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75 Cards in this Set

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In the 1920s, ?(1875–1945) conducted the first systematic study of the relation of stress to disease. He demonstrated that stimulation of the autonomic nervous system, particularly the sympathetic system, readied the organism for the “fight or flight” response characterized by hypertension, tachycardia, and increased cardiac output.
Walter Cannon
Hans Selye (1907–1982) developed a model of stress that he called the general adaptation syndrome. It consisted of three phases:
(1) the alarm reaction;
(2) the stage of resistance, in which adaptation is ideally achieved; and

(3) the stage of exhaustion, in which acquired adaptation or resistance may be lost
Endocrine response to stress?
CRF is secreted from the hypothalamus into the hypophysial-pituitary-portal system. CRF acts at the anterior pituitary to trigger release of adrenocorticotropic hormone (ACTH). Once ACTH is released, it acts at the adrenal cortex to stimulate the synthesis and release of glucocorticoids.
Glucocorticoids themselves have myriad effects within the body, but their actions can be summarized in the short term as
promoting energy use,
increasing cardiovascular activity (in the service of the “flight or fight” response), and

inhibiting functions such as growth, reproduction, and immunity.
Immune response to stress?
CRF stimulates NE release
NE can activate immune system so get release of ctyokines
ctyokines can lead to further release CRF
Top 5 Life event stressors?
1. Death of spouse
2. Divorce
3. Separation
4. Jail/detention
5. Family member death
6. Major Illness
7. Marriage
8. Fired
9. Marital reconciliation
10. Retirement
11. Family member health change
12. Pregancy
13. Sexual difficulties
14. New family member
13. Major business readjustment
An individual with a coronary personality is a ??? person who is predisposed to coronary artery disease.
hard-driving, competitive, aggressive
Meyer Friedman and Ray Rosenman first defined two types: (1) type ?—similar to the coronary personality—and (2) type? personalities—calm, relaxed, and not susceptible to coronary disease (See discussion below).
A

B
According to psychoanalytic theory, the choice of the afflicted region by stress is determined by unconscious factors, a concept known as
somatic compliance.
Organ system most linked with psychiatric disorders or functional status?
GI
In the esophagus, acute stress (increases or decreses) resting tone of the upper esophageal sphincter and (increases or decreases) contraction amplitude in the distal esophagus.
increases both
In the stomach, acute stress induces (increased or decreased) antral motor activity, potentially producing functional nausea and vomiting.
decreased
Acute stress impact on:
small intestine migrating motor function
: increased or decreased
decreased/reduced
Acute stress impact on large intestine

myoelectrical and motility activity can be (increased or decreased) under acute stress.
increased
? disorders ranked highest in a study of psychiatric comorbidity in functional esophageal spasm, being present in 67 percent of subjects referred to a GI motility laboratory for testing.

Most common specific ds?
Anxiety
GAD
Psychiatric ds associated to peptic ulcer disease
No consensus exists on specific psychiatric disorders being related to peptic ulcer disease.
Psychiatric ds associated with ulcerative colitis
Some workers have reported an increased prevalence of dependent personalities in these patients. No generalizations about psychological mechanisms for ulcerative colitis can be made, however.
Crohn's disease and associated psychiatric ds?
Panic Ds
study of psychiatric symptoms in patients with Crohn's disease before the onset of symptoms found high rates (23 percent) of preexisting panic disorder compared with control subjects and subjects with ulcerative colitis
List 2 disorders, 4 factors that have been evaluated as risk factors for the development and expression of coronary disease
Depression, anxiety, type A behavior, hostility, anger, and acute mental stress
??? have been shown to have significant relationships with each of these individual psychological factors, and some investigators have proposed these latter characteristics as more promising indices of psychological risk.
Negative affect in general, low socioeconomic status, and low social support
Strongest psych factor associated with coronary disease?
depression
Severe depression 6 months after coronary artery bypass graft (CABG) surgery, or persistence of even moderate depression symptoms beginning before surgery at 6-month postoperative follow-up, predicts increased risk of death over ?-year follow-up
5
The relationship between Type A behavior pattern characterized by ? and CAD found the type A pattern to be associated with a nearly twofold increased risk of incident MI and CAD-related mortality

What has helped decrease this risk?
easily aroused anger,
impatience,
aggression,
competitive striving, and
time urgency (type A)

Group therapy for Type A's
Key factor in Type A associated with CAD?
hostility
Is submissiveness in women protective against CAD risk?
Yes
Does psychosocial tx on rehab from CAD help?
Yes

Patients having psychosocial treatment had greater reductions in emotional distress, systolic blood pressure, heart rate, and blood cholesterol level than comparison subjects.

