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Chapter 7

Psychology 2310A/B - Chapter 7: Psychophysiological Disorders

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Western University
Psychology 2310A/B
Rod Martin

Chapter 7: Psychophysiological Disorders Historical Perspective - Initially referred to as psychosomatic medicine and health problems referred to as psychosomatic disorders - Dualistic view: mind and body are separate entities - Helen Flanders Dunbar (1935) o Specific disorders natural consequence of specific emotions and personality traits - Franz Alexander (1950) o Argued cause of classic psychosomatic disorders lay in characteristic interpersonal conflicts - Specific symptomatology seen as symbolic of underlying conflict - Late 1970s; o Realization that many disease states influenced directly or indirectly by social and psychological factors - George Engel (1977) o Biomedical model of disease should be expanded to a “biopsychosocial” model o Based on evidence that psychological characteristics and societal forces must be invoked to explain the origins of many diseases and the nature of health - Behavioural medicine: application of methods of behaviour modification to the treatment or prevention of disease - Health psychology: any application of psychological methods and theories to understand the origins of disease, individual response to disease, and the determinants of good health Diagnostic Issues - When a major element of a disorder is a diagnosable medical condition, it will be noted in Axis III - Axis I: “other conditions that may be a focus of clinical attention” and/or “psychological factor affecting medical condition” o A) must be correlated with the development of, exacerbation of, or delayed recovery from medical condition o B) must interfere with treatment o C) must place the individual at additional risk to his or her health o D) must precipitate the symptoms of the condition Psychosocial Mechanisms of Disease - Mechanism: activity of a living system that mediates the influence of an antecedent factor on disease - Symptoms: subjective reports of internal states that define an illness - Signs: objective indications of an underlying disease process, observable either directly by a person with appropriate training or indirectly through administration of specific test that mark a disease - Lesions: signs that involve specific disturbance of bodily tissue - Distinction between above terms important because it alters us to the various mechanisms by which psychological factors may contribute to ill health - Behaviour: discrete and potentially observable act - Psychological process: not observable directly, but may be inferred reasonably on the basis of other phenomena that are - Psychological influences on body tissues can be effects of behaviours, particularly if those behaviours are repeated frequently over long periods of time - Pathological influences on body tissues can also be consequence of psychological processes o Psychosocial variables - Three body systems at work here: o Endocrine o Autonomic Nervous System o Immune Endocrine System - Consists of organs that manufacture hormones and secretes them into blood stream - Hypothalamic-pituitary-adrenal (HPA) axis o Begins with hypothalamus; brain structure that controls large number of body functions, responsive to psychosocial influences o When activated, can cause pituitary gland to secrete adrenocoricotrophic hormone (ACTH) into circulation  Targets? Cells in adrenal cortex, outer layer of adrenal glands  When stimulated, they secrete cortisol o Cortisol highly active hormone  Suppresses inflammation, mobilizes glucose from liver, increases cardiovascular tone, produces immune system changes, inhibits endocrine structures  Defense mechanism  Short term; promote immediate survival and inhibit unnecessary activity  Maladaptive when prolonged or exaggerated and can contribute to neural damage in brain  Cortisol released during stress plays important role in development of abdominal obesity; plays role in increase of fat cells Autonomic Nervous System (ANS) - Autonomic: reflects belief that this system operates outside of consciousness and control - Consists of: o Sympathetic branch: nerve fibres that emanate from thoracic and limbar regions of spinal cord and make contact with several organs o Parasympathetic branch: fibres emanate from cranial and sacral regions of spinal cord - Sympathetic system tends to produce changes that prepare body for vigorous action when aroused (these could be dangerous if prolonged) - (in comparison to endocrine effects) ANS effects are rapid - Sympathetic-adrenal medullary (SAM) axis o Nerve fibres from sympathetic system stimulate cells of the inner region of adrenal gland, adrenal medulla, to secrete hormones epinephrine and norepinephrine - Catecholamines – when released into bloodstream, epinephrine and norepinephrine circulate to variety of target organs where they can have powerful effects Immune System - Network of cells and organs that defends body against external, disease-causing forces known as antigens - Immune cells produced and stored in; thymus gland, lymph nodes, bone marrow, small intestine - 3 general categories of immune response o Nonspecific  Circulating white cells (granulocytes and monocytes) identify invading antigens o Cellular  Based on action of class of blood cells (T-lymphocytes, “T” refers to site of production – thymus gland)  Invasion of foreign substange, antigen presented to T-lymphocyte by other cells (macrophages), T-cells proliferate and circulate body, Helper T-cells secrete lymphokines, Killer T-cells attack mutated/foreign cells, Supressor T-cells inhibit actions of both helper and natural killer, certain T-cells permanently altered to memory T-cells that are stored in the body next time same threat encountered o Humoural  Invading antigens presented by macrophages to B-lymphocytes (“B” for Bursa  B-cells reproduce, some activated B-cells remain memory B-cells - Psychoneuroimmunology: study of mind-brain-immunesystem interactions - Cohen and colleagues (1992) o Studied immune function in Cynomolgus monkeys exposed to stable or unstable social conditions o Impaired immune functioning was most pronounced in animals that showed less affiliative behaviour, such as contacting or grooming other animals o This suggests that such social behaviours have important stress-modifying effects Psychology of Stress - Refers to o Stimulus o Response o Transaction - Hans Selye (1956) o Father of stress concept o Theory emerged from early studies of effects of ovarian extracts in rats o Proposed stress consequence of adaptation to demands placed on body and argued that it followe
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