Medical Psychology – Lecture 1 (UNIVERSITY OF AMSTERDAM)

There are three relevant fields for medical psychology:

1. Behavioural medicine
   This field focuses on the psychobiological approach towards understanding behavioural factors in health and disease (e.g. effect of stress on immune system).
2. Health psychology
   This field focuses on primary and secondary prevention through behaviour change. It is based on theories from clinical and social psychology (e.g. interventions to promote stopping with smoking).
3. Medical psychology
   This field focuses on clinical practice and research regarding human behaviour in a medical context (e.g. effective treatments for chronic fatigue syndrome).

Secondary interventions refer to intervention for people who already have a health condition but want to prevent this condition from getting worse.

The definition of health that is used determines who is seen as ill or healthy. A definition of health can be physical (1), subjective (2), behavioural (3), functional (4), psychosocial (5), social (6) and cultural (7). Health can be seen as a continuum. Medical treatment focuses on the illness side of health whereas health promotion techniques focus on the wellness side of health.

Accurate diagnoses are more likely if it is understood how people’s experience shape perception (1), reporting of symptoms (2) and help-seeking behaviour (3). Embodied cognition states that many aspects of cognition are influenced by the bodily state.         

The medical model states that the cause of disease is determined by biological processes. This implies that the resolution of disease is also determined by biological processes. In clinical practice, this is seen as the medical doctor striving to restore biological perturbations to obtain an optimal equilibrium (e.g. depression is an imbalance of serotonin and curing depression is restoring the balance of serotonin).

Limitations of the medical model are no recognition of relevant psycho-social influences on disease (1) and there is no recognition of psychosocial dimensions of disease (2). There is a strict separation between bodily and mental functioning (i.e. dualism) and there is no consideration for non-somatic implications of disease (e.g. disease can make you depressed).

The medical model predicts that more medical expenditure will lead to a healthier population and lower mortality. There is a correlation between life expectancy and medical expenditure. However, multiple other factors influence life expectancy besides medical expenditure.

The biopsychosocial model incorporates biological, psychological and social factors. The external factors include the sociocultural environment (1), pathogenic stimuli (2) and treatment (3). The internal factors include personal history (1), psychosocial processes (2) and physiological and biochemical mechanisms (3). This model allows for a more complete understanding of the factors that can contribute to health or illness.

Limitations of the biopsychosocial model are that it is not always possible to address all illness-influencing factors (1) and the model uses circular causality while linear causality is needed for treatment planning (2).

Socio-economic status (1), general socio-political context (2), levels of gender equity (3), personality (4), ethnicity (5) and health behaviours (6) influence health. Changes in health improvements over the ages are mostly due to behavioural changes. Exercise and healthy diet reduce cancer risk (e.g. colon cancer has a 50% lowered risk).

There is a high prevalence of psychopathology in somatic disease. However, most people are very resilient. Most people can remain acting their role (e.g. parent). Role impairment is confined to people who have comorbid mental disorders along with their somatic disease. Non-compliance to taking medication is higher with comorbid mental disorders. Having a medical disease increases risk to develop psychological problems.

40-60% of mental health service users have a comorbid somatic disorder. Depression lowers treatment efficacy and increases mortality. It also increases non-compliance. Somatic disorders do not affect efficacy of psychotherapy. However, somatic disorders negatively affect the efficacy of anti-depressants.

85% of mild depression and 60% of significant depression is not recognized by a doctor or nurse. The somatic symptoms of depressed patients are poorly diagnosed.

There are several elements of medical disorders that increase the risk of mental disorders:

1. Psychosocial
   This includes trauma and loss (1), painful and debilitating aspects of treatment and disease (2), restraints on self-care, work, social and family life (3) and unpredictable and threatening nature of disease (4).
2. Psychobiological
   This includes neurological damage (1), endocrine or immune dysregulation (2) and secondary effects of medication (i.e. iatrogenic harm) (3).

The diagnosis of a serious medical disease is not a strong predictor of subsequent depression. Some types of medication can also increase the risk of mental problems. 25% of depression among older adults is caused by medication use.

Cytokine therapy appears to induce depression. There are several diseases that produce endogenous cytokines:

• Auto-immune disorders (e.g. inflammatory bowel diseases; multiple sclerosis).
• Viral and bacterial infections.
• Obesity.
• Diabetes mellitus.
• Cardiovascular diseases.

The problem with many diseases is not that the immune system is not working, it is that the immune system is working too hard.

There are several effects of glucocorticoid medication on the brain. The impact of medication and the impact of having a disease is apparent on multiple levels. Psychopathology is not the most common reason for seeking psychological counselling. The most common reasons are stress and adaptation (1), mourning (2), lifestyle change (3), fatigue (4), coping with pain (5) and relationship or sexual problems (6).

Mental well-being is a determinant of physical health. People with poor mental well-being generally have worse physical health. Pre-surgical anxiety and depressed mood predict longer hospital stays (1), lower compliance in the prescribed physical activity (2), more pain symptoms (3), more use of pain killers (4), worse physical condition (5) and more post-surgical complications (6). In addition to this, depressive symptoms predict slower wound healing.

There is a very small correlation between subjective and objective respiratory function, meaning that there is a very small correlation between symptom perception and actual illness. Quality of life can be used as a guiding principle in designing treatment and care because there is a relationship between mental and somatic health.

Epigenetics focuses on how environmental factors regulate the activity and expression of genes. Intergenerational transmission of vulnerability refers to physiological changes that can be passed on to children and are the result of environmental factors. Intersectionality refers to the idea that health is shaped by a range of demographic variables which may intersect with other variables.