Chapter 14: Heart Disease, Stroke, Cancer, and Aids: Causes, Management and Coping

Coronary heart disease

Refers to illnesses that result from the narrowing and blocking of the coronary arteries, which supply the heart with oxygen‐rich blood.

Angina pectoris

A condition marked by chest pain that generally results from a brief or incomplete blockage of the blood supply to heart tissue.

Ischemia

Lack of sufficient oxygen available to the muscular portion of the heart. Some ischemia is "silent" in that it occurs without pain.

Myocardial infarction

Damage to the heart muscle (myocar- dium) that results from severe or prolonged blockage of blood

supply to the tissue. Commonly called a heart attack.

What are the symptoms of a heart attack?

␣␣ Uncomfortable pressure, fullness, squeezing, or pain in the centre of the chest that lasts for more than a few minutes

␣␣ Pain or discomfort spreading to the shoulders, neck, jaw, or arms

␣␣ Shortness of breath ␣␣ Possiblelightheadedness,fainting,sweating,ornausea

Congestive heart failure

A condition in which the heart's capacity to pump can no longer meet the body's needs, and the individuals become short of breath with little exertion. In this often disabling condition, the heart may become enlarged from being overworked, and the lungs often become congested with fluid.

What are the age, gender and socio-cultural risk factors for heart disease?

- The prevalence rates increase as people get older, particularly after about 45 years of age

- Given higher rates of hypertension and type 2 diabetes, Canada's First Nations, Inuit, and Metis populations are all at greater risk of heart disease and stroke

- Rates of heart disease are also higher among African Americans than White Americans

- cross-cultural study found that men and women in Russia have extremely high death rates from cardiovascular disease, while French and Japanese have very low rates

What are lifestyle and biological risk factors of heart disease?

- Family history relates to genetic factors, and researchers are finding genes that affect cardiovascular disease risk

- hypertension is a major risk for heart disease - heart biomes enlarged and has difficulties

- high blood pressure increase the development of atherosclerosis increasing risk of myocardial infarction and coronary death

- High LDL with low HDL was the strongest risk factor and smoking second

- Next most important factors are stress, obesity, diabetes, and hypertension

- Being physically fit, being normal weight, and not smoking—can reduce your chances of heart disease by over 50%

What are the psychosocial risk factors of heart disease?

- High levels of negative emotions, such as anger, depression, or anxiety, are more likely than others to develop heart disease. Same emotional traits increase the risk of having a heart attack or dying form the disease.

- People ten to have less healthful lifestyles when they experience negative emotions

- negative emotions have psychosocial effects that promote heart disease (angry individuals showing physiological reactivity)

- shared genetic factors might increase vulnerability to both heart disease and negative emotions

- people with optimism are less likely to suffer from coronary disease

- People with high levels of social support are less likely to develop coronary disease and less likely to die from it if they already have it

- Conflict and disruption, such as divorce or separation, in close rela- tionships have the opposite effects on the initial develop- ment and outcome of coronary disease, raising risk

- Job stress also increases the chances of developing heart disease, and for having a second and possibly fatal heart attack

- episodes of strong emotion can precipitate a heart attack or potentially fatal heart rhythm

- psychosocial risk factors may delay seeking medical care during the early minutes of an unfolding heart attack

What is the initial treatment for a heart attack?

- thrombolytic drugs which prevent myocardial damage if administer within three hours or so after the attack begins

- Most patients are then placed in coronary care units, where medical staff can monitor their physiological func- tioning closely

- Many of these people cope with this crisis through denial, and those who use denial tend to be less anxious in the first few days than those who do not

- Excessive anxiety, depression, or denial can impair recovery, and psychological intervention may be needed

- A rehabilitation program generally begins when cardiac patients are transferred to a general ward.

Describe the rehabilitation of cardiac patients.

- These programs provide patients with information on such topics as lifestyle changes and restrictions they should follow, medications to take, and symptoms to expect.

