The fallacy of separating somatic and
psychological symptoms.
September 30 , 2013
St. Maarten
Erik Hoencamp
Two realities
• Split in classification and treatment of somatic or
psychological symptoms.
• Leading to split between pro...
Conceptual background
• Gene * environment Interaction.
• Examples of disease/phenotype
Depression<> Cardiovascular Disord...
Current paradigm,
Gene*Environment Interaction
Genetic
vulnerability
environment environment
conception
Gene-
expression
D...
Gene*Environment Interaction
Genetic
vulnerability
environment environment
conception
Gene-
expression
Disease
phenotype
e...
Depression & Cardiovascular disease
• Share genetic vulnerability and
environmental component.
• In clinical practice co-o...
Schizophrenia
Bipolar disorder
Depression ??
Anxiety disorders ??
Diabetes
Hypertension
Cardiovascular
Etc.
Metabolic
synd...
Environment
social
Migration,dicrimi
nation,etc
family
psychological
physical
economic
Childhood Adversity
Depression
Anxiety
Etc.
Cardiovascular
disease
Inflammatory
disease
etc
Affective
Physical
Sexual
Which has highest impact...
Example how ACE
effects health
In this case
cardiovascular
disorders
So, related are
• Depression <>Cardiovascular Disorder.
(Genetic component)
• Schizophrenia /Bipolar Disorder<>
Metabolic ...
Is there a common denominator
in the pathogenesis ?
• Epigenetic changes in gene expression
• Stress regulation functionin...
Domains or levels of expression of pathology
Social , economic, political situation.
Life events risk and protective facto...
Pathology “ X “ and attributed causality.
Social , economic, political situation, Life events risk and protective factors
...
Pitfalls separating psychopathology and somatic
pathology
• Psychopathology implies that the
phenotype/disease is caused b...
What are practical the consequences
• Image : psychopathology, remains having a negative
odium and easily leads to stigmat...
Thanks any questions ?
2013 09 30 evening program gp 2  eric hoencamp. the fallacy of seperating somatic and psychological symptoms -1
2013 09 30 evening program gp 2  eric hoencamp. the fallacy of seperating somatic and psychological symptoms -1
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2013 09 30 evening program gp 2 eric hoencamp. the fallacy of seperating somatic and psychological symptoms -1

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2013 09 30 evening program gp 2 eric hoencamp. the fallacy of seperating somatic and psychological symptoms -1

  1. 1. The fallacy of separating somatic and psychological symptoms. September 30 , 2013 St. Maarten Erik Hoencamp
  2. 2. Two realities • Split in classification and treatment of somatic or psychological symptoms. • Leading to split between professionals, research, training curricula and financing of care. • While • They co-occur in many clinical situations. • With regard to genetic vulnerability , environmental risk and protective factors they have the same etiological underpinning.
  3. 3. Conceptual background • Gene * environment Interaction. • Examples of disease/phenotype Depression<> Cardiovascular Disorders Bipolar Disorder, Schizophrenia<> metabolic syndrome. • Childhood Adversity as an environmental factor
  4. 4. Current paradigm, Gene*Environment Interaction Genetic vulnerability environment environment conception Gene- expression Disease phenotype epigenetics
  5. 5. Gene*Environment Interaction Genetic vulnerability environment environment conception Gene- expression Disease phenotype epigenetics Childhood adversity Depression Cardiovacular disorder. Metabolic Syndrome Psychosis
  6. 6. Depression & Cardiovascular disease • Share genetic vulnerability and environmental component. • In clinical practice co-occur often , proper treatment of depression enhances life expectancy. (psychotherapy , antidepressants, treatment CVA) • NB depends on definition Major Depressive Disorder.
  7. 7. Schizophrenia Bipolar disorder Depression ?? Anxiety disorders ?? Diabetes Hypertension Cardiovascular Etc. Metabolic syndrome both cause and consequence of the disorder? Life style Medication
  8. 8. Environment social Migration,dicrimi nation,etc family psychological physical economic Childhood Adversity
  9. 9. Depression Anxiety Etc. Cardiovascular disease Inflammatory disease etc Affective Physical Sexual Which has highest impact ???
  10. 10. Example how ACE effects health In this case cardiovascular disorders
  11. 11. So, related are • Depression <>Cardiovascular Disorder. (Genetic component) • Schizophrenia /Bipolar Disorder<> Metabolic syndrome. (Genetic component) • Childhood Adversity (environmental component)<> Depression &Cardiovascular Disorder
  12. 12. Is there a common denominator in the pathogenesis ? • Epigenetic changes in gene expression • Stress regulation functioning HPA-axis • Aberrant Inflammatory processes • Disruptive Bio-rhythms • Microbiome ? • Socio-economic risk and protective factors.
  13. 13. Domains or levels of expression of pathology Social , economic, political situation. Life events risk and protective factors Behaviour Emotional , cognitive and physical well being . Physical functioning and patho-fysiological processes Structural and functional integrity of body >> vulnerability and/or acquired disorders, disease. Pathology is perceived here in the social context.
  14. 14. Pathology “ X “ and attributed causality. Social , economic, political situation, Life events risk and protective factors Behavior Emotional , cognitive and physical well being . Physical functioning and patho-fysiological processes Structural and functional integrity of body >> vulnerability and/or acquired disorders, disease. Pathology is perceived here in the social context Pathology X Somatic Psychological
  15. 15. Pitfalls separating psychopathology and somatic pathology • Psychopathology implies that the phenotype/disease is caused by “psychological” factors. • Somatic pathology implies that it is caused by an underlying disease. • Neither is true and leads to strange situations what is a “ real “ disease example whiplash , CFD, ..
  16. 16. What are practical the consequences • Image : psychopathology, remains having a negative odium and easily leads to stigmatization and rejection. Religious, ideological and political factors play a role in these processes. • Research and treatment: A fundamental change is needed and slowly in progress where somatic and psychological symptomatology and their relation are taken into account with regard to etiology and treatment. • Training curricula should be adapted and give more background about both psychological and biological aspects of disease. • Our own attitude : well intended we may contribute to stigmatization, by treating patients different with psychopathology leading to dependency and lack of self fulfillment and empowerment. • Organization of health care services , Challenge to increase cost effectiveness of health care .
  17. 17. Thanks any questions ?

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