This document discusses psychological factors that can affect various medical conditions. It begins with an introduction on mind-body interactions and how psychological and social factors can influence medical illnesses. It then provides several examples of how psychological factors like depression, anxiety, stress, and maladaptive behaviors can negatively impact conditions like cardiovascular disease, diabetes, pulmonary disease, and end-stage renal disease. The document emphasizes that considering psychological influences is important for understanding disease mechanisms, improving health outcomes, and the physician-patient relationship. It also notes the complexity of differentiating psychological versus medical causes.
Adjustment disorders are commonly seen in primary care settings in which the 1-year prevalence varies from 11% to 18% of those with any clinical psychiatric disorder. [Casey PR et al., 1984]
A recent study [Maercker A et al., 2012] in the general population found the prevalence of adjustment disorder to be 0.9%,
Adjustment disorders are commonly seen in primary care settings in which the 1-year prevalence varies from 11% to 18% of those with any clinical psychiatric disorder. [Casey PR et al., 1984]
A recent study [Maercker A et al., 2012] in the general population found the prevalence of adjustment disorder to be 0.9%,
HIV and Psychiatry , Neuropsychiatric aspects of HIV , AIDS , Breaking bad news in HIV , Psychiatric intervention in HIV , Neuropsychiatric complications of HIV and AIDS
HIV and Psychiatry , Neuropsychiatric aspects of HIV , AIDS , Breaking bad news in HIV , Psychiatric intervention in HIV , Neuropsychiatric complications of HIV and AIDS
Recent studies both community and hospital based have shown that there is a significant burden of psychiatric disorder in epilepsy, with as many as 50% of all subjects studied being affected.
The available epidemiological data suggests that psychiatric disorders are over-represented in epilepsy, the evidence for psychosis in particular being rather compelling
The historical development of Abnormal Psychology or Psychopathology is worth studying. The progressive as well as conservative steps have contributed to a balanced view of abnormal behavior.
Depresi adalah masalah kejiwaan yang paling sering pada pasien dengan penyakit ginjal kronis dan dapat memprediksi hasil pasien dan kematian. Depresi terkait dengan kehidupan yang penuh stres yang ditandai dengan banyak kerugian dan oleh ketergantungan, yang bahkan dapat menyebabkan bunuh diri. Meskipun sejumlah besar pasien dengan penyakit ginjal kronis dan beban ekonomi mereka mewakili, hanya beberapa dari pasien ini menerima diagnosis dan terapi yang memadai. Pedoman Diagnostik dan Statistik Mental kriteria Gangguan-IV untuk depresi besar dapat membantu dalam membedakan gejala uremia dan depresi. Farmakoterapi tersedia dan antidepresan (trisiklik antidepresan dan selective serotonin re-uptake) telah berhasil digunakan dalam berbagai penelitian. Akhirnya, ada kebutuhan untuk welldesigned lanjut, membujur studi, kelangsungan hidup untuk memperjelas hubungan yang lebih baik antara depresi dan berbagai tahap disfungsi ginjal.
Psychiatric Disorders: Symptoms, Causes, and Treatment Options | The Lifescie...The Lifesciences Magazine
Psychiatric disorders encompass a broad range of conditions that affect mood, behavior, and cognition. From mood disorders like depression and bipolar disorder to anxiety disorders.
chronic health issues are common, they are also a substantial risk factor for poor mental health and reduced quality of life.
poor mental health can increase the risk of disability, poor treatment compliance, and mortality.
Depression and CV diseases: cardiologist perspectives Essam Mahfouz
The presentation discusses the epidemiology, mechanism, screening and diagnosis of depression and cardiovascular disease and how to mange this association
Brain fag syndrome,hypochondriasis and conversion disorderDr.Emmanuel Godwin
Brain fag syndrome,hypochondriasis and conversion disorder are forms of somatoform disorder....This are disorders that present with Physical symptoms with an unexplained cause.
TalkToAngel can help with teen depression. TalkToAngel is an online counseling platform that provides access to licensed therapists who specialize in treating mental health issues, including depression. Teen depression is a serious mental health concern that can affect a young person's emotional, social, and academic functioning.