- To reduce the likelihood of another infarction, most cardiac patients receive advice on lifestyle changes, such as to quit smoking, lose weight, exercise, reduce dietary fat and cholesterol, reduce high alcohol consumption

- Patients who participate in prevention pro- grams consisting of education and counselling for lifestyle changes and supervised exercise and stress management do in fact experience better health outcomes, better func- tioning, and lower emotional distress than others who receive standard medical care

- Exercise‐based rehabilitation programs for heart patients have well‐documented ben- efits for health and emotional well‐being; most import- antly, these programs reduce the risk of additional and potentially fatal heart attacks

- Cognitive-behavioural programs to enhance patients' self‐efficacy and skills in problem solving and relapse prevention can improve their likelihood of continuing to exercise through the first year

- Flexibility and convenience of home‐based programs may help patients achieve better adherence.

- Interventions for smoking cessation are effective for heart patients, especially intensive approaches that include behaviour therapy and follow‐up support

- Dietary changes to reduce fat and cholesterol

- Women are less likely to participate in cardiac rehabilitation than are men due to perceived barriers

Describe the psychosocial impact of heart disease.

- The more cardiac patients believe at the start of treatment that they will recover, the more likely they are to function well a year later and achieve long‐term survival .

- Being able to work has a special meaning to individuals who suffer from chronic health problems, and heart attack survivors often view going back to work as an important sign that they are recovering.

- Patients who are depressed or describe their jobs as stressful are more likely than others to delay or fail to go back to work

- Many heart patients, family difficulties—such as quar- relling over financial or sexual problems—existed prior to the infarction, and these difficulties tend to become worse

- Families have an enormous impact on the process of cardiac rehabilitation; patients adjust better, adhere more closely to their regimens, and recover sooner if their efforts receive family encouragement.

- Danger that families will promote cardiac invalidism, in which people with heart disease become increasingly dependent and helpless.

- family members increase their estimates of the physical ability of cardiac patients by seeing and personally experiencing the level of exertion the patients can perform safely

- The more similar the patient's and spouse's positive ideas about heart disease, such as of its timeline and consequences, the better the patient's physical and psychosocial functioning months later

- If very high levels of anxiety and depression continue beyond a few months, these emotions become signs of poor adaptation and tend to be linked to decreased adherence to the cardiac regimen, low quality of life, deterioration in the person's physical condition, and increased risk of recurrent cardiac events

What are the psychosocial interventions for heart disease?

- Health and regimen education, psychosocial counselling, stress management, or combinations of these approaches, to improve their com- pliance with the cardiac regimen, enhance their adjust- ment to the illness, and reduce their risk of future cardiac problems.

- Interventions were effective in reducing mortality for men but not women, the results of subsequent research suggest that cognitive-behavioural interventions reduce subsequent heart problems and death in women

- Standard psychological treatments, such as cognitive-behavioural therapy, are effective in reducing depression in heart patients

- Anger and hostility treatment is effective in reducing anger and risk of future cardiac events

- Changes in lifestyle can halt and possibly reverse the progression of atherosclerosis

- Effective cardiac rehabilitation programs have individuals adhere to regimens of exercise, diet, medication, and stress management

Stroke

A condition in which damage occurs in an area of the brain when the blood supply to that area is disrupted, depriving it of oxygen.

What are the symptoms of a stroke?

␣␣ Sudden numbness or weakness of the face, arm, or leg,

especially on one side of the body

␣␣ Sudden confusion, trouble speaking or understanding

␣␣ Sudden trouble seeing in one or both eyes

␣␣ Sudden trouble walking, dizziness, loss of balance or

coordination

␣␣ Sudden, severe headache with no known cause

What are the causes of stroke?

In an ischemic stroke, damage results when the blood supply in a cerebral artery is sharply reduced or cut off, similar to atherosclerosis and myocardial infarction in coronary disease, except it damages the brain rather than the heart. In a hemorrhagic stroke, a blood vessel ruptures and bleeds into the brain. A stroke caused by a hemorrhage generally occurs rapidly and causes the person to lose conscious- ness; most of the damage it produces happens in a few minutes.

What are the age, gender, and socio-cultural risk factors for stroke?

