Psychosocial aspects of Hypertension and Stroke POME 1.pdf.pdf

Psychosocial Aspects of Hypertension and stroke Mosima Marole (Lecturer) School of Medicine Department of Clinical Psychology  OBJECTIVES To introduce you to the psychosocial model of patient treatment To explore hypertension & stroke as chronic diseases and some of its cau...

Psychosocial Aspects of Hypertension and stroke Mosima Marole (Lecturer) School of Medicine Department of Clinical Psychology  OBJECTIVES To introduce you to the psychosocial model of patient treatment To explore hypertension & stroke as chronic diseases and some of its causal factors linked to lifestyle, emotional and psychological wellbeing To explore some of the psychological treatment approaches to hypertension and stroke  High blood pressure (hypertension) is designated as either essential (primary) hypertension or secondary hypertension and is defined as a consistently elevated blood pressure exceeding 140/90 mm Hg. In primary hypertension (90-95%) of people with hypertension), no specific cause is found, while secondary hypertension (5-10%) of people with hypertension) is caused by an abnormality somewhere in the body, such as in the kidney, adrenal gland, or aortic artery.  Primary hypertension may run in some families and occurs more often in the black population, although the genes for essential hypertension have not yet been identified. High salt intake, obesity, lack of regular exercise, excessive alcohol or coffee intake, and smoking may all adversely affect the outlook for the health of an individual with hypertension.  High blood pressure is called "the silent killer" because it often causes no symptoms for many years, even decades, until it finally damages certain critical organs. 2 Several classes of anti-hypertensive medications are available, including ACE inhibitors, ARB drugs, beta-blockers, diuretics, calcium channel blockers, alpha-blockers, and peripheral vasodilators.  Most anti-hypertensive medications can be used alone or in combination: some are used only in combination; some are preferred over others in certain specific medical situations; and some are not to be used (contraindicated) in other situations. The goal of therapy for hypertension is to bring the blood pressure down to 140/85 in the general population and to even lower levels in diabetics and people with certain chronic kidney diseases.  Poorly controlled hypertension ultimately can cause damage to blood vessels in the eye, thickening of the heart muscle and heart attacks, hardening of the arteries (arteriosclerosis), kidney failure, and strokes. Heightened public awareness and screening of the population are necessary to detect hypertension early enough so it can be treated before critical organs are damaged.  Lifestyle adjustments in diet, exercise and compliance with medication regimes are important factors in determining the outcome for people with hypertension. Screening, diagnosing, treating, and controlling hypertension early in its course can significantly reduce the risk of developing strokes, heart attacks, or kidney failure.  Stroke It occurs when the blood supply to part of your brain is interrupted or reduced, preventing brain tissue from getting oxygen and nutrients. Brain cells begin to die in minutes. A stroke is a medical emergency, and prompt treatment is crucial. Symptoms of stroke include trouble walking, speaking and understanding, as well as paralysis or numbness of the face, arm or leg. Early action can reduce brain damage and other complications.  There are two main causes of stroke: a blocked artery (ischemic stroke) or leaking or bursting of a blood vessel (hemorrhagic stroke). Some people may have only a temporary disruption of blood flow to the brain, known as a transient ischemic attack (TIA), that doesn't cause lasting symptoms.  Ischemic stroke This is the most common type of stroke. It happens when the brain's blood vessels become narrowed or blocked, causing severely reduced blood flow (ischemia). Blocked or narrowed blood vessels are caused by fatty deposits that build up in blood vessels or by blood clots or other debris that travel through your bloodstream and lodge in the blood vessels in your brain.  Hemorrhagic stroke Hemorrhagic stroke occurs when a blood vessel in your brain leaks or ruptures. Brain hemorrhages can result from many conditions that affect your blood vessels. Factors related to hemorrhagic stroke include: Uncontrolled high blood pressure Overtreatment with blood thinners (anticoagulants) Bulges at weak spots in your blood vessel walls (aneurysms) Trauma (such as a car accident) Protein deposits in blood vessel walls that lead to weakness in the vessel wall (cerebral amyloid angiopathy) Ischemic stroke leading to hemorrhage  A transient ischemic attack (TIA) —sometimes known as a ministroke —is a temporary period of symptoms similar to those you'd have in a stroke. A TIA doesn't cause permanent damage. They're caused by a temporary decrease in blood supply to part of your brain, which may last as little as five minutes.  Risk factors Many factors can increase your stroke risk. Potentially treatable stroke risk factors include: Lifestyle risk factors Being overweight or obese Physical inactivity Heavy or binge drinking Use of illegal drugs such as cocaine and methamphetamine  Medical risk factors High blood pressure Cigarette smoking or secondhand smoke exposure High cholesterol Diabetes Obstructive sleep apnea Cardiovascular disease, including heart failure, heart defects, heart infection or abnormal heart rhythm, such as atrial fibrillation Personal or family history of stroke, heart attack or transient ischemic attack COVID-19 infection  Complications Paralysis or loss of muscle movement. Difficulty talking or swallowing. Memory loss or thinking difficulties. Emotional problems. Pain. Changes in behavior and self-care ability.  Prevention Controlling high blood pressure (hypertension). Lowering the amount of cholesterol and saturated fat in your diet. Quitting tobacco use. Managing diabetes. Maintaining a healthy weight. Eating a diet rich in fruits and vegetables. Exercising regularly. Drinking alcohol in moderation, if at all. Treating obstructive sleep apnea (OSA). Avoiding illegal drugs. Medications These include: Anti-platelet drugs. Platelets are cells in your blood that form clots. Anti-platelet drugs make these cells less sticky and less likely to clot. The most commonly used anti-platelet medication is aspirin. Anticoagulants. These drugs reduce blood clotting. Heparin is fast acting and may be used short-term in the hospital.  