Millions of people worldwide suffer from the mental health illness known as depression. It is marked by enduring melancholy, pessimism, and a lack of interest in once-pleasant pursuits.
https://www.talktoangel.com/area-of-expertise/depression
A CROSS-SECTIONAL STUDY ANALYSING THE LEVEL OF DEPRESSION AND ITS CAUSATIVE F...amsjournal
Depression is a pathological state of the mind characterised lack of self-confidence and self-esteem. The
cause of depression is multi factorial and various physical, psychological, environmental and genetic
factors have been implicated in the causation of depression. Despite being a serious condition in all age
groups, depression is more common and significant in the geriatric population as it is associated with
significant morbidity and mortality. Various scales have been developed to assess depression of which the
Geriatric Depression Scale is most suited for elderly population. It has a long form and short form, the
latter being more appropriate for elderly patients with dementia. In our study, we aim to analyse the
prevalence of depression among elderly patients visiting the outpatient departments of a tertiary care
hospital and determine the factors influencing depression in them. The study was an Observational cross sectional
study carried out on 51 elderly patients over the age of 60 years attending the various outpatient
departments of PSG Hospital. The Geriatric Depression Scale Short form was used to determine the
prevalence of depression. A self-designed questionnaire considering various factors causing depression
was administered to determine the factors influencing depression. It was found that among 51 elders in the
age group of 60 to 80 years, 58.8% were depressed of which 54% were males and 68% were females.
Financial fears regarding future and income insufficiency were the most important factors contributing to
depression. This shows that monetary fear is a major factor resulting in depression. The most effective
strategy to combat depression is to ensure appropriate self-report. The government and other organizations
must ensure that better support, both financial and other services like healthcare are provided to the
elderly in order to prevent depressive illnesses.
Importance of Assessing Level of Consciousness in Medical Care | The Lifescie...The Lifesciences Magazine
The Level of Consciousness (LOC) is a critical indicator of an individual's overall health and neurological function. Healthcare professionals use various assessment tools to evaluate LOC.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
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2 Case Reports of Gastric Ultrasound
3. Mind–body interactions have long been a focus of interest, both in health and in disease. Psychiatric illness and medical disease frequently coexist. A more modern approach has been to recognize that all medical illnesses are potentially affected by many different factors in the biological, psychological, and social realms. BACKGROUND
6. Such factors may contribute to the initiation or the exacerbation of the illness, interfere with treatment and rehabilitation, or contribute to morbidity and mortality.
7. Psychological factors may themselves constitute risks for medical diseases, or they may magnify the effects of nonpsychological risk factors. The effects may be mediated directly at a pathophysiological level (e.g., psychological stress inducing myocardial ischemia) or through the patient’s behavior (e.g., noncompliance).PSYCHE SOMA INTERACTION-WHY SO IMPORTANT?
8. The subject of psychological factors affecting medical condition (PFAMC) has become the focus of intense research because of the illumination it may provide of basic disease mechanisms (e.g., psychoneuroimmunology) and because of the intense interest in improving both the outcomes and the efficiency of health care delivery. The diagnosis of PFAMC focuses attention on one causal direction in the interactions between psyche and soma, that is, the effects of psychological factors on the medical condition In most patients, there are effects in the other direction as well (i.e., the effects of general medical illness on psychological function). Furthermore, both mind and body interact with social and environmental factors both dramatic (e.g., poverty,racism, war) and more subtle (e.g., employment status,neighborhood) (Roux et al. 2001 ), that affect the incidence and outcome of medical illness. PSYCHE SOMA INTERACTION-WHY SO IMPORTANT?
9.
