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STRESS AND PHYSICAL HEALTH

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Depression clearly adversly affects pts perception of their heart disease & QOL Ruo et al. 2003 ... Ab inflammatory process: Elevated markers: IL-6, CRP ... – PowerPoint PPT presentation

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Title: STRESS AND PHYSICAL HEALTH


1
STRESS AND PHYSICAL HEALTH
  • Dr. YASER ALHUTHAIL
  • Ass.Prof and Consultant
  • Psychosomatic Medicine

2
  • Psychosomatic medicine is an area of
    scientific investigation concerned with the
    relation between psychological factors and
    physiological phenomena in general and disease
    pathogenesis in particular.
  • Integrates mind and body into a
    psychobiological unit to study psychological and
    biological processes as dynamic interacting
    systems.
  • It emphasizes the unity of mind and body and
    the interaction between them.
  • A unitary causative or holistic approach to
    medicine.

3
  • Biomedical Model
  • The application of biological science to
    maintain health and treating disease.
  • Engel (1977) proposed a major change in our
    fundamental model of health care.
  • The new model continues the emphasis on
    biological knowledge, but also encompasses the
    utilization of psychosocial knowledge.
  • Biopsychosocial Model

4
  • Stress causes a sympathicoadrenal medullary alarm
    reaction characterized by excess catecholamine
    secretion.
  • Epinephrine raises blood pressure and heart and
    respiratory rates, enhances neuromuscular
    transmission, elevates the concentration of blood
    sugar by glycogenolysis, mobilizes fat, redirects
    hemodynamic patterns to suit muscular activity,
    and while increasing blood oxygenation, increases
    oxygen consumption.

5
  • More-specific b-adrenergically mediated
    cardiac effects include increased heart rate,
    contractility, and conduction velocity and a
    short arteriovenous refractory period.
  • These catecholamine-mediated cardiac effects
    are thought to be pathogenically related to
    adverse cardiac events.

6
  • 5 to 10 percent with anxiety disorders
    (predominantly panic attacks and phobias) and 10
    to 15 percent with mood disorders (predominantly
    depressive episodes and minor depression or
    dysthymia).
  • Major depressive disorder occurs in 15 to 20
    percent of patients following myocardial
    infarction.

7
Depression and CAD
  • Prospective community studies domonstrate that
    history of depression or depressive symptoms is
    associated with increased risk for the
    development of IHD and for coronary disease
    death(1.5-2 fold)
  • Anda et al. 1993 Barefoot and Schroll 1996
    Barefoot et al. 1996
  • Depression increases the risk of death in pts
    with preexisting CAD 3-4 fold compared to
    nondepressed pts
  • Carney et al. 2003 Frasure-Smith et al.
    1993,1995a Ladwig et al. 1991

8
  • Depression predicts recurrent cardiac events post
    CABG at 12 months Connerney et al
    2001.
  • Depression clearly adversly affects pts
    perception of their heart disease QOL
    Ruo et al. 2003

9
MECHANISMS
  • Platelets dysfunction
  • Autonomic dysfunction
  • Ab inflammatory process Carney et al. 2002
  • Platelets dysfunction
  • Increased platelets reactivity
  • Increased levels of beta-thromboglobulin,
    platelets factor 4
  • Increased likelihood of thrombus formation
  • Serotonin

10
  • Autonomic dysfunction
  • Heart rate variability
  • Elevated sympathetic activation
  • Suppression of vagal tone
  • Vulnerability to arrhythmias
  • Ab inflammatory process
  • Elevated markers IL-6, CRP

11
Indirect ways
  • Adherence to treatment
  • Smoking cessation
  • Exercise
  • Dietary regimen

12
Depression and CHF
  • Major depression more than doubled the mortality
    risk
    Jiang et al. 2001

13
Anxiety and CAD Risk
  • 2 Prospective epidemiological studies demonstrate
    an association of anxiety with sudden cardic
    death
  • High levels of anxiety symptoms are associated
    with a tripling of risk of sudden cardiac death.

14
Anger, Hostility, and Type A Behavior
  • Type A anger, impatience, aggravation, and
    irritability
  • Mixed results !
  • hostility is associated with several
    physiological processes that in turn are
    associated with coronary disease, such as reduced
    parasympathetic modulation of heart rate,
    increased levels of circulating catecholamines,
    and increased lipid concentrations during
    interpersonal conflict

15
Acute Mental Stress
  • Studies of disasters confirm the relationship of
    acute stress to risk for sudden cardiac death
  • HR, BP, cardiac autonomic regulation, elevated
    sympathetic activation and diminished
    parasympathetic effects, and coronary vasospasm
  • 20-30 of acute coronary events

16
Stress management Health Education
  • Stress reduction interventions reduce the
    incidence of recurrent MI by 29 and death by 34
    Dusseldrop et al. 1999
  • Health education, stress management, and exercise
  • Targets BP, Cholestrol, body weight, smoking
    behavior, physical exercise etc.

17
  • Behavioral risk factors for coronary heart
    disease, such as smoking, overeating, physical
    inactivity, and poor compliance with management
    of diabetes, hypercholesterolemia, and
    hypertension, are the main targets for primary
    prevention interventions.
  • psychiatric disorders, acute mental stress, and
    psychological traits are risk factors for
    development and clinical progression of
    cardiovascular disease.
  • Psychiatric disorders frequently occur as
    complications or comorbid conditions in
    individuals with cardiovascular disease.
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