Patients who did not receive psychosocial intervention had 70 percent greater mortality and 84 percent higher cardiac recurrent event rates during 2 years of follow-up
High anxiety symptom levels are associated with a ? of risk of sudden cardiac death.
tripling
wo studies have demonstrated that, in addition to depression, a high level of anxiety symptoms raises the risk of further coronary events in patients after MI by ? times that for nonanxious comparison patients.
2 to 5
Mood disorders are common in transplant recipients, in part because of chronic ? therapy.
prednisone
Personality profiles associated with essential hypertension include persons who
have a general readiness to be aggressive, which they try to control, albeit unsuccessfully.
p to 30 percent of persons with asthma meet the criteria for
panic disorder or agoraphobia.
Certain personality traits in patients with asthma are associated with greater use of corticosteroids and bronchodilators and longer hospitalizations than would be predicted from pulmonary function alone. These traits include
intense fear,
emotional lability,
sensitivity to rejection, and
lack of persistence in difficult situations.
Family members of patients with severe asthma tend to have higher than predicted prevalence rates of
mood disorders, posttraumatic stress disorder, substance use, and antisocial personality disorder.
Tx of hyperventilation
increase PC02
with paper bag or holding breath
COPD associated with what psych ds?
Panic Ds
8 to 24 % with COPD have panic ds (versus 1.5 percent of general prev)
mania like sx seen in what GMC?
hyperthyroidism or Graves
Hyperthyroidism ... what type of antipsycotic to use?
For patients with psychotic symptoms, medium-potency antipsychotics are preferable to low-potency drugs, because the latter can worsen tachycardia.
high TSH + depressive sx + psychotic (AH, paranoia) sx:
dx + tx?
hypothyroidism

Psychotropic agents should be given at low doses initially, because the reduced metabolic rate of patients with hypothyroidism may reduce breakdown and result in higher concentrations of medications in blood, as in the following case.
Can DM onset be associated with psychological factors?
sudden onset is often associated with emotional stress, which disturbs the homeostatic balance in persons who are predisposed to the disorder.

Psychological factors that seem significant are those provoking feelings of frustration, loneliness, and dejectio
In patients with known diabetes, ? can produce some violence and confusion
ketoacidosis
? (often occurring when a patient with diabetes drinks alcohol) can produce severe anxiety states, confusion, and disturbed behavior
hypoglycemia
Cushing's psychiatric sx?
Psychiatric symptoms are common and vary from severe depression to elation with or without evidence of psychotic features.
Psychiatric symptoms are myriad. Most patients experience fatigue and approximately 75 percent report depressed mood. Of these, approximately 60 percent experience moderate or severe depression.

Dx?
Hypercortisolism
Depressive symptoms occur more commonly in ? patients than in (sex?) patients with Cushing's syndrome
Depressive symptoms occur more commonly in female patients than in male patients with Cushing's syndrome
Severity of psychiatric sx associated with Cushing's varies by?
plasma cortisol
and ACTH levels
What factor significantly increases chances of manic/psychotic sx in cortisolism ds?
Manic and psychotic symptoms occur much less frequently than depression, at a rate of approximately 3 to 8 percent of patients, but rising to as high as 40 percent in patients with adrenal carcinomas.
The psychiatric disturbances in prednisone-treated patients tend to appear within the first ? weeks of treatment and occur more commonly in (sex) than in (sex).
The psychiatric disturbances in prednisone-treated patients tend to appear within the first 2 weeks of treatment and occur more commonly in women than in men.
The withdrawal of steroids can also produce psychiatric disturbances, particularly
others

perisist as long as?
depression, weakness, anorexia, and arthralgia
Other steroid-induced withdrawal symptoms include emotional lability, memory impairment, and delirium