10. ‘PFAMC Diagnosis’ & complexities The diagnosis of PFAMC differs from most other psychiatric diagnoses in its focus on the interaction between the mental and medical realms. As noted, the criteria require more than that the patient have both a medical illness and contemporaneous psychological factors, because their coexistence does not always include significant interactions between them. To make the diagnosis of PFAMC, either the factors must have influenced the course of the medical condition, interfered with its treatment, contributed to health risks, or physiologically aggravated the medical condition. The psychological factor can be an Axis I or Axis II mental disorder (e.g., major depressive disorder aggravating coronary artery disease (CAD)), a psychological symptom (e.g., anxiety exacerbating asthma), a personality trait or coping style (e.g., type A behavior contributing to the development of CAD), maladaptive health behaviors (e.g., unsafe sex in a person with human immunodeficiency virus (HIV) infection), a stress-related physiological response (e.g., tension headache), or other or unspecified psychological factors.
11. PFAMC Diagnosis’ & complexities When a patient’s medical illness is faring worse than expected and not responding well to standard treatment, physicians should consider whether a psychological factor may be responsible for the poorer than expected outcome. To ignore the possibility of PFAMC may miss the crucial barrier to the patient’s recovery. On the other hand, premature or facile attribution to psychological factors may lead the physician to overlook medical or social explanations for “treatment-resistant disease” and unfairly blame the patient, with resultant further deterioration in health outcomes and the physician–patient relationship.
12. ‘PFAMC Diagnosis’ & complexities‘An illustration’ To illustrate, a common clinical problem is the brittle diabetic adolescent with labile blood glucose levels and frequent episodes of ketoacidosis and hypoglycemia, despite vigorous attempts by the physician to improve diabetic management and glucose control. The considerable difficulty in controlling such patients’ diabetes is often attributed to adolescents’ dislike of lifestyle restrictions, their tendency to act out and rebel against authority figures, their denial of vulnerability, their ambivalence about their need for nurturance, and their wish to be “normal”. There are many adolescent (and some adult) diabetic patients for whom these psychological issues do play an important role in undermining diabetes management through noncompliance regarding medication, diet, visits to the physician, substance use, and activity limitations. However, psychological factors do not always account for brittleness and are sometimes incorrectly suspected. It has been demonstrated that much of the difficulty in achieving stable glucose control in adolescent diabetics is the result of the dramatically labile patterns of hormone secretion (cortisol, growth hormone) typical of adolescence, independent of psychological status.
13. Epidemiology and Comorbidity Because “PFAMC”describes a variety of possible interactions between the full range of psychiatric disorders (as well as symptoms and behaviors) on the one hand and the full range of medical diseases on the other, it is impossible to estimate overall rates of prevalence or incidence. We can start, however, by noting how frequently medical and psychiatric disorders coexist. Psychiatric problems are common in medical patients, although the measured frequency varies, depending on the criteria and method of measurement used. A reasonable estimate is that 25−30% of medical outpatients and 40−50% of general medical inpatients have diagnosable psychiatric disorders.
14. Epidemiology and Co morbidity
15. How do psychological factors affect medical illnesses? May promote other known risks for medical illness. e.g, Individuals with schizophrenia or depression are much more likely to smoke than the general population. A wide variety of psychiatric illnesses are associated with an increased likelihood of substance abuse. Depression and schizophrenia also are associated with a sedentary lifestyle. Have an impact on the course of illness by influencing how patients respond to their symptoms, including whether and how they seek care. E.g., the defense mechanism of denial may lead an individual to ignore anginal chest pain, attribute it to indigestion, delay seeking medical attention, or minimize the pain when describing it to a physician. Affect the course of illness through their effects on the physician–patient relationship, since they influence both patients’ health behaviors and physicians’ diagnostic and treatment decisions. Can reduce a patient’s compliance with diagnostic recommendations, treatment, and lifestyle change, and can interfere with rehabilitation through impairment of motivation, understanding, optimism, or tolerance. Have direct effects on pathophysiologic processes. E.g., stress has been experimentally shown to cause myocardial ischemia in patients with coronary disease.
