Gemah Nuripah, dr.SpKJ, M.

Kes

Psychiatric Department
Faculty of Medicine UNISBA
 Spirituality and Religion : strong religious beliefs,
spiritual yearnings, prayer, devotional acts have positive
influences on mental & physical health

Biology :
anatomical,
structrural
molecular effects
on biological
functioning

Psychological
effects of
psychodinamic,
motivation,
personality
Social, cultural,
familial
influence
einvironment

George Engel 1977

Psychological Factors Affecting Medical
Condition (Psychosomatic medicine)

 Definition
Relation between psychological and physiological
factors in the causation or maintenance of disease
state.
Etiology
1. Specific stress factor :

 Flanders Dunbar : personality trait are spesific

for a psychosomatic disorders (coronary
personality/type A : hard driving, aggressive,
irritable  heart disease)

 Franz Alexander : unconscious conflict that

produce anxiety are mediated through the
autonomic nervous system, result in a specific
disorder (repressed dependency  peptic
ulcer)
 Stress Theory
Walter Cannon (1875-1945) :
Stimulation of the autonomic nervous system (the
sympathetic)  hypertension, tachycardia, increased
cardiac output.
Harold Wolff (1898-1952) :
gastrointestinal tract appeared to correlate with specific
emotional state.
William Beaumont(1785-1853) :
Blood flow to the stomach was influenced by emotions.
Hans Selye(1907-1982) :
Unpleasant stress = distress. Stress requires adaptation.
Etiology
 2. Nonspecific stress factor :
 Any prologed stress can cause physiological
changes that result in physical disorders.
 Each person has a shock organ that is
genetically vulnerable to stress.
 Person who are chronically anxious or
depessed are more vulnerable to physical or
psychosomatic disease.
Ranking of 10 Life-change stressor
1. Death of spouse
2. Divorce
3. Marital separation
4. Jail term
5. Death of close family member
6. Serious persoal injury of illness
7. Marriaged
8. Fired from work
9. Pregnacy
10. Marital reconciliation
Etiology
3. Physiological factors

Neurotransmitter response :
 ↑ synthesis of brain norepinephrine
 ↑ serotonin turover  depletion of serotonin
 ↑ dopaminergic transmission

Endocrine response :
 ↑ ACTH  stimulates adrenal cortisol
 ↓ testosterone with prolonged stress
 ↓ thyroid hormone
Etiology
3. Physiological factors

Immune response
 Immune activation occurs with release of
hormonal immune factors (cytokines) in acute
stress.
 ↓ number and activity of natural killer cells in
chronic stress.
 Cardiovascular
system(coronary heart
disease)
 Behavioral risk factors (smoking
overeating,physical inactivity,poor
compliance with mangement of
diabetes
hypercholesterolemia,hypertension).
 Complications / comorbid;
depression(15-20%), anxiety(5-10%),
delirium ,cognitive disorders.
 High levels of anxiety- tripling of risk
of sudden cardiac death.
 Hostility and type A Behavior pattern.
The relation between a behavior
pattern characterized by easily
aroused anger, impatience, hostility,
competitive striving, and time urgency.
 Gastrointestinal
system
 Peptic ulcer disease, psychological
factors had a role in the production of
ulcer vulnerability,mediated through the
increased gastric acid secretion.Psycho
social factors are involved in the clinical
expression of symptoms, possibly by
reducing immune responses, resulting in
vulnerability to Helicobacter pylori
infection.
 colitis Ulcerative, studies of patient
with U C have shown a predominant of
obsessive-compulsive traits.
 Diabetes Mellitus
 Stres:
1. Releases sugar(liver)→glukosa 
2. Adrenalin released→inhibits release
the role of insulin → glukosa 
acute stress→can exacerbate an
already existing diabetic condition.
Diabetic patients are unable to meet
the rapid changes in insulin
requirements resulting from continual
stress.
 Skins disorders
 Stress → 40% of all skin disorders.
 Stress→may be the cause of neurotic
excoriation and dermatitis artefacta.
 Stress can exacerbate anogenital pruritus.
 Stress → can be precipitating or perfetuating
factors → urticaria, acne rosacea,herpes
simplex and eczema.
 stress → influence psoriasis by lowering the
body’s resistance and general state of health.
 The immune system
 Stress is first experienced →
immune system  (enhanced)
 Long term stress →immune
response cell mediated /humoral
are supressed.
 Sustained stress→
cortisol&cortikosteroid 
→metabolic process  →protein
avaiable for formation of mature
blood cells&antibodies↓.
Backaches &
headache
Physical& psychological. Continual
stress,feeling of helplessness of
individuals who do not know how to
cope with the causes of stress.
Individuals tension result in
backaches and headaches suffering
from such problems often neither
eat a healthy diet nor exercise
sufficiently,resulting in unhealthy
life-style which in turn leads to
more stress, more pain and more
medication.
 Asthma & hyperventilation
syndrome
Attacks precipitated by stress,respiratory
infection,allergy. Examine family dynamics
especially when child is the patient. Look for
over-protectiveness and to encourage
appropriate independent activity.
Psychological theories strong dependency
and separation anxiety, asthma wheeze is
suppressed cry for love and protection.
 Hyperventilation syndrome; accompanies
panic disorder,generalized anxiety disorder
with asso- ciated hyperventilation,
tachycardia, vasoconst riction. May be
hazardous inpatients with coronary
insufficiency.
References
 Saddock BJ,Sadock VA,Synopsys of
Psychiatry,Behavioral Sciences/Clinical
Psychiatry,ninth ed.2003,p.822-839.