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PSY240H5 (134)
Chapter 10


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University of Toronto Mississauga
Ayesha Khan

PSY240 CHAPTER 10 – HEALTH PROBLEMS AND BEHAVIOUR Behavioural medicine  Focuses on role that psychological factors play in occurrence, maintenance, and prevention of medical problems Health psychology  Psychological subspecialty within behavioural medicine  Deals with psychology’s contributions to the diagnosis, treatment, and prevention of psychological components of medical problems Behavioural medicine approach to physical illness is concerned with following types of issues: - Psychological factors that may predispose an individual to physical illness [critical life events, particular types of behaviour, and personality] - Ways negative effects of stress can be reduced or buffered by personal resources [coping styles, social supports, and certain personality traits] - Biological mechanisms by which human physiology is altered by stressors, particularly those arising from maladaptive behaviour, effects of stress on immune, endocrine, gastrointestinal, and cardiovascular system - Psychological processes involved in health choices individuals make with respect to matters like hazardous lifestyles, healthcare decisions, and adherence to preventive regimens - Factors that determine compliance with sound medical advice [nature of relationship between medical practitioner and patient, cultural factors, and personal factors (denial of illness)] - Effectiveness of psychological measures [health education and behaviour modification] in altering unhealthful lifestyles and in directly reducing illness at both individual and community levels Disorders where psychological factors were thought to play a role WERE called “psychosomatic disorders” now preferred to be called psychophysiological disorders - Some of the medical problems that were thought to have purely psychological origins can also have nonpsychological causes Example – gastric ulcers – cause is Helicobacter pylori bacterium, and ulcers can develop in absence of bacterium – because major stressors and common lifestyle factors important in development of ulcers  Axis I of DSM-IV-TR – “Mental Disorders Due to a General Medical Condition”  To be used when general medical condition has played direct role in development of a psychological disorder  Psychological factors can play role in development, aggravation, or maintenance of physical health problems o DSM-IV-TR acknowledges this with reference to “Psychological Factors Affecting a General Medical Condition”  psychological factors that have “clinically significant effect on course or outcome of a general medical condition” o Axis I – maladaptive behaviour o Axis III – medical problem PSYCHOLOGICAL FACTORS IN HEALTH AND DISEASE Stress and the Stress Response Stress response – cascade of biological changes that prepares the organism for fight-or-flight reaction  Begins with hypothalamus, which stimulates sympathetic nervous system [SNS]  Causes inner portion of adrenal glands [adrenal medulla] to secrete adrenaline and noradrenaline  Circulate through blood, cause increase in heart rate, and get body to metabolize glucose more rapidly PSY240 CHAPTER 10 – HEALTH PROBLEMS AND BEHAVIOUR  Hypothalamus releases hormone called “corticotropin-releasing hormone” *CRH+  Travelling in blood, hormone stimulates pituitary gland  Pituitary secretes adrenocorticotrophic hormone [ACTH] which induces adrenal cortex [outer portion of adrenal gland] to produce stress hormones called “glucocorticoids”  Humans – glucocorticoids that is produced – cortisol – prepares body for fight or flight – inhibits innate immune response *if injury occurs, body’s inflammatory response to it is delayed – escape has priority over healing]  Humans – disadvantages of cortisol – if cortisol is not shut off, can damage brain cells [especially in hippocampus], can stunt growth  Brain has receptors to detect cortisol – when these activated, send feedback message that is designed to dampen activity of glands involved in stress response  If stressor remains, HPA axis stays active and cortisol release continues Biological Costs of Stress Allostatic load – biological cost of adapting to stress  When relaxed and not experiencing stress, allostatic load is low  When stressed and feeling pressured, allostatic load will be higher Stress becoming key underlying theme in understanding of development and course of virtually all physical illness, focus on major stressors and daily stressors  Any stress may tend to aggravate and maintain certain disorders Stress and the Immune System Link between stress and physical illness involves diseases (like colds) that are not directly related to nervous system activity – suggests stress may cause overall vulnerability to disease by compromising immune functioning - Early studies examined association between stress and immune functioning established associated between stressful circumstances and diminished immune reactivity - Diminished immune reactivity would make person more susceptible to infections - may be substantial individual differences in this type of reactivity to stress Immune system – protects body against viruses and bacteria – if it is too weak, it cannot function effectively, and body succumbs to damage from invading viruses and bacteria – if immune system is too strong and unselective, it can turn on its own normal cells - Front line of defence – white blood cells [leukocytes or lymphocytes] – produced in bone marrow and stored in various places throughout the body, two important types: o B-cell – matures in bone marrow, produces specific antibodies that are