Exam 2: Psychosomatic disorders

*cortisol* slows the production of _________________

"good" prostaglandins

PUD & stress:

*NOT* caused by stress but *can make ulcer sx worse*

What is Takotsubo cardiomyopathy?

-abrupt, unpredictable CP and SOB

sympathetic response (catecholamine increase) is possibly because ?

1. *repeated activation of sympathetic responses to acute stress* 2. *failure to return to resting levels* 3. *failure to habituate to repeated stressors of some type* 4. *combination*

Stress and the CV system affects what system?

1. CAD: coronary artery disease 2. CHD: coronary heart disease 3. HTN 4. Takotsubo cardiomyopathy 5. valvular heart disease

Ulcerative colitis & Crohn's disease & stress:

Stress fight/flight sets up a *flare-up*

Stress and asthma

Stress is strongly associated with asthma incidence and hospitalization, [use of asthma medication] i dont understand what the last part means...but that's how its written

______________________ determines amount of stress you can handle before happy messengers begin to fail. Hereditary?

Stress tolerance Yes! this is hereditary

Stress and Type A behavior are linked to what disease? -aggressive -competitive -time urgent -multitasking

CHD

What is cortisol?

Chief stress fighting hormone

Immune system is most sensitive to increased cortisol- _________________ (tumor, virus)

Natural Killer Cells

what is a risk factor for CAD?

Psychosocial stress

Where is dopamine located?

adjacent to where endorphin is released in the brain

Immune responses to stress involves what?

cortisol

What is a habitual act of picking at skin lesions, apparently driven by compulsion and psychologic factors independing of acne severity?

excoriation (acne excoriee)

symptom severity is attributed to ________________ w/ atopic dermatitis

interpersonal and family stress

The DSM5 on *Psychological factors affecting other medical conditions* states *psychological or behavioral factors negatively affect the medical condition in one or more of the following ways*:

the factors: 1. pose *additional health risks* 2. *aggravate pathophys of medical condition* (precipitate or exacerbate sx) 3. *affect course of medical condition* (bc of a close temporal relationship b/w the factors & the onset or exacerbaction of (or delayed recovery from) the medical condition)) 4. *disrupt tx* of medical condition (including not seeking medical care, nonadherence w/ follu-up visits or prescribed tx, or maladaptive modifications of tx by pt or family)

Tako cardio predilection for women? for men?

women >50 men: 10%

What are some other risks for CHD ?

Personality traits and occupation

continued stress raises or lowers cortisol?

RAISES

What areas of the body are affected by stress?

Brain & nerves muscles and joints heart stomach pancreas intestines reproductive system

What are the 2 parts of the adrenals and what kind of cells?

Cortex: true endocrine cells medulla: secretory cells

what are the 3 happy NT messengers?

Serotonin Noradrenalin Dopamine

Pain *increases* when stress causes the _________________________

Dopamine function to fail

increase in catecholamines increases what?

HR, CO, BP

tension headaches are referred to as ?

"stress headache"

Also when stress incurs on dopamine function, this can result in ________________________________

*loss of pleasure* in normally pleasurable affairs

Daily stress, and not stressful life events, worsened the clinical symptomatology _______________ by lupus erythematous patients

*perceived*

What do the neurotransmitters (NT) do in response to stress

- stressors activate noradrenergic system -release of catecholamines from ANS -Serotonergic systems in the brain are activated -Increase dopaminergic neurotransmission in mesoprefrontal pathway

What 4 conditions can stress cause/aggravate in the GI system

-GERD -PUD -UC and Crohn's

What specific personality traits put u at risk for CHD?

-angry -hostile -resentful -bitter

Stress and the endocrine system- DM

-stress in the postprandial period, significantly increases glucose concentrations in patients w/ type 2 DM -hyPOglycemia can produce severe anxiety states, confusion and disturbed behavior

GERD & stress:

-stress, anxiety & other affective conditions tend to *increase sx perception and reporting* -*concurrent* stress and anxiety can *potentiate sx*

what are some hypertension personality traits?

