Health and Health-Related Behavior

-Behavioral Medicine: Interdisciplinary approach applying behavioral science to the prevention, diagnosis, and treatment of medical problems. Also known as psychosomatic medicine.

-Health Psychology: Subfield of behavioral medicine that studies psychological factors important in health promotion and maintenance.

-Psychological and social factors influence health and physical problems in two distinct ways. First, they can affect the basic biological processes that lead to illness and disease. Second, long-standing behavior patterns may put people at risk to develop certain physical disorders. Sometimes both these avenues contribute to the etiology or maintenance of disease

General Adaptation syndrome (GAS)

-Sequence of reactions to sustained stress described by Hans Selye. These stages are alarm, resistance, and exhaustion, which may lead to death.

-Stress: Body's physiological response to a stressor, which is any event or change that requires adaptation

Hypothalamic–Pituitary (Adrenocortical (HPA) axis)

-Activity of the endocrine system increases when we are stressed through activation of the hypothalamic–pituitary–adrenocortical (HPA) axis

-HPA axis is closely related to the limbic system

Neuromodulators or Neuropeptides

Hormones affecting the nervous system that are secreted by the glands directly into the bloodstream

-Act much like neurotransmitters in carrying the brain's messages to various parts of the body

-Corticotropin-releasing factor (CRF) (neurohormones): secreted by the hypothalamus and stimulates the pituitary gland.

Cortisol

-Below the corticotropin, down the chain of the HPA axis, the pituitary gland (along with the autonomic nervous system) activates the adrenal gland, which secretes, among other things, the hormone cortisol.

-Because of a close relationship to the stress response, cortisol and other related hormones are known as the stress hormones.

Hippocampus

-Control our emotional memories

-The hippocampus is responsive to cortisol

-The hypothalamus, at the top of the brain stem, is next to the limbic system and contains the hippocampus

-When stimulated by this hormone during HPA axis activity, the hippocampus helps to turn off the stress response, completing a feedback loop between the limbic system and the various parts of the HPA axis.

-If hippocampal activity is compromised, excessive cortisol is secreted and, over time, the ability to turn off the stress response decreases, which leads to further aging of the hippocampus

-Chronic Stress-chronic secretion of cortisol may have long-lasting effects on physical function, including brain damage. Cell death may, in turn, lead to deficient problem-solving abilities among the aged and, ultimately, dementia

Stress, Anxiety, Depression, and Excitement

Self-efficacy- perception of having the ability to cope with stress or challenges

Immune system- body's means of identifying and eliminating any foreign materials (for example, bacteria, parasites, and even transplanted organs) that enter

- Humans under stress show clearly increased rates of infectious diseases, including colds, herpes, and mononucleosis

AIDS

AIDS-related complex (ARC)-group of minor health problems such as weight loss, fever, and night sweats that appears after HIV infection but before development of full-blown AIDS

- High levels of stress and depression and low levels of social support have been associated with a faster progression to disease

Cancer

-Category of often-fatal medical conditions involving abnormal cell growth and malignancy

Psycho-oncology- study of psychological factors involved in the course and treatment of cancer

Cardiovascular system

-Comprise of the heart, blood vessels, and complex control mechanisms for regulating their function

Cardiovascular disease- afflictions in the mechanisms, including the heart, blood vessels, and their controllers, responsible for transporting blood to the body's tissues and organs. Psychological factors may play important roles in such diseases and their treatments

Cerebral vascular accident (CVA)(Stroke)- temporary blockage of blood vessels supplying the brain, or a rupture of vessels in the brain, resulting in temporary or permanent loss of brain functioning

Coronary heart disease (CHD)

-Blockage of the arteries supplying blood to the heart muscle; a major cause of death in Western culture, with social and psychological factors involved

-Angina pectoris- chest pain resulting from partial obstruction of the arteries

-Atherosclerosis-occurs when a fatty substance or plaque builds up inside the arteries and causes an obstruction

-Myocardial infarction(heart attack)- is the death of heart tissue when a specific artery becomes clogged with plaque

Type A and B Behaviors

Type A behavior pattern- cluster of behaviors including excessive competitiveness, time-pressured impatience, accelerated speech, and anger, originally thought to promote high risk for heart disease.

