2. Why is Behavioral Science Relevant to Medicine - 2011 - SOLE

7/31/2019 2. Why is Behavioral Science Relevant to Medicine - 2011 - SOLE

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WHAT IS HEALTH?

Health is popularly defined in terms of absence of disease, butmay be viewed as an illness/wellness continuum

The World Health Organization (WHO, 1948) defines health asa complete state of physical, mental and social well-being and

not merely the absence of disease or infirmity.


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BIOMEDICAL MODEL OF HEALTH

The Biomedical model WAS dominant

It suggests that illness is a function of somatic (bodily)processes gone wrong.

The main focus is therefore to fix or cure the problem.

However it was realized that this Biomedical model was not goodenough, especially for explaining mental health.


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BIOPSYCHOSOCIAL MODEL OF HEALTH

Currently dominant

All conditions of health and disease have mentaland social components

Main focus = health (prevention not cure)

health (wellness and illness) is a function of

biological, psychological, and social factors incontinual interaction


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ILLNESS/WELLNESS CONTINUUM

Biopsychosocial

Mo

del

Biomedical

Model

Wellness

Illness

Absence of Disease

Health midpoint


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DEFINITIONS

Disease: Defined by its etiology; a process caused by trauma,malfunction, identifiable agent/substance; structural defect,

functional impairment

Sickness: Different from having a disease. Can appear sick

without any identifiable disease or impaired physiologic

functioning, or vice versa

Illness: How the person behaves/feels, how s/he perceives the

disease, and how others respond.

Wellness: ?


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Age,Sex,Genes

A FRAMEWORK

FOR THE DETERMINANTS OF HEALTH.


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A FACTORS APPROACH

A SYSTEMS APPROACH

Biological: Lesions

Bacterias Viruses Genetics pathogens

Psychological: Behavior

Beliefs Coping strategies Stress Pain

Social: Class

Employment Ethnicity Culture Support

Social Systems

Society Community Family

Psychological Systems

(behavior and experience)

Cognition Emotion Motivation

Biological Systems(genetics and physiology)

The Person

The World


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BIOPSYCHOSOCIAL MODEL

Psychological component

Behaviour (adoption and maintenance)

Emotional (feelings)

Cognition (thoughts, beliefs, and attitudes)

Personality characteristic ways of thinking andfeeling


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ASSUMPTIONS FROM THE

BIOPSYCHOSOCIAL MODEL

i. Most illnesses are influenced and determined by biological,

psychological, and social factors;

ii. All of these factors influence the predisposition, onset, course, andoutcome of most illnesses;

iii. Physicians who are able to evaluate the relationships of all of these

factors in their patients illnesses will provide more therapeuticinterventions and better outcomes.

(Stoudemire, p36)


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DO YOU WANT TO BE A GOOD DOCTOR?

The assumptions above suggest that better outcomes can

be achieved

So, adding an understanding of psychological and socialfactors will make physicians more effective.

This includes taking into account how patients subjectivelyexperience and understand their illness


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DO YOU WANT TO BE A GOOD DOCTOR?

Patient satisfaction with physician visits is based onpsychosocial dimensions of the care.

Doctors who endorse the psychosocial approach havebetter relationships with their patients and will find thepractice of medicine more fulfilling.


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PSYCHOLOGICAL AND SOCIAL FACTORS THAT

INFLUENCE HEALTH

Psychological, Behavioral, and Social Factors

Are major contributors to medical illness and disease

[Examples include AIDS, cancer, cardiovascular diseases]

Psychological factors can affect medical conditions


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HOW DO PSYCHOLOGICAL AND SOCIAL FACTORS

INFLUENCE MEDICAL ILLNESS?

Two Primary Paths

Psychological factors can influence basic biologicalprocesses

Long-standing behavior patterns may put people atrisk for disease

50% of the Leading Causes of Death in the U.S.Are Linked to Behavior Patterns


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PREDISPOSITION

Personality factors

Type A behavior and CH

Lifestyle and personal habits

Tobacco use

Substance use

Overeating

Lack of exercise

Lung cancer,

emphysema, CHD

Diabetes,hypertension, HD


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ONSET

Stress[in a later lecture]

Lack of social support

Having low social support led to increased mortality (5years later)

Controlled for health status, smoking, healthcarebehavior etc.

(Berkman & Syme 1979)

Individuals from integrated communities have lowerrisk of mortality (2 to 3 times)

Omanis ?


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COURSE & OUTCOME

Accumulation of Life Events

The Social Support Buffer

In patients with MI, those with high scoresand low social support had a 4 times higherrisk of death.

This is about the sameas having other

cardiac complications(e.g. arrythmias)


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SUMMARY

Do Psychological and Social Factors InfluenceMedical Illness?

YES

But how does knowing that help the physician?

Can Psychosocial interventions make a difference?

YES


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AN EXAMPLE

CANCER: PSYCHOLOGICAL AND SOCIAL INFLUENCES

Psycho-oncology Study of psychological factors and their relation to cancer

Psychological and Behavioral Contributions

to Cancer

Perceived lack of control

Inadequate or inappropriate coping responses (e.g., denial)

Overwhelming stressful life events

Life-style risk behaviors

Psychological factors also are involved in chemotherapy


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PSYCHOLOGICAL SYMPTOMS ASSOCIATED WITH

MEDICAL CONDITIONS

Anxiety Hyperthyroidism

Cardiac arthythmias

Pulmonary diseases

Depression

Chronic pain

Hypothyroidism Parkinsons disease

Personality Changes Dementia Brain neoplasms Huntingtons disease

Mania/psychosis Neoplasms AIDS Huntingtons disease

Personality Changes Dementia Brain neoplasms Huntingtons disease


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MEDICATION-INDUCED PSYCHIATRIC SYMPTOMS

Confusion, disorientation,mood changes

Aggression, depression,fatigue, anxiety, psychosis

Depression

Depression, fatigue

Mood symptoms, confusion

Confusion, anxiety

Psychosis

Antineoplastics inhibiting thematuration and proliferation of

malignant cells

Steroid hormones

Peptic ulcer drugs

Anti-hypertensives

Anti-convulsants \used in thetreatment of epileptic seizures

Anti-asthmatic

Analgesic\painkiller

SymptomAgent Class


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HEALTH PSYCHOLOGY

Study of social, behavioral, cognitive, andemotional factors that influencethe:

Maintenance of health

Development of illness and disease Course of illness or disease

Patients and familys response to illness and disease


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CHANGE 5 BEHAVIORS

According to the US Public Health Service, of the 10 leading

causes of death in the US, at least 7 could be reducedsubstantially if people at risk would change just 5 behaviors!

1. Adherence to medical recommendations(eg use of hypertensive medication)

2. Diet

3. Smoking

4. Lack of exercise

5. Alcohol and drug use


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You, the individual, can do more for your own

health and well-being than any doctor, any

hospital, and drug, any exotic medicalservice

US Department of Health,Education, and Welfare


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MODIFYING BEHAVIORS TO PROMOTE HEALTH

Life-Style Practices

Many health problems are traceable to lifestyles and behaviors

Behavioral risk factors are also influenced by psychological andsocial factors

Types of Life-Style Behaviors

Injury and injury prevention Repeated warnings are not enough

AIDS Highly preventable by changing lifestyle behavioral factors

China and smoking cessation programs Getting childreninvolved

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2. Why is Behavioral Science Relevant to Medicine - 2011 - SOLE