LECTURE 1 – INTRODUCTION
History of medicine
A timeline of the view on diseases:
- Prehistory: mind and body are intertwined, diseases arise when evil spirits enter the body
o Treatment: attempts to exorcise spirits
- Ancient Greece: humoral theory of illness, diseases arise when the four humors (=circulating
fluids of the body) are out of balance
o Treatment: restoring balance
o Humors were also associated with personality types
Blood: passionate temperament, outgoing, extravert
Black bile: sadness, depression
Yellow bile: angry disposition
Phlegm: laid-back approach to life, less emotional
- Middle ages: diseases arise as punishment from god
o Treatment: at first torture to drive out evil forces, replaced by prayer and doing good
- Renaissance to present day: enhanced scientific knowledge and assessment. Practice
dependent on laboratory findings and reported/observed bodily factor
o Treatment and diagnosis based on organic & cellular pathology
o Rise of biomedical model: illness explained through aberrant somatic bodily
processes (biochemical imbalance, neurophysiological abnormality)
o Health seen as biochemical or physical (psychological/social processes largely
irrelevant to disease process)
Bad understanding of illness: reduced to low-level processes, assumes mind-
body dualism, fails in recognition of social/psychological processes,
emphasizes illness over health
- Rise of modern psychology: change of biomedical viewpoint, giving rise to psychosomatic
medicine (idea that specific illnesses are produced by people’s internal conflicts,
conceptualized by Sigmund Freud).
o Hypnosis
o Dunbar & Alexander linked personality patterns to specific illnesses
Ulcer-prone personality (excessive need for dependency and love); conflict
produces anxiety which takes physical toll through secretion of acid in the
stomach, which erodes its lining
Criticism: conflict or personality type is not sufficient to produce illness
- Rise of the biopsychosocial model: health and illness as consequences of interplay between
biological, psychological, and social factors.
The biopsychosocial model is the model currently used. Focuses on understanding interaction
between different aspects to form diagnoses, and emphasizes relation between patient &
practitioner, improving patient’s use of services, treatment efficacy, and speed at which illness is
resolved.
Advantages:
o Maintains that macro- and
microlevel processes
continually interact to
influence health and illness
, o Emphasizes both health and illness (seen as a continuum rather than absence or
presence of illness)
Disadvantages:
o Social aspect is not well-captured in research
o To be studied over time, explore complex interaction systems
o Complex to work with
Psychology and medicine
In the Netherlands;
- 10.3 mil people have one or more chronic illnesses
- 32% of population has multimorbidity
- 95% of people over 75 have at least one chronic disease
- 87% of people over 75 have multimorbidity
Medicine traditionally follows mono-causal explanations for disease, emphasizing biological
pathways and clearly separating body and mind.
Disease is something an organ has; illness is something a man has
Disease needs to be cured; illness needs to be managed
More specifically;
Illness is what the patient feels; the experience of not feeling quite right as compared with
one’s normal state; sickness behavior and subjective experience
Disease is the diagnosis; something of the organ, cell, or tissue, with clear signs and
symptoms that signal a physical disorder or pathology.
The combination of psychology and medicine is treated within different fields:
Clinical psych: diagnostics of mental problems, provision of psychotherapeutic treatment, no
prescription of drugs by clinical psychologists
Health psych: main concern is prevention of disease and promotion of health
o Decrease of health-compromising behaviors
o Increase of health-enhancing behaviors
Medical psych: focus on patients in medical situations and their psychological problems,
mainly in hospitals and rehabilitation centers
o Medical psychologists (medical specialists in general) can only be consulted after a
referral from the patients GP
Different patient categories in medical settings:
o Adult patients with chronic diseases
o Patients with functional and somatic complaints, in absence of clear medical cause
o Adult patients with (suspected) brain damage, in need of neuropsychological
assessment and treatment
o Children with various diseases and symptoms
o Adult psychiatric patients with primarily psychiatric conditions
Different aspects of work in medical settings
o Direct interaction; assessment and treatment
o Indirect interaction; team coaching, consultation, staff committees, management
tasks, training of master and post-graduate students. Not generally research
Symptoms and patient delay
Recognition/interpretation of symptoms is influenced by different factors
, Individual differences: some interpret headaches as symptoms, some don’t
Attentional differences: people who focus on themselves are quicker to notice symptoms
Situational factors: boring situations make people more attentive to symptoms
o Medical students’ disease: students believing they have the same illness as the one
they’re currently studying
Mood and emotions: affects perception of symptoms and perceived vulnerability to illness
Stress: stress-related physiological changes interpreted as symptoms of illness
Prior experience: common disorders regarded as less serious than rare disorders (symptoms)
Expectations: unexpected symptoms are ignored, expected symptoms are amplified
Seriousness of symptoms: treatment only sought when symptoms affect a highly valued organ
and/or limits mobility
The common sense model of illness poses that implicit common sense beliefs about symptoms and
illnesses result in organized illness representations. Includes basic information about illness
Identity: illness name
Causes
Consequences: symptoms, treatment, implications for QOL
Timeline: expected duration
Control or cure
Coherence: how well these beliefs represent the disorder
Illnesses can be acute (caused by viral/bacterial agents, short in duration, no long-term
consequences), chronic (caused by multiple factors, long in duration, severe consequences), or cyclic
(alternating periods of no and many symptoms).