Implications of the diagnosis Compromised quality of life and longevity Relationship with the self Relationship with other Relationship with food and other consumables Lifestyle changes Diet Medication Exercise Adherence Psychopathology Depression Anxiety PSYCHOLOGICAL APPROACHES Blood pressure is influenced by biopsychosocial factors such as physical, environmental, emotional, cognitive and behavioral. Mostly patients with significant blood pressure presents with psychiatric complaints (anxiety & depression) and history of traumatic life events. Traumatic life events, sociodemographic characteristics, anxiety and depression disorders should be considered on hypertension management. Determinants of health Material conditions (e.g. food, housing etc. ) 1 Biological Factors(e.g. birth weight, genetics, etc.) 2 Psychological factors (e.g. stress, trauma, etc.) 3 Behavioural factors (e.g. dietary habits, smoking etc. 4 )  Multidisciplinary Team The MDT is client centred with the aim to optimize quality of The patient should receive all the care according to Rogers hypertension care conditions (empathy, UPR, congruency) Team Psychologist, dietician, physiotherapy, social worker, Physician/ medical Practitioner, Nursing staff, pharmacist community health care worker Psychoeducation Health promotion efforts to increase knowledge of hypertension in rural communities, and to address healthy life- Impact of socioeconomic status style choices.  Team based care has been scientifically proven to be more effective as it addresses the needs of the patient and aids the patient to better care for themselves and the family is involved.  Goal Collaborative care team Mental health care (Psychologist-Psychiatrist) Dietician on management First line intervention(dx & rx)  Psychologist role 1 Medication adherence & Health education 2 Change in health behaviour, substance use, diet, exercise, weight loss 3 Mental health- dealing with the depression, anxiety, stress, substance use etc. Adverse Childhood experiences Epidemic Abuse (physical, emotional, sexual) Neglect (physical, emotional) Household dysfunction (mental illness, Incarcerated family member, Divorce, mother treated violently, substance use) Positive Tolerable Toxic stress stress stress Toxic stress Constant feeling Overweight, Constant of hunger; poor hypertension, cortisol, glucose cardiovascular norepinephrine regulation; disease & & adrenalin insulin stroke intolerant Can Psychological Factors affect Health? Our behaviors and attitudes are critical in keeping us healthy, helping us regain health following illness, and helping us achieve well-being Health psychology: an area of study that integrates research on health and on psychology to promote health and well-being Well-being: a positive state that includes striving for optimal health and life satisfaction Health psychology is interdisciplinary BIOPSYCHOSOCIAL MODEL  Psychosocial Factors (Thoughts, lifestyle, stress & health beliefs) Biological characteristics (genetic Health Social conditions( environments, cultural predispositions, exposure to germs, and influences, family relationships, social brain & other nervous system development) Illness support) Socioeconomic status (unemployment, poverty)  The biopsychosocial approach was developed at Rochester decades ago by Drs. George Engel and John Romano. While traditional biomedical models of clinical medicine focus on pathophysiology and other biological approaches to disease, the biopsychosocial approach in our training programs emphasize the importance of understanding human health and illness in their fullest contexts.  Biological, psychological, and social factors exist along a continuum of natural systems, as depicted in the diagram above. Systematic consideration of psychological and social factors requires application of relevant social sciences, just as consideration of biological factors requires application of relevant natural sciences. Therefore, both the natural and social sciences are ‘basic’ to medical practice. In other words, psychological and social factors are not merely epiphenomena: they can be understood in scientific ways at their own levels as well as in regard to their biological correlates. PSYCHOLOGICAL APPROACHES Good rapport (Empathy, UPR and Congruence) Comprehensive history taking Relaxation training Biofeedback Psychotherapy Principles of psychotherapy Listening skills: Listen attentively to the client in an attempt to understand both the content of their problem, as they see it, and the emotions they are experiencing related to the problem. Do not make interpretations of the client's problems or offer any premature suggestions as to how to deal with, or solve the issues presented. Listen and try to understand the concerns being presented. Most people want and need to be heard and understood, not advised.  Resistance: Changing human behavior is not usually a linear, direct, and logical process. Respect: No matter how peculiar, strange, disturbed, weird, or utterly different from you that the client is, they must be treated with respect! Without this basic element successful therapy is impossible. Empathy and Positive Regard: Based on the writings of Carl Rogers, these two principles go along with respect and effective listening skills. Empathy requires you to listen and understand the feelings and perspective of the other person (in this case your client) Positive regard is an aspect of respect. Rogers calls this "unconditional positive regard" and some therapists feel that this may be a bit too much to ask that it be "unconditional." Would you say that treating the client with respect should be sufficient? Clarification, confrontation, interpretation: These are techniques of therapeutic intervention that are more advanced, although clarification is useful even at a basic level. Clarification is an attempt by the therapist to restate what the client is either saying or feeling, so the client may learn something or understand the issue better. Confrontation and interpretation are more advanced principles, and we won't go into them except to mention their existence. Transference and Countertransference: This is a process wherein the client feels things and has perceptions of the therapist that rightly belong to other people in the client's life, either past or present. It is a process somewhat related to projection. Understanding transference reactions can help the client gain understanding of important aspects of their emotional life. Countertransference refers to the emotional and perceptional reactions the therapist has towards the client that rightly belong to other significant people in the therapists life. It is important for the therapist to understand and manage their countertransference.  All of the above therapeutic principles can work effectively in people who are already diagnosed with hypertension and when raising awareness at either an individual level or group level.