Type B behavior pattern- cluster of behaviors including a relaxed attitude, indifference to time pressure, and less forceful ambition; originally thought to promote low risk for heart disease

Fight and Flight

Fight- is the typical behavioral action tendency associated with anger

Flight (escape)- is associated with fear

Chronic Pain

-Enduring pain that does not decrease over time; may occur in muscles, joints, and the lower back; and may be caused by enlarged blood vessels or degenerating or cancerous tissue. Other significant factors are social and psychological.

-Cause of chronic pain and the resulting enormous drain on our health-care system are substantially psychological and social

Pain behaviors- include changing the way one sits or walks, continually complaining about pain to others, grimacing, and, most important, avoiding various activities, particularly those involving work or leisure

Acute pain- pain that typically follows an injury and disappears once the injury heals or is effectively treated

Gate Control Theory of Pain

Accommodates both psychological and physical factors. According to this theory, nerve impulses from painful stimuli make their way to the spinal column and from there to the brain. An area called the dorsal horns of the spinal column acts as a “gate” and may open and transmit sensations of pain if the stimulation is sufficiently intense. Specific nerve fibers referred to as small fibers (A-delta and C fibers) and large fibers (A-beta fibers) determine the pattern, and the intensity, of the stimulation. Small fibers tend to open the gate, thereby increasing the transmission of painful stimuli, whereas large fibers tend to close the gate

Endogenous (natural) opioids

-Endogenous opioids Substance occurring naturally throughout the body that functions like a neurotransmitter to shut down pain sensation even in the presence of marked tissue damage. These opioids may contribute to psychological problems such as eating disorders. Also known as an endorphin or enkephalin.

- Drugs such as heroin and morphine are manufactured from opioid substances

Chronic fatigue syndrome (CFS)

-Incapacitating exhaustion following only minimal exertion, accompanied by fever, headaches, muscle and joint pain, depression, and anxiety.

-Attributed to various causes including viral infection—specifically the Epstein-Barr virus

(1) Clinically evaluated, medically unexplained fatigue of at least 6 months duration that is

            -Of new onset (not lifelong)

            -Not resulting from ongoing exertion

            -Not substantially alleviated by rest

            -A substantial reduction in previous level of activities

(2) The occurrence of four or more of the following symptoms

            -Subjective memory impairment

            -Sore throat

            -Tender lymph nodes

            -Muscle pain

-Joint pain

            -Headache

            -Unrefreshing sleep

            -Postexertional malaise lasting more than 24 hours

Relaxation and Meditation

-Transcendental meditation- attention is focused solely on a repeated syllable, or the mantra.

Relaxation response- active components of meditation methods, including repetitive thoughts of a sound to reduce distracting thoughts and closing the mind to other intruding thoughts, that decrease the flow of stress hormones and neurotransmitters and cause a feeling of calm

Biofeedback

Use of physiological monitoring equipment to make individuals aware of their own bodily functions, such as blood pressure or brain waves, that they cannot normally access, with the purpose of controlling these functions.

Bulimia nervosa (Shame)

-An eating disorder involving recurrent episodes of uncontrolled excessive (binge) eating followed by compensatory actions to remove the food (for example, deliberate vomiting, laxative abuse, and excessive exercise).

Binge- A relatively brief episode of uncontrolled, excessive consumption, usually of food or alcohol

-Features of bulimia nervosa include the following:

• Recurrent episodes of binge eating, characterized by an abnormally large intake of food within a 2-hour period, combined with a sense of lack of control over eating during these episodes
• Recurrent, inappropriate compensatory behavior to prevent weight gain, such as self-induced vomiting, misuse of laxatives, fasting, or excessive exercising
• On average, bingeing and inappropriate compensatory behaviors occur at least twice a week for at least 3 months
• Excessive preoccupation with body shape and weight

-Salivary gland enlargement caused by repeated vomiting, which gives the face a chubby appearance

-Repeated vomiting also may erode the dental enamel on the inner surface of the front teeth and tear the esophagus

-Vomiting may upset the chemical balance of bodily fluids, including sodium and potassium levels, electrolyte imbalance

-Vomit when person does not want to vomit

-Laxatives causes damage to intestines

-Antidepressants Medication

-CBT- Cognitive Behavioral Therapy (works faster than IPT)

-Small meals with monitoring

-Cognitive Restructuring-change the way patient think

-IPT-Interpersonal Therapy (catches up and more effective than CBT

Anorexia nervosa (nervous loss of appetite)

-An eating disorder characterized by recurrent food refusal, leading to dangerously low body weight.