- The incidence of stroke is very low prior to the middle‐age years; from then on, its death rates nearly triple in each successive decade of life

- The incidence of stroke is very low prior to the middle‐age years; from then on, its death rates nearly triple in each successive decade of life

- higher rates of stroke occur among Canada's Aboriginal peoples, African Canadians, and South Asian Canadians; among American men and women, stroke death rates are far higher for Blacks than for Whites.

What are the lifestyle and biological risk factors for stroke?

␣␣ High blood pressure

␣␣ Cigarette smoking

␣␣ Cardiovascular disease, diabetes, and their risk factors, such as high cholesterol, obesity, and physical inactivity

␣␣ Family history of stroke

␣␣ Atrial fibrillation, a form of heart arrhythmia

␣␣ Drug or alcohol abuse

␣␣ "Mini‐strokes" called transient ischemic attacks that may occur one or more times before a full stroke

- Negative emotions and stress also appear to be involved. Studies have found that people who are depressed are more likely than others to develop a stroke and die from one in the next two decades

- Job stress also has been found to predict risk of stroke

What are the effects of strokes?

People who survive moderate or severe strokes generally suffer some degree of motor, sensory, cognitive, or speech impairment as a result of the brain damage. If enough cells are affected, the functions controlled by the damaged area of the brain can be severely disrupted.

What is the rehabilitation for stroke?

Medical treatment and physical, occupational, and speech therapy can help patients regain some of the functions they lost.

- Biofeedback and intensive physical therapy can markedly improve motor function in stroke survivors.

What are the psychosocial aspects to stroke?

- Denial seems to be more common among patients who have had strokes than those with heart disease or cancer

- stroke patients who feel a sense of control over their condition at the end of the first month show better recovery months later than others do.

- Stroke patients are very prone to depression

- As patients see the gains in recovery slowing down and begin to realize the extent of their impairment, they may feel hopeless and helpless.

- Some stroke survivors who do not return to work are old enough to retire early with pensions, but others must leave the workforce under less favourable circumstances, which can be financially and emotionally trying

- Some families adjust well, but other families do not adjust well to the changing role relationships, and marital harmony often declines

- The decrease in social and leisure activities worsens with the extent of the person's disability, it is often substantial even when the person has made a good recovery

Cancer

A disease of the cells characterized by uncontrolled cell proliferation that usually forms a malignant neoplasm.

What are the five types of cancer?

␣␣ Carcinomas, which are malignant neoplasms in cells of the skin and the lining of body organs, such as the digestive, respiratory, and reproductive tracts. About 85% of human cancers are carcinomas.

␣␣ Melanomas, or neoplasms of a special type of skin cell that produces the skin pigment called melanin.

␣␣ Lymphomas, or cancers of the lymphatic system.

␣␣ Sarcomas, which are malignant neoplasms of the

muscle, bone, or connective tissue.

␣␣ Leukemias, or cancers of the blood‐forming organs, such as the bone marrow, that lead to an extreme pro- liferation of white blood cells.

What are the physical effects of cancer and how does it kill?

- Cancer progresses by enlarging and spreading to dif- ferent sites; its growth at each site interferes with normal development and functioning. As the disease progresses, it can produce pain, often because the tumour creates pressure on normal tissue and nerves or blocks the flow of body fluids

- In the direct route, the cancer spreads over time to a vital organ, such as the brain, liver, or lungs; it then competes for and takes most of the nutrients the organ tissues need to survive, thereby causing the organ to fail.

- Cancer kills indirectly in two ways; the disease itself weakens the patient, and both the disease and the treat- ment can impair the patient's appetite and ability to fight infection

What is the prognosis and cause of cancer?

- depends on how early it is detected and its location

- cancer is caused by the interplay of genetic, environmental, and behavioural and psychosocial factors

- Research has also found a link between certain viral infections and the development of some cancers, such as in the cervix and in the liver

What are the Age, Gender, and Socio‐cultural Factors in Cancer?

- The risk of developing cancer typically increases with age, especially from the middle‐age years onward: over 75% of all cancers are diagnosed in people 55 years of age and older (Canadian Cancer Society, 2014a).