16. MANAGEMENT OF “PFAMC” General guidelines Management of psychological factors affecting the patient’s medical condition should be tailored both to the particular psychological factor of relevance and to the medical outcome of concern. The physician, whether in primary care or a specialty, should not ignore apparent psychiatric illness. Unfortunately, this occurs all too often because of discomfort, stigma, lack of training, or disinterest. Referring the patient to a mental health specialist for evaluation is certainly better than ignoring the psychological problem but should not be regarded as “disposing” of it, because the physician must still attend to its potential impact on the patient’s medical illness. Similarly, psychiatrists and other mental health practitioners should not ignore coincident medical disease and should not assume that referral to a nonpsychiatric physician absolves them of all responsibility for the patient’s medical problem. When prescribing psychiatric medications for patients with significant medical co morbidity, the psychiatrist should keep in mind potential adverse effects on impaired organ systems (e.g., anticholinergic exacerbation of postoperative ileus; tricyclic antidepressant causing completion of heart block
17. Psychological Factors in Cardiology Coronary Disease: One of the most studied examples is the type A behavior pattern and its relationship to CAD. Type A is a complex set of traits including impatience, hostility, intense achievement drive, and time urgency, among others. Depression directly and indirectly E.g., (by increasing the incidence of smoking & sedentary life style), Generalized anxiety disorders, Psychological Stress, Psychological factors like denial, Maladaptive health behaviors etc. Arrhythmias psychological stressors can also play an important role in precipitating serious cardiac arrhythmias. Congestive Heart Failure Depression is independently associated with increased mortality and readmission rate. Hypertension Psychological stress, Depression, Anxiety, Type A personality are all independent risks for Hypertension.
20. Mental Disorder Affecting a General MedicalCondition If the patient has a mental disorder meeting criteria for an Axis I or Axis II diagnosis, the diagnostic name is mental disorder affecting medical condition, with the particular medical condition specified. Examples include Major depressive disorder that reduces energy and compliance in a hemodialysis patient. Panic disorder that makes an asthmatic patient hypersensitive to dyspnea. Schizophrenia in a patient with recurrent ventricular tachycardia who refuses placement of an automatic implantable defibrillator because he fears it will control his mind.
21. Patients who have psychological symptoms that do not meet the threshold for an Axis I diagnosis may still experience important effects on their medical illness, and the diagnosis would be psychological symptoms affecting a medical condition. Examples include Anxiety that aggravates irritable bowel syndrome (IBS). Depressed mood that hinders recovery from hip replacement surgery. Anger that interferes with rehabilitation after spinal cord injury. Psychological Symptoms Affecting a GeneralMedical Condition
22. This may include personality traits or coping styles that do not meet criteria for an Axis II disorder and other patterns of response considered to be maladaptive because they may pose a risk for particular medical illnesses. An example is the competitive hostility component of the type A behavior pattern, and its impact on CAD. Maladaptive personality traits or coping styles are particularly likely to interfere with the physician−patient relationship as well as the patient’s relationships with other caregivers. Personality Traits or Coping Style Affecting a General Medical Condition
23. Many maladaptive health behaviors have significant effects on the course and treatment of many medical conditions. Examples include Sedentary lifestyle, smoking, abuse of alcohol or other substances, and unsafe sexual practices. If the maladaptive behaviors can be better accounted for by an Axis I or Axis II disorder, the first subcategory (mental disorder affecting a medical condition) should be used instead. Maladaptive Health Behaviors Affectinga General Medical Condition
24. Examples include precipitation by psychological stress of angina, cardiac arrhythmia, migraine, or attack of colitis in medically vulnerable individuals. In such cases, stress is not the cause of the illness or symptoms; the patient has an underlying medical condition (CAD, migraine, or ulcerative colitis), and the stressor instead represents a precipitating or aggravating factor. Stress-Related Physiological Response Affectinga General Medical Condition
25. There are other psychological phenomena that may not fit within one of these subcategories. An interpersonal example is marital dysfunction. A cultural example is the extreme discomfort a woman from some cultures may experience being alone with a male physician, even while she is fully dressed. A religious exampleIs a Jehovah’s Witness who ambivalently refuses blood transfusion. These fall under the residual category of other or unspecified psychological factors affecting a medical condition. Other or Unspecified Psychological FactorsAffecting a General Medical Condition
26. Differential Diagnosis The close temporal association between psychiatric symptoms and a medical condition does not always reflect PFAMC. If the two are considered merely coincidental, then separate psychiatric and medical diagnoses should be made. In some cases of coincident psychiatric and medical illness, the mental symptoms are actually the result of the medical condition (i.e., the causality is in a direction opposite from that of PFAMC). When a medical condition is judged to be pathophysiologically causing the mental disorder (e.g., hypothyroidism causing depression), the correct diagnosis is the appropriate mental disorder due to a general medical condition (e.g., mood disorder due to hypothyroidism, with depressive features). In PFAMC, the psychological or behavioral factors are judged to precipitate or aggravate the medical condition.
