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Health Psych – Module 11

Resources

The Breakdown

Important

  • Comorbid disorders: These are chronic disorders where more than one condition can occur simultaneously, for example, an individual might have diabetes and hypertension, and then experience a stroke.
  • Metabolic syndrome: This is diagnosed when an individual presents with three or more of the following conditions: obesity centred around the waist, high blood pressure, low levels of high-density lipoprotein (HDL), difficulty metabolising blood sugar (pre-diabetes), and high levels of triglycerides.
  • Cynical hostility: This is considered the most dramatic type of hostility and carries the worst consequences. It is characterised by suspiciousness, resentment, antagonism, and a deep distrust of others.
  • Deadly quartet: This refers to a combination of four dangerous conditions: intra-abdominal body fat, hypertension, elevated lipids, and diabetes.

Core concepts

  • Major chronic disorders: The four principal chronic disorders discussed are heart disease, stroke, hypertension, and diabetes (Type I/II). These conditions all involve the circulatory and/or metabolic system, can be co-morbid, and possess modifiable risk factors. Importantly, they are non-communicable diseases.
  • Cardiovascular disease (CVD): This is a collective term that encompasses both heart disease and stroke.
  • Coronary Heart Disease (CHD):
    • CHD is the second leading cause of death in Canada, responsible for one in every five deaths. It is closely linked to modernisation and lifestyle. Death rates are very similar between men (20%) and women (22%), with most deaths occurring prematurely (before 75 years of age).
    • Atherosclerosis is the underlying cause of CHD, involving the narrowing of coronary arteries. This narrowing reduces oxygen supply to the heart. Temporary oxygen shortages lead to angina pectoris (stabbing chest pain), while severe deprivation results in a myocardial infarction (MI), or a heart attack.
    • An inflammatory process mediates CHD. Pro-inflammatory cytokine IL-6 is involved, stimulating the formation of atherosclerotic plaques. High levels of C-reactive protein (CRP) in the bloodstream are a strong predictor of CHD. CRP is produced in the liver, and its levels can be elevated by weight gain and low physical activity. CHD is classified as a systemic disease due to this inflammatory process.
    • Key risk factors for CHD include high blood pressure, diabetes, cigarette smoking, obesity, high serum cholesterol, and low physical activity. There is also a genetic link (family history), and the condition is exacerbated by lower socio-economic status.
    • Stress significantly contributes to CHD by damaging endothelial cells, facilitating lipid deposition, increasing inflammation, and promoting the development of atherosclerotic lesions. Acute stress, such as emotional stress, anger, extreme excitement, negative emotions, or sudden bursts of activity, can trigger angina or a heart attack. Coping with stress through hostility increases risk factors like cholesterol levels. Daily life stressors, work-related stress, and low levels of control also play a role.
    • Personal food consumption has seen a considerable increase, driven by larger serving sizes, widespread food access (e.g., fast-food, kiosks), a cultural shift making food less of a necessity and more of a culture, and stress.
    • Women and CHD: CHD is a leading cause of mortality in women. It typically occurs later in life for women, and their recovery rates are lower. Fewer women are referred to cardiologists, and fewer return to work after a heart attack. Younger women benefit from higher levels of HDL and estrogen, which diminishes sympathetic nervous system arousal. However, after menopause, the risk of CHD increases due to weight gain, elevated blood pressure, and increased cholesterol and triglycerides. Hormone-replacement therapy does not appear to reverse these effects. There is less media messaging and education about CHD targeted at women, less counselling on lifestyle changes, and women are less likely to use pharmacotherapy. They are also more prone to misdiagnosis. Risk factors are similar for both sexes, including hostility, negative attitudes (pessimism), anger combined with metabolic syndrome (leading to atherosclerosis), depression, and job-related stress. Women often report a lower quality of life after treatment and are more likely to be placed in long-term care facilities.
    • Cardiovascular Reactivity: In some individuals, stress induces vasoconstriction in peripheral areas of the heart while simultaneously increasing heart rate. This forces increased blood volume through constricted blood vessels, which eventually leads to the formation of atherosclerotic lesions and plaque. Stress and anxiety are also linked to CHD through changes in blood coagulation and fibrinolytic activity (the breakdown of blood clots).
    • Depression & CHD: Depression plays a significant role in the development and worsening of CHD. There is a strong association between depression and metabolic syndrome. Depression occurring just before a coronary event is linked to inflammation and elevated CRP. Treating depression can improve long-term recovery from coronary events.
    • Management of Heart Disease: Many patients delay seeking treatment, often due to denial of the episode, misinterpreting symptoms as mild, or attempting self-treatment. Initial medical interventions can include coronary artery bypass graft (CABG) surgery, hospitalisation with monitoring, and assessment for anxiety, depression, and PTSD. Cardiac rehabilitation involves education, lifestyle modification, symptom relief, disease severity reduction, limiting progression, promoting psychological and social adjustment, and restoring self-efficacy. Pharmacological treatments include antiplatelet agents (e.g., low-dose aspirin), beta-adrenergic blocking agents, and statins (e.g., Lipitor, Crestor) which target low-density lipoprotein (LDL) cholesterol. Managing diet, activity levels, stress, and depression are critical components of recovery. Strong social support from a spouse or family significantly improves recovery outcomes.
