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Chapter 9

HSM330 chap 9 notes

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Ryerson University
Health Services Management
HSM 330
Daolun Chen

A&G: Chapter 9 The Interface between Physical and Mental Health Personality Processes and Disease • Sigmund Freud is credited with developing the first Western scientific theory of mind, and he believed that eventually psychological phenomena would be traced back to neurophysiological events. • More recent research has reinstated the relationship between personality and disease outcomes. • Personality processes: Strong association between personality processes and diseases such as coronary heart for disease (CHD) and overall mortality. Psychological Risk Factors and Health Hostility • Type A Personality also known now as Type A Behaviour Pattern (TABP). • Demographic differences also exist. The relationship between hostility and CHD is stronger for men than for women and may be stronger for younger than for older people, although the results are inconsistent. Anxiety • Relatively consistent effects of anxiety on heart disease and overall mortality have been found. • Re anxiety and CHD: emotional distress, especially anxiety, may be associated with a release of catecholamines, which stimulates heart rate. • Heart rate variability also decreases with normal aging but is especially marked among those with diabetic neuropathy and vascular disease. Chronic anxiety and depression are also associated with decreased heart rate variability. Depression 1 • Strongest association between negative affect and health in late life is found with depression. • Furthermore, just as with bereavement, the impact of depression on mortality may be short-lived. • Many studies have also shown a link between depression and CHD morbidity. • The relationship between depression and cardiovascular morbidity and mortality appears to be strongest among cardiac patients. • There is also evidence for a direct effect of depression on physiological processes. Depression is linked to atherogenesis. Depression also predicts subsequent arrhythmias, perhaps because it decreases heart rate variability or responsiveness. As with anxiety, decreased heart rate variability can leave the heart vulnerable to overstimulation by the sympathetic nervous system, which reacts to stress. Decreased heart rate variability has been associated with pathophysiological processes such as atherogenesis and ischemia, as well as frank disease such as arrhythmias, MIs, and sudden death. Psychological Protective Factors and Health Control and Self-Efficacy • Many early studies showed the protective effect of control. • Most control is rather illusory, and when that sense of control is shattered, people may give up, sometimes with quite devastating consequences. Optimism (Positive Outlook) • An optimistic explanatory style has 3 dimensions: internality, stability, and globality. • Internality: • Stability: • globality : • Dispositional optimism has also been linked to better health, including self-reported health. 2 • Some of the effects of optimism on health outcomes are mediated by better health behaviour habits and perhaps coping strategies. Emotional Stability • Clearly, part of the negative effect of anxiety, hostility, and depression is related to emotional labiality. Alcohol and Aging • Sometimes there appear to be direct physiological effects, as in the relationship between hostility and increased cholesterol levels under stress, whereas in other cases, those effects are mediated by health behaviour habits such as smoking, diet, or alcohol consumption. Consumption Patterns with Age • The traditional finding that alcohol consumption decreases with age is empirically supported primarily by cross-sectional studies. Effects on Physical Health • Excess alcohol consumption creates very deleterious effects on health. It causes cirrhosis of the liver, a scarring of the tissue that can lead to liver failure. The inability of the liver to process blood quickly enough can result in peripheral artery disease. For example, long-term alcoholics typically develop rather bulbous, red noses, due to damage to the arterioles and small veins. Excess alcohol consumption also results in hypertension and cardiac myopathy (damage to the heart muscle). It can also contribute to diabetes and colon cancer; in general, it increases the risk of premature mortality. • Alcohol consumption may present special problems for older adults. Physiological changes with age can decrease alcohol tolerance. Although normal aging does not affect the ability of the liver to process alcohol, older people tend to be smaller, and the percentage of body mass due to water decreases. This results in a decreased volume of distribution for alcohol, causing higher blood levels and increased central nervous system (CNS) sensitivity to alcohol. • The effects of alcohol on the body may be potentiated by the use of prescription and nonprescription medication. Effects on Mental Health • Another well-established relationship is between alcohol and Korsakoff’s psychosis, which is characterized by hallucinations, mood disturbances, and cognitive impairment. 3 • Finally, there is a relationship between excess alcohol consumption and depression that is likely bidirectional. Effects on Cognition • The CNS may be particularly vulnerable to the effects of alcohol consumption. Differentiating Between Mental and Physical Health Problems • Illnesses may manifest differently in older adults than in younger persons. In middle- aged men, a classic symptom of an MI is a crushing chest pain radiating down the left arm, as well as pallor and perspiration. In an older person, the symptoms may be abdominal pain, confusion, weakness, and vertigo. In younger women, bladder infections are accompanied by a burning sensation with urination; in older women, the primary symptom may be confusion. On the other hand, psychological problems may have concomitant physiological symptoms: Anxiety may be accompanied by rapid and irregular heart rates, depression by fatigue and sleep problems. • Surprisingly, older individuals with illnesses such as vitamin deficiencies, pneumonia, MIs, and hyper- and hypothyroidism may present with anxiety. Illnesses that are fairly frequent in older adults – such as cardiovascular disease, chronic obstructive pulmonary disorder (COPD), and, to a lesser extent, hypothyroidism – often result in fatigue, sleep disturbances, and negative affect. Thus, they may be very difficult to differentiate from depression. • Dementias are typically irreversible, whereas confusional states (deliriums or pseudodementias) can be reversed if properly diagnosed. A&G: Chapter 10 Stress, Coping, and Health • Stress is a major pathway through which psychosocial factors affect physiology and the aging process. Through the Neuroendocrine system, psychosocial stress can have adverse effects on the cardiovascular and immune systems. Stress Stress as a Physiological State Classic Theories • Cannon (1915) was the first physiologist to systematically describe the physiological effects of stress. He noted that cats exposed to barking dogs would respond with a rush of epinephrine or adrenaline into their systems. 4 • Cannon argued that this fight/flight reaction, although adaptive in the short run, could have very harmful effects if prolonged. • Hans Selye expanded on Cannon’s conceptions in two ways. First, he noticed that corticosteroids, which are released by the adrenal cortex (or top layer
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