27. Differential Diagnosis Substance use disorders may adversely affect many medical conditions, and this canbe described through PFAMC. However, in some patients, all of the psychiatric and medical symptoms are direct consequences of substance abuse, and it is usually parsimonious to use just the substance use disorder diagnosis. For example, a patient with delirium tremens after alcohol withdrawal would receive a diagnosis of alcohol withdrawal delirium, not PFAMC, but a patient with alcohol dependence who repeatedly missed hemodialysis treatments because of intoxication would receive diagnoses of alcohol dependence and PFAMC (mental disorder affecting end stage renal disease). Patients with somatoform disorders (e.g., somatization disorder, hypochondriasis) present with physical complaints which may mimic medical illness, but the somatic symptoms are actually accounted for by the psychiatric disorder. In principle, it might seem that somatoform disorders are easily distinguished from PFAMC, because PFAMC requires the presence of a diagnosable medical condition. The distinction in practice is sometimes difficult because the patient may have both a somatoform disorder and one or more medical disorders. For example, a patient with seizures regularly precipitated by emotional stress might have true epilepsy aggravated by stress (PFAMC), pseudoseizures (conversion disorder), or both.
28.
29. Deterioration in glucose control in schizophrenic diabetics can be due to atypical antipsychotic drugs, but diabetes was also a major problem for schizophrenics before their advent, presumably because of obesity (a side effect of almost every antipsychotic), unhealthy diet, and poorer health care.
30.
31.
32. On the other hand, asthmawas associated with a significantly increased likelihood of anxiety disorders (especially panic, generalized anxiety disorder, and phobias) and affective disorders.
33. Psychological distress in COPDamplifies dyspnea without usually causing changes in objective pulmonary functions.
36. Psychological Factors in Neurology Depression is frequent after stroke, associated with poorer outcome; including higher later mortality (House et al. 2001 ), and functional status is improved with treatment of depression after stroke. Stroke patients with extensive social support have better functional outcomes than those who do not have such support. Depression is common in Parkinson’s disease, may antedate the development of motor symptoms, and is associated with cognitive dysfunction. Depression is also common and erodes quality of life in multiple sclerosis and in epilepsy. Patients with chronic migraine headaches have often been described as having a “typical” personality characterized as conscientious, perfectionistic, ambitious, rigid, tense, and resentful. Migraine patients with anxiety and depression reported poorer treatment efficacy and satisfaction with treatment.
38. Moersch (1925) described a 54-year-old man in whom, three months earlier, “a gradual mental change had been observed. The patient lost his ambition and interest in work . . . he became careless . . . and seemed little concerned about his shortcomings. For two weeks before his examination he had been content to sit aimlessly at home, or to play with his children. He voided at any time and even defecated in his clothes . . . . During general examination, the patient was indifferent and aimless, would sit and look at a newspaper, which might be upside down. He was oriented in all spheres, and his attention might be held for a few moments when aroused. He would follow his son about in a fairly good-natured manner, but always object to being examined, saying that he was not sick. He showed considerable perseveration, repeating movements at times for long periods. For example, one evening he sat before a wash bowl for over a half-hour, turning the faucets on and off.” This patient’s frontal lobe syndrome, manifest with apathy, disinhibition, and perseveration, constituted the presentation of a tumor of the anterior portion of the corpus callosum, to which the patient eventually succumbed. CASE VIGNETTE 7