  • Hypertension (High Blood Pressure):
    • This condition occurs when there is high blood supply through the vessels, placing pressure on arterial walls, or due to peripheral resistance to blood flow in smaller arteries.
    • It is measured by systolic pressure (force generated by heart contraction) and diastolic pressure (pressure in arteries when the heart is relaxed). Levels are categorised as mild (140-159 systolic), moderate (160-179 systolic), or severe (>180 systolic) hypertension. High blood pressure leads to greater reactivity to stress.
    • While 5% of cases are caused by kidney failure to regulate blood pressure, 95% are attributed to modifiable factors. Risk factors include genetics, being male over 50, cultural differences, low socio-economic status, high dietary sodium intake, and emotional factors such as anger, hostility, and family environment.
    • Treatment typically involves a low-sodium diet, reduced alcohol and caffeine consumption, weight reduction and exercise, diuretics (to reduce blood volume), beta-adrenergic blockers (to decrease cardiac output), cognitive behavioural therapy, and anger management.
    • A significant issue with hypertension is that many individuals are unaware they have it in its early, symptom-less stages, and there is a high rate of non-adherence to therapy.
  • Stroke:
    • Stroke is the third leading cause of death. It involves a disturbance in blood flow to the brain.
    • The two main types are ischemic stroke, caused by a clot blocking blood flow to a localised area of the brain, and cerebral haemorrhage, which involves bleeding in the brain.
    • Recurrence rates are high, around 20%. Outcomes vary: 15% die, 10% recover completely, 25% experience minor disability, 40% moderate-to-severe disability, and 10% require long-term care.
    • Warning signs include weakness, trouble speaking, vision problems, unusual headaches, and dizziness; these symptoms depend on the specific area of the brain affected. Daily low-dose aspirin is effective in preventing coagulation and thus stroke.
    • Risk factors are similar to those for heart disease, including high blood pressure, heart disease, diet and lifestyle choices, high red blood cell count, anger expression, and transient ischemic attacks (TIAs). A TIA is a temporary blockage of blood flow to the brain, often considered a “warning stroke”.
    • Post-stroke consequences are severe, with 71% of individuals requiring assistance with daily life. Deficits can include motor problems, cognitive issues (e.g., left-brain damage leading to lower intellect and learning difficulties; right-brain damage affecting visual feedback and causing individuals to feel “crazy”), and emotional problems (e.g., left-brain damage causing anxiety and depression; right-brain damage leading to apparent indifference).
  • Diabetes:
    • Rates of diabetes are rapidly increasing in Canada, with a significant portion of the population remaining undiagnosed. It is a chronic condition characterised by either insufficient insulin secretion or insulin resistance. Insulin, produced by the beta cells of the pancreas, is essential for mediating glucose entry into cells for energy.
    • In diabetic individuals, glucose fails to enter the cells and accumulates in the blood, leading to fluctuations between hyperglycaemia (too much blood sugar) and hypoglycaemia (not enough blood sugar).
    • Type I Diabetes involves insufficient insulin secretion because the immune system attacks the beta cells in the pancreas. This type typically develops earlier in life, accounts for about 10% of cases, and requires insulin dependency. It is considered an autoimmune disease.
    • Type II Diabetes is characterised by insulin resistance, where the body does not effectively use the insulin it produces. It generally develops later in life and is strongly associated with obesity, diet, and lifestyle choices, making it a largely preventable condition. It is more common in men and linked to socio-economic factors.
    • Health implications of diabetes include the thickening of arteries (leading to CHD), reduced life expectancy, depression, sexual dysfunction, vision loss, and in severe cases, the amputation of limbs.
    • Interventions for diabetes include cognitive behavioural therapies to improve treatment adherence, crucial weight control and lifestyle modifications (such as dietary changes and increased physical activity), pharmacological management (including oral hypoglycaemic agents and insulin therapy), and self-management techniques like monitoring blood glucose levels.

Theories and Frameworks

  • Biopsychosocial (BPS) model: This framework is applied to understand complex health relationships, such as that between reactivity and hostility in CHD, emphasizing the interconnectedness of biological, psychological, and social factors. It is also highlighted in the context of heart disease management, where social support significantly influences recovery.
  • Inflammatory process: This concept is central to understanding CHD, where inflammation, triggered by various factors, leads to the production of detrimental elements like IL-6 and CRP, contributing to the disease’s progression.

Notable Individuals

  • Charles: Referenced in the context of average daily calorie intake.
  • Dave: Featured in a Campbell’s commercial to illustrate the reduction of salt content in their soup products.