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Department of nervous diseases, psychiatry and medical psychology




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Ministry of Health of Ukraine

Bukovynian State Medical University

Department of nervous diseases, psychiatry and medical psychology



Approved on the methodology meeting

of the Department of nervous diseases, psychiatry

and medical psychology

on “____” ___________ 2009 (Report No __).

Chief of the Department

_______________________

Professor V.M.Pashkovskyy


MethodOLOGical INSTRUCTION

for the lesson

Theme 6: Psychosomatic correlation. Influence of the psychological factors on a course of somatic disorders. Theories of psychosomatic correlations. Mechanisms of the psychological maintenance of personality. Adaptation disturbances. Principles of prophylaxis of psychosomatic disorders.


For 4-th year students of medical faculty No 2


Module 1. Medical psychology

Topical module 2. Practical aspects of medical psychology


Сhernivtsi, 2009


^

1. Actuality Aim

Psychosomatic means mind ('psyche') and body ('soma'). A psychosomatic disorder is a disease which involves both mind and body. Some physical diseases are thought to be particularly prone to be made worse by mental factors such as stress and anxiety. However, in some illnesses, psychological factors seem to play a particularly important part. They can influence not only the cause of the illness, but can also worsen the symptoms and affect the course of the disorder. It is these illnesses that are termed psychosomatic disorders. Because psychological factors are important in every illness, there is lack of agreement as to what should be considered as a psychosomatic disorder.

2. Hours: 2



3. Teaching goal

The students must know:

  • Influence of the psychological factors on a course of somatic disorders;

  • Theories of psychosomatic correlations;

  • Mechanisms of the psychological maintenance of personality;

  • Adaptation disturbances;

  • Principles of prophylaxis of psychosomatic disorders.


and be able to:

  • objectively and scientifically determine the influence of the psychological factors on a course of somatic disorders;

  • interpret conditions to create healthy psychological climate in the medical environment;

  • analyze psychological peculiarities of patients with various pathologies;

  • to determine the way of communication between doctors, doctor – nurse;

  • know methods of research of personality;

  • evaluate the results of experimental-psychological research of patient’s personality and attitude toward a disease.

Assimilate practical skills

  • analyze psychological peculiarities of personality of medical workers;

  • communication with patients;

  • methods of research of «syndrome of burning out»;

  • experimental-psychological research of personality.


^ 4. List of disciplines necessary

for learning theme 1


Title of the discipline

Content of the discipline necessary for learning medical psychology

Anatomy

Brain construction

General psychology

Psychic functions of a normal person. Consciousness and self-consciousness. Psychology of personality.

Neuropsychology

Functions of different brain structures.

Normal physiology

Brain functions. Physiology of high nervous activity.


^ 5. Content of the theme

Psychosomatic means mind ('psyche') and body ('soma'). A psychosomatic disorder is a disease which involves both mind and body. Some physical diseases are thought to be particularly prone to be made worse by mental factors such as stress and anxiety. However, in some illnesses, psychological factors seem to play a particularly important part. They can influence not only the cause of the illness, but can also worsen the symptoms and affect the course of the disorder. It is these illnesses that are termed psychosomatic disorders. Because psychological factors are important in every illness, there is lack of agreement as to what should be considered as a psychosomatic disorder. Many doctors believe that illnesses such as duodenal ulcers, irritable bowel syndrome, bronchial asthma, eczema, psoriasis, high blood pressure and heart attacks are strongly influenced by psychological factors. Sometimes psychological factors can cause ill health without actually causing a disease. As a result of unhappiness, anxiety or stress due to personal problems, physical symptoms may develop. We are all familiar with the headache that develops as a result of stress. Similarly, other physical symptoms can develop. These include nausea, abdominal pain and chest pain, breathlessness, diarrhoea and giddiness and muscle pains.

Theories. Some physical disorders may have a psychological cause as in the case of hysterical paralysis and somatization disorder, while some physical conditions like vitamin deficiency or brain injury can cause psychological symptoms. It also exists psychological influence in the development and outcome of conditions as migraines and peptic ulcers. Various studies in neuropsychiatry, immunology and endocrinology among other fields, have lead to various theories and explanations. Franz Alexander led in the beginnings of the 20th century, the movement looking for the dynamic interrelation between mind and body. Sigmund Freud pursued a deep interest in psychosomatic illnesses following his correspondence with Georg Groddeck who was, at the time, researching the possibility of treating physical disorders through psychological processes. Many identifiable illnesses have previously been labeled as 'hysterical’ or 'psychosomatic', for example asthma, allergies and hypertension.

Some modern diseases are believed to have a psychosomatic component derived from the stresses and strains of everyday living. This is the case, for example, of lower back pain and high blood pressure, that appears to be partly related to stresses in everyday life. The particular ways that the body converts psychological distress to physical symptoms, varies over time and differs across cultures. An example are the specific kinds of psychosomatic symptoms found among Victorian-era women in America and western Europe which have largely disappeared. Anthropologists have noted that culture plays an important role in which particular somatic expression results from a given internal psychological experience. In modern society, psychosomatic illness has been often attributed to a result from stress, making of stress management an important factor in the development, amelioration or avoidance of psychosomatic illness.

Important distinctions were noted that led to the realization that hysterical disorders were different from the biologically-caused version of the same disorder. Patients were found who had a body part (i.e. a hand) that was paralyzed or numb; however the shape of the afflicted part did not match the shape of paralysis caused by disease or damage to specific nerves in the body. This was referred to as a "glove paralysis" since sometimes the afflicted area took the form of a glove. Similarly, some patients appeared to be blind, but they strangely did not seem to exhibit the limitations that persons with conventional, biologically-caused blindness would display. These anomalies tipped off researchers that the causal process for these diseases was different from conventional disease or injury

Illness can be due to many factors. It can occur as a result of social or environmental factors. It may also happen as a result of genetic or hereditary reasons: a tendency for a certain condition to run in families. Some families also tend to suppress feelings: any emotion then tends to be expressed by physical symptoms. Children can learn this behaviour which may continue to adult life. Some people think that it is our personality that is a major factor in determining which illness we develop. For example, people with what is known as Type A personality tend to be ambitious, impatient, and set themselves high standards. They seem more likely to develop heart attacks. Quiet, introverted individuals, who tend to conceal their feelings and fears and to suppress emotions, may be more likely to develop cancers.

Why the illness occurs at a particular time is often a mystery. It could be that a combination of the factors mentioned above triggers off the illness. Specific psychological conflicts often characterize patients with classical psychosomatic symptoms or disorders they represent; however, only one aspect of a multifactorial or heterogeneous disorder is not considered to be etiologic. Genetic factors are known to play important roles in the pathogenesis of most of these diseases. Some of the psychological difficulties demonstrated by these patients may in fact be a result of the disease. Should there be untoward stress due to personal problems at home or at work, or a bereavement, then an illness may result. We know for instance that certain life events such as moving house, getting divorced or suffering a bereavement can precipitate physical illnesses. Similarly, an existing illness may worsen as a result of these stresses.



Theorized psychological factors in classical psychosomatic disorders

^ Symptom (disease)

Psychological factors

Presumed psychosomatic mechanism

Hyperacidity (peptic ulcer)

Inhibited dependence; general stress

Increased acid secretion

Essential hypertension

Conflict over hostility; general stress

Vasoconstriction

Bronchial asthma

Conflict over wish for protection or separation; anxiety; general stress

Bronchospasm







Bronchospasm

Migraine

Conflict over control; general stress

Vasoconstriction and vasodilatation

Thyrotoxicosis (Graves' disease)

Conflict over premature self-sufficiency

Increased thyroid-stimulating hormone secretion

Diarrhea (ulcerative colitis)