designed to respond to specific antigens [foreign bodies] o T-cell – matures in the thymus o When immune system stimulated, B-cells and T-cells become activated and multiple rapidly, mounting various forms of counterattack T-cells circulate through blood and lymph systems in inactive form, each T-cell has receptors on its surface that recognize on specific type of antigen – but unable to recognize antigens by themselves – become activated when immune cells called “macrophages” detect antigens and start to engulf and digest them – to activate T-cells, macrophages release interleukin-1 – interleukins class of chemicals called cytokines [chemical messengers that appear to be of crucial importance for health] – with help of macrophages, T-cells become activated and able to begin to destroy antigens B-cells – when B-cells recognize antigen, begins to divide and to produce antibodies that circulate in the blood, process facilitated by cytokines released by T-cells – production of antibodies takes five or more days Response of immune system will be much more rapid if antigen ever appears in the future because immune system has a “memory” of the invader PSY240 CHAPTER 10 – HEALTH PROBLEMS AND BEHAVIOUR Protective activity of B- and T-cells supported and reinforced by other specialized components of the system [natural killer cells, macrophages, granulocytes, etc.] – immune systems response to antigen invasion is intricately orchestrated, requiring intact functioning of numerous components – certain that brain is certainly involved in this control of immune system events Psychological Factors and Immune Functioning AIDS/HIV – researchers wanted to learn which psychological, behavioural, and biological factors were associated with faster progression from HIV to full-blown AIDS – greater overall levels of stressful life events associated with more rapid transition from HIV-positive status to AIDS Immunosuppression [after death of spouse] can last one to three years – can be caused by short-term threats to our sense of well-being  Found that natural killer cell cytotoxicity was significantly diminished with induced negative self- evaluations, effect especially strong for persons who were anxious and/or dysphoric in mood before experiment Evidence from animal studies – being exposed to single stressful experience can enhance responsiveness to stressful events that occur later – rats exposed to stressful tail shocks produced more stress hormone cortisol when they were later exposed to another stressful experience, levels of ACTH higher in rats, results suggest prior stressful experiences may sensitize HPA axis to later stressful experiences 10.1 – Cytokines: Link between the Brain and the Immune System Cytokines – chemical messengers that allow immune cells to communicate with each other, small protein molecules, play role in mediating inflammatory and immune response can be divided into main categories: pro-inflammatory cytokines, and anti-inflammatory cytokines Pro-inflammatory cytokines – help us deal with challenges to our immune system by augmenting immune response Anti-inflammatory cytokines – decrease or dampen the response that immune system makes, sometimes accomplish this by blocking synthesis of other cytokines  Cytokines signal to the brain [brain and immune system communicate via cytokines]  Immune system can monitor our internal state and send brain information about infection and injury, the bran can then respond  brain capable of influencing immune processes Interleukin-1 can and other cytokines can stimulate HPA axis, resulting increase in cortisol sets off negative feedback loop that is designed to prevent an excessive or exaggerated immune or inflammatory response – if this system fails then either too sensitive or not sensitive enough so serious disorders can occur and emotional factors, psychosocial stresses because brain is also involved so may tilt balance in feedback loop - Disorders of the brain could potentially have “downstream” effects on immune system - Problems with immune system may lead to some behavioural changes or even psychiatric problems Patients in mental asylum in Britain had white blood cells that were abnormal in type and number – plausible to suggest that mental disorders will be found to have immune consequences Psychoneuroimmunology  Study of interaction between nervous system and immune system  Evidence – person’s behaviour and psychological states do indeed affect immune functioning; but status of immunologic defences also feeds back to influence current mental states and behavioural dispositions by affecting blood levels of circulating neurochemicals which modify brain states Stress, Depression, and Suppression of the Immune System - Researchers starting to pay attention to possibility that chronic stress and depression may actually enhance certain immune system responses - Chronic stress may trigger production of proinflammatory cytokines – interleukin-6 PSY240 CHAPTER 10 – HEALTH PROBLEMS AND BEHAVIOUR - Findings suggest that chronic stress and depression can result in immune system’s going out of balance in ways that may compromise health Lifestyle Factors in Health and Illness Aspects of the way we live been implicated in development of some severe medical problems - Lifestyle factors – habits or behaviour patterns presumably under our own control – play major role in three leading causes of death in Canada: coronary heart disease, automobile accidents, and alcohol-related deaths Health, Attitudes, and Coping Resources Optimism – expect that good things will happen, seems to serve as a buffer against disease People with too little optimism experience a psychological sense of helplessness (can be associated