Total patient delay (Anderson Model)
Appraisal delay: time taken for symptom to be evaluated as sign of illness
Illness delay: time taken from the first sign of illness until the decision to seek care
Behavioral delay: time between the decision to seek care and the moment this is acted upon
Scheduling delay: time between acting upon the decision to seek care and the appointment
Treatment delay: time between first appointment and treatment onset
Causes of delay differ
Irregular contact with physician
Phobia of medical services
Previous symptoms that turned out to be minor
Symptoms that do not hurt or change quickly, or that can be easily accommodated
Symptoms are atypical to a disorder, and therefore less likely to be treated
Delay in taking recommended treatments
Delay in the part of the health care practitioner (waiting lists)
Medical delay due to the patient deviating from the profile of the average person with a given
disease
Patients’ disease course:
Acute phase: focus on diagnosis and treatment. Loss of control, helplessness, insecurity
Chronic phase: focus on aftercare, adaptation, maintenance. Compliance, adherence
Palliative/terminal phase: focus on symptom relief and maintenance of optimal QOL. Grief,
letting go, acceptance
, LECTURE 2 – ONCOLOGY
There are solid and non-solid cancers. Non-solid cancers are located in (for example) the blood,
whereas solid cancers form tumors that are surgically removable and ‘touchable’.
History
The oldest case of cancer known to man is 1.7 million years ago. The first to mention the terms
‘carcinos’ and ‘carcinoma’, as a way to describe tumors, was Hippocrates.
He described in a way related to the humoral theory (blood, phlegm, black bile, yellow bile).
Health = balance of bodily fluids, disease = imbalance
o Cancer = too much black bile
Henri Francois le Dran first introduced the concept that cancer starts as a local affliction rather than
as a systemic malady, and advocated surgery for cancer before the tumor was allowed to metastasize
through the lymphatic system and affect other parts of the body.
Epidemiology
!! no need to learn numbers by heart as they change over time
In 2020, there was an estimated amount of 18.1 cancer cases globally (9.3 mil men, 8.8 mil women).
expected numbers are 24 million cases by 2035. Most common cancer types are breast cancer
(12.5%), lung cancer (12.2%), and colorectal cancer (10.7%).
Top three in men: lung cancer, prostate cancer, colorectal cancer (total; 41.9% of all cancers)
Top three in women: breast cancer, colorectal cancer, lung cancer (total; 44.5% of all cancers)
Other common cancers include stomach/liver and cervical cancer.
Biomedical aspects
Cancer is a disease in which abnormal cells divide without control and can invade nearby tissues.
Caused by inheritance, mutations in cell division, or damage to DNA caused by harmful
environmental substances. Dysplasia is presence of abnormal cells within a tissue or organ, of which
it is not sure if it is to become cancer. It can be mild, moderate, or severe.
Cancer cells can also spread to other parts of the body through blood and lymphatic systems,
which is called metastasis.
o Lymph vessels carry lymph (clear fluid) and route it through lymph nodes
throughout the body. Lymph nodes work as filters for harmful substances and contain
immune cells
o Edema is swelling caused by built up lymph fluid, which can be caused by many
different things (infections, cancer, treatment)
Main types of cancer:
Carcinoma: cancer that begins in the epithelium (tissue covering all internal and external
surfaces of your body, lines body cavities and hollow organs, is the major tissue in glands)
Sarcoma: cancer that begins in the bone, cartilage, fat, muscle, or other connective tissue
Melanoma: type of skin cancer that forms in the skin’s pigment-producing cells
Leukemia: cancer that starts in blood-forming tissue (e.g. bone marrow)
Lymphoma: cancer that starts in lymph
Cancer cell characteristics:
Grow in absence of required signal
Invade nearby areas and speak to other bodily areas