8 weeks after corticosteroid withdrawal
Patients presenting with mood lability or depression in association with muscle weakness,
obesity, diabetes,
easy bruising,
cutaneous striae,
acne,
hypertension

and in women
hirsutism, oligomenorrhea/amenorrhea benefit from
what kind of evaluation?
endocrinological
Prolactin production: inhibited by, increased by?
inhibited by dopamine
block dopmaine increases prolactin
Normal concentration of prolactin in men,
women
and when is concentration at peak?
Normal concentrations
5 to 25 ng/mL in women and
5 to 15 ng/mL in men

fluctuate during the day, peaking during sleep.
What can increase prolactin besides antipsychotics
exercise,
stress
Which antipsychotic not increase prolactin
clozapine
olanzapine
Relationship between thyroid and prolactin?
Hypothyroidism raises prolactin concentration because thyrotropin-releasing hormone (TRH) stimulates prolactin release.
Traumatic childhood experiences, such as separation from parents or living with an alcoholic father, have been reported to predispose to (hypo or hyper)prolactinemia
hyper
Stressful life events are also associated with galactorrhea
True or False?
Stressful life events are also associated with galactorrhea, even in the absence of increased prolactin concentrations
Low prolactin associated with
increased or decreased
libido
decrased
Eczema/atopic dermatitis associated with what psych ds?
Patients with atopic dermatitis tend to be more anxious and depressed than clinical and disease-free control groups. Anxiety or depression exacerbates atopic dermatitis by eliciting scratching behavior, and depressive symptoms appear to amplify the itch perception.
Atopic dermitis

In families that encouraged independence, children had (more, less) severe symptoms
parental overprotectiveness (increased, reduced) scratching
In families that encouraged independence, children had less severe symptoms, whereas parental overprotectiveness reinforced scratching
Psoriasis and psych ds?
Controlled studies have found that patients with psoriasis have high levels of anxiety and depression and significant comorbidity with a wide array of personality disorders including
schizoid,
avoidant,
passive-aggressive, and
obsessive-compulsive personality disorders
Depression is comorbid with rheumatoid arthritis in about ?percent of individuals.
20
Individuals with rheumatoid arthritis and depression commonly demonstrate poorer functional status, and they report more of the following: ??? than do patients with similar objective measures of arthritic activity without depression.
painful joints, pronounced experience of pain,
health care use,
bed days, and inability to work
Fibromylagia
more with women or men?
women
Fibromyalgia
exclude what?
associated with what psych ds?
The diagnosis is made after excluding rheumatic disease or hypothyroidism

Depression
recurrent unilateral headaches, with or without related visual and gastrointestinal disturbances (e.g., nausea, vomiting, and photophobia)

type of headache?
migraine
Migraines can be precipitated by cycling ?,
estrogen
which may account for their higher prevalence in women.
They are unilateral, occur up to eight times a day, and are associated with miosis, ptosis, and diaphoresis.
cluster headaches
Migraines and cluster headaches are best treated with ?
during the prodromal period with ergotamine tartrate (Cafergot) and analgesics.

Sumatriptan (Imitrex) is indicated for the short-term treatment of migraine and can abort attacks.
The scalp may be tender to the touch and, in contrast to a migraine, the headache is usually bilateral and not associated with prodromata, nausea, or vomiting
Tension Headache
Tension headaches are frequently associated with anxiety and depression and occur to some degree in about ? percent of persons during periods of emotional stress.
80
Cognitive-behavioral therapy approaches to stress management have three major aims:
(1) to help individuals become more aware of their own cognitive appraisals of stressful events,

(2) to educate individuals about how their appraisals of stressful events can influence negative emotional and behavioral responses and to help them reconceptualize their abilities to alter these appraisals, and

(3) to teach individuals how to develop and maintain the use of a variety of effective cognitive and behavioral stress management skills.
Five skills form the core of almost all stress-management programs:
self-observation (diary)
cognitive restructuring (realistic vs disortions)
relaxation training (e.g. PMR)
time management, and
problem-solving
Progressive Muscle Relaxation is what type of behaviour therapy?
systematic desenstization
Biofeedback and related techniques have been useful in ?
tension headaches, migraine headaches, and Raynaud's disease
Time management approach
Have pts create life categories (family, exercise, leisure)
Diary life and compare to desired % of time in each category