2013 09 30 evening program gp 2 eric hoencamp. the fallacy of seperating somatic and psychological...
TRANSCRIPT
The fallacy of separating somatic and
psychological symptoms.
September 30 , 2013
St. Maarten
Erik Hoencamp
Two realities
• Split in classification and treatment of somatic or psychological symptoms.
• Leading to split between professionals, research, training curricula and financing of care.
• While
• They co-occur in many clinical situations.
• With regard to genetic vulnerability , environmental risk and protective factors they have the same etiological underpinning.
Conceptual background
• Gene * environment Interaction.
• Examples of disease/phenotype Depression<> Cardiovascular Disorders
Bipolar Disorder, Schizophrenia<> metabolic syndrome.
• Childhood Adversity as an environmental
factor
Current paradigm,
Gene*Environment Interaction
Genetic
vulnerability
environment environment
conception
Gene-
expression
Disease
phenotype
epigenetics
Gene*Environment Interaction
Genetic
vulnerability
environment environment
conception
Gene-
expression
Disease
phenotype
epigenetics
Childhood adversity Depression
Cardiovacular disorder.
Metabolic Syndrome
Psychosis
Depression & Cardiovascular disease
• Share genetic vulnerability and
environmental component.
• In clinical practice co-occur often , proper
treatment of depression enhances life
expectancy. (psychotherapy ,
antidepressants, treatment CVA)
• NB depends on definition Major
Depressive Disorder.
Schizophrenia
Bipolar disorder
Depression ??
Anxiety disorders ??
Diabetes
Hypertension
Cardiovascular
Etc.
Metabolic
syndrome both
cause and
consequence of
the disorder?
Life style
Medication
Environment
social
Migration,dicrimi
nation,etc
family psychological
physical
economic Childhood Adversity
Depression
Anxiety
Etc.
Cardiovascular
disease
Inflammatory
disease
etc
Affective
Physical
Sexual
Which has highest impact ???
Example how ACE
effects health
In this case
cardiovascular
disorders
So, related are
• Depression <>Cardiovascular Disorder.
(Genetic component)
• Schizophrenia /Bipolar Disorder<>
Metabolic syndrome. (Genetic component)
• Childhood Adversity (environmental
component)<> Depression
&Cardiovascular Disorder
Is there a common denominator
in the pathogenesis ?
• Epigenetic changes in gene expression
• Stress regulation functioning HPA-axis
• Aberrant Inflammatory processes
• Disruptive Bio-rhythms
• Microbiome ?
• Socio-economic risk and protective
factors.
Domains or levels of expression of pathology
Social , economic, political situation.
Life events risk and protective factors
Behaviour
Emotional , cognitive and physical well being .
Physical functioning and patho-fysiological processes
Structural and functional integrity of body >> vulnerability and/or acquired
disorders, disease.
Pathology is
perceived
here in the
social
context.
Pathology “ X “ and attributed causality.
Social , economic, political situation, Life events risk and protective factors
Behavior
Emotional , cognitive and physical well being .
Physical functioning and patho-fysiological processes
Structural and functional integrity of body >> vulnerability and/or acquired
disorders, disease.
Pathology is
perceived
here in the
social
context
Pathology X
Somatic Psychological
Pitfalls separating psychopathology and somatic
pathology
• Psychopathology implies that the
phenotype/disease is caused by
“psychological” factors.
• Somatic pathology implies that it is caused
by an underlying disease.
• Neither is true and leads to strange
situations what is a “ real “ disease
example whiplash , CFD, ..
What are practical the consequences
• Image : psychopathology, remains having a negative odium and easily leads to stigmatization and rejection. Religious, ideological and political factors play a role in these processes.
• Research and treatment: A fundamental change is needed and slowly in progress where somatic and psychological symptomatology and their relation are taken into account with regard to etiology and treatment.
• Training curricula should be adapted and give more background about both psychological and biological aspects of disease.
• Our own attitude : well intended we may contribute to stigmatization, by treating patients different with psychopathology leading to dependency and lack of self fulfillment and empowerment.
• Organization of health care services , Challenge to increase cost effectiveness of health care .
Thanks any questions ?