with poor health outcomes) Negative Affect – evidence accumulating that negative emotions can be associated with poor help - Depression: associated with measurable and undesirable changes in immune functioning, also associated with increased mortality from all causes in medical inpatients - People with major depression run greater risk of having a heart attack that people with no history of depression - (women) depression heighten risk for osteoporosis - (men) depression at baseline predicted decline in muscle strength over three-year period - (not really studied) anxiety seems to be associated with development of coronary heart disease in both men and women - Chronic anger and hostility can be risk factors for coronary heart disease and death Positive psychology – human traits and resources that might have direct implications for our physical and mental well-being – positive affectivity [tendency to experience positive emotional states], compassion, gratitude, humour, and spirituality  Patient who believes treatment is going to be effective has much better chance of showing improvement than one who is neutral or pessimistic – even when treatment is subsequently shown to have no direct or relevant psychological effects  Placebo effect – accounts for controversies that arise between scientific community and general public about efficacy of certain drugs or other treatments CARDIOVASCULAR DISEASE  Leading cause of death in Canada Disease of cardiovascular system involve many interrelated clinical conditions: hypertension [high blood pressure], coronary heart disease [arteries supplying blood to the heart muscle itself become clogged], stroke [same types of clogging affect arterial blood supply to the brain] Hypertension With stress, vessels of visceral organs constrict (become more narrow), and blood flows in greater quantity outward to the muscles of the trunk and limbs, when tiny blood vessels supplying visceral organs become constricted, heart must work harder. As it beats faster and with greater force, pulse quickens and blood pressure mounts. When crisis passes, body resumes normal functioning and blood pressure returns to normal. Under continuing emotional strain, high blood pressure may become chronic. - Blood pressure should be 120/80 [systolic pressure – contracts, diastolic pressure] Hypertension – having a persisting systolic blood pressure of 140 or more and a diastolic blood pressure of 90 or higher - Blood pressure increases as we age - Hypertension afflicts 27.4 % of Canadians between ages of 35 and 64 PSY240 CHAPTER 10 – HEALTH PROBLEMS AND BEHAVIOUR - Researchers think hypertension begins when person has a biological tendency toward high cardiovascular reactivity to stress, and given difficult life circumstances, person progresses through borderline to frank hypertension in adult years Essential hypertension – no specific physical cause, often symptomless until its effects show up as medical complications, often causal factor in occlusive (blocking) disease of peripheral arteries, congestive heart failure (due to heart’s inability to overcome resistance of constricted arteries), kidney failure, blindness, and number of other serious physical ailments Hypertension and Anger Whether anger is communicated constructively  Explored this by measuring whether people scored high or low on scale of constructive anger, constructive anger rated by observers, observers watched interview during which person being assessed discussed how they typically responded in variety of stressful situations  Person who scored high in constructive anger tried to resolve anger by dealing with target of their anger more directly [expressing why they felt angry, and trying to reach an understanding by engaging in open communication with that person, and solicited opinions of other people to obtain objective view of situation and to find other ways to resolve it]  Found that people who expressed their anger most constructively had lowest resting blood pressure [negative correlation] Use of constructive anger was also associated with lower self-reported anxiety and depression, and lower measures of destructive hostility [factors also implicated in coronary heart disease] Coronary Heart Disease  Potentially lethal blockage of the arteries that supply blood to the heart muscle, or myocardium Chief clinical manifestations: 1) myocardial infarction [blockage of section of coronary arterial system] resulting in death of myocardial tissue supplied by that arterial branch; 2) angina pectoris, severe chest pain signaling that delivery of oxygenated blood to affected area of heart is insufficient for its current workload; 3) disturbance of the heart’s electrical conduction consequent to arterial blockage, resulting in disruption or interruption of heart’s pumping action, often leading to death - Sudden cardiac death [victims that have no prior history of CHD symptoms] attributed to silent CHD, when piece of atherosclerotic material adhering to arterial walls *“plaque”+ breaks loose and lodges in small vessel, blocking it Cardiovascular Disease in a 33-Year-Old Athlete - Found that subjects who had scored higher on initial measure of hostility that had been completed 10 years earlier were more than twice as likely to have coronary calcification as those subjects who had scored low in hostility Warning signs: 1) pain that spreads along shoulders, arm, neck, or jaw; 2) sudden sweating; 3) heavy pressure and pain in centre of chest; 4) nausea, vomiting, and shortness of breath What Psychological Factors are implicated in Cardiovascular Disease? Personality Type A behaviour pattern  excessive competitive drive, extreme c
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