressed emotions resulting from frustrated dependency and love seeking needs said to increase the secretion of acid in stomach lining and produce ulcers.

Psychosomatic medicine
(Cannon, Pavlov, Bandura).

Psychosomatic diseases and psychosomatic disorders: commonalities and differences.

Psychosomatic disorders
No organic lesions Benign and reversible Vegetative, hormonal, biochemical and electric modifications such as: migraine, diarrhea, pruritus, tachycardia, headache, diverse pains.

PS (psychic stress) often transform the psychosomatic disorders in psychosomatic disease, trough:
Repeatability of the stress factors Functional overwhelming of the weakness organs.

Somatic - psychic disorders

The echo of the somatic disease into the patients psychic. Is the result of the secondary psychic stress and may express as a new disease ( e.g. a depressive state of mind after a myocardial infarct). There is a damage to all levels (cognitive, affective, volitional and behavioral) in incurable disease such as AIDS and some form of neoplasm. Somatic-psychic recoil reactions of the patients psychic to the disagreeable symptoms of the disease and the intense suffering.

Psycho-somatic disease (PSB)

There is an organic base and some more etiological agents. There are organic disease in which psychogenic factor play an important role. They are conditioned by the organ vulnerability, where stress agents can influence the function and structure of the organ they become irreversible. (e.g. bronchial asthma, rheumatoid arthritis, arterial hypertension, ulcerative colitis, duodenal ulcer) Two mechanism can explain the way in which PS can determine PSB
Hormonal - implication of the hypotalomo-hypofizocorticosuprarenalian axe, high degree of cortisol Behavioral PS may initiate some pathogenically behavioral such as alcohol consumption, smoking, sedentary and obesity.

Cognitive representations of illness (Leventhal).

There are four dimensions of the disease:
The identity of the disease - may be abstract (the name of the disease such as duodenal ulcer) or concrete ( referring to the physical symptoms such as pain or bleeding). The consequences of the disease ( regularly negative) in direct relation with the level of the patients anxiety, and the lack of information or improper information about the disease. The causes of the disease, may be internal, genetically or external such as diet, professional activity, stress, etc. The duration of the illness may be a acute disease or a chronic disease.

Lau and Hartman add a new dimension of the disease

Curability or controllability - is the disease curable, can we control it or not?

Typical patients reactions to illness

Regression Evasion Informational contagion (Non) productive usage of illness Exaltation of self

Affective and behavioral regression

In the case of severe or acute disease, with major psychosomatic discomfort, the patient adopt a infantile regressive behavior.
Egocentrism - the result of the restrain of the patient's preoccupations exclusively to illness. Dependency - both to doctor and family, diminishing of the responsibilities- secondary beneficial of the illness. Predomination of the affect primarily emotions characterized by intensity, expansively and reduced duration, such as crying, anger. Aggressiveness latent may be observed during the anamnesis and it may be in relation to the dependency. Anxiety - a state of fear unmotivated by a real danger (fear without object). Is legitimate in the case of the patients with lack of information regarding the gravity and prognostic of their illness. Depression appear in severe cases of illness without hope or chronic patients with many therapeutically failure.

Evasion
Evasion - a behavior of leaving the world of disease full with difficulties for a world without concerns and no responsibilities. Evasion may express in unjustified aggravation of the symptoms, unjustified fear regarding the healing and exaggeration of the adverse effects. Secondary beneficial of the disease.

Informational contagion
In the hospitals this phenomenon is normal during the communication between the patients. These patients are curious about their disease, about the dangers, the possible evolution, complication of the disease and prognostic. Some chronic patients become experts and they initiate competent opinions regarding the medicines, disease, the competence of the medical staff. This opinions contaminates all the patients induced by the decrease of a critical sense and the high rate of anxiety of the patients.

Exaltation of the Self

The disease may increase some primitive characteristics of the patient. Some patients use the disease as a mean of self valorization ( I am an interesting case) Also, the children and old people may ask for more affection and may use the disease as a opportunity for more attention and care from others.