- Taking age into account, the incidence rates of cancer are higher for males than females

- cancer incidence and death rates are higher for males than females in each ethnic group. Although the incidence rates are fairly high for European Canadians, death rates are much higher in First Nations and Inuit populations, partly because their diagnoses occur later

- Some types of leukemia occur more frequently in Caucasians, while African Canadians are at an increased risk of developing prostate cancer

- Evidence indicates that environmental factors may play a role in cultural differences in cancer development.

How to diagnose cancer?

First, blood or urine tests can suggest the presence of cancer by revealing telltale signs, such as unusual levels of certain hormones or enzymes. Second, radiological imaging, such as with X‐rays, or magnetic res- onance imaging with the use of strong magnets such as with an MRI, allow physicians to see the structure of internal organs and whether a tumour exists. Third, in a biopsy a physician takes out a small piece of suspicious tissue and has it analyzed.

What are the side effects of treatment?

- some medical treatments, such as chemotherapy and radiation, can produce chronic pain conditions in some individuals

- most people who undergo repeated radiation or chemotherapy experience severe and long‐lasting fatigue that often gets worse after the treatment ends. Can lead to depression and problems sleeping

- chemotherapy and radiation often produce periods of nausea and vomiting during and soon after each treatment; patients who expect to become nauseated are more likely than others to do so

- In anticipatory nausea, patients who have received a few treatments and are about to receive the drug again begin vomiting before it is given

- Cancer patients who receive chemotherapy or radiation therapy often report that they develop a distaste for some foods they once liked, which is called a learned food aversion. The food becomes distasteful because the person associates it with symptoms of nausea and vomit- ing. Learned food aversion is a medical problem because cancer patients often experience a loss of appetite, which can lead to excessive weight loss.

- Cancer treatment not only can be unpleasant, it can be complex and demanding. Most cancer patients must also take medications at home, and many must return to their clinics frequently for laboratory tests, keep diaries of their food intake, or adhere to dietary and other changes in living habits

What are the types of medical treatment?

There are basically three types of treatment for cancer—surgery, radiation, and chemotherapy—that may be used singly or in combination.

- surgery is frequently the preferred treatment for eliminating a neoplasm, such as in breast or colorectal cancer

- If the cancer is localized, surgery often can be completely effective by itself; if the cancer has spread, surgery may be useful in removing large clusters of cancerous cells, leaving the remainder for radiation or chemotherapy treatment

- Radiation in high doses damages the DNA of cells, and malignant cells are much less able than normal cells to repair the damage

- external beam therapy, involves directing a beam of intense radiation at the malignant tissue for a period of seconds or minutes

- internal radiation therapy and involves applying radia- tion inside the body, near or into the tumour, such as by injection.

- In chemotherapy, patients receive powerful drugs, usually orally or by injection, that circulate through the body to kill cells that divide very rapidly

Acquired immune deficiency syndromes (AIDS)

An infectious disease that disables the immune system. Individuals with acquired immune deficiency syndrome (AIDS) are susceptible to a variety of life‐threatening diseases.

What is the psychosocial impact on cancer?

- Cancer patients' feelings of personal control decline in the several months after the diagnosis and then begin to increase

- Fear of the future is a common and severe stressor reported by cancer patients (Lebel et al., 2007). If the disease does flare up, the distress is worse than with the initial illness

- Those who have high levels of hopelessness, depression, and other psychosocial vulnerabilities tend to survive for shorter periods after diag- nosis than others do

- Psychologists often consider it "normal" for cancer patients to have some elevations in depression and anxiety

- adjustment to their illnesses tends to improve with time during remission or after a cure

- patients who are middle‐aged and physically disabled by the disease or in pain seem to fare worse than those who are older or have less disability or pain

- Individuals who were depressed at the time of diagnosis or had a history of prior depression often have a lower quality of life than other cancer survivors

- Patients who blame themselves for their illness have more distress and lower quality of life than other cancer patients

- Patients who perceive little social support and negative behaviours from significant people tend to have adjustment problems in part because they do not feel others want to talk about the cancer experience

- Patients' physical conditions and treatment may interfere with their seeing friends and family.

