Persistent Somatic Symptoms PDF

Persistent Somatic Symptoms Tuesday, 12 November 2024 1:58 pm What are physical symptoms? - Experienced 'in the body' - Subjective - May also present with objective 'signs' - Can be medically explained or unexplained ○ No identifiable disease or pathology Case study - Conversion Di...

Persistent Somatic Symptoms Tuesday, 12 November 2024 1:58 pm What are physical symptoms? - Experienced 'in the body' - Subjective - May also present with objective 'signs' - Can be medically explained or unexplained ○ No identifiable disease or pathology Case study - Conversion Disorder - An extreme case of PSS - Conversion disorder - neurology - Body's response to some underlying stress - power of mind over the body - Unconscious symptoms - Holly Longford - lost ability to speak, walk - suddenly after a collision in netball - Tests negative for everything - no one knew what it was - Challenge accepting the psychological nature of symptoms - - Wikipedia definition: A symptom is a departure from normal function or feeling, noticed by a patient - reflecting the presence of a physiological disturbance or a disease Biomedical model of illness… - Underlying disease (pathology) --> causes illness and symptoms of disease - Symptoms --> detection of disease - Sometimes its not that easy (symptoms with no diagnosed disease - then it's all in you head) - Following debunks this idea: Disease /=/ Symptoms - Studies on viral infections - look at biological markers vs self reports of symptoms - Influenza antibodies - found 75% of people with biological evidence of infection, didn't report having flu symptoms - You may have a disease but not realise it / show symptoms - Also found in : ur t Disease /=/ Symptoms - Studies on viral infections - look at biological markers vs self reports of symptoms - Influenza antibodies - found 75% of people with biological evidence of infection, didn't report having flu symptoms - You may have a disease but not realise it / show symptoms - Also found in : ○ Zika virus (80%) ○ Covid ○ HPV (80% contract, around 90% asymptomatic) ○ Genital herpes (25% US adults, 75-90% asymptomatic) ○ High blood pressure / cholesterol ○ Early stage cancers - Highlights need for screening!! May not have symptoms but need to catch disease early Symptoms also /=/ disease - Symptoms are more common than disease - Around 90% of people have 1+ symptom every week (across general population in NZ) - Psychological and social processes - role in perception of physical symptoms / experience Responding to everyday symptoms - What do people do when they have symptoms? ○ Self medicate t ) Responding to everyday symptoms - What do people do when they have symptoms? ○ Self medicate ○ Ask people/google - information seeking ○ Rest ○ Seek medical help Symptoms in medical care - Top reason for presenting to a GP - having symptoms (used as an index for our health status) - 1998 study - almost half of all visits were from 14 common symptoms - Only 10-15% found to be caused by organic illness over a year period (the rest are medically unexplained) - Organic - some biological marker of disease explaining the symptom Normal psychological Influences on symptom reporting - Attention (and beliefs/expectations) - Emotions 1. Attention to internal sensations - Competition Of Cues Hypothesis - Pennbaker & Lightner 1980 - Can pay attention to body, or the outside world - Natural state of attention is to be focused internally, but if the outside world is engaging - it pulls attention external - If paying attention to your internal state, more likely to notice symptoms  - Pennbaker & Lightner 1980 - Can pay attention to body, or the outside world - Natural state of attention is to be focused internally, but if the outside world is engaging - it pulls attention external - If paying attention to your internal state, more likely to notice symptoms Study: - Half participants ran around an indoor track, others ran outdoors - Indoor track - reported significantly more exercise symptoms (fatigue, muscle pain, breathless etc) - Authors say due to the focus of attention (less attention left directed to body when outside - more to look at/focus on) - Another study - people more likely to cough during boring lectures or videos - Interesting environment --> fewer symptoms Selective search for attention - Missed in the Competition of Cues theory… - We can direct / control out attention towards certain things - Illness schemas - broad idea of what a