Week 1ii. Psychology and Medicine PDF

MED 104-Medical Psychology Psychology and Medicine Dr Stelios Georgiades, AFBP’sS, C.Psychol, Associate Professor of Clinical Psychology  Learning Objectives 1. Ou...

MED 104-Medical Psychology Psychology and Medicine Dr Stelios Georgiades, AFBP’sS, C.Psychol, Associate Professor of Clinical Psychology  Learning Objectives 1. Outline the differences between the Biomedical and the Biopsychosocial Approaches to Medicine. The view that Psychology is not real Medicine led to the development and the application of the Biomedical Approach in Medicine rather than the Biopsychosocial Approach The Biomedical Approach assumes that all disease can be explained in terms of physiological processes and therefore the treatment acts on the disease and not on the person. There is a linear progression of causality from the pathogen to the person and not from the person to the disease. Psychological and social processes are considered as separate and incidental and this approach does not consider the person as a whole. This view although dominated medicine and led to great advantages it has also been criticised for many reasons, in particular that it does not consider the influence of, Social factors and Psychological factors … in health. The Biopsychosocial Model The Biopsychosocial Model proposed by Engel (1977) is a framework that takes into account the effect of biological, psychological and social factors. This approach was subsequently expanded to include factors such as ethnicity and culture. In this approach personal (or internal) and external factors have a great impact on health. Internal Factors: Personal History Ethnicity, genetic make-up, learnt behaviours, developmental processes, previous illnesses etc. This in turn influence psychosocial processes such as lifestyle, personality, sociability, perception of symptoms, behaviour etc.. Psychosocial Processes Personal history in turn influence psychosocial processes such as lifestyle, personality, sociability, perception of symptoms, behaviour etc.. Physiological and Biochemical Mechanisms. Historically, the influence of social factors on population health is clear. Example: Infectious Diseases Outburst of Cholera in London. Although the significant and steady reduction of deaths as a result of the disease can be attributed to the development of effective vaccines, one can also observe that the reduction of deaths started to occur long before the introduction of these vaccines. ??? WHY ???  The observation that cholera outbreaks clustered around particular water supplies in London led to a better understanding of the cause and transmission of cholera as well as to social changes such as improved water supply and sanitation. As it can be seen, biomedical or public health knowledge provided the impetus for social change. That shows that the reduction of cholera and other diseases cannot be explained on a purely biomedical basis as social factors and social awareness played a significant role in the reduction of the disease. Social factors are as important today as they where then. One of the most consistent findings from public health research is the influence of social class on health. People in lower social classes are at more risk of illness (morbidity) or death (mortality) from a variety of causes. This increased risk is partly due to differences in lifestyles. Examples: People in lower social classes have a poorer diet, harder working and living conditions, and are more likely to smoke. One in four deaths from cancer in UK are estimated to be due to unhealthy diets and obesity. The Example of Diet and Colorectal Cancer According to the later figures published by GLOBOCAN (2012) colorectal cancer (CRC) is considered one of the most serious forms of cancer constituting approximately 20% of all cancer sufferers. Taking into consideration the high incidence and prevalence of the disease combined with the high mortality rates (Johnson et al, 2013), scientific research in the area has produced numerous research studies aiming to identify that factors that potentially contribute to the development of this type of cancer. In this search, although several factors were investigated one factor that is consistently shown to play a role in the development of the disease is that of diet. The Example of Diet and Colorectal Cancer (cont.) There is strong evidence pointing out that some dietary habits facilitate the onset of CRC where as others seems to protect people against it. The evidence seems to indicate that specific dietary patterns may be associated with higher risk for developing colorectal cancer as opposed to others that appear either to reduce the risk or even to protect the individuals against this type of cancer. Conclusion: Changing life style and dietary habits leads to a reduced risk for developing this type of cancer. Life style is undoubtedly important in health but one has to take into consideration that it is not only life style that is important. Individual factors such as personality, health behaviour and beliefs also affect health. Example: Individuals who are high on the personality trait of conscientiousness are less likely to engage in risky behaviours and more likely to engage in positive health behaviours that contribute to longer living. Stress and depression are strongly implicated in a range of illnesses including cardiovascular disease where evidence suggests that both these factors are associated with the onset of the disease. The case of Anne. A 50 year old lady with high level of cholesterol and high blood pressure. Her high levels of blood pressure could be due High levels of cholesterol Smoking Demanding job Lack of support at home Perfectionist tendencies – stress If we look at this case on the basis of the biomedical model, theoretically, reducing her cholesterol levels should solve her problem. But would it? Imagine if Anne together with the cholesterol reducing drugs she - is offered the opportunity to change her diet patterns, - is assisted to give up smoking, - learns how to manage her stress and - is guided towards a more balanced way of living. The first approach is the Biomedical approach. The second is the Biopsychosocial Approach. The Biopsychosocial Approach takes a more holistic view of the person in relation to the disease. And In many respects is an improved version of the biomedical model in that it takes into account the multiple factors involved in health.