- people may begin to avoid the patient—for instance, because they may feel personally vulnerable in his or her presence

- receiving social support may lead some patients to feel like a burden, lowering their self‐esteem

- For couples in which one partner has cancer, the part- ners often "share" distress. That is, for better or worse, the patient's and spouse's level of emotional adjustment affects their partner's level

People with cancer tend to show better adaptation to their disease and a higher quality of life if they:

␣␣ Were involved in decisions about their treatment and follow‐up care (Andersen et al., 2009).

␣␣ Have relatively high levels of perceived control (Bárez et al., 2009).

␣␣ Cope with the cancer and treatment by using active, problem‐focused strategies rather than using avoid- ance coping (Bellizzi & Blank, 2006; Roesch et al., 2005).

␣␣ Are able to find benefits or meaning in the difficulties they face from the disease and its treatment (Malcarne, 2011; Park et al., 2008; Yanez et al., 2009).

How do cancer patients fare after surviving many years?

- They have high rates of emotional distress, especially those from the lower social classes and those who are unmarried and disabled (Hoffman et al., 2009).

- The site of the cancer is also important, and its impact often depends on the patient's age and gender.

- women and people under the age of 50 report higher levels of anxiety and depression compared with older adults and men, respectively

- Patients with certain types of cancer, such as lung cancer, are also more likely to report distress

What are the psychosocial intervention for cancer?

- The physician can promote positive adaptation to the illness by discussing the diagnosis while the patient is alert with a spouse or other significant person present, expressing concern and giving the people an opportunity to react emotionally and compose themselves, and then presenting informa- tion about the prognosis and treatment options.

- Medical personnel can also help by providing information on ways to manage the disease and difficult aspects of treatment and advice on improving the patient's diet and physical activity

- Exercise, such as brisk walking several hours a week, enhances the physical function of cancer patients, reduces their fatigue, and may improve their survival

- Two successful approaches to reduce nausea are relaxation and systematic desensitization. These individuals reported much less nausea and vomiting in subsequent chemotherapy sessions.

- Cognitive-behavioural treatments used a variety of methods, such as relaxation and problem‐solving training. The patients in especially the tailored treatment group, reported having less pain and engaging in more daily activities than the usual care group.

- Cognitive- behavioural stress management methods with breast cancer patients who met for two hours weekly in groups to discuss their difficulties and learn skills, such as relaxation and coping strategies, to apply at home. This reduced the prevalence of depression and increased their use of positive reappraisal strategies, such as seeing benefits to their condition; these effects were strongest among women whose optimism was low at the start. Second, the pro- gram enhanced the women's immune function. This program also has been found to reduce women's cancer‐ related anxiety, general anxiety symptoms, cortisol levels, and levels of inflammation

- Mindfulness‐based stress reduction methods significantly reduce indications of emotional distress in cancer patients

- A variety of supportive therapies and coping skills training programs also help manage cancer patient's depressive reactions. When these therapies are delivered in group settings, higher levels of group cohesion are associated with treatment outcomes

- Couples‐focused treatments can be effective in treating distress in women with breast cancer, especially for women whose coping style involves approach rather than avoidance. For men with prostate cancer, cognitive-behavioural stress management can improve sexual functioning.

What are the psychosocial effects of having cancer on children and their families?

- In an overall sense, the effects are like those with adult patients: the initial trauma is extremely difficult, but adjustment tends to improve over time

- Cognitive-behavioural intervention can reduce parents' emotional distress and help them cope with day‐to‐day problems

- The earlier the diagnosis and treatment occurred in their lives and the longer they survive in remission, the better their long‐ term adjustment tends to be.

What are the risk factors of AIDS?

- Involves ways by which an infected person's blood or semen contact the body fluid of an uninfected person. Sexual activity, sharing contaminated syringes, birth by an infected mother.

What are the age, gender, and socio-cultural factors in HIV/AIDS?