-upset by criticism -upset by imperfection -pent up anger, bitterness -low self-confidence

Stress and the endocrine system- Adrenal disorders

1. Spontaneous Cushing's- adrenocortical hyperfunction 2. Hypercortisolism 3. Steroid withdrawl

Stress and integumentary system

1. atopic dermatitis 2. psoriasis 3. excoriation (acne excoriee) 4. psychogenic pruritis 5. pruritus vulvae: cutaneous sensory syndromes 6. hyperhidrosis 7. urticaria 8. SLE

What does serotonin do?

1. coordinates body fxns to same rhythm 2. controls cortisol 3. Often 1st happy messenger to malfunction under stress (lack of restful sleep= usually 1st sx of overstress)

2 kinds of NT messengers that respond to stress?

1. happy 2. sad

Overview of NT, endocrine & immune responses to stress

1. life stressor 2. body perceives stressor as threat 3. ALARM- hippocampus (emotion) 4. SEAT OF EMOTIONS- Limbic system (physical response) 5. RETICULAR ACTIVATING SYSTEM- mind-body link) 6. SUPERVISOR- hypothalamus (*endocrine* and autonomic) -endocrine (hormones: cortisol & vasopressin) -autonomic (*neurotransmitter*: sympathetic=ON; parasympathetic=OFF)

recurrent psoriasis flares have attributed to stress in up to ______% of individuals

80%

Early onset psoriasis *(< ____ y/o)* may be *more or less* easily triggered than late onset disease

<40 y/o MORE easily triggered

Atopic derm and stress: stressful life events preceding the onset of disease found in _______ of patients

> 70%

increased emotional tension, fatigue, and stressful life situations may be primary factors in what percent of urticaria cases? it's contributory in what percent of patients?

>20% 68%

early presentation of tako cardio shares s/sx of ________________ including abnormalities in both the ________ and ________________

AMI ECG blood biochemical test

psoriasis= *inc/dec* stress-induced autonomic response and *extreme/diminished* pituitary adrenal activity

INCREASE stress induced autonomic response DIMINISHED pituitary adrenal activity

What's the 1st stage of general adaptation syndrome?

Alarm reaction - an *immediate reaction* to stressor - *"fight or flight"*, prepared the body for physical activity -can also decrease effectiveness of the immune system

are there significantly narrowed coronary arteries in takotsubo cardiomyopathy?

NOOOO

What's the 3rd stage of general adaptation syndrome?

Stage of Exhaustion -stress has continued for some time, stress *resistance* may gradually *reduce or may collapse quickly* -immune system & ability to resist disease may be totally eliminated (long-term stress= heart attacks or severe infections)

What's the 2nd stage of general adaptation syndrome?

Stage of Resistance/Adaptation -If stress continues, the *body adapts* to stressors it's exposed to -body changes to reduce effect of stressor (ex. starvation= person has reduced desire for activity to conserve energy)

Stress and decrease what blood count?

WBC

Endocrine system- adrenal glands are what?

adrenal glands- fused endocrine & neuroendocrine glands

body gears up for "fight or flight" by secreting what 2 hormones?

adrenalin cytokines

Stress and the Pulmonary system- what conditions are affected?

asthma hyperventilation syndrome

dysfunctional family dynamics may lead to lack of therapeutic response as well as to developmental arrest- with what condition?

atopic dermatitis

What are important adjuncts to standard therapies for psoriasis w/ stress?

biofeedback meditation hypnosis-induced relaxation behavioral techniques sx-control imagery training antidepressants

Adrenal cortex is stimulated in response to ________________. It responds to __________________ signals.

bodily stress endocrine

Adrenal medulla stimulates the release of ? from what cells?

catecholamines from the neurosecretory cells controlled by neuron signals from the brain

Cutaneous sensory syndrome patients often have _____________ or ____________

concomitant anxiety disorder or depression

Stress and CV: There's an association b/w heightened _______________ to stress and disease progression

cortisol reactivity

What is psychogenic pruritus?

cycles of stress leading to pruritus as well as of the pruritus contributing to stress

Hypercortisolism sx

depressed mood

In *men*, self excoriation is exacerbated by a coexisting______________________, while in *women* this behavior may be a manifestation of _________________

depression or anxiety immature personality

steroid withdrawl sx

depression, weakness, anorexia, emotional lability, delirium

Raised cortisol (from stress), causes immune system cells to do what?

