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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

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  • 1. The fallacy of separating somatic and psychological symptoms. September 30 , 2013 St. Maarten Erik Hoencamp
  • 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. Conceptual background • Gene * environment Interaction. • Examples of disease/phenotype Depression<> Cardiovascular Disorders Bipolar Disorder, Schizophrenia<> metabolic syndrome. • Childhood Adversity as an environmental factor
  • 4. Current paradigm, Gene*Environment Interaction Genetic vulnerability environment environment conception Gene- expression Disease phenotype epigenetics
  • 5. Gene*Environment Interaction Genetic vulnerability environment environment conception Gene- expression Disease phenotype epigenetics Childhood adversity Depression Cardiovacular disorder. Metabolic Syndrome Psychosis
  • 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. Schizophrenia Bipolar disorder Depression ?? Anxiety disorders ?? Diabetes Hypertension Cardiovascular Etc. Metabolic syndrome both cause and consequence of the disorder? Life style Medication
  • 8. Environment social Migration,dicrimi nation,etc family psychological physical economic Childhood Adversity
  • 9. Depression Anxiety Etc. Cardiovascular disease Inflammatory disease etc Affective Physical Sexual Which has highest impact ???
  • 10. Example how ACE effects health In this case cardiovascular disorders
  • 11. So, related are • Depression <>Cardiovascular Disorder. (Genetic component) • Schizophrenia /Bipolar Disorder<> Metabolic syndrome. (Genetic component) • Childhood Adversity (environmental component)<> Depression &Cardiovascular Disorder
  • 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. 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. 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. 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. 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. Thanks any questions ?