- In North America, the number of new HIV diagnoses annually is much higher among 20‐ to 49‐year‐old adults than other age groups and about three times higher in men than women

- New HIV infections remain concentrated in men who have sex with men, intravenous drug users, and both Aboriginals and Black Canadians

- Among Canadian males, AIDS mortality rates are far higher for White men than either Black Canadians or Aboriginals

- Canadian females, however, mortality rates due to AIDS are substantially higher for Black and Aboriginal women when compared with Whites.

- the largest concentrations of HIV infection today are in sub‐Saharan Africa,

What are the medical treatments for people with HIV/AIDS?

- The main treatment for AIDS today uses drugs called antiretroviral agents, which suppress HIV reproduction and reduce viral land.

- When two or more of these agents are combined, the treatment is extremely effective and called highly active antiretroviral therapy (HAART).

- Very expensive, needs 95% compliance in order to work well and unaccessible to undeveloped countries

Bereavement

Suffering a loss through death. Feeling tied and the expression of these feeling sin mourning characterize this state.

What are the psychosocial impacts of HIV/AIDS?

- They worry that family, friends, neighbours, and co‐workers will reject them. This may lead to their being secretive and withdrawn, thereby curbing social support

- Using antiretroviral agents after many months of less-effective care reduces patients' distress, and these reductions seem to result mainly from decreases in physical symptoms and limitations

- cycles of AIDS‐ related diseases can arouse feelings of hopelessness and helplessness. Depression may become severe, especially among those patients who try to cope mainly with avoid- ance strategies, believe their illness is punishment for past wrongdoings, and have been rejected by people they care about

- coping through direct action or positive reappraisal is associated with better emotional adjustment, health behaviour, and physical health among people with HIV, whereas coping through disengagement or using drugs and alcohol is associated with lower levels of these outcomes

- Depressed HIV patients subsequently show faster disease progression than those who are not depressed

What are psychosocial interventions for HIV/AIDS?

- Those who test HIV‐positive will need counselling regard- ing the illness, treatment, and the many organizations and support groups available today to help AIDS patients and their families cope.

- Interventions for individuals with access to HAART need to focus on enhancing their emotional adaptation, social support, and knowledge and self‐efficacy for treatment adherence

- Many people with HIV and AIDS need psychosocial interventions for other problems, including emotional distress, pain management, and sleep disorders

- Stress management intervention before HIV testing consisted of aerobic exercise, relaxation training, and group meetings that included cognitive restructuring methods to modify maladaptive beliefs. Individuals who tested positive, showed less anxiety and depression and much stronger immune function.

- Cognitive-behavioural therapy reduced depression and improved medication adherence.

Complicated grief

Resembles post-traumatic stress disorder and symptoms include intense yearning for the deceased person and persistent disbelief, bitterness, depression, and intrusive thoughts about the death.

Physical and psychosocial impact of bereavement.

- very stressful

- in the months after a major crisis, such as the death of a loved one, people often have reduced immune function, lower calorie intake and body weight, and higher stress‐related hormones in the blood

- Bereavement also predicts an increased risk of death in the months after the loss

- five stages of loss and grief. It was proposed that surviving loved ones similarly advance through stages of denial, anger, bargaining, depression, and eventually acceptance of the person's death

- particularly the death of a spouse, revealed four common patterns across two years (Bonanno, Westphal, & Mancini, 2011). In order from most to least common, the patterns were: resilient, or adjusting well throughout the two years; recovered, having difficulty in the first months, but improving thereafter; chronic, adjusting poorly through- out; and delayed, having moderate difficulty in the first months, which worsened thereafter.

Five stages of loss and grief

It was proposed by Elizabeth Kubler Ross that surviving loved ones similarly advance through stages of denial, anger, bargaining, depression, and eventually acceptance of the person's death.

What are some psychosocial interventions for bereavement?

- individual therapy and support groups can help people who are having difficulty adjusting to loss

- One intervention used group discussion and role‐playing to teach clients how to reduce distress by applying the coping methods, such as problem‐focused coping

- systematic desensitization to confront the death in gradual exercises and discussions of what the clients would like their futures to include, and how to achieve those goals, if their grief was lessened