particular illness involves ○ E.g. influenza - fever, aches, chills, tiredness, sore throat etc - Schemas can be formed by our experience, media portrayals, information - Schemas - generate a schema-guided search process for symptoms - - Schema activated - pay more attention to body looking for particular symptoms - then you may tend to experience them ! Experimentally tested this… Fictitious Enzyme Deficiency - Thiamine Acetylase (TAA) deficiency - Gave them an illness schema - Pancreatic enzyme that can cause headache, diarrhea, back pain - Diagnosed by saliva test - BUT - solution given was glucose and test strip wsa glucose test - Half told blue strip - positive for TAA deficiency - Other half told blye strip - negative for TAA deficiency - People with 'positive' test result experienced significantly more of those symptoms - Given schema - paying more attention to them - causes symptoms to occur Distress and Symptom reporting - People high in negative affect report more physical symptoms - True in people with trait negative affect AND experimentally manipulated negative affect n Distress and Symptom reporting - People high in negative affect report more physical symptoms - True in people with trait negative affect AND experimentally manipulated negative affect - Negative emotions - anxiety, depression, anger, distress - Doesn't seem to be that there is more disease Why? 1. Distress is experienced as symptoms ○ Somatisation - direct link from emotions to physical symptoms 2. Negative bias ○ Negative mood - negative attentional bias - focus on more physical symptoms which are generally negative ○ Memory - in a negative mood you're also more likely to remember negative memories/symptoms 3. Increased self focus ○ Negative mood - attention turns inwards to yourself - more likely to notice symptoms Somatic Symptom Disorder - Excessive thoughts, feelings or behaviours related to somatic symptoms or associated health concerns ○ Disproportionate and persistent thoughts about the seriousness of one's symptoms ○ Persistently high level of anxiety about health/symptoms ○ Excessive time and energy devoted to symptoms / health concerns - Need to be persistently symptomatic for 6+ months and cause distress - Symptoms are real and can be varied - Typically no apparent underlying cause or disease - Can also be diagnosed when someone has a disease/diagnosis - but focus on symptoms is excessive or unusual for that diagnosis - Somatisation - Alexithymia ○ Difficulty identifying feelings and distinguishing feelings from associated bodily arousal ○ Unable to link/explain physical symptoms to an emotion / psychological state (e.g. my heart is racing because I'm nervous) Impact of somatic symptom disorder - Diagnosis of exclusion - Need to run many tests - reinforces belief that something is wrong  ○ Unable to link/explain physical symptoms to an emotion / psychological state (e.g. my heart is racing because I'm nervous) Impact of somatic symptom disorder - Diagnosis of exclusion - Need to run many tests - reinforces belief that something is wrong - Lack of reinforcement from negative results - Symptoms are still there - Expensive and distressing - Can be challenging to treat - belief that symptoms are coming froma disease - not psychological contributors Exam - Pain - Distinct physical symptom that often becomes persistent, after biological healing processes have occurred - "unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage" A life without pain? - Some people don't experience pain - Congenital Analgesia - Acute pain - pain in response to actual tissue damage is very important - warning that something is wrong and need to change (e.g. put hand on a hot stove) - People with congenital analgesia often die very young - injured / very ill but don't recognise it - Genetic mutation - Peripheral pain sensing neurons not working as they should - don't get pain signals  something is wrong and need to change (e.g. put hand on a hot stove) - People with congenital analgesia often die very young - injured / very ill but don't recognise it - Genetic mutation - Peripheral pain sensing neurons not working as they should - don't get pain signals Pain processing - Nociception ○ Nervous systems process of encoding impending or actual tissue damage - Pain ○ The subjective experience of actual or impending harm - 4 stages: transduction, transmission, perception, modulation - 1. Transduction - Starts at nerve endings (nociceptors) - Primary afferent