Lecture 10 (Psychological factors and medical conditions)

Question 1

Epidemiology

Answer 1

34% of people with mental disorder have comorbid physical conditions
mental disorders more common in people with chronic physical conditions
medical conditions may lead to mental disorders or vice versa

MDD 40% comorbid, anxiety 10-57%, sleep disorders 50%

Question 2

Chronic stress and effects of illness on psychological state

Answer 2

Chronic stress is associated with the initiation and progression of a wide variety of diseases
Exercise has positive effects on brain health, and producing new brain cells
Stress can increase bad health behaviour which can cause physical illness -> can effect each other in different ways

Illness characteristics
-> aetiology (known/unknown) -> if not curable can cause more stress
-> course (episodic/progressive)
-> strength of symptoms
-> threat to life, time of onset, impact of functioning, available treatment

Adjustment to illness is influence by:
-> maintaining emotional equillibrium
-> its exhausting to deal with these conditions, uses more resources more quickly
-> sense of control can help efficacy and top up resources

Positive effect of illness
-> sense-making
Finding a new purpose, revising values and goals, accepting life
-> benefit finding
compassion, spiritual growth, mindfulness, personal growth, post-traumatic growth (beliefs needs to be reinforced through therapy)

Question 3

DSM diagnoses and clarifiers

Answer 3

adjustment disorder
-> symptoms occuring within 3 months of onset of stressor
-> once the distressor has terminated, symptoms do not persist for more than 6 months (depressed mood, anxiety, mixed, disturbed conduct, are most common specifiers for medical conditions

Psychological factors affecting other medical conditions
-> medical symptom is present (not conversion)
->psychological factors adversely effect the medical condition >1
factors have close temporal association between psych factors and development or excacerbation of medical condition, interfere with treatment, cause additional health risks (mild increases medical risk, moderate aggrevates underlying medical condition, sever results in hospitlisation, extreme threat of death

Other specified mental disorder due to another medical condition
-> symptoms of specific mental disorder predominate but do not meet the full criteria
-> used to communicate the specific reason the criteria are not met
e.g. complex partial seizure

Clarifiers
medical origin is suggested in context of
late onset -> e.g. old person getting MDD
known underlying medical condition
atypical presentation
medication use
ramp up of mental state happens at same time as ramp up of medical condition

Question 4

Treatment

Answer 4

need to be careful with treatment dont want patient to think that going to psych means all the pain is in there head -> need to have interdisciplinary work with other professionals

non-opioid treatment first
CBT is strongest evidence -> target pain catastrophising
also MBT, ACT, hypnosis

Need to try and intervene early for prevention
and help adjustment to living with chronic pain and coping strategies

Question 5

Chronic pain

Answer 5

subjective, pain persisting beyond the normal or expected healing time
struggle with failure to respond to treatment
stress associated with disability compensation

Most GPs automatic response is to provide pain meds

causing a lot of cost burden