IN MEDICAL PRACTICE
Dr. YASER ALHUTHAIL
Associate Professor & Consultant
Consultation Liaison Psychiatry
The application of biological science to maintain health
and treating disease.
Engel (1977) proposed a major change in our
fundamental model of health care.
The new model continues the emphasis on biological
knowledge, but also encompasses the utilization of
Unity of mind and body:
Psychosocial factors must be taken into account
when considering all disease states
Emphasis on examining and treating the whole
patient, not just his or her disease or disorder.
Most illness, whether physical or psychological, is
influenced and determined by biological,
psychological, and social factors
Biological, psychological, and social variables
influence the predisposition, onset, course, and
outcome of the illness
Physicians who are able to evaluate the relationship of
these variables to their patients illnesses will be able
to develop more effective therapeutic interventions
and to achieve better outcomes
Psychological and Beha vioral
Predisposition to Physical
Life style, smoking, alcohol, substance abuse, eating
habits, lack of exercise etc account for about 70% Of
all cases of illness and death in the states
Personality factors: Type A !!
Onset of illness
The role of stress
Stress can be described as a circumstance that disturbs,
or is likely to disturb, the normal physiological or
psychological functioning of a person.
The adaptive capacity of the person
THE STRESS MODEL
A psychosomatic framework.
Two major facets of stress response.
“Fight or Flight” response is mediated by
hypothalamus, the sympathetic nervous system, and
the adrenal medulla.
If chronic, this response can have serious health
The hypothalamus, pituitary gland, the adrenal cortex
mediate the second facet.
Neurotransmitter Responses to
Stressors activate noradrenergic systems in the
brain and cause release of catecholamines from
the autonomic nervous system.
Stressors also activate serotonergic systems in
the brain, as evidenced by increased serotonin
Stress also increases dopaminergic
neurotransmission in mesoprefrontal pathways.
Endocrine Responses to Stress
CRF is secreted from the hypothalamus.
CRF acts at the anterior pituitary to trigger release of
ACTH acts at the adrenal cortex to stimulate the
synthesis and release of glucocorticoids.
Promote energy use, increase cardiovascular activity,
and inhibit functions such as growth, reproduction,
Immune Response to Stress
Inhibition of immune functioning by glucocorticoids.
Stress can also cause immune activation through a
variety of pathways including the release of humoral
immune factors (cytokines) such as interleukin-1 (IL-
1) and IL-6.
These cytokines can themselves cause further release of
CRF, which in theory serves to increase glucocorticoid
effects and thereby self-limit the immune activation.
High level of Cortisol results in suppression of
immunity which can cause susceptibility to
infections and possibly also in many types of
Changes in the immune system in response to stress
are now very well established.
Course and Outcome of
Direct vs. Indirect effect
Stressful life events
Their combination: 4 times increased mortality post
Mental disorders: course, mortality, health care
utilization, LOS, ER visits, etc
Numerous studies indicate that psychosocial
interventions positively affect health outcomes
Supportive, educational, or psychotherapeutic
Too many HOWs ?!!
Psychosocial influences are well established
Education and support