Conflict over an obligation

Gastrointestinal cholinergic activation

Psychological states influence body organs through a combination of three interrelated mechanisms: neural, hormonal, and immunologic. Voluntary movements (for example, clenching the teeth) are mediated through the motor neurons by the conscious command of the brain. In stress, clenching of the teeth, mediated by the same motor neurons, may also occur, but the act may not be voluntary and conscious. Stress usually causes an activation of the sympathetic nervous system and the hypothalamo-pituitary-adrenal axis followed by a decrease in immunocompetence. Immune mechanisms may be suppressed in part through corticosteroid activation, but a decrease in T-lymphocyte activity in stress may not be mediated by hormones. Individual specific, but inadvertent, conditioning of specific conflict or stress to specific bodily malfunction may be an important psychosomatic mechanism.

Increasingly doctors are recognizing the importance of dealing with psychological and social factors in relation to physical disease. As a result, many doctors now try to deal with the whole person. This means taking all these factors into consideration. By doing this, it is important to realize that the doctor is not playing down or ignoring the physical disease. Many people with so-called psychosomatic disorders feel that their doctor does not take them seriously. They feel that the doctor believes that it's all in the mind . The doctor will always attempt to treat the physical illness with appropriate medical treatment if necessary. But he will also be interested to understand more about the person who has the illness. This will in turn help him and the patient to understand the illness better. Sometimes psychotherapy or talking treatment can help. Patients are given the opportunity and time to talk about their feelings and emotions. This will help provide them with an insight into themselves and help them understand their illness better. Sometimes it is helpful to look at the whole lifestyle of the person involved. This may require looking at how the stress is dealt with, teaching techniques for stress management, as well as examining factors such as diet and exercise.

^ 5.2. Theoretical questions:

  1. Influence of the psychological factors on a course of somatic disorders.

  2. Theories of psychosomatic correlations.

  3. Describe the interrelated mechanisms of psychosomatic disorders.

  4. Mechanisms of the psychological maintenance of personality.

  5. Adaptation disturbances.

  6. Principles of prophylaxis of psychosomatic disorders.


^ 5.3. Practical training during the tutorial

1. Clinical observation of the behavior of patients with psychosomatic disorders.

2. Research of Adaptation disturbances.


5.4. Materials for self-control

A. Questions for self-control:

  1. Influence of the psychological factors on a course of somatic disorders.

  2. Theories of psychosomatic correlations.

  3. Describe the interrelated mechanisms of psychosomatic disorders.

  4. Mechanisms of the psychological maintenance of personality.

  5. Adaptation disturbances.

  6. Principles of prophylaxis of psychosomatic disorders.



B. Tasks for self-control

1. Typical, ordinary – II level.

2. Untypical, no ordinary – III level.

C. Tests for self-control.


Literature

  1. R.J.Gatchel An introduction to health psychology. – New York: Random house. – 386 p.

  2. Lectures.

  3. Internet resource.

  4. Вітенко І.С., Вітенко Т.І. Основи психології: Підручник для студентів вищих медичних навчальних закладів ІІІ – ІV рівнів акредитації. – Вінниця, 2001.

  5. Вітенко І.С., Чабан О.С., Бусло О.О. Сімейна медицина: психологічні аспекти діагностики, профілактики і лікування хворих. – Тернопіль, ”Укрмедкнига”, 2002.

  6. Гавенко В.Л., Вітенко І.С., Самардакова Г.О. Практикум з медичної психології. – Харків: Регіон-інформ, 2002.

  7. Квасенко А.В., Зубарев Ю.Т. Психология больного. М., 1980.

  8. Лакосина Н.Д., Ушаков Г.К. Медицинская психология. М., 1984.

  9. Менделевич В.Д. Клиническая и медицинская психология. – М.: Мед.прес., 1998.

  10. Мягков И.Ф., Боков С.Н. Медицинская психология: основы патопсихологии и психопатологии: Учебник для вузов.- М.: Издательская корпорация „Логос”, 1999.



Prepared by assistant N.V.Bagriy


Positive review

Prof. assistant N.S. Karvatska


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