disappear from the blood

Tako cardio usually triggered by an ___________ or __________

emotional or physically stressful event

Stress and Vascular heart disease

evidence shows anxiety and depression are associated with developing CVD but the American heart association etc doesn't consider it a factor yet

Pruritus Vulvae: Cutaneous sensory syndromes- what is it?

experience abnormal skin sensations (itching, burning, stinging, biting, crawling) that cannot be attributed to any known medical condition

What are examples of cutaneous sensory syndromes?

glossodynia vulvodynia chronic itching in the scalp

With psychogenic pruritus, stress liberates ______________, _____________, and ___________________

histamine, vasoactive neuropeptides, and mediators of inflammation

Stress and the endocrine system- Thyroid conditions what psychiatric features w/ hypER and hyPOthyroid?

hypER- nervousness, fatigue, insomnia, labile mood and dysphoria hyPO- depressed mood, apathy impaired memory -myxedema madness (auditory hallucinations and paranoia) -psychotropic agents at low doses initially bc of reduced metabolic rate

What condition causes persistent sweating brought on by emotional stimuli?

hyperhidrosis

dysfunction of the ________________ might be involved with CAD and stress

hypothalamic-pituitary-adrenal (HPA) axis

"good" prostaglandins support __________, __________, _________ and are _____________

immune function dilate blood vessels inhibit "thick" blood anti-inflammatory

Endocrine response to stress can have a profound effect on cardiovascular and respiratory systems how?

increase HR and SV dilation of bronchioles- raise the rate of oxygen being delivered to body cells

Stimulating the immune system triggers what?

inflammation

Slowed production of good prostaglandins allows for - ?

inflammation, immune suppression, etc.

psychogenic pruritus may lower the itch threshold or aggravate ________________

itch sensitivity

Stress and Neurologic system conditions?

migraines tension headaches

emotional stress can trigger a migraine with what characteristics?

more associated w/ stressful experiences than is the case for tension-type headache in adolescents

What occupation characteristics put u at higher risk for CHD?

more stressful the job= more prevalent is heart disease

what are catecholamines?

norepi and epi

hyperventilation syndrome and stress

patients often unaware they're hyperventilating soon c/o anxiety can be treated by deliberate hyperventilation 1-2 minutes then describe the syndrome to them reassuring to pts who fear they have progressive, fatal disease

so dopamine also operates as ______________ center

pleasure

what is frequently noted with atopic derm

problems in psychosocial adjustment and low self-esteem

Stress is reported in 44% of patients prior to the initial flare of ___________________

psoriasis

What is a physical disease caused by emotional stress without a microorganism involved?

psychogenic

What is this an example of? Mind changes the body's physiology so that body part breaks down- ulcers & asthma

psychogenic

psychosomatic disease may be of what 2 origins?

psychogenic (psych origin) somatogenic (cells of the body origin, as dz process)

What kind of disease are not "all in the mind"?

psychosomatic- mind & body

what do endorphins do?

regulate pain

Body clock located in a supply of ________ in the pineal gland in the brain

serotonin

What does noradrenalin do?

sets energy levels makes us feel energized!

Spontaneous cushings sx

severe depression, elation w/ or w/o psychotic features

Urticaria and stress

severe emotional stress may exacerbate preexisting urticaria

hyperhidrosis patients have what kind of symptoms?

social phobic and avoidance sx

What is a disease that results from the mind increasing the body's susceptibility to: -dz causing organisms (germs) -natural degenerative processes (cancer, arthritis)

somatogenic

What is common in patients with hyperhidrosis?

states of tension, fear, and rage are common

What is considered the major contributor to tension-type headache?

stress

What lifestyle modifications can u do to prevent CHD?

stress management "heart transplant": -forgive others & yourself -"mend fences" in relationships

Environment (sunlight, _______, ________, certain medications, and viruses) might trigger symptoms in people who are prone to getting lupus

stress, smoking

What may all contribute to the itch-scratch-itch cycle?

stress-related hemodynamic changes such as: variation in skin temp, blood flow, and sweat response

Impact of stress on development of HTN is believed to be a ____________ NS response

sympathetic

What is the *general adaptation syndrome*?

the body's short and long-term rxn to stress -physical (starvation) -emotional or mental stress (loss of loved one) 3 stage reaction

What's the endorphin link?

when dopamine fxn declines..... so does endorphin's