College aantekeningen
Lectures of Medical Psychology
- Instelling
- Universiteit Van Amsterdam (UvA)
These are my notes of the lectures of Medical Psychology.
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Lectures of medical psychology
Lecture one: Introduction
Lecture two: Symptom Perception
Lecture three: Stress and Health
Lecture four: Stress and the Immune System
Lecture five: Depression and Health
Lecture six: Personality and Health
Lecture seven: Psychosocial Aspects of Cardiovascular Disease
Lecture eight: Fatigue and Treatment Options
Lecture nine: Psychosocial Aspects of Diabetes
Q&A
,Lecture one: Introduction
The aim of the course is to provide an overview of research and clinical practice at the
crossroads of somatic health and psychological health. The content of the exam will be
80% literature, and 20% lecture material.
There are three fields:
Behavioral medicine: this focuses on the psychobiological approach towards
understanding behavioral factors in health and disease.
Health psychology: this focuses on the primary and secondary preventions
through behavior change: leaning on theories from clinical and social psychology.
Medical psychology: this focuses on the clinical practice and research regarding
human behavior in a medical context.
This course focuses on all three fields. The fields strongly overlap, but this is an idea per
field what it entails.
The medical model says that there is a cause, and therefore a resolution, of a disease,
and that the cause and resolution are determined by biological processes. In the medical
practice, the medical doctor strives to restore biological perturbations to obtain an
optimal equilibrium. Limitations of this model are that there is no recognition of relevant
psycho-social influences on disease, and that there is no recognition of psychological
dimensions of disease. About 30 years ago, there was a strict separation between bodily
and mental functioning.
There is a steady decline of infectious diseases. Behavioral factors are much more
important to controlling infectious diseases than curative or medical interventions.
Historical trends show that. The same thing is true for heart disease. Smoking has
become less and less popular in the last years. Exercise and a healthy diet reduce the
risk of cancer. Behavioral change when it comes to a healthy lifestyle also has huge
economic implications.
The medical model predicts that, if you spend more money on medical care and
hospitals, you would in general have a healthier population. A better health care system
should equal a healthier society. But it is not always the case. The money spent on
health care and life time expectancy is minimally correlated. For example, the USA
spends a lot of money on healthcare, but life expectancy is quite low.
Studies show that people who receive a life-threatening diagnosis do not often become
depressed. People are remarkably resilient. However, the association between mental
and somatic health is universally observed. About 40 to 60% mental health service users
have a comorbid somatic disorder. Mental health issues like depression increase the risk
of mortality, and lowers the efficacy of treatment. It also increases non-compliance,
which influences the therapeutic relationship. People with depression tend to not follow
up on instructions of doctors. Furthermore, somatic disorders negatively affect the
efficacy of anti-depressants. However, somatic disorders do not affect the efficacy of
psychotherapy.
Often, a depression of not being recognized by a doctor or a nurse. These people will
look within the medical fields, and often patients come in with physical symptoms and
not with mental health problems. At the same time, somatic symptoms of depressed
patients are also poorly diagnosed. This shows that psychologists have an important role
to play in the medical field. They are the ones who can diagnose mental health
problems.
There are several depressogenic effects:
, ….
Medications with glucocorticoids have an effect on the brain. In the PASAT, you hear
several numbers and you have to keep adding them up. So, you have to memorize is
and do calculus at the same time. Research show that there is a reduced working
memory performance in patients under chronic high-dose glucocorticoid treatment. It
shows that the impact of heaving a disease (and having medication) has an impact on
multiple levels.
Psychopathology is not the most common reason for seeking psychological counseling.
Most patients seek help for other reasons: stress, mourning, life style change, fatigue,
coping with pain, or relationship and sexual problems.
, Lecture two: Symptom Perception
Addition to the previous lecture
Anxiety predicts the development of cardiovascular disease. Anxiety before a treatment
also predicts several outcomes. For example, anxiety before surgery predicts a longer
hospital stay, a lower compliance for described physical activity, more pain symptoms,
more use of painkillers, worse physical condition, and more post-surgical complications,
including death.
The classic biological model of symptom reporting says that you have a malfunction and
a symptom severity. The relation between the malfunction and symptom severity is
linear, according to this model. However, this model does not represent reality. One
study shows that the objective respiratory function and diagnosis is strongly associated
with depression, but the objective respiratory function is not associated with depression.
A lot of treatments nowadays are focused on the quality of life. This is now a guiding
principle in designing treatment and care. The biopsychosocial model is a better fit to
this form of treatment. It simply means that to provide optimal care on a population
level, but also an individual level, you have to take into account not only the biological
factors, but also the psychological and social factors.
Symptom perception
Symptom perception is a conscious awareness of a symptom, following unconscious
information processing. There is a difference between sensation, symptom, and a
complaint. The sensation is a bodily perception, a symptom reflects a negatively
valanced interpretation of a sensation, and a bodily complain is the expression of a
symptom. Bodily signs are objective and verifiable; illness symptoms are interpretations
of the signs; a bodily complaint is a subjective self-reported experience.
Everyday symptoms are very commonly experienced. 20% of the general population
experiences a somatic symptom that causes some level of worry at least once a month.
Approximately 20% to 50% of all symptoms that are reported to the primary physician
remain medically unexplained. There are four groups of people that exhibit distinct
patterns of symptom reporting:
Regular folks: there is a high number of mundane everyday symptoms. In times
of increased stress and reason to worry an inclination develops for heightened
attention towards these symptoms, leading to increased medical consumption.
Patients with a verified medical disease: Just like regular folks, but with
heightened vigilance for illness specific symptoms and increased attribution to
illness.
Patients with medically unexplained symptoms (MUS): All previous
characteristics together, but limited to a more-or-less unified cluster of symptoms
defining a syndrome.
Somatization disorder patients: All previous characteristics together,
combining into multiple clusters of symptoms. These patients are in the realm of
pathology.
The DSM-5 categorizes somatization and hypochondria in two disorders: somatic
symptom disorder, and the illness anxiety disorder. Somatic symptom disorder involves
a person having a significant focus on physical symptoms that results in major distress
and/or problems in functioning. The individual has excessive thoughts, feelings and
behaviors relating to the physical symptoms. illness anxiety disorder is worrying
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