Download METHODOLOGICAL INSTRUCTION

METHODOLOGICAL INSTRUCTION
for the lesson
Theme : Psychosomatic relationship. The influence of psychological
factors on the course of somatic disorders.
For 4-th year students of medical faculty
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.
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4. List of disciplines necessary for learning theme 1
Title of the discipline
Anatomy
General psychology
Neuropsychology
Normal physiology
5.
Content of the discipline necessary for learning medical
psychology
Brain construction
Psychic functions of a normal person. Consciousness and
self-consciousness. Psychology of personality.
Functions of different brain structures.
Brain functions. Physiology of high nervous activity.
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
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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 modem 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 modem 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
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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
Migraine
Conflict over control;
general stress
Vasoconstriction and
vasodilatation
Thyrotoxicosis (Graves'
disease)
Conflict over premature
self- sufficiency
Increased thyroidstimulating 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,
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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.
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6)
Principles of prophylaxis of psychosomatic disorders.
В. Tasks for self-control
1. Typical, ordinary - II level.
2. Untypical, no ordinary - III level.
A. Tests for self-control.
B. Literature
1. R.J.Gatchel An introduction to health psychology. - New York: Random house.
- 386 p.
2. Lectures.
3. Internet resource.
4. Вітенко I.C., Вітенко T.I. Основи психології: Підручник для студентів
вищих медичних навчальних закладів III - IV 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 B.JL, 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 A.O. Kaminska
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