neurons - sensory neurons sending messages to the brain in  1. Transduction - Starts at nerve endings (nociceptors) - Primary afferent neurons - sensory neurons sending messages to the brain in peripheral nervous system - Respond to noxious stimuli - tissue damage and inflammation - C and A delta fibres ○ A - large diameter, myelinated, fast conducting - localised/sharp/stinging / pricking/ fast pain ○ C - small diameter, unmyelinated, slow conducting - dull / diffuse/ aching/ burning / slow 2. Transmission - Nociceptors send signal through dorsal horn of spinal cord to brainstem - Brainstem distributes signal across your brain - 3. Perception - Conscious multidimensional experience - Motivational - Behavioural - Sensory-discriminative - Emotional - This is where the biomedical view of pain stops… - It says: pain severity = amount of tissue damage - It says: same injury = same amount of pain - This doesn't do a great job of explaining the pain experience - Magnitude of injury doesn't always match the pain someone's experiencing Gate Control Theory (Melzack & Wall 1965) - Biopsychosocial view of pain - Hypothetical 'gate' that can open or shut (in dorsal horn of spinal cord) ○ Open - all the pain and suffering flows through Gate Control Theory (Melzack & Wall 1965) - Biopsychosocial view of pain - Hypothetical 'gate' that can open or shut (in dorsal horn of spinal cord) ○ Open - all the pain and suffering flows through ○ Shut - won't experience pain - 'Gate' receives in put from two directions: ○ Ascending messages - biological - bottom up information (maps onto biomedica model - periphery to brain) ○ Descending messages - psychological - top down modulation 4. Modulation - Extra step - only involved in biopsychosocial view (not in biomedical model) - Can be excitatory - increase pain (gate wide open) or inhibitory - decrease pain (close gate) - Psychological factors that influence pain - Emotions ○ Negative emotion (trait or induced) experience more pain - Thoughts about pain: ○ Beliefs about cause and effect, experiences, control, self-efficacy for managing - Meaning: ○ Study using blood pressure machine ○ 1 group - negative info (painful, blocking blood flow) other group - positive info (good for muscle cells) al  - Thoughts about pain: ○ Beliefs about cause and effect, experiences, control, self-efficacy for managing - Meaning: ○ Study using blood pressure machine ○ 1 group - negative info (painful, blocking blood flow) other group - positive info (good for muscle cells) ○ Negative group could tolerate pain for much less time than positive group ○ Focusing on positive/beneficial effects - inhibited modulating effect - less pain signal sent to brain - Attention: ○ When distracted - experience significantly less pain than when paying attention to the pain experience Acute pain - Typically results from a specific injury or disease process - E.g. wound or infection - Short lived - resolves when tissue damage heals (but not always!) - Duration 3 months or less … - Psychological factors can influence the development of chronic pain from acute pain Chronic pain - Begins as acute pain - Lasts longer than 3 months - Beyond expected healing time - In excess of injury or disease Fear avoidance model - When an injury leads to pain experience - 2 pathways you may take 1. No fear - heal from injury 2. Pain catastrophising …. -  - **know for exam: Biological processes of Pain Peripheral Sensitisation - Acute Pain - Nociceptor neurons have: ○ Reduced threshold - require less stimulation to send on a pain signal ○ Augmented response - send a more dramatic pain signal ○ ^Caused by inflammatory processes at the injury site, common after injury Central Sensitisation - Chronic Pain - Neurons in dorsal horn: ○ Amplify incoming information ○ 'wind up' - persistently high reactivity - strong signals to the brain ○ Lowered pain threshold Cortical Reorganisation - Chronic Pain - Somatosensory cortex: ○ Remodels in response to repeated input (neuroplasticity) ○ Greater and more widespread activation to nociceptive(painful) input - Second two are thought to be what maintains chronic pain and are influenced by psychological factors Treating chronic pain - CBT can be helpful  - Second two are thought to be what maintains chronic pain and are influenced by psychological factors Treating chronic pain - CBT can be helpful - Educating people on the processes - Helping to tackle attention and affective mood - Restructure cognitions around pain Exam Info: