Health Psych Midterm 2

immune system

• Lymphatic system mature and are stored in immune system organs

• Tissues, organs, and processes that protect the body from invasion

• Locates foreign microorganisms, mutant cells, or damaged cells and activates processes to eliminate them

inflammation in the immune system response

• Phagocytosis and inflammation involving granulocytes and macrophages

• Works to restore tissue damaged by invaders.

• Blood vessels in area of injury dilate causing redness and warmth.

• Damaged cells release enzymes that help destroy invaders.

• Granulocytes & macrophages migrate to site of injury to help destroy invaders.

secondary immune response

Some sensitized T-cells and B-cells (called memory lymphocites) replicate and are held in reserve for next time pathogen invades

Nonspecific response

works great for general, minor threats to our immune system

Specific response

works great for more serious threats to our immune system (i.e. fungi, viruses, parasites, and mutations of cells)

Primary immune response initiated at first exposure

every exposure afterwards initiates secondary immune response

“suppression” of the immune system

weaker (i.e. Blood samples from those highly hostile couples or PTSD)

How can we create immunity to a virus?

Vaccination: weakened form of virus or bacterium is introduced into body, stimulating production of antibodies. Small pox eradicated through vaccine

Autoimmune diseases

• Immune system doesn’t recognize that own body is SELF

• Immune system treats own body like a virus, infection, germ

• Includes lupus, rheumatoid arthritis, multiple sclerosis

Adler and Cohen

• Shaped by 1975 experiment using classical conditioning

• Taught rat to associate sweet tasting water with chemical that suppressed the immune system

• Rats rank solution and were injected with immunosuppressive drug

• Immune system was suppressed with just water after removing injection

psychoneuroimmunology

Multidisciplinary field focusing on interactions among behavior, the nervous system, the endocrine system, and the immune system

Janice Kiecolt-Glaser’s research

• Exam Stress

  • Medical students had more symptoms of infectious disease before and after exams

    Drew blood and found evidence that immune system functioning was suppressed (less antibodies)

• Heterosexual couples come in for 2 visits. Each visit the couple got eight tiny uniform blisters on their arms

  • Wounds took a day longer to health after arguments

    Couple who showed high levels of hostility needed two days longer for wound healing compared with low hostile

    Blood samples from high hostile couples → suppress immune system?

diathesis-stress model

Some individuals are vulnerable to stress-related diseases because either genetic weakness or biochemical imbalance inherently predisposes them to those diseases. These diseases may not occur without environmental stress

health behaviors

Diet, exercise, and no smoking

Sheldon Cohen’s research

• Higher the stress → higher likelihood of getting aq cold

• Duration matters more than severity

  • Acute severe stress < 1 month didn’t lead to cold

  • Severe chronic stress > 1 month led to substantiation increase in colds

• People who are more sociable developed fewer colds

How is stress related to HIV?

Stress affects both the progression of HIV infection and the affected person’s immune response to antiviral drug treatment

Stress & Heart disease

increases heart rate

Stress & Asthma

• Proinflammatory cytokines may a fundamental or even causal role in development of disorder

• Stressors, such as emotional events & pain can trigger asthma attack

• Kids living in inner-city with parents who have mental problems showed sharply heightened risk

Stress & Arthritis

Occur when immune system attacks body; not well understood

Stress & Ulcers

Stress is not a major factor

Stress & Headaches

causes muscle tension

Stress & Pregnancy

• Mothers who are stressed are more likely to deliver preterm babies and babies with lower birth weights

• Chronic stress more damaging than acute stress

• Stress later in pregnancy more damaging than earlier stress

What is the link between stress and psychological disorders?

• Stress and Depression: 

  • Stress contributes to development of depressive symptoms

  • Rumination may increase stress and depression

  • Kindling hypothesis – major life stress provides a “kindling

  • experience that prompts the development of depression

  • Some types of stress (chronic workplace stress, health problems) produce greater risk of depression.

• Stress and PTSD

  • PTSD produces long-lasting suppression of the immune system and an increase in proinflammatory cytokines.

What parts of the brain are involved in the sensory and emotional aspects of pain?

• The somatosensory system (nerves, sensory surfaces on our organs & skin)

  • All sensory information from the body to the brain

  • Nociceptors: the specific receptors

Henry Beecher’s study

• Soldiers more cheerful and optimistic vs normal surgical patients experience more pain and request more drugs

• Intensity of suffering is largely determined by pain perception to the patient

• Size of wound bears only a small relationship to how much pain is experienced

What are pain behaviors and how can they be affected by other people?

• The brain (somatosensory Cortex)

  • Signals from thalamus from afferent nerves

• The spinal cord

  • Nerves responsible for spinal reflexes (immediate reflexes to noxious stimuli, like a hot stove)

specificity theory of pain

• Body used to be viewed as a machine → not always the case!!

• Pain = results of the transmission of specific signals

• Experience of pain is approximately equal to the amount of tissue damage or bodily injury

• Linear model of pain

gate control theory of pain

• Pain is only PARTLY controlled by bottom-up processes: afferent neurons (neurons that go from the body/spinal cord to the brain)

• It is ALSO controlled by the top-down processes - the brain and spinal cord decide how much of the messages from the afferent neurons affect the brain

What factors open or close the pain gate?

• Open gate = Pain

• Closed gate = decreased pain

• Physical

  • Extent of injury

  • Inappropiate activity level

• Cognitive

  • Focusing on the pain

  • Boredom

• Emotional

  • Anxiety, worry

  • Depression, anger

Ronald Melzack’s theory

Focused on how different parts of the brain are involved in the increasing or decreasing the experience of pain.

What methods have been used to measure pain?

Self-report, Behavioral assessment, and Physiological measures

Self-report

Pain intensity on a scale of 1-10 and Pain unpleasantness or on Visual Analogue Scale where you draw a line

Behavioral assessment

Watching to see if they exhibit pain behaviors: Guarded movement, Bracing, Position shifts, Partial movement, Grimacing, Limitation statements, Emitting pain sounds (Good for kids, older adults )

Physiological measures

Researchers have tried muscle tension and autonomic nervous system response. However, they don’t show sufficient reliability or validity.

Migraine headaches

recurrent, throbbing, very painful headache, happens on or worse one side

Tension headaches

is dull and happens on both sides of the head

Acute pain

short period of time (i.e. pain from cuts, burns)

Chronic pain

enduring beyond normal healing time, constant (i.e. lower back pain)

What conditions contribute to low back pain?

chronic low back pain usually resulting from injury and or structural vulnerabilities.

percentage of people with low back pain have an identified cause

20%

How well do physicians and nurses do in estimating the pain of patients?

• Doctors and nurses underestimate the pain of patients.

• They may prescribe or administer too little pain medication

What do we know about the risk of opiate drugs for pain patients?

• the most effective analgesic drugs, have the potential to produce tolerance and dependence, making health care professionals reluctant to prescribe adequate doses.

• The recent increase in prescription analgesic drugs was due mostly to the demand for oxycodone (Oxycontin) and Hydrocodone

Alternative medicine

used instead of conventional medicine

Complementary medicine

used along with or as a complement to conventional medicine

how are alternative and complementary medicine different from conventional medicine?

Neither practice is used in western medicine

Integrative medicine

mixture of both conventional medicine and CAM

main limitations of alternative and complementary medicine

• Limited research examining effectiveness or comparing to placebo

• Natural products not regulated

• Some herbal remedies and botanical products have dangerous interactions with each other

• Limited avaliability and high cost

• Individuals with some conditions should avoid some treatments

• People may use CAM instead of more effective treatments

What are the main ancient systems of medicine?

Traditional Chinese medicine (TCM: unblocking Qi) and Ayurveda (Origins in India; balance of body, mind, & spirit)

Naturopathy

diseases can treated or prevented without the use of drugs through diet, exercise and massage

Homeopathy

Based on principle of “like cures like” – substances have curative power when they produce symptoms like those of disease.

Acupuncture

• inserting needles into specific points on skin and continuoslty stimulating needles to unblock qi

  • Better for neck pain, shoulder, or elbow pain and tension-type headaches vs migraines

  • Reduction of arthritis

Chiropractic Treatment

• Adjustments to spine and joints to correct misalignment

• Covered by many insurance plans

• Most used for back and neck paikn and somewhat effective for both of those conditions

How are demographic factors related to the use of alternative and complementary medicine?

• Ethnic stereotypes of recent immigrants using CAM is incorrect

• CAM use is associated with being European American, well educated, wealthy, and female.

• Chinese Americans’ use of CAM depends on how strongly they identify with Asian heritage

integrative medicine

• mixture of both conventional medicine and CAM

• “Best of both worlds”

• Faces challenge of melding very different philosophies of treatment but offers benefits of both approaches.

• Two areas in which integrative medicine is advancing most rapidly are pain management and cancer treatment.

mindfulness meditation

•  origins in buddhist practices

  • Sitting in a relaxed, upright posture

  • 8 wk course, 2 hrs per day, intensive retreat. Works by altering brain function

transcendental meditation

• Usually sit with eyes closed and muscles relaxed, focusin on breathing, and silently repeat a sound, such as an “om”

  • Repetition of mantra meant to distract from outside thoughts

Brain imaging results of mindfulness meditation

• During mindfulness meditation, left frontal lobe of brain becomes more active and right lobe less so 

• Consistent with an increase in the experience of positive emotions

What problems are mindfulness meditation and transcendental meditation effective for?

Meditation and mindfulness have proven effective for people with anxiety, stress-related problems, and relapse into depression

Guided imagery

people conjure up a calm, peaceful image which can divert attention away from the painful experience

Effective with chronic pain, quality of life in cancer patients, hypertension, obesity, headaches

Hypnosis

an altered state of consciousness that boosts relaxation and suggestibility vs. a more generalized trait of some individuals

Biofeedback

Patients gain awareness and alter physiological responses by viewing their measure of biological responses

Effective with lower back pain, tension headache, migraines

What problems are guided imagery, hypnosis, and biofeedback effective for?

Meditation and guided imagery have been shown to be very effective in managing chronic pain. Less suggestible subjects respond no better to hypnosis than to a placebo.

Biofeedback- shows limited benefits for pain management

Coronary Arteries

Supply blood to the myocardium (heart muscle)

Atherosclerosis

cholesterol and lipids build up plaque that restricts and partially blocks blood flow in the artery - blood can’t get to the heart muscle

Arteriosclerosis

hardening or loss

Heart/myocardium

a muscle that pumps blood throughout the body

the strongest predictors of heart attacks and stroke

• Hypertension number one risk factor for CVD

  • Our systolic blood pressure over our diastolic blood pressure

  • Force exerted during ventricular contractions over pressure between the contractions

• Inflammation: stress influences low grade, chronic inflammation

Low density lipoprotein

marked as “bad” cholesterol because it accumulates in our arteries as plaque and is a risk factor for heart disease

High density lipoprotein

good cholesterol because it absorbs other cholesterol in our bodies

kinds of foods offer protection against heart disease

HDL – high density lipoprotein (“good cholesterol”) (i.e. oil, nuts, fruit, oats)

Type A personality

is someone who is outgoing, ambitious, rigidly organized, highly status-conscious, impatient, anxious, proactive, and concerned with time management

what part of Type A personality puts people at the greater risk for heart disease?

Someone who is impatient, aggressive, and very competitive, often called a Type A personality, has a higher risk of heart disease

marital status and gender related to heart disease

Poor marriages and men have slightly higher risk of death from CVD than women

What racial / ethnic groups have higher rates of heart disease and why?

African Americans have higher risk – may be related to discrimination

anti-inflammatory drugs elated to lower risk of heart disease

Taking low-dose aspirin

How have health psychologists contributed to heart health?

Health psychologists develop and test interventions to encourage behaviors that reduce the risk of heart disease, such as:

Quitting smoking, Eating a balanced diet, Exercising regularly, Reducing alcohol intake, Adhering to medications

Balloon angioplasty

• A small balloon is inserted into a narrowed or blocked artery. The balloon is inflated to compress the plaque against the artery walls, widening the artery. Then the balloon is removed, and nothing is left behind.

Stent Angioplasty

same process as ballon, except a stent (a small metal mesh tube) is placed in the artery.

Bypass surgery

• Replaces blocked portion of the coronary artery called CABG -coronary artery bypass graft or coronary bypass surgery.

• Expensive and risky but usually relieves angina and improves quality of life

Cardiac rehabilitation

• Helps cardiac patients (e.g. those with CAD or who have had MI or heart surgery) adjust lifestyle to minimize risk factors

• Programs can be very effective.

  • But only 15-35% of patient follow through with such programs.

  • Perhaps as low as 10% who have heart attacks enter them

Cancer

Group of disease characterized by the occurence of new cells that grow and spread beyond control

Benign tumors

remain localized, less threatening

Malignant tumors

spread, more dangerous

biggest reasons for declining death rates due to cancer

• Declined in the 1990s

  • Early detection and treatment

  • Lifestyle factors (better diets, less smoking)

Strongest inherent risk factors for cancer

• Ethnic Background

  • Black people have higher incidence for most cancers, due to later diagnoses in later stages

  • Asians generally have lower total cancer death than other ethnic groups

• Stomach cancer is highly correlated with diet and chronic H. pylori bacterial infection

• Liver cancer highly correlated with infection and hepatitis C infection

• Family History

  • Only a small genetic component to getting cancer

  • Women who have a mutated form of BRCA1 are much as 7 times as likely to develop one form of breast cancer

  • However, the forms of cancer related to BRCA1 and BRCA2 are responsible for no more than 10% of breast cancer cases. BRCA 18

• Advancing Age

strongest behavioral risk factors for cancer

• Behavioral

  • • Smoking

    • Stomach

    • Bladder

    • Upper digestive tract

    • Esophagus, Colon, Prostate cancer

    • 23.3 moe times likely to die of lung cancer than men who have never smoked

  • • Diet

    • • Foods that may cause cancer are called carcinogenic

    • • Foods with no preservatives or high level of

    • preservatives

    • • Foods high in fat

    • Preserved meats and red meat increase risk of colorectal cancer

    • Overweight and obesity account for 14-20% of all cancer-related deaths – strong link to colorectal, esophageal, breast, endometrial, and kidney cancer

  • • Alcohol

    • Increases risk for mouth, esophageal, breast, and liver cancers

    • People who abuse alcohol are more likely to die from other causes before they develop liver cancer.

    • Women who drink alcohol daily have higher risk for breast cancer

  • • Sedentary Lifestyle

    • Increases risk of colon, endometrial, breast, lung, and pancreatic cancer

  • • UV light exposure

    • One form of skin cancer – malignant melanoma, has high death rate

    • Strong genetic component for skin cancer – fair-skinned, blue-eyed people at higher risk

    • Can decrease risk by wearing sunscreen and sun-protective clothing

  • • Sexual behavior

    • HPV increases risk for cervical and oral cancer

    • Can decrease risk by practicing safe sex

most common cancer for women

breast cancer

most common cancer for men

prostate cancer

most deadly cancer for men and women

Lung & Bronchus Cancer

What factors may account for the different cancer death rates across ethnic backgrounds?

• Ethnic background

  • African Americans have greater incidence

  • NOT biological

• Family history

  • BRCA1 & BRCA2 mutations (breast cancer)

• Advancing age

• Environmental 

  • Radiation

  • Abestos

  • Pesticides & chemicals

risk factors for cervical cancer

HPV (70% of cervical cancer by this)

behavioral factors are most important for preventing cancer

• Behavioral

  • Smoking, Diet, & Alcohol

  • Sendentary Lifestyle

  • UV light exposure

  • Sexual behavior (HPV)

Treatments for Cancer

Surgery, radiation, chemotherapy

Side effects of treatments for cancer

Fear, anxiety, loss of hair, fatigue, depression

How do people adjust to a diagnosis and learn to live with cancer, including finding support and psychological interventions?

• More than a million Americans are diagnosed with cancer each year

• Most of these people will experience feelings of fear, anxiety, and anger as a result of their diagnosis

• About 25% may have major depression

• Optimism

  • Helps reducting negative affect and social inhibitions

  • Not for a long term cancer survival

• Social Support

  • Health care professionals: instrumental

  • Family and friends: emotional

• Psychological interventions

  • Shirt-term benefits

  • No evidence on prolonging the life span

How have health psychologists been most involved in treating people with cancer?

• Individual and group techniques to help cancer patients:

  • Cognitive behavioral stress management skills

  • Providing social support 

  • Opportunities to express emotions