Features of anorexia nervosa include the following:

• Refusal to maintain body weight at or above a minimally normal level
• Intense fear of gaining weight
• Inappropriate evaluation of one's weight or shape or denial of the seriousness of the current low body weight
• Amenorrhea

Highest Death Rate

-Cessation of menstruation (amenorrhea)

-Other medical signs and symptoms of anorexia include dry skin, brittle hair or nails, and sensitivity to or intolerance of cold temperatures

-Common to see lanugo, downy hair on the limbs and cheeks

-Cardiac arrest

-Kidney failure

-Osteoporosis

-No Medication treatment exists

-Cognitive Restructuring- change the way the patient thinks

-Family Therapy (extremely effective) (change family perspective)

-Hospitalization (if body fat is under 70% of the norm

Binge-eating disorder (BED)

-A pattern of eating involving distress-inducing binges not followed by purging behaviors; being considered as a new DSM diagnostic category.

Purging techniques- n the eating disorder bulimia nervosa, the self-induced vomiting or laxative abuse used to compensate for excessive food ingestion.

Males (Reverse Anorexia)

-Men with this syndrome reported they were extremely concerned about looking small, even though they were muscular

-Many of these men avoided beaches, locker rooms, and other places where their bodies might be seen

-Prone to using anabolic– androgenic steroids to bulk up, risking both the medical and the psychological consequences of taking steroids

Biological Dimensions to Eating Disorders

-Eating disorders run in families and thus seem to have a genetic component

-Relatives of patients with eating disorders are 4 to 5 times more likely than the general population to develop eating disorders

- An emerging consensus is that genetic makeup is about half of the equation among causes of anorexia and bulimia

--Gay Men and ballet dancers are greatly effected because of culture

-Low Serotonin (depression)

Dyssomnias

-A problem in getting to sleep or in obtaining sleep of sufficient quality

Parasomnias

-An abnormal behavior such as a nightmare or sleepwalking that occurs during sleep.

Polysomnographic (PSG) evaluation

-An assessment of sleep disorders in which a client sleeping in the lab is monitored for heart, muscle, respiration, brain wave, and other functions

-Being monitored on a number of measures, including respiration and oxygen desaturation (a measure of airflow); leg movements; brain wave activity,; eye movements, muscle movements and heart activity, measured by an electrocardiogram

Actigraph-a small electronic device that is worn on the wrist like a watch and records body movements. This device can be used to record sleep–wake cycles.

-Records the number of arm movements, and the data can be downloaded into a computer to determine the length and quality of sleep

Sleep efficiency (SE)- the percentage of time actually spent sleeping of the total time spent in bed

Insomnia (not sleeping)

-One of the most common sleep disorders. You may picture someone with insomnia as being awake all the time

-Microsleeps- the short, seconds-long periods of sleep that occurs when someone has been deprived of sleep

-Primary insomnia- a difficulty in initiating, maintaining, or gaining from sleep; not related to other medical or psychological problems.

-Features of primary insomnia include the following:

• Difficulty initiating or maintaining sleep, or nonrestorative sleep, for at least 1 month
• The sleep disturbance (or associated daytime fatigue) causes clinically significant distress or impairment in functioning
• The sleep disturbance does not occur exclusively during the course of narcolepsy, a breathing-related sleep disorder, a circadian rhythm sleep disorder, or a parasomnia
• The disturbance does not occur exclusively during the course of another mental disorder
• The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition

Rebound insomnia

In a person with insomnia, the worsened sleep problems that can occur when medications are used to treat insomnia and then withdrawn.

Primary Hypersomnia

Features of primary hypersomnia include the following:

• Excessive sleepiness for at least 1 month (or less if recurrent) as evidenced by either prolonged sleep episodes or daytime sleep episodes that occur almost daily
• The excessive sleepiness causes clinically significant distress or impairment in functioning
• The excessive sleepiness is not better accounted for by insomnia, does not occur exclusively during the course of another sleep disorder, and cannot be accounted for by an inadequate amount of sleep
• The disturbance does not occur exclusively during the course of another mental disorder
• The disturbance is not due to the direct physiological effects of a substance or a general medical condition

Sleep apnea- a disorder involving brief periods when breathing ceases during sleep.

Narcolepsy

The sleep disorder involving sudden and irresistible sleep attacks.

Features of narcolepsy include the following:

• Irresistible attacks of refreshing sleep that occur daily over at least 3 months
• The presence of one or both of the following:

-Cataplexy (i.e., brief episodes of sudden bilateral loss of muscle tone, most often in association with intense emotion)

-Recurrent intrusions of elements of rapid eye movement (REM) sleep into the transition between sleep and wakefulness, as manifested by either hypnopompic or hypnagogic hallucinations or sleep paralysis at the beginning or end of sleep episodes

• The disturbance is not due to the direct physiological effects of a substance or another general medical condition

Breathing-related sleep disorders

-A sleep disruption leading to excessive sleepiness or insomnia, caused by a breathing problem such as interrupted (sleep apnea) or labored (hypoventilation) breathing.

-Features of breathing-related sleep disorders include the following:

• Sleep disruption, leading to excessive sleepiness or insomnia, that is judged to be due to a sleep-related breathing condition (e.g., obstructive or central sleep apnea syndrome, central alveolar hypoventilation syndrome)
• The disruption is not better accounted for by another mental disorder and is not due to the direct physiological effects of a substance or another general medical condition

Circadian Rhythm Sleep Disorders (Formerly Sleep–Wake Schedule Disorders)

-A sleep disturbance resulting in sleepiness or insomnia, caused by the body’s inability to synchronize its sleep patterns with the current pattern of day and night.

-Features of circadian rhythm sleep disorders include the following:

• A persistent or recurrent pattern of sleep disruption leading to excessive sleepiness or insomnia that is due to a mismatch between the sleep–wake schedule required by a person's environment and his or her circadian sleep–wake pattern
• The sleep disturbance causes clinically significant distress or impairment in functioning
• The disturbance does not occur exclusively during the course of another sleep disorder or other mental disorder
• The disturbance is not due to the direct physiological effects of a substance or a general medical condition

Medical Treatments for Sleep Disorders

-Benzodiazepine or related medications, which include short-acting drugs such as triazolam (Halcion), zaleplon (Sonata), and zolpi-dem (Ambien) and long-acting drugs such as flurazepam (Dalmane)

- Benzodiazepine medications can cause excessive sleepiness

- People can easily become dependent on them and rather easily misuse them

-Longer use can cause dependence and rebound insomnia

-To help people with hypersomnia or narcolepsy, physicians usually prescribe a stimulant such as methylphenidate (Ritalin, the medication Ann was taking) or modafinil

- The gold standard for the treatment of obstructive sleep apnea involves the use of a mechanical device—called the continuous positive air pressure (CPAP) machine

Nightmare

-A frightening and anxiety-provoking dream occurring during rapid eye movement sleep. The individual recalls the bad dream and recovers alertness and orientation quickly

-Nightmares are defined as disturbing dreams that awaken the sleeper; bad dreams are those that do not awaken the person experiencing them

-Features of nightmare disorder include the following:

• Repeated awakenings from the major sleep period or naps with detailed recall of extended and extremely frightening dreams, generally during the second half of the sleep period
• On awakening from the frightening dreams, the person rapidly becomes oriented and alert
• The dream experience, or the sleep disturbance resulting from the awakening, causes significant distress or impairment in functioning
• Nightmares do not occur exclusively during the course of another mental disorder and are not due to the direct physiological effects of a substance or a general medical condition

-One approach to reducing chronic sleep terrors is the use of scheduled awakenings

Sleep terrors

-An episode of apparent awakening from sleep, accompanied by signs of panic and followed by disorientation and amnesia for the incident. Sleep terrors occur during nonrapid eye movement sleep and so do not involve

-Occur during NREM sleep and therefore are not caused by frightening dreams

- Children do not remember sleep terrors, despite their often dramatic effect

Features of sleep terror disorder include the following:

• Recurrent episodes of abrupt awakening from sleep, usually occurring during the first third of the major sleep episode and beginning with a panicky scream
• Intense fear and signs of autonomic arousal, such as tachycardia, rapid breathing, and sweating, during each episode
• Relative unresponsiveness to efforts of others to comfort the person during the episode
• No detailed dream is recalled, and there is amnesia for the episode
• The episodes cause clinically significant distress or impairment in functioning
• The disturbance is not due to the direct physiological effects of a substance or a general medical condition

Sleepwalking (Somnambulism)

-Parasomnia that involves leaving the bed during nonrapid eye movement sleep. See also somnambulism.

- This parasomnia typically occurs during the first few hours while a person is in the deep stages of sleep